Review Practice Exercise 5

Drugs Used to Treat Hypertension > Pharmacology

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Practice Exercise 5

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Total Questions : 3

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Question 1:

During an admission assessment, a patient states that she takes amlodipine (Norvasc). The nurse wishes to determine whether the patient has any common side effects of a calcium channel blocker. The nurse asks the patient if she has which signs and symptoms? Select all that apply

A. Insomnia B. Dizziness C. Headache D. Angioedema E. Ankle edema F. Hacking cough

Answer and Explanation

Choice A:

InsomniaAmlodipine does not stimulate the central nervous system and rarely causes sleep disturbances. Insomnia is not considered a typical or expected side effect.

Choice B:

DizzinessAmlodipine induces vasodilation, leading to lowered blood pressure, which can cause transient dizziness or lightheadedness, especially when changing positions. The nurse should educate the patient to rise slowly to prevent falls related to postural hypotension.

Choice C:

HeadacheVasodilation of cerebral vessels commonly triggers headaches, particularly during initial therapy. These headaches are typically mild and may diminish as the body adjusts to the medication.

Choice D:

AngioedemaAngioedema is associated with ACE inhibitors (e.g., lisinopril), not calcium channel blockers. Amlodipine does not affect bradykinin metabolism, the mechanism responsible for angioedema in ACE inhibitor use.

Choice E:

Ankle edemaPeripheral (ankle) edema results from increased capillary hydrostatic pressure due to arterial dilation, leading to fluid leakage into interstitial tissues. It is one of the most frequent side effects of calcium channel blockers and often dose-related.Rationales for incorrect answers:

Choice F:

Hacking coughA persistent, dry cough is another hallmark side effect of ACE inhibitors, not CCBs. Since amlodipine does not increase bradykinin levels, this symptom would not be expected.

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Question 2:

Nifedipine (Procardia) has been ordered for a client with hypertension. In the care plan, the nurse includes the need to monitor for which adverse effect?

A. Rash and chills B. Reflex tachycardia C. Increased urinary output D. Weight loss

Answer and Explanation

Choice A:

Rash and chills
These are not typical side effects of nifedipine. Rash and chills would more likely suggest hypersensitivity or infection, which are unrelated to the drug’s mechanism of action.

Choice B:

Reflex tachycardiaWhen nifedipine causes rapid vasodilation, systemic blood pressure drops suddenly, and the body compensates by stimulating the sympathetic nervous system, resulting in reflex tachycardia. This increased heart rate can increase myocardial oxygen demand, which may be harmful, especially in clients with coronary artery disease or angina.Rationales for incorrect answers:

Choice C:

Increased urinary outputUnlike diuretics, nifedipine does not directly affect the kidneys or promote diuresis. Its antihypertensive effect occurs through vascular smooth muscle relaxation, not fluid excretion.

Choice D:

Weight loss
Weight loss is not associated with nifedipine therapy. While some antihypertensive drugs indirectly influence body weight (e.g., diuretics through fluid loss), nifedipine has no such effect.

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Question 3:

A nurse is teaching a client who is starting verapamil (Calan) to control hypertension. Which of the following should the nurse include in the teaching?

A. Increase the amount of dietary fiber in the diet. B. Drink grapefruit juice daily to increase vitamin C intake. C. Decrease the amount of calcium in the diet. D. Withhold food for 1 hr after the medication is taken.

Answer and Explanation

Choice A:

Increase the amount of dietary fiber in the diet.Constipation is one of the most common side effects of verapamil due to reduced smooth muscle contractility in the gastrointestinal tract. The nurse should instruct the client to increase fiber intake (e.g., fruits, vegetables, whole grains), maintain adequate hydration, and stay physically active to minimize this effect.Rationales for incorrect answers:

Choice B:

Drink grapefruit juice daily to increase vitamin C intake.Grapefruit juice inhibits cytochrome P450 enzymes, which can increase plasma levels of verapamil, leading to toxicity, hypotension, and bradycardia. The client should be advised to avoid grapefruit juice while taking this medication.

Choice C:

Decrease the amount of calcium in the diet.Dietary calcium intake does not interfere with the action or effectiveness of calcium channel blockers. There is no need to restrict calcium-containing foods.

Choice D:

Withhold food for 1 hr after the medication is taken.Verapamil can be taken with or without food, but taking it with meals may help reduce gastric irritation. There is no requirement to delay eating after taking the medication.

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Practice Exercise 5

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