Understanding Arterial Constriction and Heart Function in
School
Jomo Kenyatta University of Agriculture and Technology, Nairobi**We aren't endorsed by this school
Course
NUR HEALTH ASS
Subject
Nursing
Date
Dec 12, 2024
Pages
5
Uploaded by DeanSnailMaster1265
Constriction of arterioles increases the load against which the heart must pump to eject blood. Increased constriction of arterioles would decrease, not increase, the stroke volume of the heart. Myocardial contractility is determined by the sympathetic nervous system, acting through beta1- adrenergic receptors in the myocardium. POINTS: 1 3.A hospital client with a history of hypertension is admitted for a procedure. If the hospital client’s arterialpressure decreases, which clinical manifestation would the nursing attendant expect to see? a.Decreased heart rate b.Increased heart rate c.Decreased blood pressure d.Syncope ACCURATE ANSWER:- B When arterial pressure decreases, the vasoconstrictor center causes constriction of nearly all arterioles, leading to an increase in peripheral resistance, constriction of veins, increasing venous return, and subsequent acceleration of the heart rate. A decrease in arterial pressure would not cause a decrease in the heart rate or blood pressure, nor would it cause syncope. POINTS: 1 4.A nursing attendant is teaching a nursing student how blood can return to the heart when pressure in the venous capillary beds is very low. Which statement by the student indicates a need for furtherteaching? a.“Constrictionof small muscles in the venous wall increases venous pressure.”b.“Negativepressure in the left atrium draws blood toward the heart.”c.“Skeletalmuscles relax to allow the free flow of blood.”d.“Venousvalves help prevent the backflow of blood.”ACCURATE ANSWER:- C Skeletal muscle contraction, along with one-way venous valves, helps create an “auxiliary”venous pump that helps drive blood toward the heart. Constriction of small muscles in venous walls helps increase venous pressure. Negative pressure in the left atrium sucks blood toward the heart. Valves, which are one way, work with the contraction of skeletal muscles to create a venous pump. POINTS: 1 5.A nursing attendant is assessing a hospital client who has heart failure. The hospital client complains ofshortness of breath,and the nursing attendant auscultates crackles in both lungs. The nursing attendant understands that these symptoms are the result of: a.decreased force of ventricular contraction. b.increased force of ventricular contraction. c.decreased ventricular filling. d.increased ventricular filling. ACCURATE ANSWER:- A
In the failing heart, Starling’s law breaks down, and the force of contraction no longer increases in proportion to the amount of ventricular filling. The result is the backup of blood into the lungs and the symptoms of shortness of breath and crackles caused by fluid. Increased ventricular contraction would not result in a backup of blood into the lungs. Changes in ventricular filling are not the direct cause of this symptom. POINTS: 1 6.A hospital client with hypertension is admitted to the health center. On admission the hospital client’s heart rateis 72 beats/min, and the blood pressure is 140/95 mm Hg. After administering an antihypertensivedrugs, the nursing attendant notes a heart rate of 85 beats/ min and a blood pressure of 130/80 mm Hg.What does the nursing attendant expect to occur? a.A decrease in the heart rate back to baseline in 1 to 2 days b.An increase in the blood pressure within a few days c.An increase in potassium retention in 1 to 2 days d.A decrease in fluid retention within a week ACCURATE ANSWER:- A When blood pressure drops, the baroreceptors in the aortic arch and carotid sinus sense this and relay information to the vasoconstrictor center of the medulla; this causes constriction of arterioles and veins and increased sympathetic impulses to the heart, resulting in an increased heart rate. After 1 to 2 days, this system resets to the new pressure, and the heart rate returns to normal. The blood pressure will not increase when this system resets. Increased potassium retention will not occur. Over time, the body will retain more fluid to increase the blood pressure. POINTS: 1 7.A hospital client is taking a drugs that interferes with venous constriction. The nursing attendant will tell the hospital clientto: a.ask for assistance when getting out of bed. b.expect bradycardia for a few days. c.notify the provider if headache occurs. d.report shortness of breath. ACCURATE ANSWER:- A A drop in venous pressure reduces venous return to the heart, and as blood pools in the extremities, orthostatic hypotension can occur. Hospital clients taking drugs that reduce venous constriction should be cautioned to ask for assistance when getting out of bed. Bradycardia,headache, and shortness of breath are not expected effects. POINTS: 1 CH 47: Drugs Acting on the Renin-Angiotensin-Aldosterone SystemBurchum: Lehne’s Pharmacology for Nursing Care, 12TH Edition MULTIPLE CHOICE
1.A hospital client with hypertension is prescribed an angiotensin-converting enzyme (ACE) inhibitor. The nursing attendant reviewing this hospital client’s chart before administering the drugs will be most concerned about which other illness process? a.Bronchial asthma b.Coronary artery illness c.Diabetes mellitus d.Renal artery stenosis ACCURATE ANSWER:- D ACE inhibitors can cause severe renal insufficiency in hospital clients with bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney. Bronchial asthma, coronary artery illness, and diabetes mellitus are not comorbidities that are contraindications to treatment with an ACE inhibitor. POINTS: 1 2.A nursing attendant administers an ACE inhibitor to a hospital client who is taking the drugs for the first time. Whatwill the nursing attendant do? a.Instruct the hospital client not to get up without assistance. b.Make sure the hospital client takes a potassium supplement. c.Report the presence of a dry cough to the prescriber. d.Request an order for a diuretic to counter the side effects of the ACE inhibitor. ACCURATE ANSWER:- A Severe hypotension can result with the first dose of an ACE inhibitor. The hospital client should be discouraged from getting up without assistance. Potassium supplements are contraindicated. A dry cough is an expected side effect that eventually may cause a hospital client to discontinue the drugs;however, it is not a contraindication to treatment. Diuretics can exacerbate hypotension and should be discontinued temporarily when a hospital client starts an ACE inhibitor. POINTS: 1 3.A hospital client who has been taking an antihypertensive drugs for several years is recovering from a myocardial infarction. The prescriber changes the hospital client’s drugs to an ACEinhibitor. The hospital client asks the nursing attendant why a new drugs is necessary. What is the nursing attendant’sresponse? a.“ACEinhibitors can prevent or reverse pathologic changes in the heart’sstructure.”b.“ACEinhibitors help lower LDL cholesterol and raise HDL cholesterol.”c.“ACE inhibitorsincrease venous return to the heart, improving cardiac output.”d.“ACEinhibitors regulate electrolytes that affect the cardiac rhythm.”ACCURATE ANSWER:- A ACE inhibitors have many advantages over other antihypertensive drugs, the most important of which is their ability to prevent or reverse pathologic changes in the heart and reduce the risk of cardiac mortality caused by hypertension. They are useful in hospital clients with high low-density lipoprotein (LDL) or low high-density lipoprotein (HDL) cholesterol, but they do not directly affect this comorbidity. They reduce venous return to the heart, thereby reducing right heart size. They do not alter serum electrolyte levels.
POINTS: 1 4.A prescriber orders ramipril [Altace] for an obese hospital client with type 2 diabetes mellitus who has developed hypertension. The nursing attendant provides teaching before dismissing the hospital client home. Whichstatement by the hospital client indicates understanding of the teaching? a.“Iam less likely to develop diabetic nephropathy when taking this drugs.”b.“Ishould check my blood sugar more often, because hyperglycemia is a side effect of this drugs.”c.“Takingthis drugs helps reduce my risk of stroke and heart attack.”d.“This drugswill probably prevent the development of diabetic retinopathy.”ACCURATE ANSWER:- C Ramipril [Altace] is approved for reducing the risk of stroke and myocardial infarction (MI) in hospital clients at high risk for a major cardiovascular event because they have hypertension in conjunction with a history of stroke or MI or because they have diabetes. ACE inhibitors cannot be used for primary prevention of diabetic nephropathy, but they can delay the onset of overt nephropathy in hospital clients who already have less advanced nephropathy. ACE inhibitors do not affect serum electrolytes or glucose. One ACE inhibitor, enalapril, can reduce the risk of diabetic retinopathy in some hospital clients with type 1 diabetes mellitus. POINTS: 1 5.A hospital client begins taking an ACE inhibitor and complains of a dry cough. What does the nursing attendantcorrectly tell the hospital client about this symptom? a.It indicates that a serious side effect has occurred. b.It is a common side effect that occurs in almost all hospital clients taking the drugs. c.It may be uncomfortable enough that the drugs will need to be discontinued. d.It occurs frequently in hospital clients taking the drugs but will subside over time. ACCURATE ANSWER:- C A cough occurs in about 10% of hospital clients taking ACE inhibitors and is the most common reason for discontinuing therapy. It does not indicate a serious condition. It occurs in about 10% of all hospital clients and is more common in women, older adults, and those of Asian ancestry. It does not subside until the drugs is discontinued. POINTS: 1 6.A provider has ordered captopril [Capoten] for a hospital client who has hypertension. The hospital client reports a history of swelling of the tongue and lips after taking enalapril [Vasotec] in the past. Which action by the nursing attendant is correct? a.Administer the captopril and monitor for adverse effects. b.Hold the dose and notify the provider. c.Request an order to administer fosinopril instead of captopril. d.Reassure the hospital client that this is not a serious side effect. ACCURATE ANSWER:- B
Angioedema is a potentially life-threatening reaction to ACE inhibitors. If a hospital client has exhibited this reaction with any ACE inhibitor, he or she should not receive ACE inhibitors again. The nursing attendant should hold the drugs and notify the provider. Fosinopril is an ACE inhibitor and should not be given. POINTS: 1 7.A nursing attendant is reviewing a hospital client’s drugs before administration. Which drugs-to-drugs interactions will most concern the nursing attendant in a hospital client with a history of heart failure and apotassium level of 5.5 mEq/L? a.Furosemide [Lasix] and enalapril [Vasotec] b.Amlodipine [Norvasc] and spironolactone [Aldactone] c.Captopril [Capoten] and spironolactone [Aldactone] d.Metoprolol [Lopressor] and furosemide [Lasix] ACCURATE ANSWER:- C ACE inhibitors increase the risk of hyperkalemia, and combining this drugs with a potassium- sparing diuretic creates a significant risk of hyperkalemia. Furosemide and enalapril, an ACE inhibitor, would not be contraindicated in this hospital client. Amlodipine and spironolactone would notcause hyperkalemia. The combination of metoprolol, a beta blocker, and furosemide would not be contraindicated in this hospital client. POINTS: 1 8.A hospital client who is taking furosemide [Lasix] and digoxin will begin taking captopril [Capoten]. The nursing attendant is providing information about the drugs. Which statement by the hospital client indicates aneed for further teaching? a.“Ican use acetaminophen for analgesia if needed.”b.“Ishould stop taking the Lasix about a week before starting the Capoten.”c.“Ishould take this drugs on a full stomach.”d.“Iwill need to have blood tests done every 2 weeks for a few months.”ACCURATE ANSWER:- C Most oral formulations of ACE inhibitors may be given without regard for meals; captopril and moexipril, however, should be given 1 hour before meals. Nonsteroidal anti-inflammatory drugs should be avoided; acetaminophen is not contraindicated. Hospital clients taking diuretics should stop taking them 1 week before starting an ACE inhibitor to minimize the risk of hypotension. A WBC with differential should be evaluated at baseline and, after treatment starts, every 2 weeks for several months to monitor for neutropenia. POINTS: 1 9.A hospital client who stops taking an ACE inhibitor because of its side effects will begin taking an angiotensin II receptor blocker (ARB) drugs. Which side effect of ACE inhibitors will notoccur with an ARB drugs? a.Angioedema b.Cough c.Hyperkalemia