TEST BANK LEHNE’S PHARMACOLOGY
CHAPTERS 46-50
Chapter 46: Vasodilators
MULTIPLE CHOICE
1. A nurse is administering a vasodilator that dilates resistance vessels. The nurse
understands that this drug will have which effect on the patient?
a. Decreased cardiac preload
b. Decreased cardiac output
c. Increased tissue perfusion
d. Increased ventricular contraction
ANS: C
Vasodilators that dilate resistance vessels, or arterioles, cause a decrease in afterload,
which allows cardiac output and tissue perfusion to increase. A decrease in preload
would be the result of dilation of capacitance vessels, or veins. Dilation of arterioles
increases cardiac output. Ventricular contraction results when preload is increased.
DIF: Cognitive Level: Application REF: Selectivity of Vasodilatory Effects
TOP: Nursing Process: Planning MSC: NCLEX Client Needs
Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
2. A patient is taking a vasodilator that relaxes smooth muscles in veins. To help minimize
drug side effects, the nurse caring for this patient will:
a. caution the patient not to get up without assistance.
b. encourage the patient to increase fluid intake.
c. tell the patient to report shortness of breath.
d. warn the patient about the possibility of bradycardia.
ANS: A
Postural hypotension occurs when moving from a supine or seated position to an
upright position. It is caused by relaxation of smooth muscle in veins, which allows
blood to pool in veins and decreases venous return of blood to the heart. Patients
taking such drugs should ask for assistance when getting up to prevent falls.
Prolonged use of vasodilators can lead to expansion of blood volume and fluid
overload, so increasing fluid intake is not appropriate. Shortness of breath is a
symptom associated with heart failure. Tachycardia can occur when the blood
pressure drops as a result of the baroreceptor reflex.
DIF: Cognitive Level: Application REF: Adverse Effects Related to
3. A nurse is caring for a patient with hypertension and diabetes. The patient’s prescriber
recently ordered an angiotensin-converting enzyme (ACE) inhibitor. Which statement by
the patient indicates understanding of the nurse’s teaching about this drug?
a. “ACE inhibitors only dilate veins, so I may have more edema in my ankles.”
b. “ACE inhibitors prevent the nervous system from causing increased blood
pressure.”
c. “This drug can also cause shortness of breath because of bronchoconstriction.”
d. “This drug will help lower my blood pressure and will benefit my kidneys.”
ANS: D
ACE inhibitors reduce blood pressure and help preserve renal function in people with
diabetes. ACE inhibitors dilate both veins and arterioles. ACE inhibitors work on the
renin-angiotensin-aldosterone system, not the nervous system. ACE inhibitors do not
have effects on the bronchioles of the lungs.
DIF: Cognitive Level: Application REF: Drugs Acting on the Renin-
Angiotensin-Aldosterone System | ACE Inhibitors TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Pharmacologic and Parenteral Therapies
4. The nurse is caring for a patient who is taking a vasodilator that dilates capacitance
vessels. The nurse will expect which effect in this patient?
a. Decrease in cardiac work
b. Increase in cardiac output
c. Increase in tissue perfusion
d. Increase in venous return
ANS: A
Vasodilators that dilate capacitance vessels, or veins, lead to a decrease in venous
return to the heart, which reduces preload and the force of ventricular contraction. The
resultant effect is a decrease in cardiac work. With a decrease in ventricular
contraction, cardiac output is reduced, as is tissue perfusion. Dilation of veins causes a
decrease in venous return.
DIF: Cognitive Level: Application REF: Selectivity of Vasodilatory Effects
TOP: Nursing Process: Planning MSC: NCLEX Client Needs
Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
5. A nurse is reviewing the phenomenon of reflex tachycardia with a group of nursing
students. Which statement by a student indicates understanding of this phenomenon?
a. “Baroreceptors in the aortic arch stimulate the heart to beat faster.”
b. “Reflex tachycardia can negate the desired effects of vasodilators.”
, c. “Reflex tachycardia is more likely to occur when beta blockers are given.”
d. “Venous dilation must occur for reflex tachycardia to occur.”
ANS: B
Reflex tachycardia, which is a compensatory mechanism in response to decreased
blood pressure, can negate the desired effect of a vasodilator by eventually increasing
blood pressure. Baroreceptors relay information to the vasomotor center of the
medulla; the medulla sends impulses to the heart. Beta blockers are given to counter
reflex tachycardia. Reflex tachycardia can be produced by dilation of both arterioles
and veins.
DIF: Cognitive Level: Application REF: Reflex Tachycardia TOP:
Nursing Process: Evaluation MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
6. A female patient with essential hypertension is being treated with hydralazine
(Apresoline) 25 mg twice daily. The nurse assesses the patient and notes a heart rate of 96
beats per minute and a blood pressure of 110/72 mm Hg. The nurse will request an order
to:
a. administer a beta blocker.
b. administer a drug that dilates veins.
c. reduce the dose of hydralazine.
d. give the patient a diuretic.
ANS: A
This patient is showing signs of reflex tachycardia, so a beta blocker is indicated to
slow the heart rate. Patients with heart failure who take hydralazine often require the
addition of isosorbide dinitrate, which also dilates veins. There is no indication for
reducing the dose of hydralazine. A diuretic can be given with hydralazine if sodium
and water retention is present.
DIF: Cognitive Level: Application REF: Hydralazine | Apresoline | Drug
Interactions TOP: Nursing Process: Implementation MSC: NCLEX
Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
7. A nurse is obtaining a medication history on a newly admitted patient, who reports taking
minoxidil for hypertension. Admission vital signs reveal a heart rate of 78 beats per
minute and a blood pressure of 120/80 mm Hg. What is an important part of the initial
assessment for this patient?
a. Evaluating ankle edema
b. Monitoring for nausea and vomiting
c. Noting the presence of hypertrichosis
d. Obtaining a blood glucose
ANS: A
Fluid retention is a common and serious adverse effect of minoxidil, because it can
, lead to cardiac decompensation. If present, a diuretic is indicated. Nausea and
vomiting may occur with this drug but is not a serious side effect. Hypertrichosis
occurs in about 80% of patients taking the drug, but its effects are cosmetic and not
life threatening. It may be important to monitor the blood glucose level in some
patients, because the drug can alter glucose tolerance, but this effect is not as serious
as fluid retention.
DIF: Cognitive Level: Application REF: Minoxidil | Adverse Effects
TOP: Nursing Process: Assessment MSC: NCLEX Client
Needs Category: Physiologic Integrity: Reduction of Risk Potential
8. A patient is admitted with severe hypertensive crisis. The nurse will anticipate
administering which medication?
a. Captopril PO
b. Hydralazine (Apresoline) 25 mg PO
c. Minoxidil 20 mg PO
d. Sodium nitroprusside (Nitropress) IV
ANS: D
Sodium nitroprusside is the drug of choice for hypertensive emergencies and is given
intravenously. ACE inhibitors, such as captopril, are not used. Hydralazine may be
used but should be given IV. Minoxidil is effective, but its severe side effects make it
a second-line drug.
DIF: Cognitive Level: Application REF: Sodium Nitroprusside |
Therapeutic Uses | ACE Inhibitors | Hydralazine | Therapeutic Uses |
Minoxidil | Therapeutic Uses TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
9. A nursing student asks a nurse why a patient in hypertensive crisis is receiving both
intravenous sodium nitroprusside (Nitropress) and oral hydralazine (Apresoline). The
nurse will explain that this is done to prevent:
a. cyanide poisoning.
b. fluid retention.
c. rebound hypertension.
d. reflex tachycardia.
ANS: C
Sodium nitroprusside acts rapidly and is given only intravenously. Rebound
hypertension occurs immediately when the IV is stopped, so an oral antihypertensive
should be given simultaneously. Cyanide poisoning can occur with sodium
nitroprusside, but giving hydralazine does not counter this adverse effect. Hydralazine
does not prevent fluid retention or reflex tachycardia.
DIF: Cognitive Level: Application REF: Sodium Nitroprusside |
Therapeutic Uses | Hydralazine | Therapeutic Uses TOP: Nursing Process:
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