Ch 25,30,31 for Concept 2-3
Which condition contributes to secondary hypertension?
Arterial vasoconstriction
The nurse prepares to apply ECG electrodes to a male client who requires continuous cardiac monitoring. Which action should the nurse complete to optimize skin adherence and conduction of the heart's electrical current?
Clip the client's chest hair prior to applying the electrodes.
Thiazides HTN med
increases EXcretion of Na and H2O by inhibiting Na reabsorption in the Distal tuble.
A nurse is teaching a client with severe hypertension about the damage this condition can cause to the body. What system/organs will the nurse note are particularly targeted for damage due to severe hypertension?
sensory
The nurse is conducting patient teaching about cholesterol levels in the body. When discussing the patient's elevated low-density lipoprotein (LDL) and lowered high-density lipoprotein (HDL) levels, the patient shows an understanding of the significance of these levels by stating what?
"Increased LDL and decreased HDL increase my risk of coronary artery disease."
A 55-year-old male client newly diagnosed with hypertension returns to the physician's office for a routine follow-up appointment after several months of treatment with metoprolol. During the initial assessment, the nurse records the client's blood pressure (BP) as 180/90 mm Hg. The client states that the medication is not taken as prescribed. Which is the best response by the nurse?
"The medication you were prescribed may cause sexual dysfunction; are you experiencing this side effect?"
The nurse is explaining the DASH diet to a client diagnosed with hypertension. The client inquires about how many servings of fruit per day can be consumed on the diet. What is the nurse's best response?
4-5 servings
An older adult client visits the clinic for a blood pressure check. The client's hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about blood pressure medicine?
A possible adverse effect of blood pressure medicine is dizziness when you stand.
stage 1 HTN
A systolic BP of 140 to 159 mm Hg is Stage I hypertension
The nurse is evaluating the types of medications prescribed for a client's hypertension. Which of the following medication classifications establishes an action on vasoconstrictive hormones in the blood stream?
ACE inhibitors The angiotensin-converting enzyme (ACE) inhibitor's primary action is to prevent the conversion of angiotensin I to angiotensin II, a potent vasoconstricting hormone in the blood. A beta-blocker blocks the beta-adrenergic receptors decreasing sympathetic nervous system stimulation. Loop diuretics excrete water from the loop of Henle, reducing circulating blood volume. Calcium channel blockers dilate coronary and peripheral arteries.
A 56-year-old man visits his primary care provider infrequently but has now presented with complaints of transient visual disturbances. Assessment of the patient has yielded few remarkable findings with the exception of blood pressure (BP) of 169/106 mm Hg. When do signs and symptoms of hypertension typically appear?
After target organ damage has occurred
Autoregulation of blood flow is directly connected to raising or lowering blood pressure via vasoactive substances. What are vasoconstrictive substances? (Select all that apply.)
Angiotensin II Endothelin-1
A patient is receiving an ACE inhibitor. The nurse ensures that the patient's hydration status is maintained to prevent:
Any condition that might lead to a drop in fluid volume could lead to excessive hypotension.
Mr. Seeman, 65 years old, is admitted to the hospital for cardiogenic shock. He is placed on dopamine to improve his blood pressure. He also has a history of peripheral vascular disease, hyperlipidemia, and diabetes mellitus type 2. What adverse effect(s) would require health care provider notification?
Changes in temperature or color of skin
The nurse is obtaining a health history from a client with a blood pressure of 146/88 mm Hg. The client states that lifestyle changes have not been effective in lowering blood pressure. Which medication classification does the nurse anticipate first?
Clients with hypertension, unable to be lowered by lifestyle changes, usually are placed on a thiazide diuretic initially. However, most people with hypertension will need two or more antihypertensive medications to reduce their blood pressure.
A client is receiving captopril. Which would be most important for the nurse to monitor?
Complete blood count
A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following?
Constant, intense back pain and falling blood pressure Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit.
The clinic nurse caring for a client with a cardiovascular disorder is performing an assessment of the client's pulse. Which of the following steps is involved in determining the pulse deficit?
Count the heart rate at the apex. The nurse determines the pulse deficit by counting the heart rate through auscultation at the apex while a second nurse simultaneously palpates and counts the radial pulse for a full minute. The difference, if any, is the pulse deficit. The pulse quality refers to its palpated volume. Pulse rhythm is the pattern of the pulsations and the pauses between them.
Choose the statements that correctly match the hypertensive medication with its side effect. Select all that apply. With thiazide diuretics, monitor serum potassium concentration. Cough is a common side effect of adrenergic inhibitors. With ACE inhibitors, assess for bradycardia. Direct vasodilators may cause headache and tachycardia.
Direct vasodilators may cause headache and tachycardia. With thiazide diuretics, monitor serum potassium concentratio
After teaching a group of students about nitroprusside and cyanide toxicity, the instructor determines that the teaching was successful when the students identify what as an assessment finding? (Select all that apply.)
Dyspnea Dilated pupils Distant heart sounds Shallow breathing
When caring for a patient with leg ulcers, the positioning of the legs depends on whether the patient's ulcer is arterial or venous in origin. How should the nurse position a patient who has leg ulcers that are venous in origin?
Elevate the patient's lower extremities.
Which tasks should a nurse assist a client with in the ambulatory setting in regards to hypertensive management? (Select all that apply.)
Finds local resources in the community for taking blood pressure Teaches client how to properly record weight and blood pressure Schedules regular monitoring of weight and blood pressure
A nurse providing education about hypertension to a community group is reviewing consequences of the disease. Which of the following would the nurse identify as target organs for hypertensive damage? Choose all that apply.
Heart Kidneys Brain Eyes
Which condition(s) indicates target organ damage from untreated/undertreated hypertension? Select all that apply.
Heart failure Retinal damage Stroke Target organs include the heart, kidney, brain, and eyes. Hyperlipidemia and diabetes are risk factors for development of hypertension.
A client is newly diagnosed with hypertension. When explaining this diagnosis, the nurse would include information that hypertension increases the person's risk for which conditions? Select all that apply.
Heart failure Stroke Blindness Kidney disease
Which term describes a situation in which blood pressure is very elevated but there is no evidence of impending or progressive target organ damage?
Hypertensive urgency
The nurse reviews a client's lab results and notes a serum calcium level of 7.9 mg/dL. It is most appropriate for the nurse to monitor the client for what condition?
Impaired myocardial contractility slow nodal functioning and impaired myocardial contractility, which can increase the risk of heart failure.
The nurse is administering a beta blocker to a patient with hypertension. Which would the nurse expect this drug to do? (Select all that apply.)
Increase renal blood flow Decrease heart rate Decrease cardiac muscle contraction
Which of the following is the hallmark symptom for peripheral arterial disease (PAD) in the lower extremity?
Intermittent claudication The hallmark symptom of PAD in the lower extremity is intermittent claudication. This pain may be described as aching or cramping in a muscle that occurs with the same degree of exercise or activity and is relieved with rest
Which of the following would be inconsistent with a hypertensive urgency?
Intracranial hemorrhage
A client is being seen at the clinic on a monthly basis for assessment of blood pressure. The client has been checking blood pressure at home as well and has reported a systolic pressure of 158 and a diastolic pressure of 64. What does the nurse suspect this client is experiencing?
Isolated systolic hypertension
The nurse is assessing a patient with severe hypertension. When performing a focused assessment of the eyes, what does the nurse understand may be observed related to the hypertension?
Papilledema swelling of optic disc
An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for?
Postural hypotension and resulting injury Antihypertensive medication can cause hypotension, especially postural hypotension that may result in injury. Rebound hypertension occurs when antihypertensive medication is stopped abruptly. Sexual dysfunction may occur, especially with beta blockers, but other medications are available should this problem ensue. This is not immediately a priority concern. Antihypertensive medications do not usually cause postural hypertension.
Which adrenergic inhibitor acts directly on the blood vessels, producing vasodilation?
Prazosin Prazosin is a peripheral vasodilator acting directly on the blood vessels. It is not used in angina and coronary artery disease, however, because it induces tachycardia if not preceded by administration of propranolol and a diuretic. Reserpine impairs synthesis and reuptake of norepinephrine. Propranolol blocks the beta-adrenergic receptors of the sympathetic nervous system, especially the sympathetics to the heart, producing a slower heart rate and lowered blood pressure. Clonidine acts through the central nervous system, apparently through centrally mediated alpha-adrenergic stimulation in the brain, reducing blood pressure.
A client is brought to the emergency department with reports of a bad headache and an increase in blood pressure. The blood pressure reading obtained by the nurse is 260/180 mm Hg. What is the therapeutic goal for reduction of the mean blood pressure?
Reduce the blood pressure by 20% to 25% within the first hour of treatment.
What does the administration of a calcium channel blocker result in?
Relaxation of blood vessels Increase oxygen supply to the heart Reduce the workload on the heart Decrease blood pressure
Which of the following is the most effective intervention for preventing progression of vascular disease?
Risk factor modification is the most effective intervention for preventing progression of vascular disease. Measures to prevent tissue loss and amputation are a high priority. Patients are taught to avoid trauma; wear sturdy, well-fitting shoes or slippers; and use pH neutral soaps and body lotions.
A nurse is providing education about the prevention of arterial constriction to a client with peripheral arterial disease. Which of the following includes priority information the nurse would give to the client?
STOP SMOKING
The nurse is caring for a client prescribed bumetanide for the treatment of stage 2 hypertension. Which finding indicates the client is experiencing an adverse effect of the medication?
Serum potassium value of 3.0 mEq/L
The nurse is instructing a client who is newly prescribed an antihypertensive medication. Which nursing instruction is emphasized to maintain client safety?
Sit on the edge of the chair and rise slowly.
The nurse is conducting a service project for a local elderly community group on the topic of hypertension. The nurse will relay that which risk factors and cardiovascular problems are related to hypertension? Select all that apply.
Smoking Overweight/obesity Age ≥65 in women
Which diuretic medication conserves potassium?
Spironolactone Spironolactone is known as a potassium-sparing diuretic. Furosemide causes loss of potassium from the body. Chlorothiazide and chlorthalidone cause mild hypokalemia.
What should the nurse do to manage persistent swelling in a client with severe lymphangitis and lymphadenitis?
Teach the client how to apply a graduated compression stocking. The nurse recommends elevating the area to reduce the swelling and provides warmth to promote comfort and to enhance circulation
dash diet
The client can consume 4 or 5 servings of fruit per day on the DASH diet. The servings for grains and grain product is 7 or 8. Two or 3 servings of low-fat or fat-free dairy foods can be consumed per day. Meat, fish, and poultry servings are 2 or fewer per day.
The nurse is caring for a client with essential hypertension. The nurse reviews lab work and assesses kidney function. Which action of the kidney would the nurse evaluate as the body's attempt to regulate high blood pressure?
The kidney excretes sodium and water. Hypernatremia (elevated serum sodium level) increases blood volume, which raises blood pressure. The kidney's response to the elevation in blood pressure is to excrete sodium and excess water. Any retention of sodium and water would increase blood volume and, thus, blood pressure. Sodium and water move together.
The nurse is evaluating the types of medications prescribed for a client's hypertension. Which of the following medication classifications establishes an action on vasoconstrictive hormones in the blood stream?
aCE inhibitor
A black client is receiving lisinopril. The nurse would need to closely monitor for which concern?
airway patency
A client is receiving carvedilol to treat hypertension. The nurse identifies this drug as a(n):
alpha and beta blocker
perpherial arterial disease
arteries are not allowing blood to flow to certain areas such as feet or fingers. Youll see less pulse, coolor skin, ulcers can be intbetween toes, may have intermittent claudation which is pain while walking/excercising in LE. LOWER legs because the blood is not flowing so we want to promote gravity to help.
A black client is being treated for stage-2 hypertension. What antihypertensive agent is the drug of choice for this client?
calcium channel blocker
The nurse is caring for an elderly client with left-sided heart failure. When auscultating lung sounds, which adventitious sound is expected?
crackles When the heart is pumping inefficiently, blood backs up into the pulmonary veins and lung tissue. Auscultation reveals a crackling sound. Possible wheezes and gurgles are also possibilities.
A client has been newly diagnosed with primary hypertension. Which medication classification represented in the client's current medication regime should the nurse question when considering the treatment for this new diagnosis?
direct vasoconstrictors
A patient is receiving verapamil. What would be important for the nurse to stress that the patient avoid?
grapefruit juice
Which outcome is most important for a client recently diagnosed with hypertension?
multiple diastolic blood pressure readings less than 90 mm Hg
The public health nurse is presenting a workshop on hypertension for the Parent Teacher Organization of the local elementary school. A parent asks the nurse who is at risk for hypertension. What would be the nurse's best answer?
people at highest risk for hypertension include those with diabetes.
A diastolic blood pressure of 90 mm Hg is classified as
stage 1 HTN A diastolic BP of 80 to 89 mm Hg is classified as prehypertension or elevated BP. A diastolic BP less than 80 mm Hg is normal. A diastolic BP of 90 to 99 mm Hg is stage I hypertension. A diastolic BP of 100 mm Hg or above is classified as stage 2 hypertension.
A male client's friend tells him to stop taking his metoprolol because he read that it causes cancer. The nurse encourages the client to consult his prescriber because abrupt withdrawal from the drug may cause what effect?
Exacerbation of his angina
The nurse has admitted a client with type 1 diabetes mellitus who has been prescribed captopril for treatment of hypertension. The nurse knows this medication is used in clients with diabetes for what reason?
It reduces proteinuria.
You are precepting a new graduate nurse on your unit. The two of you are caring for a client with malignant hypertension. The new nurse asks what malignant hypertension can cause. What would be your best answer?
L ventricular failure
The nurse is planning the care of a patient admitted to the hospital with hypertension. What objective will help to meet the needs of this patient?
Lowering and controlling the blood pressure without adverse effects and without undue cost
hypertension places people at risk for
heart disease, heart failure, stroke, and kidney disease.
A client with a history of hypertension is receiving client education about structures that regulate arterial pressure. Which structure is a component of that process?
kidneys The autonomic nervous system, the kidneys, and various endocrine glands regulate arterial pressure.
client has just received a diagnosis of hypertension after the completion of diagnostics. What can the client do to decrease the consequences of hypertension? Select all that apply.
loose weight manage stress
The nurse is administering a beta blocker to a patient in order to decrease automaticity. Which medication will the nurse administer?
metroprolol
The nurse is teaching a client about chronic untreated hypertension. What complication will the nurse explain to the client?
stroke A stroke occurs if vessels in the brain rupture and bleed. If an aneurysm has developed in the aorta from chronic hypertension, it may burst and cause hemorrhage and shock.
peripheral vascular disease
valves are incompetient and dont work. They arent allowing the fluid to go back up to the R side of the heart. So youll have increased edema from the blood of the left side of the heart pumping it out but its unable to be forced back up to the R side of the heart because maybe the valves arent working. So youll want to ELEVATE legs to help the fluid go back to R side of the heart.
