Ch. 31 PrepU

A nurse is caring for a client who has hypertension and diabetes mellitus. The client's blood pressure this morning was 150/92 mm Hg. He asks the nurse what his blood pressure should be. The nurse's most appropriate response is:

"Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg."

A nurse is educating a client about monitoring blood pressure readings at home. Which of the following will the nurse be sure to emphasize?

"Sit quietly for 5 minutes prior to taking blood pressure."

A patient has been diagnosed with prehypertension and has been encouraged to exercise regularly and begin a weight loss program. After what period of time does the nurse tell the patient to return for a follow-up visit?

1 year

Which ethnic background would the nurse screen for hypertension at an early age?

African American

The nurse is caring for a patient with an intracranial hemorrhage. The patient is having a hypertensive emergency. Which of the following nursing intervention would take priority in this patient?

Avoid lowering the blood pressure (BP) too quickly

An African American client at the clinic has just been diagnosed with essential hypertension. The client tells the nurse that they do not take medicine. What would the nurse tell the client is the most serious consequence of chronic hypertension?

Death

A client is being seen at the clinic for a routine physical when the nurse notes the client's blood pressure is 150/97. The client is considered to be a healthy, well-nourished young adult. What type of hypertension does this client have?

Essential (primary)

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

The nurse in an oncology clinic notes that the client being treated has hypertension. What tumor is a predisposing condition for secondary hypertension?

Pheochromocytoma

The nurse is caring for a client newly diagnosed with secondary hypertension. Which condition contributes to the development of secondary hypertension?

Renal disease

Which finding indicates that hypertension is progressing to target organ damage?

Retinal blood vessel damage

Lifestyle modifications are recommended to prevent and manage hypertension. Select the modification that has been found to have the greatest effect in reducing blood pressure measurements.

Weight reduction

A 66-year-old client presents to the emergency department reporting severe headache and mild nausea for the past 6 hours. Upon assessment, the client's BP is 210/120 mm Hg. The client has a history of hypertension and takes 1.0 mg clonidine twice daily. Which question is most important for the nurse to ask the client next?

"Have you taken your prescribed clonidine today?"

The nurse and a dietitian are instructing the client on a low-sodium diet needed to lower the blood pressure. Which question, asked by the nurse, is most important?

"How do you prepare your food?"

Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension?

"Limiting my salt intake to 2 grams per day will improve my blood pressure."

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."

When monitoring a patient who has hypertension and chronic kidney disease, the target pressure for this individual should be less than which blood pressure reading?

130/80 mm Hg

A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. For a client without diabetes mellitus, the target blood pressure is 140/90 or lower. Because this client has diabetes mellitus, the target blood pressure will be which of the following?

130/80 or lower

A female client, aged 82, visits the clinic for a blood pressure (BP) check. Her hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about her blood pressure medicine?

A possible adverse effect of blood pressure medicine is dizziness when you stand.

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

It is important for the nurse to encourage the patient to rise slowly from a sitting or lying position because:

Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain.

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

Management of hypertension includes three of the following four goals, depending on the primary and secondary causes. Select all that apply.

Impairing the synthesis of norepinephrine. Modifying the rate of myocardial contraction. Decreasing renal absorption of sodium.

The nurse teaches the client which guidelines regarding lifestyle modifications for hypertension?

Maintain adequate dietary intake of fruits and vegetables

A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. Which of the following are risk factors for cardiovascular problems in clients with hypertension? Choose all that apply.

Physical inactivity Smoking Diabetes mellitus

The nurse is instructing a student on the proper technique for measuring blood pressure (BP). Which of the following would indicate a need for further teaching?

Positions the arm at waist level

The nurse is completing a cardiac assessment on a patient. The patient has a blood pressure (BP) reading of 126/80. The nurse would identify this blood pressure reading as which of the following?

Prehypertension

As recommended follow-up for a client initially diagnosed with prehypertension, the client should get his or her blood pressure rechecked within which time frame?

Recheck in 1 year

A nurse is discussing with a nursing student how to accurately measure blood pressure. Which of the following points does the nurse emphasize?

Routinely calibrate the sphygmomanometer.

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

The nurse is caring for a client with essential hypertension. The nurse reviews labwork 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.

Hypertension is defined as "sustained elevations in systolic or diastolic blood pressures that exceed prehypertension levels." What are some of the consequences of hypertension that make it such a health menace in the United States?

all options are correct

When measuring blood pressure in each arm of a healthy adult, the nurse recognizes that the pressures

differ no more than 5 mm Hg between arms.

Which of the following diagnostic tests may reveal an enlarged left ventricle?

echo

A nurse on a busy medical unit is aware of the importance of accurate blood pressure (BP) measurement. To ensure accuracy when assessing patients' blood pressures, the nurse should always:

ensure correct cuff size

Which of the following would be inconsistent with a hypertensive urgency?

intracranial hemmhorage

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

When assessing your client, you note a blood pressure (BP) of 205/115. The client has had BP's within normal limits up until this time. The client complains of a sudden onset severe headache. The nurse recognizes this as probable malignant hypertension. What would be the nurse's first action?

notify the physician

A systolic blood pressure of 135 mm Hg would be classified as

prehypertension.

A client, newly admitted to the nursing unit, has a primary diagnosis of renal failure. When assessing the client, the nurse notes a blood pressure (BP) of 180/100. The nurse knows that this is what kind of hypertension?

secondary

Choose the statements that correctly match the hypertensive medication with its side effect. Select all that apply.

Direct vasodilators may cause headache and tachycardia. With thiazide diuretics, monitor serum potassium concentration.

A nurse is educating about lifestyle modifications for a group of clients with newly diagnosed hypertension. While discussing dietary changes, which of the following points would the nurse emphasize?

It takes 2 to 3 months for the taste buds to adapt to decreased salt intake

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?

Left ventricular failure

A nurse is providing education about lifestyle modifications to a group of clients who have been newly diagnosed with hypertension. The nurse would include all the following statesments except:

Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women.

A patient is being treated for hypertensive emergency. When treating this patient, the priority goal is to lower the mean blood pressure (BP) by which percentage in the first hour?

Up to 25%

When administering an angiotensin-converting enzyme (ACE) inhibitor with spironolactone, the nurse should be aware that which electrolyte imbalance may occur?

hyperkalemia

A patient has severe coronary artery disease (CAD) and hypertension. Which medication order should the nurse consult with the physician about that is contraindicated for a patient with severe CAD?

Clonidine (Catapres)

Which condition(s) indicates target organ damage from untreated/undertreated hypertension? Select all that apply.

Heart failure Retinal damage Stroke

What response is appropriate when a client with hypertension declines to take prescribed antihypertensive medications because due to the absence of symptoms?

Inform the client that this is why hypertension is known as "the silent killer."

The nurse is caring for a client who has had 25 mg of oral hydrochlorothiazide added to the medication regimen for the treatment of hypertension. Which instruction should the nurse give the client?

"Increase the amount of fruits and vegetables you eat."

A nurse is teaching a 38-year-old man with newly diagnosed hypertension who asks if there is any harm in stopping his antihypertensive medication if he decides to discontinue it. The correct reply addresses the consequence of stopping antihypertensive medications abruptly. Which of the following statements from the nurse would be appropriate?

"Rebound hypertension can occur."

A 77-year-old client presents to the local community center for a blood pressure (BP) screening; BP is recorded as 180/90 mm Hg. The client has a history of hypertension but currently is not taking the prescribed medications. Which question is most appropriate for the nurse to ask the client first?

"Why are you not taking your medications?"

The nurse is explaining the DASH diet to a patient diagnosed with hypertension. The patients inquires about how many servings of fruit per day can be consumed on the diet. The nurse would be correct in stating which of the following?

4 or 5

A client with newly diagnosed hypertension asks what she can do to decrease the risk for related cardiovascular problems. Which of the following risk factors is not modifiable by the client?

Age

Which condition contributes to secondary hypertension?

Arterial vasoconstriction

A nurse is providing education to a client about monitoring blood pressure readings at home. The nurse will review all the following items except:

Avoid smoking cigarettes for 1 hour prior to taking blood pressure.

A patient with hypertension has been able to maintain a blood pressure of 130/70 mm Hg for 1 year while reducing dietary sodium and taking hydrochlorothiazide (HCTZ) and atenolol (Tenormin). What treatment plan will the nurse educate the patient about?

Gradual reducing the HCTZ and the atenolol and continuing to reduce sodium intake

The nurse is performing an assessment on a patient to determine the effects of hypertension on the heart and blood vessels. What specific assessment data will assist in determining this complication? (Select all that apply.)

Heart rate Heart rhythm Character of apical and peripheral pulses

The staff educator is talking to a group of new emergency department nurses about hypertensive crises. The nurse educator is aware that hypertensive urgency differs from hypertensive emergency in what way?

Hypertensive emergencies are associated with evidence of target organ damage.

A patient is being seen at the clinic on a monthly basis for assessment of blood pressure. The patient has been checking her 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 patient is experiencing?

Isolated systolic hypertension

A patient informs the nurse, "I can't adhere to the dietary sodium decrease that is required for the treatment of my hypertension." What can the nurse educate the client about regarding this statement?

It takes 2 to 3 months for the taste buds to adapt to changes in salt intake.

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

A client in a clinic setting has just been diagnosed with hypertension. She asks what the end goal is for treatment. The correct reply from the nurse is which of the following?

To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less

A client with hypertension visits the health clinic for a routine checkup. The nurse measures the client's blood pressure at 184/92 mm Hg and notes a 5-lb (2.3-kg) weight gain within the past month. Which nursing diagnosis reflects the most serious problem in managing a client with hypertension?

Noncompliance (nonadherence to therapeutic regimen)

A 35-year-old client has been diagnosed with hypertension. The client is a stock broker, smokes daily, and has diabetes. During a follow-up appointment, the client states that regular visits to the doctor just to check blood pressure (BP) are cumbersome and time consuming. As the nurse, which aspect of client teaching would you recommend?

Purchasing a self-monitoring BP cuff

Which diuretic medication conserves potassium?

Spironolactone

During the physical assessment of a client with hypertension, what would you expect to be the most obvious finding?

Sustained increase of either one or both systolic or diastolic measurements.

A client comes to the emergency department complaining of visual changes and a severe headache. The nurse measures the client's blood pressure at 210/120 mm Hg. However, the client denies having hypertension or any other disorder. After diagnosing malignant hypertension (hypertensive emergency), a life-threatening disorder, the physician initiates emergency intervention. What is the most common cause of malignant hypertension (hypertensive emergency)?

Untreated hypertension

Which statements are true when the nurse is measuring blood pressure (BP)? Select all that apply.

Using a BP cuff that is too small will give a higher BP measurement. The client's arm should be positioned at the level of the heart. The client should sit quietly while BP is being measured.

The nurse is administering medications on a medical-surgical unit. A client is ordered to receive 40 mg oral nadolol for the treatment of hypertension. Before administering the medication, the nurse should

check the client's heart rate.

A nurse providing education to a community group about hypertension is reviewing appropriate lifestyle modifications. Which of the following are among changes that can help prevent and control hypertension? Choose all that apply.

Weight reduction Substitution of low-fat for whole dairy products in diet Increased physical activity

A client is taking 50 mg of oral spironolactone twice a day to assist with blood pressure control. While the nurse is performing the morning assessment, the client reports nausea, general muscle cramps, and weakness. The ECG strip shows a peaked, narrow T-wave, which is a change. What electrolyte imbalance does the nurse suspect?

hyperkalemia

It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine

increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood.

The nurse understands that client education related to antihypertensive medication should include which of the following?

inform client to avoid over-the-counter cold and sinus medications

Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through:

ophthalmic examination.

A patient comes to the walk-in clinic. While assessing the patient's vital signs, the nurse assesses the patient's blood pressure at 128/89 mm Hg. According to JNC7, how would this patient's blood pressure be classified?

prehypertensive

It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position

provide time for the heart to increase the rate of contraction to resupply oxygen to the brain.

It is important for the nurse to encourage the cltient diagnosed with hypertension to rise slowly from a sitting or lying position because gradual changes in position

provide time for the heart to increase the rate of contraction to resupply oxygen to the brain.

Which term is refers to hypertension in which blood pressure that is controlled with therapy becomes uncontrolled (abnormally high) when the therapy is discontinued?

rebound

According to the classification of hypertension diagnosed in older adults, hypertension that can be attributed to an underlying cause is termed

secondary.

A client with severe hypertension states, "I feel fine; I'm not really sick at all." The nurse will teach the client that the system/organs particularly targeted for damage by severe hypertension include which of the following?

sensory

A diastolic blood pressure of 90 mm Hg is classified as

stage 1 hypertension.

The nurse is seeing a client for the first time and has just checked the client's blood pressure. The nurse would consider the client prehypertensive if:

systolic BP is between 120 and 139 mm Hg.

The nurse understands that an overall goal of hypertension management is that

there is no indication of target organ damage.