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A patient has not reached goal BP despite taking full doses of an appropriate three-drug therapy regimen, including a diuretic. Which finding in the patient history is the likely cause of resistant hypertension? 1 Increasing obesity 2 Excess pepper intake 3 Consumes peppermints 4 Erectile dysfunction (ED) medication
1 An increase in obesity is one of the causes of resistant hypertension. Licorice (rather than peppermint), excess salt (rather than pepper) intake, and oral contraceptives (rather than ED medications) are also possible causes of resistant hypertension.
A patient arrives at a medical clinic for a routine physical exam. The patient's BP is 150/94 mm Hg. All other assessment findings are within normal limits, and there is no previous history of elevated BP. Which situation may have falsely elevated the BP reading? 1 The BP cuff was too small for the size of the patient. 2 There is atherosclerosis present in the subclavian artery. 3 The patient smoked the day before the BP measurement. 4 The patient engaged in strenuous exercises the day before.
1 BP measurements should be performed using proper technique to get an accurate reading. BP measurements may be falsely high if the BP cuff is too small because it puts undue pressure on the artery. If the subclavian artery has atherosclerosis, the BP measurement would be falsely low. Smoking and engaging in strenuous exercise should be avoided 30 minutes before the BP measurement because they can alter the measurement. Smoking or engaging in strenuous exercise one day before a BP measurement will not affect the readings.
Which mechanism of hypertension causes target organ damage? 1 Promotion of atherosclerosis and damage to the walls of the arteries 2 Thickening of the capillary membranes, leading to hypoxia of organs 3 Direct pressure on organs that results in necrosis and replacement of cells with scar tissue 4 Increased blood viscosity that contributes to intravascular coagulation and tissue necrosis
1 Hypertension is a major risk factor for the development of atherosclerosis by mechanisms not yet fully known. However, once atherosclerosis develops, it damages the walls of arteries and reduces circulation to target organs and tissues. Hypertension does not thicken capillary membranes, cause direct pressure on organs, or increase blood viscosity.
A patient presents to the emergency department with a sudden rise in BP and a severe headache. Which precaution will the nurse take while administering the prescribed IV labetalol? 1 Keeping the patient supine 2 Monitoring for tachycardia 3 Maintaining seizure precautions 4 Taking the BP every five minutes
1 The patient is experiencing a hypertensive crisis. Labetalol is an α- and β-adrenergic blocker and reduces BP by causing vasodilation and a decrease in heart rate. Patients must be kept supine during IV administration because of the severe orthostatic hypotension that occurs with the medication. The medication will decrease, not increase, the heart rate. The BP should be assessed every two to three minutes during the initial administration of the drug. Seizure activity is not an adverse effect of the medication.
A patient is diagnosed with primary hypertension and asks the nurse what caused the condition. Which response would the nurse give? 1 "There is no identified cause." 2 "A decrease in plasma renin levels." 3 "Too much plaque in the blood vessels." 4 "Kidney disease is the most common cause."
1 There is not one exact cause of primary hypertension; there are several contributing factors. Renal or kidney disease is a cause of secondary hypertension. An increase, not a decrease, in plasma renin levels is a contributing factor in the development of primary hypertension. Hypertension speeds up the process of atherosclerosis in the peripheral blood vessels.
The nurse provides education to a patient about the symptoms of uncontrolled hypertension. Which symptoms would the nurse include? Select all that apply. 1 Fatigue 2 Dizziness 3 Palpitations 4 Cluster headaches 5 Shortness of breath
1, 2, 3, 5 A patient with severe hypertension may have a variety of symptoms secondary to the effects on blood vessels in the various organs and tissues or to the increased workload of the heart. These secondary symptoms include fatigue, dizziness, palpitations, angina, and dyspnea. Cluster headaches do not occur with uncontrolled hypertension.
A nurse provides education to a patient with hypertension related to lifestyle modifications to reduce overall cardiovascular risk. Which statement made by the patient indicates effective learning? Select all that apply. 1 "I should exercise for at least 30 minutes daily." 2 "I should achieve and maintain a healthy weight." 3 "I should limit my alcohol intake to five drinks per day." 4 "I should restrict my salt intake to less than or equal to 1500 mg/day." 5 "I can continue to smoke because nicotine does not affect BP."
1, 2, 4 Lifestyle modifications play a vital role in reducing BP and cardiovascular risk. Overweight people are at higher risk of cardiovascular disease. A weight loss of 22 lb may decrease systolic BP by approximately 5 to 20 mm Hg. Being physically active is essential to maintaining good health. It decreases the cardiovascular risk of hypertension. Sodium reduction helps to control BP. A patient with hypertension should lower salt intake to 1500 mg/day. The nicotine in tobacco causes vasoconstriction and increases BP. Therefore smokers who are hypertensive should stop smoking. Excessive alcohol consumption increases the risk of hypertension. Consuming three or more drinks per day increases the risk of cardiovascular disease and stroke.
Which factors in a patient's health history are nonmodifiable risk factors for primary hypertension? Select all that apply. 1 Age 65 years 2 Black ethnicity 3 Dietary sodium 4 Alcohol consumption 5 Family history of hypertension
1, 2, 5 Nonmodifiable risk factors for hypertension include increasing age, black ethnicity, and a family history of hypertension. Consumption of excessive dietary sodium and alcohol are considered modifiable risk factors.
As treatment for hypertensive crisis, a patient has received sodium nitroprusside for three days. For which reason would the nurse plan to monitor the patient's thiocyanate levels? 1 The medication has a long half-life. 2 The medication is metabolized to cyanide, then thiocyanate. 3 An increased level indicates interactions with other drugs the patient is taking. 4 An increased level indicates adverse effects on target organs caused by the medication.
2 Sodium nitroprusside causes arterial vasodilation and reduces systemic vascular resistance. This, in turn, decreases the BP. Sodium nitroprusside is metabolized to cyanide and then to thiocyanate, which can reach lethal levels. Therefore thiocyanate levels should be monitored in patients receiving the drug for more than three days or at doses greater than or equal to 4 mcg/kg/min. An increased level does not indicate adverse effects on target organs. It does not indicate interactions with other medications. The cause of concern and the need to assess the thiocyanate level do not relate to the medication's half-life.
The nurse is preparing a presentation related to the complications of hypertension. Which information will the nurse include? Select all that apply. 1 Stroke as a result of atherosclerosis 2 Heart failure as a result of increased heart contractility 3 Blurring of vision or loss of vision secondary to retinal damage 4 Right ventricular hypertrophy as a result of increased workload 5 Coronary artery disease caused by an increase in the elasticity of arterial walls
1, 3 Hypertension is a significant risk factor for cerebral atherosclerosis and stroke. Even in mildly hypertensive people, the risk for stroke is 4 times higher than in normotensive people. Adequate BP control decreases the risk of stroke. Embolic stroke may be a result of cerebral blood flow obstruction by a portion of atherosclerotic plaque or a blood clot formed in the carotid arteries. Hypertension leads to retinal damage that is manifested by blurred vision or loss of vision and retinal hemorrhage. Heart failure is a result of decreased heart contractility along with decreased stroke volume and cardiac output. Hypertension leads to an increased cardiac workload that causes left ventricular hypertrophy. Coronary artery disease is caused by decreased elasticity of the arterial walls and narrowing of the lumen.
A patient is diagnosed with primary hypertension. Which factors in the patient's history likely contributed to the development of the hypertension? Select all that apply. 1 Tobacco use 2 Thyroid disease 3 Diabetes mellitus 4 Increased sodium intake 5 Greater-than-ideal body weight 6 Underproduction of sodium-retaining hormones
1, 3, 4, 5 Contributing factors to primary hypertension include tobacco use, diabetes mellitus, increased sodium intake, and greater-than-ideal body weight. Thyroid disease is related to secondary hypertension. Overproduction (not underproduction) of sodium-retaining hormones contributes to primary hypertension.
Which mechanism of action makes atenolol beneficial to a patient with hypertension? 1 Activates dopamine receptors 2 Blocks β-adrenergic receptors 3 Relaxes arterial and venous smooth muscles 4 Reduces conversion of angiotensin I to angiotensin II
2 Atenolol is a cardioselective β-adrenergic receptor blocker (β-blocker) that reduces BP. It also reduces cardiac output and reduces sympathetic vasoconstrictor tone. It also decreases renin secretion by the kidneys. Fenoldopam, a direct vasodilator, activates dopamine receptors, resulting in systemic and renal vasodilation. Nitroglycerin is a direct vasodilator, which relaxes arterial and venous smooth muscle, reducing preload and systemic vascular resistance (SVR). Angiotensin-converting enzyme (ACE) inhibitors inhibit ACE, reducing the conversion of angiotensin I to angiotensin II.
A patient who is black is hospitalized for the treatment of hypertension. Which type of medication has been shown to provide better control for black individuals? 1 β-Adrenergic receptor blockers (β-blockers) 2 Calcium channel blockers 3 Peripheral adrenergic inhibitors 4 Angiotensin-converting enzyme inhibitors
2 Calcium channel blockers provide better control for black individuals than other classes of antihypertensives, including β-blockers and peripheral adrenergic inhibitors. Blacks have a higher risk of angioedema with angiotensin-converting enzyme inhibitors than whites.
Which information would the nurse teach to a patient who has a new prescription for doxazosin? 1 "Monitor yourself for a fast heart rate, which is a common side effect." 2 "Make position changes slowly, especially from lying down to standing." 3 "The medication also improves breathing by decreasing chest congestion." 4 "It is common for patients who take this medication to experience nausea."
2 Doxazosin is an α-adrenergic blocker and can cause marked orthostatic hypotension. For this reason, the patient should be instructed to rise slowly, especially when moving from a recumbent to a standing position. It is recommended to take the medication at bedtime to reduce the risk of associated orthostatic hypotension. Tachycardia, respiratory effects, and nausea are not evident with the medication.
Which medication should be used with caution in patients with diabetes because the drug may depress the tachycardia associated with hypoglycemia? 1 Diltiazem 2 Metoprolol 3 Prednisone 4 Hydromorphone
2 Metoprolol, a β-adrenergic receptor blocker (β-blocker), slows the heart rate. Tachycardia is a classic symptom of hypoglycemia; therefore patients must be made aware of the failure of the heart rate to respond to decreasing glucose levels and should be instructed to look for other signs of hypoglycemia. Diltiazem and hydromorphone will not affect blood sugars or signs/symptoms of hypoglycemia. Prednisone will increase, not decrease, blood sugar levels.
Which actions of a diuretic medication help to control BP? Select all that apply. 1 Vasodilation 2 Reduces plasma volume 3 Promotes sodium and water excretion 4 Reduces vascular response to catecholamines 5 Prevents extracellular calcium from moving into the cells
2, 3, 4 Diuretics are an important component of BP treatment. Diuretics tend to reduce the plasma volume by promoting the excretion of sodium and water. The net result is a reduction in the circulating volume, which causes a decrease in the BP. Diuretics also reduce the vascular response to catecholamines. The blood vessels do not constrict in response to catecholamines; as a result, the BP is reduced. Diuretics do not cause vasodilation or prevent the movement of extracellular calcium into the cells; these effects are brought about by calcium channel blockers.
The nurse observes another health care provider taking the BP of an older patient. The cuff is inflated to 180 mm Hg. The care provider records the systolic BP (SBP) as 180 mm Hg. For which reason is the BP measurement likely to be inaccurate? 1 An older patient's SBP is typically at or below 140 mm Hg. 2 An older patient is prone to anxiety, which can alter the reading. 3 The SBP could be underestimated if an auscultatory gap is present. 4 The patient's arm was level with the patient's heart during the reading.
3 Careful technique is important in assessing BP in older adults. Some older people have a wide gap between the first Korotkoff sound and subsequent beats. This is called the auscultatory gap. Failure to inflate the cuff high enough may result in underestimating SBP. Changes in the older population often place the patient at risk for hypertension. Taking the reading with the arm at heart level is the correct technique. There is no information provided that the patient was anxious.
The nurse provides discharge teaching to a female patient who was newly diagnosed with primary hypertension. Which instruction would be included? 1 Decrease the intake of omega-3 fatty acids. 2 Restrict sodium to less than or equal to 2300 mg/day. 3 Limit the intake of alcohol to no more than one drink per day. 4 Begin taking a calcium supplement to help lower BP.
3 Excessive alcohol intake is strongly associated with hypertension. Women and lighter-weight men should limit their intake to no more than one drink per day. Calcium supplements are not recommended to lower BP. Increased levels of dietary omega-3 fatty acids are associated with lower BP. People with hypertension should restrict sodium to less than or equal to 1500 mg/day.
The nurse provides medication education to a patient with a new prescription for lisinopril. Which information would the nurse include in the teaching? 1 "Never take this medication on an empty stomach." 2 "You should not take this medication if you have asthma." 3 "You may develop a dry cough while taking this medication." 4 "Discontinue this medication if you develop a drop in your BP."
3 Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. A common side effect is a dry cough. This medication is safe for use with asthma, can be taken on an empty stomach, and should not be discontinued unless instructed to do so by a health care provider.
Which systolic BP (SBP) measurement correlates with stage 1 hypertension? 1 118 mm Hg 2 129 mm Hg 3 132 mm Hg 4 142 mm Hg
3 Stage 1 hypertension is defined as an SBP of 130 to 139 or a diastolic BP (DBP) of 80 to 89 mm Hg. Normal BP is defined as an SBP of less than 120 mm Hg and a DBP of less than 80 mm Hg. Elevated BP is defined as an SBP between 120 and 129 mm Hg and a DBP of less than 80 mm Hg. Hypertension (stage 1) is defined as an SBP between 130 and 139 mm Hg and a DBP between 80 and 89 mm Hg. Hypertension (stage 2) is defined as an SBP of greater than 140 mm Hg and a DBP of greater than 90 mm Hg. If either the SBP or DBP is outside of a range, the higher measurement determines the classification.
A female patient with chronic hypertension is admitted to the emergency department with a sudden rise in BP. Which question is the priority for the nurse to ask the patient? 1 "Are you pregnant?" 2 "Do you need to urinate?" 3 "Do you have a headache or confusion?" 4 "Are you taking antiseizure medications?"
3 The nurse's priority assessments include neurologic deficits, retinal damage, heart failure, pulmonary edema, and renal failure. The headache or confusion could be seen with hypertensive encephalopathy, from increased cerebral capillary permeability leading to cerebral edema. Pregnancy can lead to secondary hypertension. Needing to urinate and taking antiseizure medication do not indicate a hypertensive emergency.
The nurse provides education to a group of women about preventing hypertension. Which information would the nurse include? Select all that apply. 1 Lose weight. 2 Limit nuts and seeds. 3 Limit sodium and fat intake. 4 Drink fat-free or low-fat milk. 5 Perform moderate physical activity for at least 30 minutes on most days.
3, 4, 5 The primary prevention of hypertension involves making lifestyle modifications that prevent or delay the increase in BP. Along with exercise for 30 minutes on most days, the Dietary Approaches to Stop Hypertension (DASH) eating plan is a healthy way to lower BP by limiting sodium and fat intake and drinking fat-free or low-fat milk. Weight loss may or may not be necessary for the individuals within the community group. Nuts and seeds and dried beans are excellent sources of protein and are included in the DASH eating plan.
The nurse notes that there is a difference in a patient's BP and heart rate (HR) when the patient changes position from supine to standing. The differences are a decrease of 20 mm Hg in systolic BP, a decrease of 10 mm Hg in diastolic BP, and an increase in the HR of 20 beats/minute. Which interpretation would the nurse make about the patient's condition? 1 Hypertensive crisis 2 An auscultatory gap 3 Resistant hypertension 4 Orthostatic hypotension
4 A decrease in BP with a change of position indicates orthostatic hypotension. It may manifest as light-headedness, dizziness, or syncope. Intravascular volume loss and inadequate vasoconstrictor mechanisms related to disease or medications are common causes. A hypertensive crisis is characterized by severely elevated BP with or without the presence of target organ damage. An auscultatory gap is commonly seen in elderly patients as a wide gap between the first Korotkoff sound and subsequent beats. Resistant hypertension is a condition in which the patient fails to reach BP goals despite an effective treatment regimen.
An adult patient with no medical history is being seen in a clinic for a routine physical exam. The patient's BP reading is 158/92. The patient asks the nurse: "Does this mean that I have hypertension?" Which response would the nurse provide? 1 "Do not worry. Everything is fine." 2 "It is a normal BP reading for an adult." 3 "Yes, you have hypertension because your BP is over 140/90." 4 "You need a follow-up BP check to make that determination."
4 A diagnosis of hypertension will not be made based on one elevated BP reading. Considering the fact that the patient does not have any medical problems and that this reading is the first elevated BP reading, a follow-up office visit is required. Providing false reassurance to the patient is leading to misinformation. Normal BP is defined as a systolic BP (SBP) of less than 120 mm Hg and a diastolic BP (DBP) of less than 80 mm Hg, so a reading of 158/92 is not normal.
A patient with hypertension has been prescribed an antihypertensive medication. During a follow-up visit, the patient asks if the medication can be stopped because the BP is now within the normal range. Which response would the nurse provide? 1 "You may stop the medication now because your BP is normal." 2 "Begin taking half-doses of the medication because the BP has decreased." 3 "You may stop taking the medication only if you maintain a healthy lifestyle." 4 "Continue the medication unless your health care provider advises discontinuing it."
4 Antihypertensive medications are effective at reducing BP; however, the medications should not be stopped abruptly because this can cause a severe hypertensive reaction. The medications should be discontinued only after consulting with the health care provider. The medication should not be stopped even if the BP measurements show normal readings. Medications should be taken regularly for sustained therapeutic effects. A reduction of the dosage may reduce the efficacy of the drug. Lifestyle modifications are necessary to reduce cardiovascular risks; however, antihypertensive medications should also be used for effective reduction of BP.
The nurse provides education to a 68-year-old patient who is experiencing orthostatic hypotension. Which statement made by the patient indicates the need for further teaching? 1 "I should change positions slowly so that I do not become light-headed." 2 "I should continue to limit my salt intake, which helps prevent high BP." 3 "This may be caused by dehydration, so perhaps I should increase my fluid intake." 4 "This may be caused by my BP medications, which I should stop taking."
4 BP medications may contribute to orthostatic hypotension; however, medications should not be discontinued unless advised by the health care provider. Changing positions slowly and limitation of salt intake are both correct ways to promote cardiovascular health and safety associated with the hypotension. Dehydration is a common cause of orthostatic hypotension and should be addressed.
A patient's BP reading is 142/91 mm Hg. How should the nurse classify the BP? 1 Normal 2 Prehypertension 3 Hypertension, stage 1 4 Hypertension, stage 2
4 Normal BP is defined as a systolic BP (SBP) of less than 120 mm Hg and a diastolic BP (DBP) of less than 80 mm Hg. Elevated BP is defined as an SBP between 120 and 129 mm Hg and a DBP of less than 80 mm Hg. Hypertension (stage 1) is defined as an SBP between 130 and 139 mm Hg and a DBP between 80 and 89 mm Hg. Hypertension (stage 2) is defined as an SBP of greater than 140 mm Hg and a DBP of greater than 90 mm Hg. If either the SBP or DBP is outside of a range, the higher measurement determines the classification.
The nurse provides information to a group of nursing students about measuring BP in older patients. Which information would the nurse include in the teaching? 1 Measure the patient's BP one hour after eating. 2 Peripheral vascular resistance decreases with aging. 3 Older adults are less likely to have postural hypotension. 4 Inflate the cuff 20 to 30 mm Hg after the radial pulse disappears.
4 When measuring BP, the nurse should inflate the cuff 20 to 30 mm Hg after the radial pulse disappears. Elderly patients experience a postprandial drop in BP; the greatest drop occurs approximately one hour after eating. The BP returns to preprandial levels three to four hours after eating. An age-related change is increased peripheral vascular resistance. Care should be taken to assess for orthostatic hypotension and acute kidney injury in patients over 65 years old.
A patient is newly diagnosed with hypertension. Which information would the nurse provide about the reasons for prescribed diagnostic studies? Select all that apply. 1 Echocardiography to provide baseline information about electrical conduction 2 Electrocardiogram (ECG) to evaluate the degree of left ventricular hypertrophy 3 Uric acid level to establish a baseline because the levels often decrease with diuretic therapy 4 Blood urea nitrogen (BUN) and serum creatinine levels to provide information about renal function 5 Lipid profile to provide information about risk factors related to atherosclerosis and cardiovascular disease
4, 5 BUN, creatinine, and urinalysis provide information about baseline renal function and help to identify renal damage caused by hypertension. An elevated lipid profile is an additional risk factor for hypertension because having elevated blood lipids leads to the development of atherosclerosis. Echocardiography evaluates the degree of ventricular hypertrophy. An ECG can identify the presence but not the degree of ventricular hypertrophy and is used to assess baseline cardiac conduction. Diuretic therapy used for hypertensive treatment frequently leads to an increase in uric acid.
An elderly patient often experiences sudden dizziness when standing. In which order would the nurse perform the steps of an assessment for orthostatic hypotension?
When assessing a patient for orthostatic or postural changes in BP and pulse, the nurse initially measures BP in the supine position after two to three minutes of rest. BP and pulse are then measured one to two minutes after assisting the patient to a sitting position with the legs dangling. Next, BP and pulse are assessed in the standing position after standing for one to two minutes. Finally, the findings should be evaluated to determine if orthostatic hypotension exists.
