Chap. 31: Disorders of Blood Pressure Regulation
The nurse knows that systolic hypertension is characterized by systolic pressure of ____mm Hg or higher.
140 Systolic hypertension is a consistent systolic pressure of 140 mm Hg or higher with near normal diastolic pressure.
The physician's order states, "Calculate the pulse pressure of the client's B/P." The blood pressure reading is as follows: systolic pressure of 146 mm Hg and a diastolic pressure of 82 mm Hg. The pulse pressure would be:
64 mm Hg
Which of the following patients is at greatest risk for orthostatic hypotension?
A 66-year-old post-surgery patient on bed rest Post-surgery patients who have been immobile are at greatest risk for developing othostatic hypotension. The 70-year-old female may also be at some risk: age is a risk factor, as is administration of some antihypertensive medications.
Which of the following patients should most likely be assessed for orthostatic hypotension?
An elderly patient who has experienced two falls since admission while attempting to ambulate to the bathroom. Dizziness and syncope are characteristic signs and symptoms of orthostatic hypotension, and both predispose an individual to falls; this is especially the case among older adults. Headaches, edema, diabetes, and vision changes are not associated with orthostatic hypotension.
The nurse recognizes that there are many factors that influence blood flow within the systemic circulation. In the circulatory system, which of the following are called resistance vessels?
Arterioles Arterioles can constrict or dilate selectively and control the resistance to blood flow into capillaries.
A client has been prescribed a thiazide diuretic, hydrochlorothiazide (HCTZ), for the initial treatment of hypertension. What effect does the nurse know this drug will have to decrease blood pressure?
Decrease vascular volume Diuretics, such as the thiazides, loop diuretics, and the aldosterone antagonist (potassium-sparing) diuretics, lower blood pressure initially by decreasing vascular volume (by suppressing renal reabsorption of sodium and increasing salt and water excretion) and cardiac output.
The nurse knows that which group of antihypertensive drugs is usually the least expensive and is well tolerated?
Diuretics Diuretics are usually the least expensive, and are usually well tolerated by most patients.
An elderly patient is diagnosed with orthostatic hypotension. For which of the following clinical manifestations should the nurse assess?
Dizziness and fainting Orthostatic or postural hypotension is an abnormal drop in blood pressure on assumption of the standing position The presence of orthostatic symptoms (e.g., dizziness, syncope) is more relevant to the diagnosis that the actual blood pressure readings.
A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms?
Headache and confusion Cerebral vasoconstriction probably is an exaggerated homeostatic response designed to protect the brain from excesses of blood pressure and flow. The regulatory mechanisms often are insufficient to protect the capillaries, and cerebral edema frequently develops. As it advances, papilledema (i.e., swelling of the optic nerve at its point of entrance into the eye) ensues, giving evidence of the effects of pressure on the optic nerve and retinal vessels. The client may have headache, restlessness, confusion, stupor, motor and sensory deficits, and visual disturbances. In severe cases, convulsions and coma follow. Lethargy, nervousness, and hyperreflexia are not signs or symptoms of cerebral edema in malignant hypertension.
A patient has developed atherosclerosis. The nurse knows that a major cause for this disorder is which of the following?
Hypertension Constant high pressure damages arterial walls and promotes formation and rupture of plaque, with subsequent stroke and myocardial infarction. Atherosclerosis can also contribute to heart failure. Elevated HDL cholesterol would mitigate the development of atherosclerosis.
When will the nurse plan to assess a patient's blood pressure to confirm the possible diagnosis of orthostatic hypotension?.
In the morning before arising from bed To confirm orthostatic hypotension, blood pressure should be assessed while the patient is supine and then after standing for one minute and 3 minutes. A fall of 20 mm Hg or more in systolic pressure, or 10 mm Hg or more in diastolic pressure are considered orthostasis.
A patient's blood pressure is persistently in the range of 130-135 mm Hg systolic and 85-88 mm Hg diastolic. The nurse knows that which of the following conditions correctly describes this patient's blood pressure?
Prehypertension Normal blood pressure is considered to be systolic below 120 mm Hg or diastolic below 80 mm Hg. Prehypertension is systolic 120-139 mm Hg and diastolic 80-89 mm Hg. This condition should be checked at least once yearly. Stage 1 hypertension is 140-159 mm Hg systolic or 90-99 mm Hg diastolic and should be confirmed within two months. Stage 2 is systolic equal to or greater than 160 mm Hg or diastolic equal to or greater than 100 mm Hg. Antihypertensive medication should be considered for Stage 1 and 2; lifestyle changes should be recommended as appropriate for any blood pressure higher than normal.
A patient is prescribed an angiotensin converting enzyme inhibitor (ACEI) for hypertension. The nurse knows that ACEIs are contraindicated by which clinical condition?
Renal artery stenosis ACEI are contraindicated in renal artery stenosis, a condition that relies on the renin-angiotensis system to maintain adequate renal perfusion. ACEI are used clinically in the management of heart failure. Coronary artery disease and diabetes do not contraindicate ACEI.
A patient is diagnosed with stage 2 hypertension. The nurse knows that which of the following is characteristic of stage 2 hypertension?
Sustained systolic pressure equal to or greater that 160 mm Hg Stage 2 hypertension is systolic pressure greater than 159 mm Hg or diastolic pressure greater than 99 mm Hg. Systolic pressure of 140-159 mm Hg or diastolic pressure of 90-99 mm Hg are characteristic of stage 1 hypertension.
The ACE inhibitors act by inhibiting the conversion of angiotensin I to angiotensin II, thus decreasing angiotensin II levels and reducing its effect on vasoconstriction.
The kidneys The kidneys exert long-term control of blood pressure by modulating sodium content and extracellular fluid volume. An increase in extracellular fluid will yield an increase in blood volume and an increase in cardiac output. If this results in too great an increase in blood pressure, the kidneys will excrete sodium and water. Neural (autonomic nervous system) and humoral mechanisms (renin-angiotensin-aldosterone system and vasopressin) exert short-term control of blood pressure. Hormonal influence involves release of epinephrine (which works through the sympathetic nervous system) from the adrenal glands.
The nurse knows that the primary long term regulation of blood pressure is exerted by which of the following?
The kidneys The kidneys exert long-term control of blood pressure by modulating sodium content and extracellular fluid volume. An increase in extracellular fluid will yield an increase in blood volume and an increase in cardiac output. If this results in too great an increase in blood pressure, the kidneys will excrete sodium and water. Neural (autonomic nervous system) and humoral mechanisms (renin-angiotensin-aldosterone system and vasopressin) exert short-term control of blood pressure. Hormonal influence involves release of epinephrine (which works through the sympathetic nervous system) from the adrenal glands.
A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for treatment of hypertension. What expected outcome does the nurse expect this medication will have?
Will prevent the conversion of angiotensin I to angiotensin II Among the drugs used in the treatment of hypertension are ACE inhibitors. The ACE inhibitors act by inhibiting the conversion of angiotensin I to angiotensin II, thus decreasing angiotensin II levels and reducing its effect on vasoconstriction, aldosterone levels, intrarenal blood flow, and glomerular filtration rate. ACE inhibitors are increasingly used as the initial medication in mild to moderate hypertension.
Autonomic nervous system control of blood pressure is mediated through which of the following? Select all that apply.
• Baroreceptors in blood vessels • Carotid artery chemoreceptors • Pain and strong emotion • Aortic chemoreceptors Baroreceptors in blood vessels and heart sense pressure changes in the circulatory system, and chemoreceptors at the carotid arteries and in the aorta detect blood levels of oxygen, carbon dioxide and hydrogen. When pressure falls or blood gases change, the autonomic nervous system can activate reflex responses to maintain adequate blood flow to vital organs. Pain, emotion and cold also can activate the autonomic nervous system control of blood pressure. Hepatic function does not directly affect autonomic control of blood pressure.
The nurse is providing education for a patient diagnosed with essential hypertension. The nurse will state that the cause of this disorder is which of the following?
Unknown Essential or primary hypertension has no identifiable cause, although there are many risk factors. The other options are causes of secondary hypertension, for which a cause can be identified and often treated.
The nurse knows that which of the following statements regarding the physiology of blood pressure are correct? Select all that apply.
• Blood pressure is very variable. • Constant elevation of blood pressure can be lethal. • A decrease in blood flow can be an immediate threat to life. Blood pressure is a very variable yet highly regulated function in healthy persons. Blood flow is most vital to heart, brain and kidneys; other tissues can better survive periods of decreased blood flow. Constant elevation of blood pressure (hypertension) can cause severe damage to heart, blood vessels and kidneys, leading to premature disability and death. A sudden decrease in blood flow, especially to the heart and brain, can rapidly be deadly: these organs, vital to survival, require a constant supply of oxygen to function effectively.
A nurse is planning a community education program on lifestyle modification to manage hypertension. Which of the following topics should be included in the teaching plan? Select all that apply.
• Consume a diet rich in fruits, vegetables, and low-fat dairy products. • Reduce dietary sodium intake. • Stop smoking. • Limit alcohol consumption. Hypertension lifestyle modification included the maintenance of normal body weight (BMI, 18.5-24.9 kg/m2) 5-20 mm Hg/10 kg weight loss. Adoption of the Dietary Approaches to Stop Hypertension (DASH) eating plan including consuming a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat 8-14 mm Hg. Dietary sodium reduction to no more than 100 mmol/day (2.4 g sodium or 6 g sodium chloride) 2-8 mm Hg. Engage in regular aerobic physical activity such as brisk walking (at least 30 minutes per day. Moderation of alcohol consumption; limiting consumption to no more than 2 drinks (1 oz or 30 mL ethanol) (e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and 1 drink per day in women and lighter-weight persons.
A teenager is diagnosed with hypertension. The nurse knows that risk factors for hypertension in children and adolescents include which of these? Select all that apply.
• Inactive lifestyle • High salt consumption • Obesity The prevalence of hypertension in children and adolescents in increasing due to increases in obesity, and lifestyle factors such as lack of exercise and consumption of high-calorie, high-salt foods. Gender is not a factor nor is academic performance.
The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below which of the following?
140/90 The main objective of hypertension management is to achieve a pressure of 140/90, although persons with renal disease or diabetes are advised to aim for 130/80 or lower. Persons with blood pressure between 140/90 and 120/80 are considered to be prehypertensive and should be monitored at regular intervals to detect any rise in pressure.
A nurse is teaching a patient with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the patient understands when the patient correctly describes which of the following as the mechanism of action of an angiotensin-converting enzyme (ACE) inhibitor?
Inhibition of the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction The ACE inhibitors act by inhibiting the conversion of angiotensin I to angiotensin II, thus decreasing angiotensin II levels and reducing its effect on vasoconstriction.
A nurse is evaluating hypertension risk factors with an African American male who is a lawyer in a busy legal firm. He reports that he eats fairly well, usually having red meat and potatoes daily. His father and older brother have hypertension. His paternal grandfather had a stroke. The lawyer drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 pounds in the past year. Which of the following are nonmodifiable risk factors associated with this diagnosis? Select all that apply.
• Race • Family history Nonmodifiable risk factors include a family history of hypertension, age-related increases in blood pressure, and race. Modifiable risk factors are lifestyle factors can contribute to the development of hypertension by interacting with the constitutional risk factors. These lifestyle factors include high salt intake, excessive calorie intake and obesity, excessive alcohol consumption, and low intake of potassium. Although stress can raise blood pressure acutely, there is less evidence linking it to chronic elevations in blood pressure. Smoking and a diet high in saturated fats and cholesterol, although not identified as primary risk factors for hypertension, are independent risk factors for coronary heart disease and should be avoided.
The nurse knows that which of the following statements regarding the arterial chemoreceptors are correct? Select all that apply.
• The chemoreceptors can induce widespread vasodilation. • The main function of the chemoreceptors is in regulation of ventilation. • The chemoreceptors trigger increased blood pressure in persons with sleep apnea. • The chemoreceptors induce systemic hypertension in persons with chronic obstructive pulmonary disease (COPD). The arterial chemoreceptors detect blood levels of oxygen, carbon dioxide and hydrogen. If oxygen levels fall and carbon dioxide levels rise, respiration is The chemoreceptors activate the renin-angiotensin-aldosterone system (RAAS). Tstimulated in an attempt to bring better gas exchange in the lungs. These receptors also can induce vasoconstriction, attempting to shunt blood to vital organs. Persons with sleep apnea experience periods of hypoxemia detected by the chemoreceptors, and persons with COPD often have decreased levels of oxygen in the circulatory system. Blood content of oxygen, carbon dioxide and hydrogen do not directly affect the RAAS.