Chapter 31

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? A) "Are you having trouble paying for your medications?" B) "Can you tell me the reasons you aren't taking your medications?" C) "What medications are you prescribed?" D) "Are you able to get to your pharmacy to pick up your medications?"

"Can you tell me the reasons you aren't taking your medications?"

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. When the client asks the nurse what his or her blood pressure should be, what is the nurse's most appropriate response? A) "Your blood pressure is fine. Just keep doing what you're doing." B) "The current recommendation is for everyone to have blood pressure of 140/90 mm Hg or lower." C) "The lower the better. Blood pressure of 130/80 mm Hg is best for everyone." D) "Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg."

"Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg."

A client with high blood pressure is receiving an antihypertensive drug. When developing a client teaching plan to minimize orthostatic hypotension, which instruction should the nurse include? A) "Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night." B) "Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising." C) "Flex your calf muscles, avoid alcohol, and change positions slowly." D) "Rest between demanding activities, eat plenty of fruits and vegetables, and drink 6 to 8 cups of fluid daily."

"Flex your calf muscles, avoid alcohol, and change positions slowly."

A nurse working in the clinic is seeing a client who has just been prescribed a new medication for hypertension. The client asks why hypertension is sometimes called the "silent killer." What is the best response by the nurse? A) "Hypertension often causes no symptoms." B) "Hypertension often kills early in the disease process." C) "Hypertension often causes no pain." D) "Hypertension is difficult to diagnose."

"Hypertension often causes no symptoms."

A client is placed on a low-sodium (500 mg/day) diet. Which client statement indicates that the nurse's nutrition teaching plan has been effective? A) "I can still eat a ham-and-cheese sandwich with potato chips for lunch." B) "I chose broiled chicken with a baked potato for dinner." C) "I chose a tossed salad with sardines and oil and vinegar dressing for lunch." D) "I'm glad I can still have chicken bouillon."

"I chose broiled chicken with a baked potato for dinner."

Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension? A) "A glass of red wine each day will lower my blood pressure." B) "I should eliminate caffeine from my diet to lower my blood pressure." C) "If I include less fat in my diet, I'll lower my blood pressure." D) "Limiting my salt intake to 2 grams per day will improve my blood pressure."

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

A patient is being treated for hypertensive emergency. When treating this patient, the priority goal is to lower the mean blood pressure (BP) by up to which percentage in the first hour? A) 25% B) 35% C) 40% D) 45%

25%

According to the DASH diet, how many servings of vegetables should a person consume each day? A) 2 or fewer B) 2 or 3 C) 4 or 5 D) 7 or 8

4 or 5

A nurse is discussing with a nursing student how to accurately measure blood pressure. What statement by the student indicates an understanding of the education? A) A cuff that is too small will give a false high blood pressure. B) A cuff that is too small will give a false low blood pressure. C) A cuff that is too large will give a false high blood pressure. D) The size of the cuff does not matter as long as it fits snugly around the arm.

A cuff that is too small will give a false high blood pressure.

The nurse is administering metoprolol to a client. What type of medication should the nurse educate the client about? A) Beta blocker B) Diuretic C) Angiotensin-converting enzyme (ACE) inhibitor D) Vasodilator

Beta blocker

Which diagnostic method is recommended to determine whether left ventricular hypertrophy has occurred? A) Echocardiography B) Electrocardiography C) Blood chemistry D) Blood urea nitrogen

Echocardiography

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? A) Secondary B) Pathologic C) Malignant D) Essential (primary)

Essential (primary)

The nurse is creating a community teaching demonstration focusing on the cause of blood pressure. When completing the visual aid, which body structures represent the mechanism of blood pressure? A) Lung and arteries B) Heart and blood vessels C) Brain and sympathetic nervous system D) Kidneys and autonomic nervous system

Heart and blood vessels

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 Respiratory rate Heart rhythm Character of apical and peripheral pulses Lung sounds

Heart rate Heart rhythm Character of apical and peripheral pulses

When administering benazepril with spironolactone, the nurse should be aware that which electrolyte imbalance may occur? A) Hyperkalemia B) Hypokalemia C) Hypercalcemia D) Hypocalcemia

Hyperkalemia

Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage? A) Hypertensive emergency B) Hypertensive urgency C) Primary hypertension D) Secondary hypertension

Hypertensive emergency

A client experiences orthostatic hypotension while receiving furosemide to treat hypertension. How will the nurse intervene? A) Administer I.V. fluids as ordered. B) Administer an isosorbide as ordered. C) Insert an indwelling urinary catheter as ordered. D) Instruct the client to sit for several minutes before standing.

Instruct the client to sit for several minutes before standing.

The nurse is caring for an older adult client who has come to the clinic for a yearly physical. When assessing the client, the nurse notes the blood pressure (BP) is 140/93. The nurse knows that in older clients what happens that may elevate the systolic BP? A) Loss of arterial elasticity B) Decrease in blood volume C) Increase in calcium intake D) Decrease in cardiac output

Loss of arterial elasticity

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? A) Postural hypertension and resulting injury B) Rebound hypertension C) Sexual dysfunction D) Postural hypotension and resulting injury

Postural hypotension and resulting injury

When measuring the blood pressure in each arm of a healthy adult client, the nurse recognizes that which statement is true? A) Pressures must be equal in both arms. B) Pressures may vary 10 mm Hg or more between arms. C) Pressures should not differ more than 5 mm Hg between arms. D) Pressures may vary, with the higher pressure found in the left arm.

Pressures should not differ more than 5 mm Hg between arms.

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? A) Reduce the blood pressure by 20% to 25% within the first hour of treatment. B) Reduce the blood pressure to about 140/80 mm Hg. C) Rapidly reduce the blood pressure so the client will not suffer a stroke. D) Reduce the blood pressure by 50% within the first hour of treatment.

Reduce the blood pressure by 20% to 25% within the first hour of treatment.

Which finding indicates that hypertension is progressing to target organ damage? A) Retinal blood vessel damage B) Urine output of 60 mL over 2 hours C) Blood urea nitrogen concentration of 12 mg/dL D) Chest x-ray showing pneumonia

Retinal blood vessel damage

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? A) Primary B) Essential C) Secondary D) Malignant

Secondary

The nurse is instructing a client who is newly prescribed an antihypertensive medication. Which nursing instruction is emphasized to maintain client safety? A) Use a pillbox to store daily medication. B) Sit on the edge of the chair and rise slowly. C) Do not operate a motor vehicle. D) Take the medication at the same time daily.

Sit on the edge of the chair and rise slowly.

The nurse is caring for a client who is prescribed medication for the treatment of hypertension. The nurse recognizes that which medication conserves potassium? A) Furosemide B) Spironolactone C) Chlorothiazide D) Chlorthalidone

Spironolactone

Which diuretic medication conserves potassium? A) Furosemide B) Spironolactone C) Chlorothiazide D) Chlorthalidone

Spironolactone

The nurse observes a certified nursing assistant (CNA) obtaining a blood pressure reading with a cuff that is too small for the patient. The nurse informs the CNA that using a cuff that is too small can affect the reading results in what way? A) The results will be falsely decreased. B) The results will be falsely elevated. C) It will give an accurate reading. D) It will be significantly different with each reading.

The results will be falsely elevated.

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. Using a BP cuff that is too large will give a higher BP measurement. The client's BP should be measured 1 hour before consuming alcohol. The client should sit quietly while BP is being measured.

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 A) check the client's heart rate. B) check the client's serum K+ level. C) check the client's urine output. D) weigh the client.

check the client's heart rate.

Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress A) increases the production of neurotransmitters that constrict peripheral arterioles. B) increases the resistance that the heart must overcome to eject blood. C) increases blood volume and improves the potential for greater cardiac output. D) decreases the production of neurotransmitters that constrict peripheral arterioles.

decreases the production of neurotransmitters that constrict peripheral arterioles.

When measuring blood pressure in each arm of a healthy adult, the nurse recognizes that the pressures A) must be equal in both arms. B) may vary 10 mm Hg or more between arms. C) differ no more than 5 mm Hg between arms. D) may vary, with the higher pressure found in the left arm.

differ no more than 5 mm Hg between arms.

A client who is newly diagnosed with hypertension is going to be starting antihypertensive medicine. What is one of the main things the client and the client's spouse should watch for? A) dizziness B) persistent cough C) blurred vision D) tremor

dizziness

The nurse is teaching a client about hypertension and the effects on the left ventricle. What diagnostic test will the nurse describe? A) echocardiography B) computed tomographic (CT) scan C) fluorescein angiography D) positron emission tomography (PET) scan

echocardiography

A blood pressure (BP) of 140/90 mm Hg is considered to be A) normal. B) prehypertension. C) hypertension. D) a hypertensive emergency.

hypertension

What risk factors would cause the nurse to become concerned that the client may have atherosclerotic heart disease? Select all that apply. hypertension diabetes obesity lowered triglyceride levels active lifestyle family history of early cardiovascular events

hypertension diabetes obesity family history of early cardiovascular events

It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine A) increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. B) decreases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. C) increases the heart rate, constricts arterioles, and increases the heart's ability to eject blood. D) decreases circulating blood volume.

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

Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through: A) ophthalmic examination. B) using a sphygmomanometer. C) laboratory tests. D) an MRI.

ophthalmic examination.

It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position A) help reduce the blood pressure to resupply oxygen to the brain. B) help reduce the work required by the heart to resupply oxygen to the brain. C) provide time for the heart to increase the rate of contraction to resupply oxygen to the brain. D) provide time for the heart to reduce the rate of contraction to resupply oxygen to the brain.

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

The nurse is teaching a client about chronic untreated hypertension. What complication will the nurse explain to the client? A) peripheral edema B) right-sided heart failure C) stroke D) pulmonary insufficiency

stroke

A diabetic client visits a walk-in clinic and asks the nurse to take a blood pressure (BP) reading. The measurements are 150/90 mm Hg. Which of the following would the nurse expect as the treatment to normalize the client's BP? A) Smoking cessation programs B) Low-fat diet C) Daily exercise D) Drug therapy

Drug therapy

A patient is flying overseas for 1 week for business and packed antihypertensive medications in a suitcase. After arriving at the intended destination, the patient found that the luggage had been stolen. If the patient cannot take the medication, what condition becomes a concern? A) Isolated systolic hypertension B) Rebound hypertension C) Angina D) Left ventricular hypertrophy

Rebound hypertension

The nurse is employed in a physician's office and is caring for a client present for an annual exam. A blood pressure of 124/84 mm Hg is documented. Following revised guidelines for identifying hypertension, which educational pamphlet is help? A) Increasing fluids for low blood pressure B) Stress reduction to lower prehypertensive state C) Use of beta-blockers for treatment of hypertension D) Diagnostic testing for determining cardiac functioning

Stress reduction to lower prehypertensive state

A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. What are risk factors for cardiovascular problems in clients with hypertension? Select all that apply. Gallbladder disease Smoking Diabetes mellitus Physical inactivity Frequent upper respiratory infections

Smoking Diabetes mellitus Physical inactivity

The nurse is volunteering at a community blood pressure screening. A client, never diagnosed with hypertension, presents with a blood pressure of 158/90 mm Hg. Which assessment questions, asked by the nurse, are appropriate? Select all that apply. "Have you recently drunk a caffeinated beverage?" "Did you have a beer after work?" "Do you smoke?" "Do you have a friend accompanying you?" "Are you married and with children?"

"Have you recently drunk a caffeinated beverage?" "Do you smoke?"