Hinkle Chapter 31: Assessment and Management of Patients With Hypertension

A client comes to the emergency department complaining of visual changes and severe headache and denies past medical history. The nurse measures the client's blood pressure at 210/120 mm Hg. What question will the nurse ask to explore the hypertension situation?

"Do you have hypertension in your family?" Asking the client about family history is a pertinent question to help relate the hypertension. Untreated hypertension is the most common cause of malignant hypertension (hypertensive emergency). Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as those that occur with monoamine oxidase inhibitors and aged cheeses).

Hypertension is diagnosed when the client demonstrates a systolic blood pressure greater than ______ mm Hg or a diastolic blood pressure greater than _____ mm Hg over a sustained period.

130, 80 The latest guidelines (November 2017) released by the American College of Cardiology and the American Heart Association are: Normal blood pressure: Systolic less than 120 mm Hg and diastolic less than 80 mm Hg. Elevated blood pressure: Systolic between 120 and 129 mm Hg and diastolic less than 80 mm Hg. Stage 1 hypertension: Systolic between 130 and 139 mm Hg or diastolic between 80 and 89 mm Hg. Stage 2 hypertension: Systolic of 140 or greater mm Hg or diastolic of 90 or greater mm Hg.

Approximately what percentage of adults in the United States have hypertension?

30 About 32.6% of the adults in the United States have hypertension.

During a routine physical examination, the nurse assesses a blood pressure reading of 150/90 mm Hg. The patient's blood work indicates several abnormal results. The health care provider informs the nurse that he suspects that the patient has metabolic syndrome. The nurse knows that this diagnosis is associated with three classic signs/symptoms. Select all that apply.

A blood pressure reading greater than 130/85 mm Hg Dyslipidemia and/or abdominal obesity Insulin resistance Pathologic changes in the kidneys, indicated by increased blood urea nitrogen and serum creatinine levels, are not part of the metabolic syndrome that is a risk factor for hypertension. However, with advanced cardiovascular disease, these signs may occur.

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 During the physical examination, the nurse must also pay specific attention to the rate, rhythm, and character of the apical and peripheral pulses to detect the effects of hypertension on the heart and blood vessels.

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. Increasing the force of cardiac output would only increase peripheral resistance, thus increasing blood pressure. The other actions would all help regulate hypertension.

Primary or essential hypertension accounts for about 95% of all hypertension diagnoses with an unknown etiology. Secondary hypertension accompanies specific conditions that create hypertension as a result of tissue damage. Which condition contributes to secondary hypertension?

arterial vasoconstriction Secondary hypertension may accompany any primary condition that affects fluid volume or renal function, or causes arterial vasoconstriction.

You are teaching a health class at the local YMCA. What body system would you explain regulates arterial blood pressure?

autonomic nervous system The autonomic nervous system, the kidneys, and various endocrine glands regulate arterial pressure. The cardiovascular system, immune system, and lymphatic systems do not regulate arterial blood pressure.

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 Major risk factors (in addition to hypertension) include smoking, dyslipidemia (high LDL, low high-density lipoprotein cholesterol), diabetes mellitus, impaired renal function, obesity, physical inactivity, age (younger than 45 years for men, 65 years and older for women), and family history of cardiovascular disease.

A client in a clinic setting has just been diagnosed with hypertension. When the client asks what the end goal is for treatment, what is the nurse's best response?

To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less The end goal of hypertension treatment is to prevent complications and death by achieving and maintaining arterial blood pressure at 140/90 or lower for most people. To achieve this end goal, the client is taught to make the following lifestyle changes (these are not end goals; they are ways to reach the end goal listed above): (1) maintaining a normal body mass index (about 24; greater than 25 is considered overweight); maintaining a waist circumference of less than 40 inches for men and 35 inches for women; limiting alcohol intake to no more than 2 drinks for men and 1 drink for women per day; engaging in aerobic activity at least 30 minutes per day most days of the week.

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. These statements are all true when measuring a BP. When using a BP cuff that is too large, the reading will be lower than the actual BP. The client should avoid smoking cigarettes or drinking caffeine for 30 minutes before BP is measured.

Which condition contributes to secondary hypertension?

arterial vasoconstriction Secondary hypertension may accompany any primary condition that affects fluid volume or renal function or causes arterial vasoconstriction. Calcium deficiency or acid-based imbalance does not contribute to hypertension.

The nurse is completing a cardiac assessment on a client. The patient has a blood pressure (BP) reading of 126/78. What would the nurse would identify this blood pressure reading as?

elevated The latest guidelines (November 2017) released by the American College of Cardiology and the American Heart Association are: Normal blood pressure: Systolic less than 120 mm Hg and diastolic less than 80 mm Hg. Elevated blood pressure: Systolic between 120 and 129 mm Hg and diastolic less than 80 mm Hg. Stage 1 hypertension: Systolic between 130 and 139 mm Hg or diastolic between 80 and 89 mm Hg. Stage 2 hypertension: Systolic of 140 or greater mm Hg or diastolic of 90 or greater mm Hg.

An older African American client is found to have a blood pressure of 150/90 mm Hg during a work-site health screening. What should the nurse do?

recommend the client have blood pressure rechecked within 2 weeks The nurse should recommend the client have blood pressure rechecked within 2 weeks because a blood pressure of 150/90 mm Hg isn't considered normal. One year is too long to wait. The client need not see a health care provider yet.

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?

"Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg." An individual with diabetes mellitus should strive for blood pressure of 130/80 mm Hg or less. An individual without diabetes should strive for blood pressure of 140/90 mm Hg or less.

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?" "Do you smoke?" At a community blood pressure clinic, the nurse would assess for common factors for a blood pressure to be elevated. *Factors that can affect blood pressures readings include smoking or drinking coffee within 30 minutes of the reading*. One beer after work should not affect the blood pressure reading, and some individuals may find it relaxing. Social situations are difficult to assess in a community blood pressure clinic. The client would be referred to having another blood pressure reading and, if elevated, referred to a physician.

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" Thiazide diuretics cause loss of sodium, potassium, and magnesium. The client should be encouraged to eat fruits and vegetables that are high in potassium. Diuretics cause increased urination; the client should not take the medication before going to bed. Thiazide diuretics to not cause dry mouth or nasal congestion. Postural hypotension (side effect) may be potentiated by alcohol.

A client 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 program usually consists of restricting sodium and fat intake, increasing intake of fruits and vegetables, and implementing regular physical activity. Explaining that it takes 2 to 3 months for the taste buds to adapt to changes in salt intake may help the client adjust to reduced salt intake.

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?" It is important for the nurse to first ascertain why the client is not taking prescribed medications. Adherence to the therapeutic program may be more difficult for older adults. The medication regimen can be difficult to remember, and the expense can be a challenge. Monotherapy (treatment with a single agent), if appropriate, may simplify the medication regimen and make it less expensive. The other questions are appropriate, but the priority is to determine why the medication regimen is not being followed.

The nurse is teaching a client about recommended follow-up for a person initially diagnosed with prehypertension. What time frame will the nurse advise the client to have the blood pressure (BP) rechecked?

1 year A client with an initial BP in the prehypertension range should have another BP check in 1 year. A normal BP should be rechecked in 2 years. Grade 1 hypertension should be confirmed and followed up within 2 months. Grade 2 hypertension should be evaluated or referred to a source of care within 1 month.

The nurse is monitoring a client with hypertension and chronic kidney disease. What is the target blood pressure for the client?

140/90 mmHg For clients with diabetes or chronic kidney disease, the Joint National Committee 8 specifies a target pressure of less than 140/90 mm Hg.

A nurse educator is providing information to a small group of clients about hypertension. A participant asks what her target blood pressure should be. The nurse is aware of the target goals of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). Which of the following reflects the goal for blood pressure readings for people without co-morbidities?

140/90 or lower The goal of hypertension treatment is to prevent complications and death by achieving and maintaining the arterial blood pressure at 140/90 or lower. The JNC7 specifies a lower goal pressure of 130/80 for people with diabetes mellitus or chronic kidney disease.

The nurse is teaching a client diagnosed with hypertension about the DASH diet. How many servings of meat, fish, and poultry should the client consume per day?

2 or fewer Two or fewer servings of lean meat, fish, and poultry are recommended in the DASH diet. The diet also recommends two or three servings of low-fat or fat-free dairy foods, four or five servings of fruits and vegetables, and seven or eight servings of grains and grain products.

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 a day 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.

A nurse is providing education to a client about monitoring blood pressure readings at home. What reminders will the nurse review with the client? Select all that apply.

Avoid talking during the measurement. Sit with both feet on the ground during the measurement. Ensure at least 5 minutes of quiet rest before measurements. Be sure the forearm is well supported at heart level while taking blood pressure Instructions for the client regarding measuring the blood pressure at home include the following: (1) Avoid smoking cigarettes or drinking caffeine for 30 minutes before measuring blood pressure; (2) sit quietly for 5 minutes before the measurement (no talking); and (3) have the forearm supported at heart level, with both feet on the ground during the measurement of the blood pressure.

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 Thiazide diuretics may deplete potassium; many clients will need potassium supplementation. Direct vasodilators may cause headache and increased heart rate. Adrenergic inhibitors can cause sedation and fatigue. Beta-blockers may induce decreased heart rate; pulse rate should be assessed before administration. Angiotensin-converting enzyme inhibitors can induce a mild to severe dry cough.

A client 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. What treatment plan will the nurse educate the client about?

Gradual reducing the HCTZ and the atenolol and continuing to reduce sodium intake When the blood pressure is less than 140/90 mm Hg for at least 1 year, gradual reduction of the types and doses of medication is indicated. Continuing to reduce sodium intake is a healthy lifestyle measure than anyone with hypertension should make.

The physician is ordering a test for the hypertensive client that will be able to evaluate whether the client has experienced heart damage. Which diagnostic test would the nurse anticipate to determine heart damage?

Multiple gated acquisition scan (MUGA) The nurse realizes that undiagnosed (untreated), long-standing hypertension can cause heart damage. The diagnostic test that best determines heart damage is the multiple gate acquisition scan (MUGA). This test is used to detect how efficiently the heart pumps. A blood chemistry determines electrolyte balance. A chest radiograph (chest x-ray) can provide details of the heart size through shading on the scan. Fluorescein angiography is an ophthalmologic test revealing leaking retinal blood vessels.

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) Noncompliance is the most serious problem in managing a client with hypertension. One authority estimates that 40% to 60% of hypertensive clients fail to comply with ordered treatment. Reasons for noncompliance include lack of symptoms, which makes the problem seem less serious; the difficulty of making required lifestyle changes, such as eating a low-sodium diet, stopping smoking, and losing or managing weight; adverse reactions to antihypertensive drugs; and the inconvenience and high cost of obtaining health care. Deficient knowledge contributes to noncompliance; Excess fluid volume, caused by excess sodium intake, and Imbalanced nutrition: More than body requirements may result from noncompliance.

The nurse is working on a busy cardiac unit caring for four hypertensive clients. Which client description would the nurse assess first because the client is at an increased risk for malignant hypertension?

a client with anorexia and a history of no medical insurance Accelerated and malignant hypertension can occur in individuals who fail to maintain follow-up or comply with medical therapy. Those individuals who have no healthcare insurance often are unable to obtain the medical follow-up or afford the cost of medications to treat the hypertensive state. If the hypertension is untreated, symptoms and complication can rapidly follow. The other choices need further assessment but are not the priority.

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

clonidine Clonidine (Catapres) is contraindicated for clients with severe coronary artery disease.

A patient with hypertension is waking up several times a night to urinate. The nurse knows that what laboratory studies may indicate pathologic changes in the kidneys due to the hypertension? (Select all that apply.)

creatinine blood urea nitrogen (BUN) A patient with hypertension is waking up several times a night to urinate. The nurse knows that what laboratory studies may indicate pathologic changes in the kidneys due to the hypertension? (Select all that apply.)

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?

drug therapy The nurse would expect drug therapy to be recommended for the client. Smoking cessation, a low-fat diet, and daily exercise may be useful in the prehypertension stage. A client with diabetes should have BP levels below 139/80 mm Hg to avoid drug therapy.

A client with newly diagnosed hypertension asks how to decrease the risk for related cardiovascular problems. What risk factor is modifiable by the client?

dyslipidemia Age, family history, and impaired renal function are risk factors for cardiovascular disease related to hypertension that the client cannot change. Obesity, inactivity, and dyslipidemia are risk factors that the client can improve through diet, exercise, and other healthy lifestyle changes.

The nurse is caring for a client with accelerated hypertension. Which body system would the nurse assess to identify early signs of blood pressure progression?

eyes Accelerated hypertension is defined as a markedly elevated blood pressure with symptoms of hemorrhages and exudates in the eyes. If the hypertension is untreated, accelerated hypertension progresses to malignant hypertension with symptoms of papilledema. Long-standing hypertension can produce changes in the kidney, heart, and musculoskeletal system.

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?

heart and blood vessels Blood pressure is the force produced by the volume of the blood in arterial walls. It is represented by the formula: BP= CO (cardiac output)× PR (peripheral resistance). To highlight the mechanism of cardiac output, a heart would be on the visual aid and blood vessels.

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 family history of early cardiovascular events Risk factors for atherosclerotic heart disease, include hypertension, dyslipidemia (including high total, low-density lipoprotein [LDL], and triglyceride levels as well as low high-density lipoprotein [HDL] levels), obesity, diabetes, a family history of early cardiovascular events, metabolic syndrome, a sedentary lifestyle, and obstructive sleep apnea.

A patient arrives at the clinic for a follow-up visit for treatment of hypertension. The nurse obtains a blood pressure reading of 180/110 but finds no evidence of impending or progressive organ damage when performing the assessment on the patient. What situation does the nurse understand this patient is experiencing?

hypertensive urgency Hypertensive urgency describes a situation in which blood pressure is very elevated but there is no evidence of impending or progressive target organ damage (Chobanian et al., 2003). Elevated blood pressures associated with severe headaches, nosebleeds, or anxiety are classified as urgencies. In these situations, oral agents can be administered with the goal of normalizing blood pressure within 24 to 48 hours (Rodriguez et al., 2010).

Which of the following nursing diagnosis is the nurse most correct to choose when caring for a client with long-standing hypertension?

ineffective tissue perfusion The nurse is most correct in choosing Ineffective Tissue Perfusion for the client with long-standing hypertension. In hypertension, the extra work increases the size of the heart muscle. Eventually, the heart cannot meet the body's metabolic needs limiting the perfusion to the tissues. Impaired Gas Exchange, Activity Intolerance, and a Risk for Decreased Cardiac Output may occur due to the ineffective perfusion.

The nurse assesses a client's blood pressure reading of 150/90 mm Hg along with several abnormal laboratory results. What data supports the medical diagnosis of metabolic syndrome? Select all that apply.

insulin resistance abdominal obesity dyslipidemia blood pressure reading greater than 140/90 mm Hg

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

intercranial hemorrhage Elevated blood pressure in hypertensive urgency is associated with severe headache, epistaxis, and anxiety. An example of a hypertensive emergency is a myocardial infarction, intracranial hemorrhage, or dissecting aortic aneurysm.

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 As a result of changes that occur with aging, the aorta and large arteries are less able to accommodate the volume of blood pumped out by the heart (stroke volume), and the energy that would have stretched the vessels instead elevates the systolic blood pressure, resulting in an elevated systolic pressure without a change in diastolic pressure. This condition, known as isolated systolic hypertension, is more common in older adults and is associated with significant cardiovascular and cerebrovascular morbidity and mortality (Chobanian et al., 2003).

The nurse is discussing aging and the incidence of hypertension with an older adult. What lifestyle change will lower blood pressure for the older adult?

keep weight stable Obesity can contribute to hypertension, so keeping weight stable is healthy. Salt can add to hypertension. The American Heart Association recommends exercising more than once a week for the older adult. Sleeping for four hours is not enough for rest.

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.

A 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.

lose weight manage stress effectively Obesity, inactivity, smoking, excessive alcohol intake, and ineffective stress management are risk factors for hypertension.

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 costs The objective of nursing care for patients with hypertension focuses on lowering and controlling the blood pressure without adverse effects and without undue cost.

The nurse teaches the client which guideline regarding lifestyle modification for hypertension?

maintain adequate dietary intake of potassium In general, one serving of a potassium-rich food such as banana, kale, broccoli, or orange juice will meet the daily need for potassium. The client should be guided to stop smoking. The general guideline is to advise the client to increase aerobic activity to 30 to 45 minutes most days of the week. In general, alcohol intake should be limited to no more than 1 oz ethanol/day.

A nurse is assessing a client and notes a blood pressure (BP) of 205/115. The client has had BP's within normal limits up until this time. The client reports a sudden onset severe headache. The nurse recognizes this as probable malignant hypertension. What would be the nurse's first action?

notify the healthcare provider Malignant hypertension is fatal unless BP is quickly reduced. Even with intensive treatment, the kidneys, brain, and heart may be permanently damaged.

The nurse is caring for a client with long-standing hypertension. As a client advocate, which instruction is most helpful in preventing further complications?

obtain a regular appointment with eye doctor When a client has long-standing hypertension, the high blood pressure damages the arterial vascular system. As a client advocate, the nurse must instruct on not only prevention but also on early identification of complications. Damages may occur to the tiny arteries in the eyes compromising vision. The most helpful instruction is to maintain a regular appointment with an eye doctor. The other options are good instruction for a healthy lifestyle.

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

pheochromocytoma Predisposing conditions include kidney disease, pheochromocytoma (a tumor of the adrenal medulla), hyperaldosteronism (increased secretion of mineralocorticoid by the adrenal cortex), atherosclerosis, use of cocaine or other cardiac stimulants (e.g., weight-control drugs, caffeine), and use of oral contraceptives. Wilms tumors, astrocytomas and lymphomas are not predisposing conditions for secondary hypertension. A nurse educator is providing information to a small group of clients about hypertension. A participant asks what her target blood pressure should be. The nurse is aware of the target goals of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). Which of the following reflects the goal for blood pressure readings for people without co-morbidities?

What lifestyle factors will the nurse discuss with the client who has a blood pressure of 130/88? Select all that apply.

physical activity dietary sodium weight reduction the DASH diet alcohol moderation The client's blood pressure classifies the client as having stage 1 hypertension. Lifestyle modifications to prevent and manage hypertension include weight reduction, adoption of the DASH diet, reduction of dietary sodium, physical activity, and moderation of alcohol consumption.

The nurse is instructing a student on the proper technique for measuring blood pressure (BP). Which student action indicates a need for further teaching?

positions the arm at waist level Positioning the arm above the heart level will give a falsely low reading. Placing the arm below the heart will falsely elevate the reading. All other options are correct steps in achieving an accurate blood pressure.

A client is taking amiloride and lisinopril for the treatment of hypertension. What laboratory studies should the nurse monitor while the client is taking these two medications together?

potassium level Amiloride (Midamor) is a potassium-sparing diuretic, meaning that it causes potassium retention. The nurse should monitor for hyperkalemia (elevated potassium level) if given with an ACE inhibitor, such as lisinopril (Zestril) or angiotensin receptor blocker.

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 nurse is teaching a client with newly diagnosed hypertension who asks if there is any harm in stopping antihypertensive medication. What is the nurse's best response?

rebound hypertension can occur Clients need to be informed that rebound hypertension can occur if they stop antihypertensive medications suddenly. This can be extremely dangerous and have serious consequences. Hypotension would not be a problem with discontinuation of antihypertensive medications.

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 client with an initial blood pressure (BP) in the prehypertension range should have his or her BP rechecked in 1 year. A normal BP should be rechecked in 2 years. Stage 1 hypertension should be confirmed and followed up within 2 months. Stage 2 hypertension should be evaluated or referred to a source of care within 1 month.

Which of the following is the nurse most correct to recognize as a direct effect of client hypertension?

renal dysfunction resulting from atherosclerosis The nurse is most correct to realize high blood pressure damages the arterial vascular system and accelerates atherosclerosis. The effect of the atherosclerosis impairs circulation to the kidney, resulting in renal failure. Neither anemia, hyperglycemia, nor emphysema occurs as a direct effect of hypertension.

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 Prolonged elevated blood pressure eventually damages blood vessels throughout the body, particularly in target organs such as the heart, kidneys, brain, and eyes. The usual consequences of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, renal failure, strokes, and impaired vision.

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 Bumetanide is a loop diuretic that can cause fluid and electrolyte imbalances. Clients taking these medications may experience a low serum potassium concentration. ECG changes associated with an elevated serum potassium concentration include peaked T waves. Diuresis is a desired effect postadministration of bumetanide. The serum glucose concentration is elevated and requires intervention; however, this elevation is not associated with the administration of bumetanide.

The nurse is caring for a patient with systolic blood pressure of 135 mm Hg. This finding would be classified as

stage 1 hypertension The latest guidelines (November 2017) released by the American College of Cardiology and the American Heart Association indicate that a systolic blood pressure of 135 mm Hg is classified as stage 1 hypertension. The guidelines are: Normal blood pressure: Systolic less than 120 mm Hg and diastolic less than 80 mm Hg. Elevated blood pressure: Systolic between 120 and 129 mm Hg and diastolic less than 80 mm Hg. Stage 1 hypertension: Systolic between 130 and 139 mm Hg or diastolic between 80 and 89 mm Hg. Stage 2 hypertension: Systolic of 140 or greater mm Hg or diastolic of 90 or greater mm Hg.

A diastolic blood pressure of 92 mm Hg is classified as

stage 2 hypertension The latest guidelines (November 2017) released by the American College of Cardiology and the American Heart Association are: Normal blood pressure: Systolic less than 120 mm Hg and diastolic less than 80 mm Hg. Elevated blood pressure: Systolic between 120 and 129 mm Hg and diastolic less than 80 mm Hg. Stage 1 hypertension: Systolic between 130 and 139 mm Hg or diastolic between 80 and 89 mm Hg. Stage 2 hypertension: Systolic of 140 or greater mm Hg or diastolic of 90 or greater mm Hg.

A client is beginning medical management of recently diagnosed hypertension. The most important strategy in this client's treatment is reducing:

systolic pressure below 150 mmHg Currently, it is believed that in persons younger than 60 years of age, reducing the systolic pressure below 140 mmHg is more important than decreasing the diastolic blood pressure. In persons older than 60 years, the goal is below 150 mmHg.

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 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 nurse understands that an overall goal of hypertension management is that

there is not indications of target organ damage Prolonged blood pressure elevation gradually damages blood vessels throughout the body, particularly in target organs such as the heart, kidneys, brain, and eyes. The overall goal of management is that the client does not experience target organ damage. The desired effects of antihypertensives are to maintain a normal blood pressure. Postural hypotension and sexual dysfunction are side effects of certain antihypertension medications.