Hypertension

A nurse is interested in providing community education and screening on hypertension. In order to reach a priority population, to what target audience would the nurse provide this service? A. African-American churches B. Women's health clinics C. High school sports camps D. Asian-American groceries

A. African-American churches African-Americans in the US have one of the highest rates of hypertension in the world.

Which action should the nurse take when giving the initial dose of oral labetalol to a patient with hypertension? A. Ask the patient to request assistance before getting out of bed. B. Encourage the use of hard candy to prevent dry mouth. C. Teach the patient that headaches often occur with this drug. D. Instruct the patient to call for help if heart palpitations occur.

A. Ask the patient to request assistance before getting out of bed. Labetalol decreases SNS activity by blocking both alpha and beta adrenergic receptors, leading to vasodilation and a decrease in HR, which can cause severe orthostatic hypotension.

The nurse obtains the following information from a patient newly diagnosed with prehypertension. Which finding is most important to address with the patient? A. No regular physical exercise B. Low dietary fiber intake C. Drinks a beer with dinner every night D. Weight is 5 pounds above ideal weight.

A. No regular physical exercise. The recommendations for preventing hypertension include exercise aerobically for 30 mins most days of the week.

The registered nurse (RN) is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside. Which nursing action can the nurse delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? A. Set up the automatic noninvasive BP machine to take readings every 15 minutes. B. Titrate nitroprusside to decrease mean arterial pressure (MAP) to 115 mmHg. C. Assess the patient's environment for adverse stimuli that might increase BP. D. Evaluate effectiveness of nitroprusside therapy on blood pressure (BP).

A. Set up the automatic noninvasive BP machine to take readings every 15 minutes. LPN/LVN education and scope of practice include the correct use of common equipment such as automatic noninvasive blood pressure machines.

During change-of-shift report, the nurse obtains the following information about a hypertensive patient who received the first dose of nadolol (Corgard) during the previous shift. Which information indicates that the patient needs immediate intervention? A. The patient has developed wheezes throughout the lung fields. B. The patient complains that the fingers and toes feel quite cold. C. The patient's blood pressure (BP) reading is now 158/91 mmHg. D. The patient's pulse has dropped from 68 to 57 beats/min.

A. The patient has developed wheezes throughout the lung fields. The most urgent for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the nonselective beta blockers) is occuring. The nurse should immediately obtain an O2 sat. measurement, apply supplemental O2, and notify the health care provider.

Which action will be included in the plan of care when the nurse is caring for a patient who is receiving nicardipine (Cardene) to treat a hypertensive emergency? A. Use an automated noninvasive blood pressure machine to obtain frequent measurements. B. Keep the patient NPO to prevent aspiration caused by nausea and possible vomiting. C. Organize nursing activities so that the patient has undisturbed sleep for 8 hours at night. D. Assist the patient up in the chair for meals to avoid complications associated with immobility.

A. Use an automated noninvasive blood pressure machine to obtain frequent measurements. Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV antihypertensive medications. This can be most easily accomplished with an automated BP machine or arterial line. The patient will require frequent assessments, so allowing 8 hours of undisturbed sleep is not reasonable. When patients are receiving IV vasodilators, bed rest is maintained to prevent decreased cerebral perfusion and fainting. There is no indication that this patient is nauseated or at risk for aspiration, so an NPO status is unnecessary.

The nurse has just finished teaching a hypertensive patient about the newly prescribed drug, ramipril (Altace). Which patient statement indicates that more teaching is needed? A. "I will call the doctor if I notice that I have a frequent cough." B. "I can expect some swelling around my lips and face." C. "The medication may not work well if I take aspirin." D. "The doctor may order a blood potassium level occasionally."

B. "I can expect some swelling around my lips and face." Angioedema occuring with ACE inhibitor therapy is an indication that the ACE inhibitor should be d/c'ed. The patient should be taught that if any swelling of the face or oral mucosa occurs, the health care provider should be immediately notified because this could be life threatening.

The nurse on the intermediate care unit received change-of-shift report on four patients with hypertension. Which patient should the nurse assess first? A. 52-yr-old with blood pressure of 198/90 mmHg who has intermittent claudication. B. 48-yr-old with a blood pressure of 160/92 mmHg who reports chest pain C. 50-yr-old with a blood pressure of 190/104 mmHg who has a creatinine of 1.7 mg/dL D. 43-yr-old with a blood pressure of 172/98 mmHg whose urine shows microalbuminuria

B. 48-yr-old with a blood pressure of 160/92 mmHg who reports chest pain. The patient with chest pain may be experiencing acute MI and rapid assessment and intervention are needed.

A patient with a history of heart failure and hypertension is in the clinic for a follow-up visit. The patient is on lisinopril (Prinivil) and warfarin (Coumadin). The patient reports new-onset cough. What action by the nurse is most appropriate? A. Obtain a set of vital signs and document them. B. Assess the patient's lung sounds and oxygenation. C. Remind the patient that cough is a side effect of Prinivil. D. Instruct the patient on another antihypertensive.

B. Assess the patient's lung sounds and oxygenation. This patient could be having an exacerbation of heart failure or experiencing a side effect of lisiniopril. The nurse would assess the patient's lung sounds and other signs of oxygenation first. The patient may or may not need to switch antihypertensive medications.

A patient has hypertension and high-risk factors for cardiovascular disease. The patient is overwhelmed with the recommended lifestyle changes. What action by the nurse is best? A. Inquire about delegating some of the patient's obligations. B. Assist in finding one change the patient can control. C. Determine what stressors the patient faces in daily life. D. Assess the patient's support system.

B. Assist in finding one change the patient can control. All options are appropriate when assessing stress and responses to stress. However, this patient feels overwhelmed by the suggested lifestyle changes. Instead of looking at all the needed changes, the nurse would assist the patient in choosing one the patient feels optimistic about controlling.

Which nursing action should the nurse take first to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes? A. Teach the patient about foods that are high in potassium. B. Collect a detailed diet history. C. Provide a list of low-sodium foods. D. Help the patient make an appointment with a dietitian.

B. Collect a detailed diet history. The initial nursing action should be assessment of the patient's baseline dietary intake through a thorough diet history.

Which action will the nurse in the hypertension clinic take to obtain an accurate baseline blood pressure (BP) for a new patient? A. Obtain two BP readings in the dominant arm and average the results. B. Have the patient sit in a chair with the feet flat on the floor. C. Assist the patient to the supine position for BP measurements. D. Deflate the BP cuff at a rate of 5 to 10 mmHg per second.

B. Have the patient sit in a chair with the feet flat on the floor. The patient should be seated with the feet flat on the floor. The BP obtained in both arms, and the results of the two arms are not averaged. The patient does not need to be in the supine position. The cuff should be deflated at 2 to 3 mmHg per second.

A nurse wants to provide community service that helps meet the goals of Healthy People 2020 (HP2020) related to cardiovascular disease and stroke. What activity would best meet this goal? A. Teach high school students heart-healthy living. B. Participate in blood pressure screenings at the mall. C. Provide pamphlets on heart disease at the grocery store. D. Set up an "Ask the nurse" booth at the pet store.

B. Participate in blood pressure screenings at the mall. An important goal of HP2020 is to increase the proportion of adults who have had their blood pressure measured withing the preceding 2 years and can state whether their blood pressure was normal or high.

The nurse is caring for a 70-yr-old patient who uses hydrochlorothiazide and enalapril (Norvasc) but whose self-monitored blood pressure (BP) continues to be elevated. Which patient information may indicate a need for a change? A. Patient takes a daily multivitamin tablet. B. Patient uses ibuprofen (Motrin) to treat osteoarthritis. C. Patient drinks win three to four times a week. D. Patient checks BP daily just after getting up.

B. Patient uses ibuprofen (Motrin) to treat osteoarthritis. NSAIDs can prevent adequate BP control, the patient may need to avoid the use of ibuprofen.

The nurse is reviewing the laboratory test results for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider? A. Serum hemoglobin of 14.7 g/dL B. Serum creatinine of 2.8 mg/dL C. Serum potassium of 4.5 mEq/L D. Blood glucose level of 96 mg/dL

B. Serum creatinine of 2.8 mg/dL The elevated serum creatinine indicates renal damage caused by the hypertension. The other lab results are normal.

An older patient has been diagnosed with possible white coat hypertension. Which planned action by the nurse best addresses the suspected cause of the hypertension? A. Instruct the patient about the need to decrease stress levels. B. Teach the patient how to self-monitor and record BPs at home. C. Inform the patient and caregiver that major dietary changes will be needed. D. Schedule the patient for regular blood pressure (BP) checks in the clinic.

B. Teach the patient how to self-monitor and record BPs at home. "white coat" hypertension, patients have elevated BP readings in a clinical setting and normal readings when BP is measured elsewhere.

After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented, which diet choice indicates that the teaching has been most effective? A. The patient restricts intake of chicken and fish. B. The patient drinks low-fat milk with each meal. C. The patient avoids eating nuts or nut butters. D. The patient has two cups of coffee in the morning.

B. The patient drinks low-fat milk with each meal. For the prevention of HTN, DASH recommendations include increasing the intake of calcium-rich foods.

Propanolol (Inderal) is prescribed for a patient diagnosed with hypertension. The nurse should consult with the health care provider before giving this drug when the patient reveals a history of A. daily alcohol use. B. reactive airway disease. C. peptic ulcer disease. D. myocardial infarction (MI).

B. reactive airway disease. nonselective beta-blockers block beta1 and beta2 adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma.

A student nurse asks what "essential hypertension" is. What response by the registered nurse is best? A. "It means it is 'essential' that it be treated." B. "It refers to severe and life-threatening hypertension." C. "It is hypertension with no specific cause." D. "It means it is caused by another disease."

C. "It is hypertension with no specific cause." Essential hypertension is the most common type of hypertension and has no specific cause such as an underlying disease process. Secondary hypertension is hypertension that is due to another disease process.

A patient has been diagnosed with hypertension but does not take the antihypertensive medications because of a lack of symptoms. What response by the nurse is best? A. "You need to take your medicine or you will get kidney failure." B. "Do you have trouble affording your medications?" C. "Most people with hypertension do not have symptoms." D. "You are lucky; most people get severe morning headaches."

C. "Most people with hypertension do not have symptoms." Most people with hypertension are asymptomatic, although a small percentage do have symptoms such as headache. The nurse would explain this to the patient.

Which blood pressure (BP) finding by the nurse indicates that no changes in therapy are needed for a 48-yr-old patient with newly diagnosed hypertension? A. 142/78 mmHg B. 128/92 mmHg C. 128/76 mmHg D. 98/56 mmHg

C. 128/76 mmHg The 8th JNC's recommended goal for antihypertensive therapy for a 30- to 59-yr-old patient with HTN is a BP below 140/90 mmHg. The BP of 98/56 mmHg may indicate overtreatment of the hypertension and an increased risk for adverse drug effects. The other two blood pressures indicate a need for modifications in the patient's treatment.

The nurse is caring for four hypertensive patients. Which drug-laboratory value combination would the nurse report immediately to the healthcare provider? A. Sprinolactone (Aldactone)/potassium: 5.1 mEq/L B. Hydrochlorothiazide (Hydrodiuril)/potassium: 4.2 mEq/L C. Furosemide (Lasix)/potassium: 2.1 mEq/L D. Torsemide (Demadex)/ sodium: 142 mEq/L

C. Furosemide (Lasix)/ potassium: 2.1 mEq/L Lasix is a loop diuretic and can cause hypokalemia. Potassium level of 2.1 mEq/L is quite low and would be reported immediately. Sprinolactone is a potassium-sparing diuretic that can cause hyperkalemia.

Which information is most important for the nurse to include when teaching a patient with newly diagnosed hypertension? A. Annual BP checks are needed to monitor treatment effectiveness. B. Most people are able to control BP through dietary changes. C. Hypertension is usually asymptomatic until target organ damage occurs. D. Increasing physical activity alone controls blood pressure (BP) for most people.

C. Hypertension is usually asymptomatic until target organ damage occurs. Hypertension is usually asymptomatic until target organ damage has occurred Home BP monitoring should be taught to the patient and findings checked by the health care provider frequently when starting treatment for hypertension and then every 3 months when stable.

A nurse is caring for four patients. Which one would the nurse see first? A. Patient who needs pain medication prior to a dressing change of a surgical wound. B. Hypertensive patient with a blood pressure of 188/92 mmHg C. Patient who has a first dose of captopril (Capoten) and needs to use the bathroom D. Patient who needs a beta-blocker, and has a blood pressure of 92/58 mmHg.

C. Patient who had a first dose of captopril (Capoten) and needs to use the bathroom. ACE inhibitors such as captopril can cause hypotension, especially after the first dose. The nurse would see this patient first to prevent falling if the patient decides to get up without assistance.

Which assessment finding for a patient who is receiving IV furosemide (Lasix) to treat stage 2 hypertension is MOST important to report the health care provider? A. Blood glucose level of 175 mg/dL B. Most recent blood pressure (BP) reading of 168/94 mmHg C. Serum potassium level of 3.0 mEq/L D. Orthostatic systolic BP decrease of 12 mmHg

C. Serum potassium level of 3.9 mEq/L Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening dysrhythmias. The health care provider should be notified of the K level immediately and administration of K supplements initiated. The elevated blood glucose and BP also indicated a need for collaborative interventions but will not require action as urgently as the hypokalemia. An orthorstatic drop of 12 mmHg will require intervention only if the patient is symptomatic.

The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a hypertensive emergency. Which finding is most important to report to the health care provider? A. The patient complains of a headache with a pain at level 7 of 10 (0 to 10 scale) B. Urine output over 8 hours is 250 mL less than the fluid intake. C. The patient cannot move the left arm and leg when asked to do so. D. Tremors are noted in the fingers when the patient extends the arms.

C. The patient cannot move the left arm and leg when asked to do so. The patient's inability to move the left arm and leg indicates that a stroke may be occurring and will require immediate action to prevent further neurological damage.

A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and nausea and has a blood pressure (BP) of 238/118 mmHg. Which question should the nurse ask to follow up on these findings? A. "Did you take any acetaminophen (Tylenol) today?" B. "Have you recently taken any anti histamines?" C. "Have there been recent stressful events in your life?" D. "Have you consistently taken your medications?"

D. "Have you consistently taken your medications?" Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines, and acetaminophen do not increase BP. Stressful events will increase BP but not usually to the level seen in this patient.

A nurse is teaching a larger female patient about alcohol intake and how it affects hypertension. The patient asks if drinking two beers a night is an acceptable intake. What answer by the nurse is best? A. "No, you should not drink any alcohol with hypertension." B. "Yes, since you are larger, you can have more alcohol." C. "Yes, two beers per day is an acceptable amount of alcohol." D. "No, women should only have one beer as a general rule."

D. "No, women should only have on beer as a general rule." Alcohol intake should be limited to two drinks a day for men and one drink a day for women. A "drink" is classified as one beer, 1.5oz. of hard liquor, or 5 oz. of wine.

A patient with hypertension who has just started taking atenolol (Tenormin) returns to the health clinic after 2 weeks for a follow-up visit. The blood pressure (BP) is unchanged from the previous visit. Which action should the nurse take first? A. Question the patient regarding any lifestyle changes made to help control BP. B. Inform the patient that multiple drugs are often needed to treat hypertension. C. Tell the patient why a change in drug dosage is needed. D. Ask the patient if the medication is being taken as prescribed.

D. Ask the patient if the medication is being taken as prescribed. Nonadherence with antihypertensive therapy is common, the nurse's initial action should be to determine whether the patient is taking the atenolol as prescribed.

A patient has been diagnosed with hypertension and has been started on captopril. Which information is MOST important to include when teaching the patient about this drug? A. Include high-potassium foods such as bananas in the diet. B. Check blood pressure (BP) in both arms before taking the drug. C. Increase fluid intake if dryness of the mouth is a problem. D. Change position slowly to help prevent dizziness and falls.

D. Change position slowly to help prevent dizziness and falls. The angiotensin-converting enzyme (ACE) inhibitors frequently cause orthostatic hypotension, and patients should be taught to change position slowly to allow the vascular system time to compensate for the position change. Increasing fluid intake may counteract the effect of the drug, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP should be taken in the nondominant arm by newly diagnosed patients in the morning, before taking the drug, and in the evening. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.

A 56-yr-old patient who has no previous history of hypertension or other health problems suddenly develops a blood pressure (BP) of 198/110 mmHg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that A. there is an immediate danger of a stroke, requiring hospitalization. B. a BP recheck should be scheduled in a few weeks. C. dietary sodium and fat content should be decreased. D. diagnosis, treatment, and ongoing monitoring will be needed.

D. diagnosis, treatment, and ongoing monitoring will be needed. A sudden increase in BP in a patient older than age 50 years with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem.

The charge nurse observes a new registered nurse (RN) doing discharge teaching for a patient with hypertension who has a new prescription for enalapril (Vasotec). The charge nurse will need to intervene if the new RN tells the patient to A. make an appointment with the dietitian for teaching. B. move slowly when moving from lying to sitting to standing. C. check the blood pressure (BP) at home at least once a day. D. increase the dietary intake of high-potassium foods.

D. increase the dietary intake of high-potassium foods. The ACE inhibitors cause retention of potassium by kidney, so hyperkalemia is a possible adverse effect.