Med Surg - Hypertension - ch 32

A patient with chronic hypertension is admitted to the emergency department with a sudden rise in blood pressure (BP). What is the priority question for the nurse to ask the patient? "Are you pregnant?" "Do you need to urinate?" "Do you have a headache or confusion?" "Are you taking antiseizure medications as prescribed

"Do you have a headache or confusion?" 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. p. 698-99

The nurse provides education to a patient about the Dietary Approaches to Stop Hypertension (DASH) diet. Which statement made by the patient indicates understanding of the teaching? "I should drink no more than three glasses of whole milk per day." "I should include four to five servings of fruits and vegetables daily." "I should eat three servings of red meat, such as pork or beef, daily." "I should consume whole grain products no more than once per week."

"I should include four to five servings of fruits and vegetables daily." The DASH diet encourages consumption of fruits and vegetables. Pork and beef are high in fat and therefore have to be restricted according to the DASH diet; poultry and fish have to be consumed instead of red meat. Fat-free or low-fat milk has to be used instead of whole milk according to the DASH recommendations. The DASH diet recommends a few servings of whole grain products daily.

A patient with hypertension asks the nurse, "What can I do to decrease my blood pressure?" How should the nurse respond? "Reduce sodium intake to less than 3000 mg per day." "Restrict alcohol consumption to no more than three drinks daily." "Perform moderate-intensity aerobic physical activity for at least 30 minutes daily." "Reduce weight by 10 pounds, which can decrease systolic blood pressure by 20 to 30 mm Hg."

"Perform moderate-intensity aerobic physical activity for at least 30 minutes daily." Moderate physical activity, such as walking for at least 30 minutes, is recommended at least five days per week to reduce BP. For those with hypertension, sodium should be restricted to less than or equal to 1500 mg per day. Weight reduction by 20 lbs leads to a reduction in SBP of 5 to 20 mm Hg. Alcohol consumption should be restricted to no more than one drink per day for women and no more than two drinks per day for men.

A patient undergoes routine blood pressure (BP) monitoring. What actions should the nurse take when obtaining the BP measurement? Select all that apply. 1. Support the patient's arm at heart level. 2. Deflate the cuff at a rate of 5-10 mm Hg/sec. 3. Average two or more readings, taken at intervals of at least 1 minute. 4. Ensure the patient has not exercised within 30 minutes before measurement. 5. Take the measurement immediately after placing the patient in the seated position.

1, 3, 4 The nurse should ensure that the patient has not exercised, smoked, or ingested caffeine within 30 minutes before measurement. The patient's arm should be supported at heart level. The nurse should average two or more readings (taken at intervals of at least 1 minute). The nurse should obtain additional readings if the first two readings differ by more than 5 mm Hg. The radial pulse is palpated for auscultatory measurement. The nurse should begin measurement only after the patient has rested patiently for 5 minutes after sitting. The cuff should be deflated at a rate of 2 to 3 mm Hg/sec.

The nurse is preparing discharge teaching for a patient with orthostatic hypotension. Which instructions would be included? Select all that apply. 1. Lie down or sit if dizziness occurs. 2. Avoid sleeping with the head elevated. 3. Do not stand still for prolonged periods. 4. Rise slowly from a supine to a sitting position. 5. Perform leg exercises to increase venous return.

1, 3, 4, 5 Orthostatic hypotension is a condition in which there is a decrease in blood pressure upon rising to a standing position from a lying down or sitting position. The patient should be instructed to rise slowly from the sitting and lying down positions and to move only when no dizziness occurs. The patient should sit or lie down if there is dizziness. This decreases the risk of falling. Standing still for prolonged periods may cause venous stasis and worsen hypotension. Doing leg exercises helps to increase venous return to the heart and lowers blood pressure. Sleeping with the elevated helps to keep the blood flow to the brain uniform and prevents orthostatic hypotension, so this should be included in the instructions. pp. 695, 697

A patient asks the nurse, "How can I use my smartphone to help control my hypertension?" The nurse should inform the patient that a smartphone can perform what functions that will help manage the patient's blood pressure? Select all that apply. 1. Appointment tracking 2. Maintaining a drug history 3. Generating a report to the patient's healthcare provider 4. Contacting emergency services if a blood pressure reading is critical 5. The patient can enter variables including time of day and arm or wrist used

1. Appointment tracking 2. Maintaining a drug history 3. Generating a report to the patient's healthcare provider 5. The patient can enter variables including time of day and arm or wrist used A smartphone can be used to help a patient with hypertension manage his or her care by tracking clinical appointments, generating reports, maintaining a drug history, and allowing the patient to enter variables. A smartphone does not correlate critical blood pressure readings to the need to contact emergency services. p. 697

The nurse provides education to a patient with hypertension about symptoms of uncontrolled hypertension. What should the nurse include in the education? Select all that apply. 1. Fatigue 2. Dizziness 3. Palpitations 4. Cluster headaches 5. Shortness of breath

1. Fatigue 2. Dizziness 3. Palpitations Uncontrolled hypertension may result in fatigue, dizziness, and palpitations. Cluster headaches and shortness of breath do not occur with uncontrolled hypertension. p. 695

A patient is diagnosed with acute ischemic stroke. The patient is receiving IV antihypertensive drugs. Which interventions should the nurse perform for this patient? Select all that apply. 1. Measure hourly urine output. 2. Perform frequent neurologic checks. 3. Ambulate the patient with a 1-person assist. 4. Assess blood pressure (BP) and heart rate (HR) every 30 minutes. 5. Titrate drug according to mean arterial pressure (MAP) or BP as prescribed.

1. Measure hourly urine output. 2. Perform frequent neurologic checks 5. Titrate drug according to mean arterial pressure (MAP) or BP as prescribed. Drugs should be titrated according to MAP or BP as prescribed. The nurse should measure hourly urine output to assess renal perfusion and should perform frequent neurologic checks. Antihypertensive IV drugs have a rapid onset of action; hence, BP and pulse should be assessed every two to three minutes using a noninvasive BP machine. The patient should be restricted to bed; severe cerebral ischemia or fainting may result if the patient tries to get up. p. 699

A patient with a history of pheochromocytoma presents to the emergency department with a blood pressure of 246/144 mm Hg. The health care provider prescribes sodium nitroprusside. What are appropriate nursing interventions when administering this medication? Select all that apply. 1. Place the patient on bed rest. 2. Monitor the urine output hourly. 3. Monitor the ECG for dysrhythmias. 4. Assess the blood pressure and heart rate every 15 minutes during the initial administration. 5. Titrate the infusion according to mean arterial pressure (MAP) or blood pressure (BP) as prescribed.

1. Place the patient on bed rest. 2. Monitor the urine output hourly. 3. Monitor the ECG for dysrhythmias. 5. Titrate the infusion according to mean arterial pressure (MAP) or blood pressure (BP) as prescribed. Measure urine output hourly to assess renal perfusion. Patients are placed on bed rest; getting up may cause severe cerebral ischemia and fainting. The drug is titrated according to MAP or BP as prescribed. The nurse should monitor the ECG for dysrhythmias and signs of ischemia or myocardial infarction MI. Lowering the BP too quickly or too much may decrease cerebral, coronary, or renal perfusion. This could precipitate a stroke, MI, or renal failure. Antihypertensive medications given through an IV have a rapid (within seconds to minutes) onset of action. The patient's BP and HR should be assessed every 2 to 3 minutes during the initial administration of these drugs. p. 699

A 22-year-old healthy patient with a family history of hypertension asks the nurse about how to reduce the risk of developing high blood pressure. What recommendations should the nurse give to the patient? Select all that apply. 1. Restrict sodium intake to less than or equal to 2300 mg/day. 2. Limit alcohol intake; one drink is defined as 24 oz of regular beer. 3. Eat fish, such as salmon and catfish, at least two times per week. 4. Perform moderate-intensity aerobic physical activity for 20 minutes a day, three days a week. 5. Jog at a pace that substantially increases the pulse; this is an example of moderate physical activity.

1. Restrict sodium intake to less than or equal to 2300 mg/day. 3. Eat fish, such as salmon and catfish, at least two times per week. Healthy adults should restrict sodium intake to less than or equal to 2300 mg/day. For healthy adults with no history of heart disease, the American Heart Association recommends eating fish at least two times per week; fatty fish such as catfish and salmon are recommended. Jogging at a pace that substantially increases the pulse is considered to be vigorous activity. One drink is defined as 12 oz of regular beer. Moderate-intensity aerobic physical activity should be performed for 30 minutes a day, at least five days a week. pp. 688-689

The nurse is teaching a patient about common side effects of antihypertensive medications. Which information should the nurse include? Select all that apply. 1. Sexual problems 2. Resistant hypertension 3. Orthostatic hypotension 4. Rebound hypotension if the drug is stopped abruptly 5. Frequent voiding and dry mouth if the antihypertensive is a diuretic

1. Sexual problems 3. Orthostatic hypotension 5. Frequent voiding and dry mouth if antihypertensive is diuretic Reduced libido or erectile dysfunction are examples of sexual problems as a side effect of antihypertensive medications. Alteration of the autonomic nervous system mechanism by antihypertensive medications leads to orthostatic hypotension. Diuretics are one class of medications for treatment of hypertension that cause frequent urination and dry mouth. "Resistant hypertension" is a term used to describe failure to reach desired blood pressure (BP) in the patient who takes multiple antihypertensive medications. Rebound hypertension results from abrupt stopping of antihypertensive medication use.p. 693

The nurse is preparing a presentation related to complications of hypertension. Which information should 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. Stroke as a result of atherosclerosis 3. Blurring of vision or loss of vision secondary to retinal damage 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 increased cardiac workload that causes left ventricular hypertrophy. Coronary artery disease is caused by decreased elasticity of arterial walls and narrowing of the lumen. pp. 685-687

A patient is diagnosed with primary hypertension. The nurse reviews the patient's history and identifies which factors that 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. Tobacco use 3. Diabetes mellitus 4. Increased sodium intake 5. Greater-than-ideal body weight Contributing factors to primary hypertension include increased sympathetic nervous system (SNS) activity, overproduction (not underproduction) of sodium-retaining hormones and vasoconstricting substances, increased sodium intake, greater-than-ideal body weight, diabetes mellitus, tobacco use, and excessive alcohol consumption. Thyroid disease is related to secondary hypertension. p. 685

A patient is prescribed lisinopril for the treatment of hypertension. The patient asks about side effects of this medication. Which side effects should the nurse include? Select all that apply. 1. Cough 2. Edema 3. Impotence 4. Hypotension 5. Muscle stiffness

1. cough 4. hypotension Cough and hypotension are side effects of angiotensin-converting enzyme (ACE) inhibitors. Peripheral edema is a side effect of calcium channel blockers. Impotence is a side effect of thiazide diuretics, aldosterone receptor blockers, central-acting alpha-adrenergic antagonists, peripheral-acting alpha-adrenergic antagonists, beta-adrenergic blockers, and mixed alpha 1 and beta 1 blockers. Muscle stiffness is not associated with an ACE inhibitor.

The patient is diagnosed with stage 1 hypertension. The nurse understands that this correlates with which systolic blood pressure measurement? <p>The patient is diagnosed with stage 1 hypertension. The nurse understands that this correlates with which systolic blood pressure measurement?</p> 130mm Hg 139mm Hg 142mm Hg 162mm Hg

142 Stage 1 hypertension is defined as a systolic blood pressure of 140 to 159 or a diastolic blood pressure of 90 to 99 mm Hg. Systolic blood pressures of 130 and 139 are defined as prehypertension. A systolic blood pressure of 162/92 mm Hg is categorized as stage 2 hypertension.

A nurse provides discharge education to a patient about care and management of hypertension. What should the teaching plan include? Select all that apply. 1. Supplement the diet with foods high in sodium. 2. Explain the meaning of the blood pressure (BP) values. 3. Explain the potential dangers of uncontrolled hypertension. 4. Assure the patient that short-term therapy will cure hypertension. 5. Exercise after taking the medication prescribed for hypertension. 6. Do not alter medication dosage without first consulting the health care provider.

2,3,6 The nurse should explain the meaning of the systolic blood pressure (SBP) and diastolic blood pressure (DBP) values. The nurse should also explain the potential dangers of uncontrolled hypertension and dangers of altering the dosage without consulting the health care provider. The nurse should inform the patient that long-term therapy and follow-up care are essential to treat hypertension, and that therapy will not cure but should control hypertension. The patient should avoid foods high in sodium; instead, supplement diet with foods high in potassium. The patient should avoid strenuous exercise, hot baths, and excessive amounts of alcohol within three hours of medication.

A patient that has been taking an antihypertensive medication for four years reports blurred vision. The nurse notes that the patient's diagnostic reports indicate the blurred vision is due to retinal damage caused by hypertension. What are other manifestations of target organ disease? Select all that apply. 1. Anemia 2. Aneurysm 3. Proteinuria 4. Pneumonia 5. Transient ischemic attack

2. Aneurysm 3. Proteinuria 5. Transient ischemic attack Hypertension affects the kidneys; a manifestation of renal disease is proteinuria ( >1+). Hypertension speeds up the process of atherosclerosis in the peripheral blood vessels, leading to aneurysms. Adequate control of blood pressure (BP) reduces the risk of transient ischemic attack. Pneumonia and anemia are not manifestations of target organ disease. p. 686

The nurse is providing care for a patient who continues to experience hypertension despite taking a calcium channel blocker daily. A diuretic has been prescribed. How does a diuretic help control blood pressure? Select all that apply. 1. It causes vasodilation. 2. It reduces plasma volume. 3. It promotes sodium and water excretion. 4. It reduces the vascular response to catecholamines. 5. It prevents extracellular calcium from moving into the cells.

2. It reduces plasma volume. 3. It promotes sodium and water excretion. 4. It reduces the vascular response to catecholamines. Diuretics are an important component of BP treatment. Diuretics tend to reduce the plasma volume by promoting 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 provides medication education to a patient with a new diagnosis of hypertension. The nurse should include what common effects of several of the antihypertensive medications? Select all that apply. 1. Constipation 2. Sexual problems 3. Impaired memory 4. Orthostatic hypotension 5. Urge urinary incontinence

2. Sexual problems 4. orthostatic hypotension A common side effect of several of the antihypertensive drugs is orthostatic hypotension. This condition results from an alteration of the autonomic nervous system's mechanisms for regulating BP, which are needed for position changes. Sexual problems may occur with many of the antihypertensive drugs. Problems can range from reduced libido to erectile dysfunction. Constipation, impaired memory, and urge urinary incontinence are not side effects of antihypertensive drugs. p. 693

The nurse provides education to a group of women in the community about prevention of hypertension. What information should be included in the teaching? 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-intensity aerobic physical activity for at least 30 minutes most days

3. Limit sodium and fat intake 4. Drink fat-free or low-fat milk 5. Perform moderate-intensity aerobic physical activity for at least 30 minutes most days Primary prevention of hypertension is to make lifestyle modifications that prevent or delay the increase in blood pressure (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. pp. 688-689

The nurse provides information about prescribed diagnostic studies to a patient newly diagnosed with hypertension (HTN). What should the nurse include in the education about the reasons the studies are being performed? Select all that apply. 1. Echocardiography to provide baseline information about heart status 2. Electrocardiogram (ECG) to evaluate the degree of left ventricular hypertrophy 3. Uric acid level to establish a baseline, since 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. 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 An elevated lipid profile is an additional risk factor for hypertension because having elevated blood lipids leads to development of atherosclerosis. BUN, creatinine, and urinalysis provide information about baseline renal function and help to identify renal damage. Echocardiography evaluates the degree of ventricular hypertrophy, whereas an ECG is used to assess baseline cardiac function. Diuretic therapy frequently leads to an increase in uric acid. p. 687

The nurse performs blood pressure measurements at a wellness clinic. The nurse identifies that which patient has the highest risk for developing primary hypertension? A 65-year-old African American patient; BMI of 35 A 45-year-old patient who has chronic pain caused by cancer A 65-year-old retired Caucasian patient; body mass index (BMI) of 15 A 45-year-old factory worker who smokes one pack of cigarettes per day

A 65-year-old African American patient; BMI of 35 The 65-year-old African American patient has three risk factors for primary hypertension: advanced age, African American race, and morbid obesity with a BMI of 35. All of the other patients have fewer risk factors for primary hypertension, In the 45-year-old, smoking is the only risk factor. In the 45-year-old with cancer, pain is the only risk factor. In the 65-year-old retiree, the only risk factor is advanced age.

he nurse receives information about the assigned patients during shift report. Which patient should the nurse assess first? A patient that reports a severe headache and that is vomiting A patient that reports dizziness and whose blood pressure (BP) is 150/92 A patient with a hip fracture that reports a pain level of "2" on a 1 to 10 scale A patient that received an angiotensin-converting enzyme (ACE) inhibitor 30 minutes previously reports fatigue

A patient that reports a severe headache and that is vomiting Severe headache and vomiting are signs of hypertensive crisis that is an emergency situation; therefore, the nurse must assess this patient first. Dizziness is one of the symptoms of hypertension, and the patient has an elevated blood pressure, but it is not an emergency situation. A pain level of 2 on a scale of 1 to 10 is mild pain and, therefore, this patient is not a priority. Fatigue is one of the symptoms of hypertension, but the patient just received an antihypertensive medication. pp. 698-699

The nurse observes another health care provider taking the blood pressure (BP) of an older patient. The cuff is inflated to 180 mm Hg. The care provider records the systolic blood pressure (SBP) as 180 mm Hg. The nurse recognizes that the reading is inaccurate based on what understanding of BP measurements in older adults? An older patient's SBP is typically at or below 140 mm Hg. That's high. The older patient is more prone to anxiety, which can alter the SBP reading. An auscultatory gap may be present. The older patient's SBP was underestimated. The wrong size cuff was used. A cuff that fit the older patient's arms more snugly should have been obtained.

An auscultatory gap may be present. The older patient's SBP was underestimated. Careful technique is important in assessing blood pressure 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 systolic blood pressure (SBP). There is no information provided that the wrong size cuff was used or that the patient was anxious. Gerentologic changes in the older population often place the patient at risk for hypertension. p. 698

A patient is hospitalized with uncontrolled hypertension. The nurse anticipates that which diagnostic study will be prescribed? Cardiac MRI Thyroid function tests Ophthalmic examination Computerized tomography (CT) scan of the head

An ophthalmic exam is performed to assess the appearance of the retina. It can provide important information about the severity and duration of hypertension. A cardiac MRI, a CT of the head, or thyroid function tests will not provide useful information about hypertension.

An elderly patient is prescribed enalapril. The nurse instructs the patient to avoid taking the drug with meals. What is the reason for this instruction? Antihypertensive drugs may worsen postprandial hypotension. Antihypertensive drugs may reach toxic levels in elderly patients. Antihypertensive drugs cause orthostatic hypotension in elderly patients. Antihypertensive drugs may cause nausea and vomiting if taken with meals.

Antihypertensive drugs may worsen postprandial hypotension. Rationale Elderly people experience postprandial drops in blood pressure (BP). BP drops to its slowest level about one hour after eating and returns to normal within three to four hours. Vasoactive drugs taken with meals may worsen the hypotension and cause dangerously low levels of BP; therefore, vasoactive drugs should not be taken with meals. Orthostatic hypotension is a side effect of antihypertensive drugs but is not related to food. As with all drugs, vasoactive drugs may reach toxic levels in elderly patients if the dosage is not titrated; however, taking the drug with meals or without meals does not affect this. Nausea and vomiting are common side effects of drugs; however, avoiding the drug with meals does not prevent the side effects.

A patient receives a prescription for nadolol 50 mg by mouth (PO) daily. The nurse questions the prescription after noting which medical diagnosis in the patient's health record? Asthma Hypertension Diabetes mellitus Renal insufficiency

Asthma Nadolol is a nonselective β 1- and β2-adrenergic blocking agent that reduces blood pressure. Nonselective agents may cause bronchospasm, especially in patients with asthma. Nadolol will not worsen renal insufficiency and diabetes and will treat, not worsen, hypertension. p. 692

Non-cardioselective beta blockers are contraindicated for

Asthma HF

The nurse is preparing to administer atenolol to a patient with hypertension. The medication has what mechanism of action that makes it beneficial to a patient with this diagnosis? Activates dopamine receptors Blocks β-adrenergic receptors Relaxes arterial and venous smooth muscles Reduces conversion of angiotensin I to angiotensin II

Beta blocker Atenolol is a cardioselective β-adrenergic blocker that reduces blood pressure. It also reduces cardiac output and reduces sympathetic vasoconstrictor tone. It also decreases renin secretion by kidneys. Fenoldopam, a direct vasodilator, activates dopamine receptors, resulting in systemic and renal vasodilation. Angiotensin-converting enzyme inhibitors inhibit ACE, reducing conversion of angiotensin I to angiotensin II. Nitroglycerin is a direct vasodilator, which relaxes arterial and venous smooth muscle, reducing preload and SVR.

The nurse is caring for a patient admitted with a history of hypertension. The patient's medication history includes hydrochlorothiazide daily for the past 10 years. Which parameter would indicate the optimal intended effect of this drug therapy? Weight loss of 2 lb Blood pressure 128/86 Absence of ankle edema Output of 600 mL per eight hours

Blood pressure 128/86 Hydrochlorothiazide may be used alone as monotherapy to manage hypertension or in combination with other medications if not effective alone. After the first few weeks of therapy, the diuretic effect diminishes, but the antihypertensive effect remains. Because the patient has been taking this medication for 10 years, the most direct measurement of its intended effect would be the blood pressure. p. 691

A patient is scheduled for a dose of metoprolol. The nurse should withhold the medication and consult the health care provider after noting which assessment finding? Migraine headache Pitting edema of +1 Blood sugar 217 mg/dL Pulse 112 beats/minute

Blood sugar 217 mg/dL Metoprolol is a β-adrenergic-blocking agent that reduces blood pressure. It should be used with caution in patients with diabetes because the drug may depress the tachycardia associated with hypoglycemia and may adversely affect glucose metabolism. Metoprolol will not worsen migraine, will decrease the elevated pulse rate, and may help with decreasing edema. p. 691

A patient has been prescribed atenolol. Before administering the drug, the nurse should assess for which condition? Asthma Dry cough Depression Diabetes mellitus

DM Atenolol is a cardioselective β-1 blocker that reduces blood pressure by blocking β-adrenergic effects. It should be used with caution in patients with diabetes mellitus, because it depresses the tachycardia associated with hypoglycemia and may hinder diagnosing hypoglycemia. A history of asthma, dry cough, or depression does not affect administration of the drug. Non-cardioselective β-blockers should not be used in patients with asthma due to the risk of bronchospasm, but this is not the case with atenolol because it is cardioselective. Angiotensin-converting enzymes may cause dry cough. Reserpine should not be administered in patients with depression because this may cause the condition to worsen. p. 691

A patient has been prescribed atenolol. Before administering the drug, the nurse should assess for which condition? Asthma Dry cough Depression Diabetes mellitus

DM Atenolol is a cardioselective β-1 blocker that reduces blood pressure by blocking β-adrenergic effects. It should be used with caution in patients with diabetes mellitus, because it depresses the tachycardia associated with hypoglycemia and may hinder diagnosing hypoglycemia. A history of asthma, dry cough, or depression does not affect administration of the drug. Non-cardioselective β-blockers should not be used in patients with asthma due to the risk of bronchospasm, but this is not the case with atenolol because it is cardioselective. Angiotensin-converting enzymes may cause dry cough. Reserpine should not be administered in patients with depression because this may cause the condition to worsen.

The nurse suspects that a patient is experiencing postural hypotension. The nurse recalls that the hypotension occurs when there are what changes in the blood pressure (BP) and heart rate (HR)? Increased systolic BP and/or decreased HR Increased diastolic BP and/or decreased HR Decreased systolic BP, decreased diastolic BP, and/or increased HR Decreased systolic BP, increased diastolic BP, and no change in HR

Decreased systolic BP, decreased diastolic BP, and/or increased HR A decrease in both systolic and diastolic blood pressure and an increase in pulse would be seen in a patient with postural hypotension. Blood pressure drops as the volume of circulating blood decreases when a patient abruptly stands from a lying or sitting position. The pulse rate increases as the heart attempts to compensate by increasing the amount of circulating blood by increasing cardiac output. Increased systolic blood pressure and decreased pulse rate; increased diastolic blood pressure and increased pulse rate; and decreased systolic blood pressure, increased diastolic blood pressure, and no change in pulse rate are all incorrect. p. 695

A patient is being discharged from the hospital. The primary health care provider prescribes propranolol for hypertension. Which instruction should the nurse include in the patient's discharge teaching plan? Do not stop taking the medication abruptly. Increase the intake of green leafy vegetables. Take with orange juice to prevent hypokalemia. Take a hot bath within one hour of the medication to promote vasodilation.

Do not stop taking the medication abruptly. Patients should not stop taking this medication abruptly because this may cause rebound hypertension. Beta blockers are not potassium wasting, so it is not necessary to take them with orange juice or to increase the intake of potassium-rich foods such as green leafy vegetables. The patient should be instructed to avoid hot baths within 3 hours of taking drugs that promote vasodilation; excessive hypotension may occur.

The nurse provides information to a group of nursing students about measuring the blood pressure (BP) in older patients. What should the nurse include in the teaching? Measure BP one hour after eating. Inflate the cuff until the pulse disappears. Expect some of the patients to have an auscultatory gap. An age-related change is decreased peripheral vascular resistance.

Expect some of the patients to have an auscultatory gap. The nurse measuring the BP of an older patient should check for an auscultatory gap. Some elderly patients have a wide gap between the first Korotkoff sound and subsequent beats. 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. When measuring BP, the nurse should inflate the cuff 20 to 30 mm Hg after the radial pulse disappears. An age-related change is increased peripheral vascular resistance. p. 698

A patient with a high triglyceride level takes an over-the-counter fish oil tablet every day. What risk factor should the nurse inform the patient about with the use of fish oil? Fish oil may increase prostate-specific antigen (PSA) levels. Fish oil may decrease blood pressure. Fish oil may increase the risk of bleeding. Fish oil may decrease blood sugar levels.

Fish oil may increase the risk of bleeding. Fish oil is used for hypertriglyceridemia and hypertension. However, patients should be informed that the use of fish oil may increase the risk of bleeding, and the patient should be observant for related signs and symptoms. Fish oil may increase blood sugar levels. It does not have any effect on prostate cancer or blood pressure levels. p. 689

The nurse teaches a patient with hypertension that uncontrolled hypertension may damage organs in the body primarily by which mechanism? Hypertension promotes atherosclerosis and damage to the walls of the arteries. Hypertension causes thickening of the capillary membranes, leading to hypoxia of organ systems. Hypertension causes direct pressure on organs, resulting in necrosis and replacement of cells with scar tissue. Hypertension increases blood viscosity, which contributes to intravascular coagulation and tissue necrosis distal to occlusions.

Hypertension promotes atherosclerosis and damage to the walls of the arteries. 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.

The nurse reviews the history of a patient that has failed to reach goal BP despite taking full doses of an appropriate three-drug therapy regimen, including a diuretic. The nurse identifies that what history finding is the likely cause of the resistant hypertension? Increasing obesity Excess pepper intake Consumes peppermints Erectile dysfunction (ED) medication

Increasing obesity 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 meds) are also possible causes of resistant hypertension. p. 695

A patient presents to the emergency department with a sudden rise in blood pressure (BP) and a severe headache. The patient receives a prescription for IV labetalol. The nurse recognizes that what precaution should be taken while administering the medication? Maintaining seizure precautions Monitoring for severe tachycardia Keeping the patient supine during the administration Taking the patient's blood pressure every 5 minutes

Keeping the patient supine during the administration The patient is experiencing hypertensive crisis. Labetalol is an alpha- and beta-adrenergic blocker and reduces BP by causing vasodilatation and a decrease in heart rate. Patients must be kept supine during IV administration due to severe orthostatic hypotension that occurs with the medication. The BP should be assessed every 2 to 3 minutes during the initial administration of the drug. Seizure activity is not an adverse effect of the medication. The medication will decrease the heart rate.

The nurse provides discharge teaching to a female patient that was newly diagnosed with primary hypertension. What instruction should be included? Decrease the intake of omega-3 fatty acids. Restrict sodium to less than or equal to 2300 mg/day. Limit the intake of alcohol to no more than one drink per day. Begin taking a calcium supplement to help lower blood pressure.

Limit the intake of alcohol to no more than one drink per day. 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 is preparing to measure the blood pressure of a patient who is lying down on a bed. What technique should the nurse use? Place the BP cuff on the forearm when measuring the BP. Measure the BP in both arms and record the lowest reading. Rest the patient's arms on the bed during the BP measurement. Measure the BP twice, waiting one minute between measurements.

Measure the BP twice, waiting one minute between measurements. When recording BP, two measurements should be taken one minute apart. This allows the blood to drain from the arm and prevents inaccurate readings. If the patient is in a lying down position, the arm should be placed on a pillow so that it is at the heart level. Atherosclerosis in the subclavian artery may result in a falsely low BP in the affected side; therefore, the arm which has the highest recording of the BP should be used for further measurements. The upper arm, not the forearm, is the preferred site of BP cuff placement due to its accuracy of recordings.

The nurse recalls that which medication should be used with caution in patients with diabetes because the drug may depress the tachycardia associated with hypoglycemia and may adversely affect glucose metabolism? Diltiazem Metoprolol Prednisone Hydromorphone

Metoprolol, a beta blocker, slows the heart rate. Tachycardia is a classic symptom of hypoglycemia; therefore, patients must be made aware of 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.

The nurse presents information to a group of nursing students about cultural and ethnic health disparities related to hypertension. What should the nurse include in the education about Mexican Americans, when comparing them to the white and African American populations? Mexican Americans have higher rates of blood pressure control. Mexican Americans are more likely to receive treatment for hypertension. Mexican Americans have the highest prevalence of hypertension in the world. Mexican Americans have lower levels of awareness of hypertension and its treatment.

Mexican Americans have lower levels of awareness of hypertension and its treatment. Mexican Americans have lower levels of awareness of hypertension and its treatment than do whites and African Americans. Mexican Americans are less likely to receive treatment for hypertension, and they have lower rates of blood pressure control. African Americans have the highest prevalence of hypertension in the world. p. 682

The nurse is caring for a patient admitted to the hospital with a diagnosis of hypertension. The primary health care provider prescribes prazosin. What should be included in the patient's plan of care? Monitor for orthostatic hypotension. Observe patient for cardiac dysrhythmias. Do not give the medication with grapefruit juice. Do not give to patients with benign prostatic hyperplasia (BPH).

Monitor for orthostatic hypotension. Low blood pressure or postural hypotension can cause a fall from dizziness. The medication can reduce resistance to outflow of urine in patients with BPH. Administering grapefruit juice with certain calcium channel blockers may increase the serum concentrations, resulting in toxicity. The direct vasodilator minoxidil may cause EKG changes of flattened and inverted T waves. p. 691

The nurse provides teaching to a patient with hypertension that receives a prescription for chlorothiazide. The instructions should include limiting the intake of what? NSAIDs Ginkgo biloba Grapefruit juice Potassium-rich foods

NSAIDs Chlorothiazide is a diuretic, which inhibits NaCl reabsorption in the distal convoluted tubule. It increases excretion of sodium and chloride. NSAIDs can decrease diuretic and antihypertensive effects of thiazide diuretics and potentially cause renal impairment. Ginkgo biloba and grapefruit juice will not decrease the effectiveness of chlorothiazide cause hypokalemia; patients are advised to supplement with potassium-rich foods. p. 717

The nurse provides teaching to a patient with hypertension that receives a prescription for chlorothiazide. The instructions should include limiting the intake of what? NSAIDs Ginkgo biloba Grapefruit juice Potassium-rich foods

NSAIDs NSAIDs can decrease diuretic and antihypertensive effects of thiazide diuretics and potentially cause renal impairment

A patient receives a prescription for nadolol 50 mg by mouth (PO) daily. The nurse questions the prescription after noting which medical diagnosis in the patient's health record? Asthma Hypertension Diabetes mellitus Renal insufficiency

Nadolol is a nonselective β 1- and β2-adrenergic blocking agent that reduces blood pressure. Nonselective agents may cause bronchospasm, especially in patients with asthma. Nadolol will not worsen renal insufficiency and diabetes and will treat, not worsen, hypertension. p. 692

A patient is hospitalized with uncontrolled hypertension. The nurse anticipates that which diagnostic study will be prescribed? Cardiac MRI Thyroid function tests Ophthalmic examination Computerized tomography (CT) scan of the head

Ophthalmic examination An ophthalmic exam is performed to assess the appearance of the retina. It can provide important information about the severity and duration of hypertension. A cardiac MRI, a CT of the head, or thyroid function tests will not provide useful information about hypertension.

The nurse is teaching an older patient with hypertension about developing an exercise program. Which instructions should the nurse include? Perform weightlifting on a daily basis. Perform flexibility and balance exercises daily. Perform high-intensity aerobic physical activity for at least 30 minutes most days. Perform muscle-strengthening activities using the major muscles of the body at least twice a week.

Perform muscle-strengthening activities using the major muscles of the body at least twice a week. All adults should perform muscle-strengthening activities using the major muscles of the body at least twice a week. Weightlifting is not recommended for a patient with hypertension because it may increase blood pressure (BP). It is recommended to perform moderate-intensity aerobic physical activity for at least 30 minutes most days (i.e., more than 5 days a week). Flexibility and balance exercises are recommended at least twice a week for older adults, especially those at risk for falls.

The nurse is caring for a patient with hypertension who is scheduled to receive a dose of esmolol. The nurse should withhold the dose and consult the prescribing health care provider for which vital sign taken just before administration? Pulse 48 Respirations 24 Blood pressure 118/74 Oxygen saturation 93%

Pulse 48 Because esmolol is a β 1-adrenergic blocking agent, it can cause hypotension and bradycardia as adverse effects. The nurse should withhold the dose and consult with the health care provider for parameters regarding pulse-rate limits. Respirations, blood pressure, and oxygen saturation are not a source of concern in this case.

The nurse teaches a healthy adult with no history of heart disease that it is recommended to eat fish at least two times per week. The adult asks the nurse to be provided with a list of recommended types of fish. What should the nurse include on the list? Select all that apply. 1. Salmon 2. Catfish 3. Whitefish 4. Albacore tuna 5. Orange roughy

Salmon Catfish Whitefish Albacore tuna For healthy adults with no history of heart disease, the American Heart Association recommends eating fish at least two times per week. Fatty fish such as anchovies, bluefish, catfish, halibut, lake trout, mackerel, pompano, salmon, striped sea bass, albacore tuna, and whitefish are recommended. The orange roughy fish lives a long life but is slow to reproduce, making it vulnerable to overfishing. The orange roughy fish lives 100 years or more; the fillet may be kept in freezers for a very long time. This also means it has high levels of mercury. p. 689

When caring for a patient admitted with poorly controlled hypertension, the nurse identifies that which laboratory test result indicates the presence of target organ damage? Serum uric acid of 3.8 mg/dL Serum creatinine of 2.6 mg/dL Serum potassium of 3.5 mEq/L Blood urea nitrogen (BUN) of 15 mg/dL

Serum creatinine of 2.6 mg/dL The normal serum creatinine level is 0.6 to 1.3 mg/dL. This elevated level indicates target organ damage to the kidneys. BUN of 15 mg/dL, serum uric acid of 3.8 mg/dL, and serum potassium of 3.5 mEq/L are within normal limits.

A patient receives instructions about monitoring the blood pressure (BP) levels at home. What should the nurse teach the patient about measuring the BP in a supine position? Take the reading immediately after lying down. Support the arm with a pillow during measurement. Take at least two consecutive readings one after another. Use the arm with the lower BP for all future measurements.

Support the arm with a pillow during measurement. When measuring BP in a supine position, the patient should support the arm with a small pillow to raise the position of the hand to the level of the heart. Record the average pressure by taking two consecutive readings at least one minute apart; this allows the blood to drain from the arm and prevents inaccurate readings. The first reading should be taken after two to three minutes of rest in a supine position. If bilateral BP measurements are not equal, the patient should use the arm with the highest BP for all future measurements. pp. 696-697

As treatment for hypertensive crisis, a patient has received sodium nitroprusside for three days. The nurse recognizes that it is important to assess the patient's thiocyanate levels for what reason? The medication has a long half-life. The medication is metabolized to cyanide, then thiocyanate. An increased level indicates interactions with other drugs the patient is taking. An increased level indicates adverse effects on target organs caused by the medication.

The medication is metabolized to cyanide, then thiocyanate. Sodium nitroprusside causes arterial vasodilation and reduces systemic vascular resistance. This, in turn, decreases the blood pressure. 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 4mcg/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. p. 692

The nurse helps a patient move from a supine position to a standing position. The patient suddenly reports feeling dizzy. What is the probable reason for the dizziness? The peripheral arteries constricted. The venous return to the heart increased. The force of contraction of the heart increased. The sympathetic nervous system (SNS) did not respond.

The sympathetic nervous system (SNS) did not respond. During any change in position, the vasomotor center is activated and stimulates the sympathetic nervous system (SNS) response. The SNS response ensures that cerebral blood flow is maintained by causing peripheral vasoconstriction and by increasing venous return. If the patient feels dizzy when changing positions, it means that the SNS response did not occur. If the peripheral arteries constrict and the venous return to the heart is increased, the blood flow to the heart is maintained, preventing dizziness in the patient. If the force of contraction is increased, the patient would not experience dizziness; the blood flow to the brain would be maintained. p. 683

A nurse is counseling a patient about dietary supplements normally used for the prevention and treatment of cardiovascular disease. Which supplement has strong scientific evidence for its use? Melatonin Green tea Glucosamine Omega-3 fatty acids

There is strong scientific evidence for the use of omega-3 fatty acids in the treatment and prevention of hypertension, hypertriglyceridemia, and cardiovascular disease. Melatonin, green tea, and glucosamine are not indicated for prevention and treatment of cardiovascular disease. There is unclear scientific evidence for the use of green tea in the treatment of high cholesterol. p. 689

A patient that has been taking clonidine for ten years tells the nurse, "I decided to quit taking the medication a few days ago." The nurse should monitor the patient for which indication of withdrawal syndrome? Tremors Lethargy Dysphasia Bradycardia

Tremors Withdrawl symptoms include: rebound hypertension, tachycardia, HA, tremors, apprehension, sweating

What are the withdrawal symptoms associated with abrupt discontinuation of clonidine, a centrally acting alpha-adrenergic agonist?

Withdrawl symptoms include: rebound hypertension tachycardia HA tremors apprehension sweating

A patient whose blood pressure is 200/120 mm Hg receives a prescription for clonidine. The nurse instructs the patient to avoid hazardous activities due to what medication side effect? Drowsiness Orthostatic hypotension Rapid decrease in BP Rebound hypertension

drowsiness Clonidine is an adrenergic inhibitor that reduces sympathetic outflow from the central nervous system. It lowers BP by reducing peripheral sympathetic tone, dilating the blood vessels, and decreasing the systemic vascular resistance. Drowsiness is a side effect of the drug, and the patient is advised to avoid engaging in hazardous activities, because this can increase the risk of injury. The drug also causes orthostatic hypotension, so the patient is advised to change position slowly. The drug does not cause a rapid decrease in BP. The drug can cause rebound hypertension if discontinued abruptly. p. 700

evaluates the degree of ventricular hypertrophy

echocardiography

used to assess baseline cardiac function

electrocardiogram (ECG)

Non-cardioselective beta blockers include

nadolol pinolol propranolol

The nurse providing dietary instruction to a patient with hypertension should advise the patient to reduce the intake of which foods? Select all that apply. Nuts Poultry Red meat Canned soup Frozen dinners

red meat, canned soup, frozen dinners Foods high in fat and sodium, including canned soup, red meat, and frozen dinners, should be avoided by the patient with hypertension. Nuts and poultry are included in the Dietary Approaches to Stop Hypertension (DASH) eating plan. p. 688