NSG 245 Ch 31- Assessment & Management of Hypertension
A client with high blood pressure is receiving an antihypertensive drug. When developing a client teaching plan to minimize orthostatic hypotension, which instruction should the nurse include?
"Flex your calf muscles, avoid alcohol, and change positions slowly." Measures that minimize orthostatic hypotension include flexing the calf muscles to boost blood return to the heart, avoiding alcohol and straining at stool, changing positions slowly, eating a high-protein snack at night, wearing elastic stockings, and holding onto a stationary object when rising. Although the client should rest between demanding activities and consume plenty of fluids and fiber (contained in fruits and vegetables) to maintain a balanced diet, these measures don't directly relieve orthostatic hypotension.
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 120/80 mm Hg." An individual with diabetes mellitus should strive for blood pressure of 120/80 mm Hg or less. An individual without diabetes should strive for blood pressure of 140/90 mm Hg or less.
A 66-year-old client presents to the emergency department reporting severe headache and mild nausea for the past 6 hours. Upon assessment, the client's BP is 210/120 mm Hg. The client has a history of hypertension and takes 1.0 mg clonidine twice daily. Which question is most important for the nurse to ask the client next?
"Have you taken your prescribed clonidine today?" Explanation: The nurse must ask whether the client has taken his prescribed clonidine. Clients need to be informed that rebound hypertension can occur if antihypertensive medications are suddenly stopped. Specifically, a side effect of clonidine is rebound or withdrawal hypertension. Although the other questions may be asked, it is most important to inquire whether the client has taken the prescribed hypertension medication given the client's severely elevated BP.
A client is placed on a low-sodium (500 mg/day) diet. Which client statement indicates that the nurse's nutrition teaching plan has been effective?
"I chose broiled chicken with a baked potato for dinner."
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, so 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 do not cause dry mouth or nasal congestion; both side effects are associated with alpha2-agonists. Postural hypotension may be potentiated by alcohol.
A nurse is educating a client about monitoring blood pressure readings at home. What will the nurse be sure to emphasize?
"Sit quietly for 5 minutes prior to 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. (3) Have the forearm supported at heart level, with both feet on the ground during the measurement of the blood pressure.
A 55-year-old male client newly diagnosed with hypertension returns to the physician's office for a routine follow-up appointment after several months of treatment with metoprolol. During the initial assessment, the nurse records the client's blood pressure (BP) as 180/90 mm Hg. The client states that the medication is not taken as prescribed. Which is the best response by the nurse?
"The medication you were prescribed may cause sexual dysfunction; are you experiencing this side effect?" The nurse needs to understand why the client is not taking the medication. Metoprolol is a beta-blocker. All clients should be informed that beta-blockers might cause sexual dysfunction and that other medications are available if problems with sexual function occur.
A patient is being treated for hypertensive emergency. When treating this patient, the priority goal is to lower the mean blood pressure (BP) by up to which percentage in the first hour?
25% Explanation: The therapeutic goals are reduction of the mean BP by up to 25% within the first hour of treatment, a further reduction to a goal pressure of about 160/100 mm Hg over a period of 2 to 6 hours, and then a more gradual reduction in pressure to the target goal over a period of days.
A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective assessment data from a patient with hypertension, the nurse learns that the patient has a family history of hypertension and she herself has high cholesterol and lipid levels. The patient says she smokes one pack of cigarettes daily and drinks about a pack of beer every day. The nurse notes what nonmodifiable risk factor for hypertension?
A family history of hypertension Unlike cholesterol levels, alcohol intake and adherence to treatment, family history is not modifiable.
An older adult client visits the clinic for a blood pressure check. The client's hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about blood pressure medicine?
A possible adverse effect of blood pressure medicine is dizziness when you stand. A possible adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. Teaching should include tips for managing syncope and dizziness
A patient in hypertensive emergency is being cared for in the ICU. The patient has become hypovolemic secondary to natriuresis. What is the nurses most appropriate action?
Administer normal saline IV, as ordered. If there is volume depletion secondary to natriuresis caused by the elevated BP, then volume replacement with normal saline can prevent large, sudden drops in BP when antihypertensive medications are administered. Sodium administration, cessation of antihypertensive therapy, and administration of vasoconstrictors are not normally indicated.
A client with newly diagnosed hypertension asks what to do to decrease the risk for related cardiovascular problems. Which risk factor is not modifiable by the client?
Age
The nurse is providing care for a patient with a diagnosis of hypertension. The nurse should consequently assess the patient for signs and symptoms of which other health problem?
Atherosclerosis Hypertension is both a sign and a risk factor for atherosclerotic heart disease. It is not associated with structural cardiac defects, low platelet levels, or migraines.
The nurse is administering metoprolol to a client. What type of medication should the nurse educate the client about?
Beta blocker Metoprolol is classified as a beta blocker. Beta blockers block beta adrenergic receptors of the sympathetic nervous system, causing vasodilation and decreased cardiac output and heart rate. Metoprolol is not classified as a diuretic, ACE inhibitor, or vasodilator.
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 Explanation: Clonidine (Catapres) is contraindicated for clients with severe coronary artery disease.
A patient in a hypertensive emergency is admitted to the ICU. The nurse anticipates that the patient will be treated with IV vasodilators, and that the primary goal of treatment is what?
Decrease the mean arterial pressure between 20% and 25% in the first hour of treatment. Initially, the treatment goal in hypertensive emergencies is to reduce the mean arterial pressure by 25% in the first hour of treatment, with further reduction over the next 24 hours. Lowering the BP too fast may cause hypotension in a patient whose body has adjusted to hypertension and could cause a stroke, MI, or visual changes. Neurologic symptoms should be addressed, but this is not the primary focus of treatment planning.
The home health nurse is caring for a patient who has a comorbidity of hypertension. What assessment question most directly addresses the possibility of worsening hypertension?
Do you ever see spots in front of your eyes? To identify complications or worsening hypertension, the patient is questioned about blurred vision, spots in front of the eyes, and diminished visual acuity. The heart, nervous system, and kidneys are also carefully assessed, but angina pain and decreased energy are not normally suggestive of worsening hypertension. Sodium limitation is a beneficial lifestyle modification, but nonadherence to this is not necessarily a sign of worsening symptoms.
Which diagnostic method is recommended to determine whether left ventricular hypertrophy has occurred?
Echocardiography An echocardiogram is recommended method of determining whether hypertrophy has occurred. Electrocardiography and blood chemistry are part of the routine workup. Renal damage may be suggested by elevations in blood urea nitrogen and creatinine concentrations.
A patient has been diagnosed as being prehypertensive. What should the nurse encourage this patient to do to aid in preventing a progression to a hypertensive state?
Exercise on a regular basis To prevent or delay progression to hypertension and reduce risk, JNC 7 urged health care providers to encourage people with blood pressures in the prehypertension category to begin lifestyle modifications, such as nutritional changes and exercise. There is no need for patients to limit their activity in the morning or to avoid potassium and protein intake.
The nurse is providing care for a patient with a new diagnosis of hypertension. How can the nurse best promote the patients adherence to the prescribed therapeutic regimen?
Have the patient participate in monitoring his or her own BP Adherence to the therapeutic regimen increases when patients actively participate in self-care, including self-monitoring of BP and diet. Dire warnings may motivate some patients, but for many patients this is not an appropriate or effective strategy. Screening for vision changes and promoting healthy lifestyle are appropriate nursing actions, but do not necessarily promote adherence to a therapeutic regimen.
Which condition(s) indicates target organ damage from untreated/undertreated hypertension? Select all that apply.
Heart failure Retinal damage Stroke Explanation: Target organs include the heart, kidney, brain, and eyes. Hyperlipidemia and diabetes are risk factors for development of hypertension.
A 55-year-old patient comes to the clinic for a routine check-up. The patients BP is 159/100 mm Hg and the physician diagnoses hypertension after referring to previous readings. The patient asks why it is important to treat hypertension. What would be the nurses best response?
Hypertension greatly increases your risk of stroke and heart disease. Hypertension, particularly elevated systolic BP, increases the risk of death, stroke, and heart failure in people older than 50 years. Hypertension is not a direct precursor to pulmonary emboli, and it does not put older adults at increased risk of type 1 diabetes or cancer. It is not the leading cause of death in people 55 years of age.
A patients medication regimen for the treatment of hypertension includes hydrochlorothiazide. Following administration of this medication, the nurse should anticipate what effect?
Increased urine output Thiazide diuretics lower BP by reducing circulating blood volume; this results in a short-term increase in urine output. These drugs do not cause bradycardia, agitation, or drowsiness.
The nurse is assessing a patient new to the clinic. Records brought to the clinic with the patient show the patient has hypertension and that her current BP readings approximate the readings from when she was first diagnosed. What contributing factor should the nurse first explore in an effort to identify the cause of the clients inadequate BP control?
Lack of adherence to prescribed drug therapy Deviation from the therapeutic program is a significant problem for people with hypertension and other chronic conditions requiring lifetime management. An estimated 50% of patients discontinue their medications within 1 year of beginning to take them. Consequently, this is a more likely problem substance use, organ damage, or adverse drug interactions.
The nurse is screening a number of adults for hypertension. What range of blood pressure is considered normal?
Less than 120/80 mm Hg JNC 7 defines a blood pressure of less than 120/80 mm Hg as normal, 120 to 129/80 to 89 mm Hg as prehypertension, and 140/90 mm Hg or higher as hypertension
A client hospitalized for treatment of hypertension is being prepared for discharge. Which teaching topic should the nurse be sure to cover?
Maintaining a low-sodium diet Explanation: The nurse must teach the hypertensive client how to modify his diet to restrict sodium and saturated fats. In addition to teaching about adverse effects of ordered antihypertensives, she must discuss the actions and dosages of these drugs. A client receiving antihypertensives may also take a diuretic as part of the drug regimen and thus may require dietary potassium supplements and high-potassium foods to avoid electrolyte disturbances. Instead of skipping medication if dizziness occurs, the client should notify the physician of this symptom. The client receiving antihypertensives at home takes them by mouth, not I.V.
The hospital nurse cares for many patients who have hypertension. What nursing diagnosis is most common among patients who are being treated for this health problem?
Noncompliance with therapeutic regimen related to adverse effects of prescribed therapy Deviation from the therapeutic program is a significant problem for people with hypertension and other chronic conditions requiring lifetime management. For many patients, this is related to adverse effects of medications. Medication cost is relevant for many patients, but adverse effects are thought to be a more significant barrier. Many patients are aware of necessary lifestyle modification, but do not adhere to them. Most patients are aware of the need to monitor their BP.
A nurse is teaching an adult female patient about the risk factors for hypertension. What should the nurse explain as risk factors for primary hypertension?
Obesity and high intake of sodium and saturated fat Obesity, stress, high intake of sodium or saturated fat, and family history are all risk factors for primary hypertension. Diabetes and oral contraceptives are risk factors for secondary hypertension. Metabolic syndrome, renal disease, and coarctation of the aorta are causes of secondary hypertension.
The nurse is assessing a patient with severe hypertension. When performing a focused assessment of the eyes, what does the nurse understand may be observed related to the hypertension?
Papilledema Explanation: Physical examination may reveal no abnormalities other than elevated blood pressure. Occasionally, retinal changes such as hemorrhages, exudates (fluid accumulation), arteriolar narrowing, and cotton-wool spots (small infarctions) occur. In severe hypertension, papilledema (swelling of the optic disc) may be seen.
A patient has been prescribed antihypertensives. After assessment and analysis, the nurse has identified a nursing diagnosis of risk for ineffective health maintenance related to nonadherence to therapeutic regimen. When planning this patients care, what desired outcome should the nurse identify?
Patient takes medication as prescribed and reports any adverse effects. The most appropriate expected outcome for a patient who is given the nursing diagnosis of risk for ineffective health maintenance is that he or she takes the medication as prescribed. The other listed goals are valid aspects of care, but none directly relates to the patients role in his or her treatment regimen.
The nurse would screen a client from which ethnic background hypertension at an early age?
Population of African descent
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 Explanation: 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.
During an adult patients last two office visits, the nurse obtained BP readings of 122/84 mm Hg and 130/88 mm Hg, respectively. How would this patients BP be categorized?
Prehypertensive Prehypertension is defined systolic BP of 120 to 139 mm Hg or diastolic BP of 80 to 89 mm
A 35-year-old client has been diagnosed with hypertension. The client is a stock broker, smokes daily, and has diabetes. During a follow-up appointment, the client states that regular visits to the doctor just to check blood pressure (BP) are cumbersome and time consuming. As the nurse, which aspect of client teaching would you recommend?
Purchasing a self-monitoring BP cuff Because this client finds visiting the doctor time-consuming just for a BP reading, as the nurse, you can suggest the use of an automatic cuff at a local pharmacy, or purchasing a self-monitoring cuff. Discussing methods to reduce stress, advising smoking cessation, and achieving glycemic control would constitute client education in managing hypertension.
A client is brought to the emergency department with reports of a bad headache and an increase in blood pressure. The blood pressure reading obtained by the nurse is 260/180 mm Hg. What is the therapeutic goal for reduction of the mean blood pressure?
Reduce the blood pressure by 20% to 25% within the first hour of treatment. A hypertensive emergency is a situation in which blood pressures are extremely elevated and must be lowered immediately (not necessarily to less than 140/90 mm Hg) to halt or prevent damage to the target organs (Chobanian et al., 2003; Rodriguez et al., 2010). Hypertensive emergencies are acute, life-threatening blood pressure elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. The therapeutic goals are reduction of the mean blood pressure by 20% to 25% within the first hour of treatment, a further reduction to a goal pressure of about 160/100 mm Hg over a period of up to 6 hours, and then a more gradual reduction in pressure over a period of days.
A patient newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a patient with prolonged, uncontrolled hypertension is at risk for developing what health problem?
Renal failure When uncontrolled hypertension is prolonged, it can result in renal failure, myocardial infarction, stroke, impaired vision, left ventricular hypertrophy, and cardiac failure. Glaucoma and anemia are not directly associated with hypertension.
A patient with primary hypertension comes to the clinic complaining of a gradual onset of blurry vision and decreased visual acuity over the past several weeks. The nurse is aware that these symptoms could be indicative of what?
Retinal blood vessel damage Blurred vision, spots in front of the eyes, and diminished visual acuity can mean retinal blood vessel damage indicative of damage elsewhere in the vascular system as a result of hypertension. Glaucoma and cranial nerve damage do not normally cause these symptoms. A hypertensive emergency would have a more rapid onset.
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 Explanation: 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.
A student nurse is taking care of an elderly patient with hypertension during a clinical experience. The instructor asks the student about the relationships between BP and age. What would be the best answer by the student?
Structural and functional changes in the cardiovascular system that occur with age contribute to increases in blood pressure. Structural and functional changes in the heart and blood vessels contribute to increases in BP that occur with aging. Venous insufficiency does not cause hypertension, however. Increased BP is not primarily a result of neurologic changes.
A patients recently elevated BP has prompted the primary care provider to prescribe furosemide (Lasix). The nurse should closely monitor which of the following?
The patients potassium level Loop diuretics can cause potassium depletion. They do not normally affect level of consciousness, erythrocytes, or oxygen saturation.
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.
The nurse is assessing a client with hypertension. Which actions will the nurse take when measuring the client's blood pressure? Select all that apply.
Wrap the cuff firmly around the arm. Measure two readings, 1 to 2 minutes apart. Place the client's arm at the level of the heart. Center the cuff bladder over the brachial artery. Explanation: Blood pressure is used to determine cardiovascular functioning. To measure the blood pressure, wrap the cuff firmly around the arm. Prepare to measure two readings, 1 to 2 minutes apart. The client's arm should be placed at the level of the heart. The cuff bladder is to be centered over the brachial artery. The client should sit quietly with both feet on the floor while the blood pressure is measured because it can be increased when the client is engaged in conversation.
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 Explanation: Secondary hypertension may accompany any primary condition that affects fluid volume or renal function, or causes arterial vasoconstriction.
Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress
decreases the production of neurotransmitters that constrict peripheral arterioles. Reduced stress decreases the production of neurotransmitters that constrict peripheral arterioles. Reduced stress may assist in reducing blood volume and resistance to the heart.
When measuring blood pressure in each arm of a healthy adult, the nurse recognizes that the pressures
differ no more than 5 mm Hg between arms. Normally, in the absence of disease of the vasculature, arm pressures differ by no more than 5 mm Hg. The pressures in each arm do not have to be equal to be considered normal. Pressures that vary more than 10 mm Hg between arms are an abnormal finding. The left arm pressure is not anticipated to be higher than the right as a normal anatomical variant.
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 Explanation: 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 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 Explanation: The autonomic nervous system, the kidneys, and various endocrine glands regulate arterial pressure.
A client who was recently diagnosed with prehypertension is to meet with a dietitian and return for a follow-up with the cardiologist in 6 months. What would this client's treatment likely include?
nonpharmacological interventions Explanation: Nonpharmacologic interventions are used for clients with prehypertension.
Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through:
ophthalmic examination. Papilledema is an edema of the optic nerves, and thus needs an ophthalmic examination for detection.
It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position
provide time for the heart to increase the rate of contraction to resupply oxygen to the brain. Explanation: It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position provide time for the heart to increase its rate of contraction to resupply oxygen to the brain, not blood pressure or heart rate.
The nurse is teaching a client about chronic untreated hypertension. What complication will the nurse explain to the client?
stroke A stroke occurs if vessels in the brain rupture and bleed. If an aneurysm has developed in the aorta from chronic hypertension, it may burst and cause hemorrhage and shock. Peripheral edema, right-sided heart failure, and pulmonary insufficiency are not usually consequences of untreated chronic hypertension.
The nurse understands that an overall goal of hypertension management is that
there is no indication 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.
The nurse is planning the care of a patient who has been diagnosed with hypertension, but who otherwise enjoys good health. When assessing the response to an antihypertensive drug regimen, what blood pressure would be the goal of treatment?
140/90 mm Hg or lower The goal of antihypertensive drug therapy is a BP of 140/90 mm Hg or lower. A pressure of 130/80 mm Hg is the goal for patients with diabetes or chronic kidney disease.
The nurse is caring for an elderly client with a diagnosis of hypertension, who is taking several antihypertensive medications. Which safety precaution is the nurse most likely to reinforce?
Changing positions slowly related to possible hypotension The elderly have impaired cardiovascular reflexes and thus are more sensitive to the extracellular volume depletion caused by diuretics and to the sympathetic inhibition caused by adrenergic antagonists. The nurse teaches clients to change positions slowly when moving from a lying or sitting position to a standing position. This will help prevent falls. Eating extra potassium is not a good idea if taking a potassium-sparing diuretic. The other choices are good teaching points, but not necessarily safety precautions.
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.
A client is taking 50 mg of oral spironolactone twice a day to assist with blood pressure control. While the nurse is performing the morning assessment, the client reports nausea, general muscle cramps, and weakness. The ECG strip shows a peaked, narrow T-wave, which is a change. What electrolyte imbalance does the nurse suspect?
Hyperkalemia Potassium-sparing diuretics, such as spironolactone, can cause hyperkalemia, especially if given with an ACE inhibitor. Signs of hyperkalemia are nausea, diarrhea, abdominal cramps, and peaked narrow T-waves.
Which term describes a situation in which blood pressure is very elevated but there is no evidence of impending or progressive target organ damage?
Hypertensive urgency Explanation: Hypertensive urgency is a situation in which blood pressure is severely elevated but there is no evidence of actual or probable target organ damage. A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage. Primary hypertension denotes high blood pressure from an unidentified source. Secondary hypertension is high blood pressure from an identified cause, such as renal disease.
Which of the following would be inconsistent with a hypertensive urgency?
Intracranial hemorrhage Explanation: 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.
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 cost Explanation: The objective of nursing care for patients with hypertension focuses on lowering and controlling the blood pressure without adverse effects and without undue cost.
Which term is refers to hypertension in which blood pressure that is controlled with therapy becomes uncontrolled (abnormally high) when the therapy is discontinued?
Rebound Rebound hypertension may precipitate a hypertensive crisis. Essential or primary hypertension denotes high blood pressure from an unidentified source. Secondary hypertension denotes high blood pressure from an identified cause, such as renal disease.
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 Explanation: 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.
The nurse is teaching a patient about some of the health consequences of uncontrolled hypertension. What health problems should the nurse describe? Select all that apply.
Transient ischemic attacks Cerebrovascular accident Retinal hemorrhage Potential complications of hypertension include the following: left ventricular hypertrophy; MI; heart failure; transient ischemic attacks (TIAs); cerebrovascular accident; renal insufficiency and failure; and retinal hemorrhage. Venous insufficiency and right ventricular hypertrophy are not potential complications of uncontrolled hypertension
It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine
increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood.
A newly diagnosed patient with hypertension is prescribed Diuril, a thiazide diuretic. What patient education should the nurse provide to this patient?
Diuril can cause low blood pressure and dizziness, especially when you get up suddenly. Thiazide diuretics can cause postural hypotension, which may be potentiated by alcohol, barbiturates, opioids, or hot weather. Diuril does not cause either moderate hyperkalemia or severe hypokalemia and it does not result in hypernatremia
Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage?
Hypertensive emergency A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage. Hypertensive urgency is a situation in which blood pressure is severely elevated but there is no evidence of actual or probable target organ damage. Secondary hypertension is high blood pressure from an identified cause, such as renal disease. Primary hypertension denotes high blood pressure from an unidentified source.
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 Explanation: 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).
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 Explanation: 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 teaches the client which guidelines regarding lifestyle modifications for hypertension?
Maintain adequate dietary intake of fruits and vegetables Explanation: Guidelines include adopting the Dietary Approaches to Stop Hypertension (DASH) eating plan: consume a diet rich in fruits, vegetables, and low-fat dairy products and reduced amounts of saturated and total fat; reduce dietary sodium intake to no more than 100 mmol/day (2.4 g sodium or 6 g sodium chloride); engage in regular aerobic physical activity such as brisk walking (at least 30 min/day, most days of the week); moderate alcohol consumption, limiting consumption to no more than two drinks (e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and to no more than one drink per day in women and lighter-weight people. Tobacco should be avoided because anyone with high blood pressure is already at increased risk for heart disease, and smoking amplifies this risk.
The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. Which of the following should the nurse integrate into the management of this clients hypertension?
Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion. Elderly people have impaired cardiovascular reflexes and thus are more sensitive to extracellular volume depletion caused by diuretics. The nurse needs to assess hydration status, low BP, and postural hypotension carefully. Older adults may have impaired absorption, but they do not need a higher initial dose of an antihypertensive than a younger person. Adherence to treatment is not necessarily linked to age. Kidney function and absorption decline with age; less, rather than more antihypertensive medication is prescribed. Weight gain is not necessarily indicative of kidney function decline.
An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for?
Postural hypotension and resulting injury Antihypertensive medication can cause hypotension, especially postural hypotension that may result in injury. Rebound hypertension occurs when antihypertensive medication is stopped abruptly. Sexual dysfunction may occur, especially with beta blockers, but other medications are available should this problem ensue. This is not immediately a priority concern. Antihypertensive medications do not usually cause postural hypertension.
Which finding indicates that hypertension is progressing to target organ damage?
Retinal blood vessel damage Symptoms suggesting that hypertension is progressing to the extent that target organ damage is occurring must be detected early so that appropriate treatment can be initiated. All body systems must be assessed to detect any evidence of vascular damage. An eye examination with an ophthalmoscope is important because retinal blood vessel damage indicates similar damage elsewhere in the vascular system. The client is questioned about blurred vision, spots in front of the eyes, and diminished visual acuity. The heart, nervous system, and kidneys are also carefully assessed. A BUN concentration of 12 mg/dL and urine output of 60 mL over 2 hours are normal findings.
A client, newly admitted to the nursing unit, has a primary diagnosis of renal failure. When assessing the client, the nurse notes a blood pressure (BP) of 180/100. The nurse knows that this is what kind of hypertension?
Secondary Secondary hypertension is elevated BP that results from or is secondary to some other disorder. This type of hypertension is not primary, essential, or malignant.
A patient with secondary hypertension has come into the clinic for a routine check-up. The nurse is aware that the difference between primary hypertension and secondary hypertension is which of the following?
Secondary hypertension has a specific cause. Secondary hypertension has a specific identified cause. A cause could include narrowing of the renal arteries, renal parenchymal disease, hyperaldosteronism, certain medications, pregnancy, and coarctation of the aorta. Secondary hypertension does respond to antihypertensive drug therapy and can cause target organ damage if left untreated.
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 Explanation: 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.
A patient has come to the clinic for a follow-up assessment that will include a BP reading. To ensure an accurate reading, the nurse should confirm that the patient has done which of the following?
Tried to rest quietly for 5 minutes before the reading is taken Prior to the nurse assessing the patients BP, the patient should try to rest quietly for 5 minutes. The forearm should be positioned at heart level. Caffeine products and cigarette smoking should be avoided for at least 30 minutes prior to the visit. Recent fluid intake is not normally relevant.
A nurse is providing education about hypertension to a community group. What are possible consequences of untreated hypertension? Select all that apply.
Coronary artery disease Myocardial infarction Stroke People with hypertension may remain asymptomatic for many years. When specific signs and symptoms appear, however, they usually indicate vascular damage. Coronary artery disease with angina and myocardial infarction are common consequences of hypertension. Cerebrovascular involvement may lead to a stroke. Tension pneumothorax and pancreatitis are not directly related to hypertension.
The nurse is reviewing the medication administration record of a patient who takes a variety of medications for the treatment of hypertension. What potential therapeutic benefits of antihypertensives should the nurse identify? Select all that apply.
Decreased peripheral resistance Decreased blood volume Decreased strength and rate of myocardial contractions The medications used for treating hypertension decrease peripheral resistance, blood volume, or the strength and rate of myocardial contraction. Antihypertensive medications do not increase venous return or decrease blood viscosity.
A community health nurse is planning an educational campaign addressing hypertension. The nurse should anticipate that the incidence and prevalence of hypertension are likely to be highest among members of what ethnic group?
Hispanics The prevalence of uncontrolled hypertension varies by ethnicity, with Hispanics and African Americans having the highest prevalence at approximately 63% and 57%, respectively.
A patient in hypertensive urgency is admitted to the hospital. The nurse should be aware of what goal of treatment for a patient in hypertensive urgency?
Normalizing BP within 24 to 48 hours In cases of hypertensive urgency, oral agents can be administered with the goal of normalizing BP within 24 to 48 hours. For patients with this health problem, a BP of 120/80 mm Hg may be unrealistic.
A patient comes to the walk-in clinic complaining of frequent headaches. While assessing the patients vital signs, the nurse notes the BP is 161/101 mm Hg. According to JNC 7, how would this patients BP be defined if a similar reading were obtained at a subsequent office visit?
Stage 2 hypertensive JNC 7 defines stage 2 hypertension as a reading 160/100 mm Hg.
The nursing lab instructor is teaching student nurses how to take blood pressure. To ensure accurate measurement, the lab instructor would teach the students to avoid which of the following actions?
Taking the BP at least 10 minutes after nicotine or coffee ingestion Blood pressures should be taken with the patient seated with arm bare, supported, and at heart level. The patient should not have smoked tobacco or taken caffeine in the 30 minutes preceding the measurement. The patient should rest quietly for 5 minutes before the reading is taken. The cuff bladder should encircle at least 80% of the limb being measured and have a width of at least 40% of limb circumference. Using a cuff that is too large results in a lower BP and a cuff that is too small will give a higher BP measurement.
The nurse is administering medications on a medical-surgical unit. A client is ordered to receive 40 mg oral nadolol for the treatment of hypertension. Before administering the medication, the nurse should
check the client's heart rate. Nadolol is a beta-blocker. A desired effect of this medication is to reduce the pulse rate in clients with tachycardia and elevated blood pressure (BP). The nurse should check the client's heart rate (HR) before administering nadolol to ensure that the pulse is not less than 60 beats per minute. The other interventions are not indicated before administering a beta-blocker medication.
The nurse is caring for a client with a blood pressure of 210/100 mm Hg in the emergency room. What is the most appropriate route of administration for antihypertensive agents?
continuous IV infusion The medications of choice in hypertensive emergencies are best managed through the continuous IV infusion of a short-acting titratable antihypertensive agent. The nurse avoids the sublingual and IM routes as their absorption and dynamics are unpredictable. The oral route would not have as quick an onset as a continuous IV infusion.
A nurse working in the clinic is seeing a client who has just been prescribed a new medication for hypertension. The client asks why hypertension is sometimes called the "silent killer." What is the best response by the nurse?
"Hypertension often causes no symptoms." Hypertension is sometimes called the "silent killer" because people with it are often symptom free. Physical examination may reveal no abnormalities other than elevated blood pressure. People with hypertension may remain asymptomatic for many years. The usual consequences of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, renal failure, strokes, and impaired vision. Pain is not usually an issue, but that is not why hypertension is called the "silent killer." Hypertension is easily diagnosed by taking a series of blood pressure readings.
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
An older adult is newly diagnosed with primary hypertension and has just been started on a beta-blocker. The nurses health education should include which of the following?
Use of strategies to prevent falls stemming from postural hypotension Elderly people have impaired cardiovascular reflexes and are more sensitive to postural hypotension. The nurse teaches patients to change positions slowly when moving from lying or sitting positions to a standing position, and counsels elderly patients to use supportive devices as necessary to prevent falls that could result from dizziness. Lifestyle changes, such as regular physical activity/exercise, and a diet rich in fruits, vegetables, and low-fat dairy products, is strongly recommended. Increasing fluids in elderly patients may be contraindicated due to cardiovascular disease. Increased intracranial pressure is not a risk and activity should not normally be limited.
A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. What will the nurse specify about this client's target blood pressure?
130/80 or lower Explanation: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) specifies a lower goal pressure of 130/80 for people with diabetes mellitus.
According to the DASH diet, how many servings of vegetables should a person consume each day?
4 or 5 Explanation: Four or five servings of vegetables are recommended in the DASH diet. The diet recommends two or fewer servings of lean meat, fish, and poultry; two or three servings of low-fat or fat-free dairy foods; and seven or eight servings of grains and grain products.
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.
Which term describes high blood pressure from an identified cause, such as renal disease?
Secondary hypertension Secondary hypertension is high blood pressure from an identified cause, such as renal disease. Primary hypertension denotes high blood pressure form an unidentified source. Rebound hypertension is pressure that is controlled with therapy and becomes uncontrolled (abnormally high) when that therapy is discontinued. A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage.
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.
A community health nurse teaching a group of adults about preventing and treating hypertension. The nurse should encourage these participants to collaborate with their primary care providers and regularly monitor which of the following?
Blood lipid levels Hypertension often accompanies other risk factors for atherosclerotic heart disease, such as dyslipidemia (abnormal blood fat levels), obesity, diabetes, metabolic syndrome, and a sedentary lifestyle. Individuals with hypertension need to monitor their sodium intake, but hypernatremia is not a risk factor for hypertension. In many patients, heart rate does not correlate closely with BP. Potassium levels do not normally relate to BP.
The nurse is collaborating with the dietitian and a patient with hypertension to plan dietary modifications. These modifications should include which of the following?
Reduced intake of fat and sodium Lifestyle modifications usually include restricting sodium and fat intake, increasing intake of fruits and vegetables, and implementing regular physical activity. There is no need to increase calcium, potassium, and vitamin intake. Calorie restriction may be required for some patients, but a specific reduction in protein and carbohydrates is not normally indicated.
A patient with newly diagnosed hypertension has come to the clinic for a follow-up visit. The patient asks the nurse why she has to come in so often. What would be the nurses best response?
We do this to make sure your health is stable. Well then monitor it at routinely scheduled intervals. When hypertension is initially detected, nursing assessment involves carefully monitoring the BP at frequent intervals and then at routinely scheduled intervals. The reference to stroke is frightening and does not capture the overall rationale for the monitoring regimen. Changes throughout the day are not a clinical priority for most patients. The patient must not change his or her medication doses unilaterally.
The nurse is developing a nursing care plan for a patient who is being treated for hypertension. What is a measurable patient outcome that the nurse should include?
Patient will reduce Na+ intake to no more than 2.4 g daily Dietary sodium intake of no more than 2.4 g sodium is recommended as a dietary lifestyle modification to prevent and manage hypertension. Giving a specific amount of allowable sodium intake makes this a measurable goal. None of the other listed goals is quantifiable and measurable.
A client diagnosed with hypertension informs the nurse that they are not taking prescribed antihypertensive medications due to an absence of symptoms. What is the most appropriate response by the nurse?
Inform the client that this is why hypertension is known as "the silent killer." Explanation: Hypertension is known as "the silent killer" because many people never experience any troubling symptoms until they are in an extremely dangerous medical position. Sometimes the condition actually leads to death without any warning. That is why it is important to take medications as prescribed in addition to following the recommended diet.
A client experiences orthostatic hypotension while receiving furosemide to treat hypertension. How will the nurse intervene?
Instruct the client to sit for several minutes before standing. To minimize the effects of orthostatic hypotension, the nurse should instruct the client to rise slowly, such as by sitting for several minutes before standing. Administering I.V. fluids would be inappropriate (unless the client were dehydrated) because doing so would counteract the effects of furosemide and could cause fluid imbalance. Administering a vasodilator, isosorbide, would further reduce the client's blood pressure, worsening orthostatic hypotension. Inserting an indwelling urinary catheter would make it easier to monitor urine output, but wouldn't minimize the effects of orthostatic hypotension.
A patient with primary hypertension complains of dizziness with ambulation. The patient is currently on an alpha-adrenergic blocker and the nurse assesses characteristic signs and symptoms of postural hypotension. When teaching this patient about risks associated with postural hypotension, what should the nurse emphasize?
Rising slowly from a lying or sitting position Patients who experience postural hypotension should be taught to rise slowly from a lying or sitting position and use a cane or walker if necessary for safety. It is not necessary to teach these patients about increasing fluids or taking medication in the morning (this would increase the effects of dizziness). Patient should not be taught to stop the medication if dizziness persists because this is unsafe and beyond the nurses scope of practice.
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?
"Can you tell me the reasons you aren't 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.
When administering benazepril with spironolactone, the nurse should be aware that which electrolyte imbalance may occur?
Hyperkalemia Explanation: ACE inhibitors like benazepril (Lotensin) and angiotensin receptor blockers (ARBs) block aldosterone and may cause hyperkalemia when used with a potassium sparing diuretic such as spironolactone (Aldactone). Hypercalcemia and hypocalcemia would not occur as an imbalance.
A client is admitted to the intensive care unit (ICU) with a diagnosis of hypertension emergency/crisis. The client's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV nitroprusside. Upon assessment, which finding requires immediate intervention by the nurse?
Numbness and weakness in the left arm Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. The finding of numbness and weakness in left arm may indicate the client is experiencing neurological symptoms associated with an ischemic stroke because of the severely elevated BP; immediate intervention is required. Urine output of 40 mL/h is within normal limits. The other findings are likely caused by the hypertension and require intervention, but they do not require action as urgently as the neurologic changes.
A patient is flying overseas for 1 week for business and packed antihypertensive medications in a suitcase. After arriving at the intended destination, the patient found that the luggage had been stolen. If the patient cannot take the medication, what condition becomes a concern?
Rebound hypertension Explanation: Patients need to be informed that rebound hypertension can occur if antihypertensive medications are suddenly stopped. Thus, patients should be advised to have an adequate supply of medication, particularly when traveling and in case of emergencies such as natural disasters. If traveling by airplane, patients should pack the medication in their carry-on luggage.
A 40-year-old male newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the patient and advises that the patient should avoid tobacco use. What is the primary rationale behind that advice to the patient?
Tobacco use increases the patients concurrent risk of heart disease. Smoking increases the risk for heart disease, for which a patient with hypertension is already at an increased risk. Quitting will not necessarily cause hypertension to resolve and smoking does not directly cause ventricular hypertrophy. The association with a sedentary lifestyle is true, but this is not the main rationale for the nurses advice; the association with heart disease is more salient.
A client who is newly diagnosed with hypertension is going to be starting antihypertensive medicine. What is one of the main things the client and the client's spouse should watch for?
dizziness A common adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. The client and the client's spouse should be alerted to this possibility and provided with some tips for managing dizziness.
The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in what way?
Hypertensive emergencies are associated with evidence of target organ damage Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. Blood pressures are extremely elevated in both urgency and emergencies, but there is no evidence of target organ damage in hypertensive urgency. Extremely close hemodynamic monitoring of the patients BP is required in both situations. The medications of choice in hypertensive emergencies are those with an immediate effect, such as IV vasodilators. Oral doses of fast-acting agents, such as beta-adrenergic blocking agents, angiotensin-converting enzyme inhibitors, or alpha-agonists, are recommended for the treatment of hypertensive urgencies.
The critical care nurse is caring for a patient just admitted in a hypertensive emergency. The nurse should anticipate the administration of what medication?
Sodium nitroprusside (Nitropress) The medications of choice in hypertensive emergencies are those that have an immediate effect. IV vasodilators, including sodium nitroprusside (Nitropress), nicardipine hydrochloride (Cardene), clevidipine (Cleviprex), fenoldopam mesylate (Corlopam), enalaprilat, and nitroglycerin, have immediate actions that are short lived (minutes to 4 hours), and they are therefore used for initial treatment. Ramipril is administered orally and would not meet the patients immediate need for BP management. Diuretics, such as Lasix, are not used as initial treatments and there is no indication for anticoagulants such as Coumadin.
A 66-year-old client presents to the emergency department reporting severe headache and mild nausea for the past 6 hours. Upon assessment, the client's BP is 210/120 mm Hg. The client has a history of hypertension and takes 1.0 mg clonidine twice daily. Which question is most important for the nurse to ask the client next?
"Have you taken your prescribed clonidine today?" The nurse must ask whether the client has taken his prescribed clonidine. Clients need to be informed that rebound hypertension can occur if antihypertensive medications are suddenly stopped. Specifically, a side effect of clonidine is rebound or withdrawal hypertension. Although the other questions may be asked, it is most important to inquire whether the client has taken the prescribed hypertension medication given the client's severely elevated BP.
Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension?
"Limiting my salt intake to 2 grams per day will improve my blood pressure." To lower blood pressure, a client should limit daily salt intake to 2 g or less. Alcohol intake is associated with a higher incidence of hypertension, poor compliance with treatment, and refractory hypertension. Moderate caffeine and fat intake don't significantly affect blood pressure
A 55-year-old male client newly diagnosed with hypertension returns to the physician's office for a routine follow-up appointment after several months of treatment with metoprolol. During the initial assessment, the nurse records the client's blood pressure (BP) as 180/90 mm Hg. The client states that the medication is not taken as prescribed. Which is the best response by the nurse?
"The medication you were prescribed may cause sexual dysfunction; are you experiencing this side effect?" Explanation: The nurse needs to understand why the client is not taking the medication. Metoprolol is a beta-blocker. All clients should be informed that beta-blockers might cause sexual dysfunction and that other medications are available if problems with sexual function occur. The other statements, although true, are not therapeutic and would not elicit the reason why the client was not taking the medication as prescribed.
A group of student nurses are practicing taking blood pressure. A 56-year-old male student has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, he exclaims, My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it? Which of the following responses by the nursing instructor would be best?
A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made Hypertension is confirmed by two or more readings with systolic pressure of at least 140 mm Hg and diastolic pressure of at least 90 mm Hg. An age of 56 does not constitute a risk factor in and of itself. The nurse should not tell the student that there is no need to worry.
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.
