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The most commonly recognized outcome of hypertension is pulmonary disease.

The most commonly recognized outcome of hypertension is cardiovascular disease

Hypertension is closely linked to a. obstructive sleep apnea. b. urinary tract infection. c. de Quervain syndrome. d. spinal stenosis.

ANS: A Hypertension is present in 45% to 60% of those diagnosed with obstructive sleep apnea. Urinary tract infection is not directly linked to hypertension. de Quervain syndrome is a type of tendonitis and is not linked to hypertension. Spinal stenosis is not closely associated with hypertensio

An erroneously low blood pressure measurement may be caused by a. positioning the arm above the heart level. b. using a cuff that is too small. c. positioning the arm at heart level. d. measuring blood pressure after exercise.

ANS: A An erroneous blood pressure result could occur with the arm above the level of the heart. It is important to measure blood pressure with the appropriate size cuff. The arm should be positioned at the level of the heart for a more accurate reading. Measuring pressure after exercise yields a higher measurement.

Which finding is indicative of orthostatic hypotension in a person with a supine blood pressure (BP) of 110/70 and a heart rate (HR) of 100? a. Sitting BP 88/60, HR 118 b. Sitting BP 108/68, HR 102 c. Sitting BP 110/78, HR 98 d. Sitting BP 120/80, HR 100

ANS: A The definition of orthostatic hypotension is a decrease in systolic blood pressure greater than 20 mm Hg or a decrease in systolic pressure that is greater than 10 mm Hg within 3 minutes of moving to an upright position. The measurements of BP 108/68, HR 102 and BP 110/78, HR 98 are not indicative of orthostatic hypotension. An increase in blood pressure do not occur with orthostatic hypotension.

After being diagnosed with hypertension, a patient returns to the clinic 6 weeks later. The patient reports "moderate" adherence to the recommended lifestyle changes and has experienced a decreased from 165/96 to 148/90 mm Hg in blood pressure. What is the most appropriate intervention for this patient at this time? a. Continue lifestyle modifications only. b. Continue lifestyle modifications plus diuretic therapy. c. Continue lifestyle modifications plus ACE inhibitor therapy. d. Continue lifestyle modifications plus -blocker therapy.

ANS: A The patient should be encouraged to continue compliance with lifestyle changes since the patient has exhibited some positive response to his changes. Diuretics are not needed at this time. ACE inhibitors should not be added to the therapy yet. Beta-blockers are not required at this time.

Orthostatic hypotension is a risk factor for (Select all that apply.) a. stroke. b. cognitive impairment. c. death. d. myocardial infarction. e. urinary retention.

ANS: A, B, C Orthostatic hypotension is associated with cardiovascular disease and is a risk factor for stroke, cognitive impairment, and death. Myocardial infarction is not as a result of orthostatic hypotension. Urinary retention is not associated with orthostatic hypotension.

Blood pressure is regulated on a short-term basis through (Select all that apply.) a. interaction of carotid and aortic baroreceptors. b. vasomotor center in the brainstem. c. activation of SNS. d. inhibition of PSNS. e. activation of RAAS.

ANS: A, B, C, D Blood pressure is regulated on a short-term basis through the interaction of the carotid and aortic baroreceptors, the vasomotor center in the brainstem, and the activation of the SNS and inhibition of the PSNS influences on the heart and smooth muscle in the arterioles. Activation of the RAAS affects fluid balance, but does not directly regulate short-term blood pressure.

It can be explained to a patient that high blood pressure increases the risk of (Select all that apply.) a. stroke. b. renal disease. c. diabetes. d. ischemic heart disease. e. liver disease.

ANS: A, B, D Hypertension increases morbidity and mortality associated with stroke. Kidney disease or failure is associated with hypertension. Ischemic heart disease has an increase in morbidity and mortality when partnered with hypertension. Diabetes is not directly associated with hypertension. Liver disease is not linked with hypertension.

Atherosclerosis puts a patient at risk for (Select all that apply.) a. ischemic stroke. b. hemorrhagic stroke. c. retinal injury. d. renal impairment. e. liver disease.

ANS: A, C, D Ischemic strokes are associated with atherosclerosis because of weakened blood vessels in the brain. Retinal injury and renal impairment may result because of changes in the microcirculation as a result of atherosclerosis. Hemorrhagic stroke is not associated with atherosclerosis. Liver disease is not associated with atherosclerosis.

Angiotensin-converting enzyme (ACE) inhibitors block the a. release of rennin. b. conversion of angiotensin I to angiotensin II. c. conversion of angiotensinogen to angiotensin I. d. effect of aldosterone on the kidney.

ANS: B Angiotensin I is converted into angiotensin II while it is circulating through the pulmonary vessels, by the angiotensin-converting enzyme. ACE inhibitors block the conversion of angiotension I to angiotension II. Renin plays a role in the regulation of arterial blood pressure. ACE inhibitors do not block the conversion of angiotensinogen to angiotensin or the effect of aldosterone on the kidney.

A middle-aged patient has a follow up visit for a recorded blood pressure of 162/96 mm Hg taken 3 weeks ago. The patient has no significant past medical history and takes no medications, but smokes 1 1/2 packs of cigarettes per day, drinks alcohol regularly, and exercises infrequently. The patient is about 40 lbs. overweight and admits to a high-fat, high-calorie diet. At the office visit today, the patient's blood pressure is 150/92 mm Hg. What is the least appropriate intervention for this patient at this time? a. Begin lifestyle modifications. b. Begin antihypertensive drug therapy. c. Recheck blood pressure in 4 to 6 weeks. d. Encourage smoking cessation.

ANS: B Antihypertensive drug therapy is not the first intervention in a person with modifiable risk factors. Therefore, lifestyle alterations are attempted first. Lifestyle alterations include exercise, smoking cessation, and weight loss. Blood pressure should be rechecked in 4 to 6 weeks. Smoking cessation counseling is an appropriate lifestyle alteration.

A patient has a history of falls, syncope, dizziness, and blurred vision. The patient's symptomology is most likely related to a. hypertension. b. hypotension. c. deep vein thrombosis. d. angina.

ANS: B Hypotension is low blood pressure characterized by dizziness, blurred vision, syncope, and injury from falls. Hypertension is high blood pressure characterized by headache, confusion, chest pain, and difficulty breathing. Deep vein thrombosis is evidenced by calf pain or tenderness. Angina is characterized by chest, shoulder, or jaw pain.

Which blood pressure reading is considered to be indicative of prehypertension according to the JNC-7 criteria? a. 118/78 b. 128/82 c. 140/88 d. 138/94

ANS: B In adults, a normal blood pressure is <120 mm Hg systolic and <80 mm Hg diastolic pressure. Stage 1 hypertension begins with a systolic pressure of 140 mm Hg or a diastolic pressure of 90 mm Hg. Between these values, the individual is said to have prehypertension, and interventions related to lifestyle changes should be initiated for primary hypertension. 118/78 is considered normal. An individual with a reading of 140/88 or 138/94 may be considered to have stage 1 hypertension.

Critically ill patients may have parenterally administered vasoactive drugs that are adjusted according to their _____ pressure. a. systolic b. mean arterial c. diastolic d. pulse

ANS: B The mean arterial pressure is used to make incremental adjustments to vasoactive drugs. The MAP is the calculated average pressure within the circulatory system throughout the cardiac cycle. The systolic pressure is a part of the calculation but is not the data element used in adjustment of vasoactive medications. The diastolic reading is involved in calculating the MAP, but is not the number used in titration of vasoactive medications. The pulse pressure is the difference between the systolic and diastolic pressure.

Hypertension with a specific, identifiable cause is known as _____ hypertension. a. primary b. orthostatic c. secondary d. malignant

ANS: C Secondary hypertension has a specific identifiable cause such as a specific pathology or a condition that results in hypertension. Primary hypertension does not have a clearly identifiable etiology and is therefore an idiopathic disorder. Positional changes do not generally result in hypertension. Malignant hypertension is a hypertensive crisis.

Restriction of which electrolytes is recommended in the management of high blood pressure? a. Calcium b. Potassium c. Sodium d. Magnesium

ANS: C The balance of the intake of water and sodium with their excretion by the kidney remains the central feature of long-term blood pressure maintenance. Sodium is not rapidly eliminated by the kidney like water and adds to the body's fluid volume. It is not necessary to restrict the intake of calcium when managing high blood pressure. Potassium does not need to be restricted in the management of high blood pressure. Magnesium does not play a role in the management of high blood pressure.

The prevalence of high blood pressure is higher in a. non-Hispanic white adults. b. Mexican-American adults. c. non-Hispanic black adults. d. Asian children.

ANS: C The prevalence of high blood pressure remains higher among non-Hispanic black adults. Non-Hispanic white adults have a lower prevalence of high blood pressure. Mexican-American adults have a lower prevalence than black adults. Asian children do not display a high prevalence for high blood pressure.

What results when systemic blood pressure is increased? a. Hypovolemia b. Decreased cardiac output c. Vasoconstriction d. Decreased vascular resistance

ANS: C At the smooth muscle of the arterial system, neurotransmitters bind to receptors to initiate vasoconstriction and increase systemic vascular resistance. An increase in vascular resistance causes the heart to work harder and thus increases blood pressure. Hypovolemia does not result in an increase in blood pressure. Cardiac output is not decreased when systemic blood pressure is increased. Vascular resistance is actually increased when the systemic blood pressure is increased.

Pulse pressure is defined as a. two thirds of systolic pressure + diastolic pressure. b. systolic pressure + diastolic pressure. c. systolic pressure - diastolic pressure. d. systolic pressure systemic resistance.

ANS: C Pulse pressure is defined as the difference between systolic and diastolic blood pressure. Pulse pressure is the difference between systolic and diastolic pressure. Pulse pressure is not the sum of the systolic and diastolic pressures. Systemic resistance is not involved in determining the pulse pressure.

High blood pressure increases the workload of the left ventricle, because it increases a. stroke volume. b. blood volume. c. preload. d. afterload.

ANS: D Hypertension reflects an elevation in SVR; rising afterload increases myocardial oxygen demand and overall cardiac workload. The w

A patient presents to the emergency department with a diastolic blood pressure of 132 mm Hg, retinopathy, and symptoms of an ischemic stroke. This symptomology is likely the result of a. arthrosclerosis. b. angina. c. myocardial infarction. d. hypertensive crisis.

ANS: D Hypertensive crisis is characterized by a diastolic blood pressure of greater than 120 mm Hg, and symptoms of end-organ damage such as retinopathy and ischemic stroke. Blood pressure is not an indication of arthrosclerosis. Angina may accompany hypertensive crisis, but the question stem relates directly to hypertensive crisis. The patient may be having a myocardial infarction, but the addition of end-organ damage symptoms points to hypertensive crisis.

New-organ damage is a function of both the stage of hypertension and its duration.

ANS: F End-organ damage is a function of both the stage of hypertension and its duration.

The ingestion of certain drugs, foods, or chemicals can lead to secondary hypertension.

ANS: T The ingestion of certain drugs, foods, or chemicals can lead to secondary hypertension.

orthostatic hypotension

Decrease in blood pressure related to positional or postural changes from lying to sitting or standing positions

ischemic stroke

a type of stroke that occurs when the flow of blood to the brain is blocked