review question chapt 31

A 55-year-old man newly diagnosed with hypertension returns to his physician's office for a routine follow-up appointment after several months of treatment with Lopressor (metoprolol). During the nurse's initial assessment the patient's blood pressure (BP) is recorded as 180/90 mm Hg. The patient states he does not take his medication as prescribed. The best response by the nurse is which of the following

"The medication you were prescribed may cause sexual dysfunction; are you experiencing this side effect?" The nurse needs to understand why the patient is not taking his medication. Lopressor is a beta-blocker. All patients should be informed that beta-blockers might cause sexual dysfunction and that other medications are available if problems with sexual function occur.

Isolated systolic hypertension is demonstrated by readings in which the systolic pressure exceeds

140 mm Hg and the diastolic measurement is normal or near normal (less than 90 mm Hg).

Officially, hypertension is diagnosed when the patient demonstrates a systolic blood pressure greater than ______ mm Hg and a diastolic blood pressure greater than _____ mm Hg over a sustained period

140, 90

A systolic BP of greater than or equal to

160 is classified as stage II hypertension.

The patient should avoid smoking cigarettes or drinking caffeine for 30 minutes before

BP is measured.

Diuresis is a desired effect post administration of

Bumex.

flow rate of filtered fluid through the kidney, an indicator of renal function

Glomerular filtration rate GFR

It is important for the nurse to encourage the patient diagnosed with hypertension to rise slowly from a sitting or lying position for which of the following reasons

Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. It is important for the nurse to encourage the patient 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 and not blood pressure or heart rate.

a Situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage

Hypertensive emergency

The nurse understands that patient education related to antihypertensive medication should include all of the following instructions except which of the following

If a dosage of medication is missed, double up on the next one to catch up. Doubling doses could cause serious hypotension (HTN) and is not recommended. Medications should be taken as prescribed. Hot baths, strenuous exercise, and excessive alcohol are all vasodilators and should be avoided. Many OTC preparations can precipitate HTN.

A 77-year-old woman presents to the local community center for a blood pressure screening. The women's blood pressure is recorded as 180/90 mm Hg. The woman has a history of hypertension, but she currently is not taking her medications. Which of the following questions is most appropriate for the nurse to ask the patient first

It is important for the nurse to first ascertain if the reason why the patient is not taking her 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.

When measuring the blood pressure in each of the patient's arms, the nurse recognizes that in the healthy adult, which of the following is true

Pressures should not differ more than 5 mm Hg between arms. Normally, in the absence of disease of the vasculature, there is a difference of no more than 5 mm Hg between arm pressures.

denotes high blood pressure from an unidentified cause; also called essential hypertension

Primary hypertension

The nurse understands that an overall goal of hypertension management includes which of the following

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 patient does not experience target organ damage.

The nurse is caring for a client newly diagnosed with secondary hypertension. Which of the following conditions contributes to the development of secondary hypertension

Renal disease

Hypertension that can be attributed to an underlying cause is termed which of the following

Secondary

The nurse is caring for a patient prescribed Bumex (bumetanide) for the treatment of stage 2 hypertension. Which of the following indicates the patient is experiencing an adverse effect of the medication

Serum potassium value of 3.0 mEq/L

Target organ damage from untreated/undertreated hypertension includes which of the following

Target organ systems include cardiac, cerebrovascular, peripheral vascular, renal, and the eye.

A 66-year-old client presents to the emergency room (ER) complaining of a severe headache and mild nausea for the last 6 hours. Upon assessment, the patient's BP is 210/120 mm Hg. The patient has a history of HTN for which he takes 1.0 mg clonidine (Catapres) twice daily for. Which of the following questions is most important for the nurse to ask the patient next

The nurse must ask if the patient has taken his prescribed Catapres.

The nurse is administering medications on a medical surgical unit. A patient is ordered to receive 40 mg of oral Corgard (nadolol) for the treatment of hypertension. Prior to administering the medication, the nurse should complete which of the following

The nurse should check the patient's heart rate (HR) prior to administering Corgard to ensure that the patient's pulse rate is not below 60 (beats per minute (bpm).

The nurse is caring for a patient newly diagnosed with hypertension. Which of the following statements if made by the patient indicates the need for further teaching

The patient needs to understand the disease process and how lifestyle changes and medications can control hypertension. The patient must take his/her medication as directed. A normal BP indicates the medication is producing its desired effect. The other responses do not indicate the need for further teaching.

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

Two or fewer servings of meat, fish, and poultry are recommended in the DASH diet.

Which of the following statements are true when the nurse is measuring blood pressure (BP)

Using a BP cuff that is too small will give a higher BP measurement, The patient's arm should be positioned at the level of the heart, Ask the patient to sit quietly while the BP is being measured.

Patients taking loop diuretic may experience

a low serum potassium level.

Angiotensin-converting enzyme (ACE) inhibitors can induce

a mild to severe dry cough.

The desired effects of antihypertensives are to maintain

a normal BP.

According to the categories of blood pressure levels established by the Joint National Committee (JNC) VI, stage 1 hypertension is demonstrated by

a systolic pressure of 140 to 159, or a diastolic pressure of 90 to 99. Pressure of 130 systolic and 80 diastolic falls within the normal range for an adult. Pressure of 110 systolic and 60 diastolic falls within the normal range for an adult. Pressure of 120 systolic and 70 diastolic falls within the normal range for an adult.

Guidelines for lifestyle modification in patients with hypertension include

adopting the dietary approaches to stop hypertension (DASH) eating plan: consume a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat, dietary sodium reduction: reduce dietary sodium intake to no more than 100 mmol/day (2.4 g sodium or 6 g sodium chloride),

Patients need to be informed that rebound hypertension can occur if

antihypertensive medications are suddenly stopped.

The heart, nervous system, and kidneys are also carefully

assessed.

Postural hypotension and sexual dysfunction are side effects of

certain antihypertension medications.

Abnormal blood lipid levels, including high total, low density lipoprotein, and triglyceride levels as well as low high density lipoprotein levels

dyslipidemia

Guidelines for lifestyle modification in patients with hypertension include physical activity such as

engage in regular aerobic physical activity such as brisk walking (at least 30 min/day, most days of the week),

Bumex is a loop diuretic that can cause

fluid and electrolyte imbalances.

Direct vasodilators may cause

headache and increased heart rate.

Beta-blockers may induce decreased

heart rate; pulse rate should be assessed before administration.

Hyperlipidemia and diabetes are risk factors for development of

hypertension.

Stopping antihypertensives abruptly can precipitate a severe

hypertensive reaction and is not recommended.

a situation in which blood pressure is severely elevated but there is no evidence of target organ damage

hypertensive urgency

Secondary hypertension occurs when a cause for the high blood pressure can be

identified. These causes include renal parenchymal disease, narrowing of the renal arteries, hyperaldosteronism (mineralocorticoid hypertension), pheochromocytoma, certain medications (e.g., prednisone, epoietin alfa [Epogen]), and coarctation of the aorta.

a condition most commonly seen in the older adult in which the systolic pressure is greater than 140 mm Hg and the diastolic pressure is within normal limits (less than 90 mm Hg)

isolate systolic hypertension

Guidelines for lifestyle modification in patients with hypertension include Moderate alcohol consumption

limit consumption to no more than two drinks (eg, 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and to no more than 1 drink per day in women and lighter-weight people.

When using a BP cuff that is too large the reading will be

lower than the actual BP.

medication therapy with a single medication

monotherapy

A BUN level and 60 cc/mL over 2 hours are

normal findings.

A systolic BP of less than 120 mm Hg is

normal.

ECG changes associated with an elevated serum potassium levels include

peaked T waves.

Thiazide diuretics may deplete

potassium; many clients will need potassium supplementation.

High blood pressure can also occur with

pregnancy; women who experience high blood pressure during pregnancy are at increased risk of ischemic heart disease, heart attacks, strokes, kidney disease, diabetes, and death from heart attack.

A systolic blood pressure of 135 mm Hg is classified as

prehypertension.

Blood pressure that is controlled with medication and becomes uncontrolled (abnormally high) with the abrupt discontinuation of medication

rebound hypertension

a side effect of Catapres is

rebound or withdrawal hypertension.

High blood pressure from an identified cause, such as renal disease

secondary hypertension

Adrenergic inhibitors can cause

sedation and fatigue.

A systolic BP of 140 to 159 mm Hg is

stage I hypertension.

prehypertension for adults

systolic 120-139 and diastolic 80-89

stage 1 hypertension for adults

systolic 140-159 diastolic 90-99

Normal Blood pressure range for adults

systolic <120 and diastolic <80

stage 2 hypertension for adults

systolic equal to or greater than 160 and diastolic equal to or greater than 100

Secondary hypertension may be caused by a

tumor of the adrenal gland (eg, pheochromocytoma).

Essential hypertension has no known

underlying cause.

Primary hypertension has no known

underlying cause.

Diuretics cause increased

urination; the patient should not take the medication prior to going to bed.

The nurse is caring for a client who is prescribed diuretic medication for the treatment of hypertension. The nurse recognizes that which of the following medications conserves potassium

Aldactone is known as a potassium-sparing diuretic. Lasix causes loss of potassium from the body. Diuril causes mild hypokalemia. Hygroton causes mild hypokalemia.

Which of the following findings indicates that hypertension is progressing to target organ damage

An eye examination with an ophthalmoscope is important because retinal blood vessel damage indicates similar damage elsewhere in the vascular system. The patient is questioned about blurred vision, spots in front of the eyes, and diminished visual acuity.

A patient is admitted to the intensive care unit (ICU) with a diagnosis of hypertension emergency/crisis. The patient's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV Nitropress (nitroprusside). Upon assessment, which of the following patient findings requires immediate intervention by the nurse

Left arm numbness and weakness The finding of left arm numbness and weakness may indicate the patient is experiencing neurological symptoms associated with an ischemic stroke because of the severely elevated BP and requires immediate interventions.

The nurse teaches the patient which of the following guidelines regarding lifestyle modifications for hypertension

Maintain adequate dietary intake of fruits and vegetables

The nurse is conducting a service project for a local elderly community group on the topic of hypertension. The nurse will relay that risk factors and cardiovascular problems related to hypertension include which of the following

Major risk factors (in addition to hypotension) include smoking, dyslipidemia (high LDL, low HDL cholesterol), diabetes mellitus, impaired renal function, obesity, physical inactivity, age (older than 55 years for men, 65 years for women), and family history of cardiovascular disease.

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

Prehypertension

The nurse is caring for a female client who has had 25 mg of oral hydrochlorothiazide added to her medication regimen for the treatment of hypertension (HTN). Which of the following instructions should the nurse give the patient

Thiazide diuretics cause loss of sodium, potassium, and magnesium. The patient should be encouraged to eat fruits and vegetables which are high in potassium.

Corgard is a

beta-blocker. A desired effect of this medication is to reduce the pulse rate in patients with tachycardia and an elevated blood pressure (BP).

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.

Guidelines for lifestyle modification in patients with hypertension include Tobacco

should be avoided because anyone with high blood pressure is already at increased risk for heart disease, and smoking amplifies this risk.

A 35-year-old female patient has been diagnosed with hypertension. The patient is a stock broker, smokes daily, and is also a diabetic. During a follow-up appointment, the patient states that she finds it cumbersome and time consuming to visit the doctor regularly just to check her blood pressure (BP). As the nurse, which of the following aspects of patient teaching would you recommend

Purchasing a self-monitoring BP cuff Because this patient finds it time consuming to visit the doctor just for a blood pressure reading, as the nurse, you can suggest the use of an automatic cuff at a local pharmacy, or purchasing a self-monitoring cuff.