414 E2 Brunner SG Ch 31

7. A patient has severe coronary artery disease (CAD) and hypertension. Which medication prescription should the nurse consult with the healthcare provider about that is contraindicated for a patient with severe CAD? a. Clonidine b. Amiloride c. Bumetanide d. Methyldopa

a. Clonidine Clonidine (Catapres) is contraindicated for clients with severe coronary artery disease.

3. A patient with hypertension is waking up several times a night to urinate. What laboratory studies should the nurse assess that may indicate pathologic changes in the kidneys due to the hypertension? (Select all that apply.) a. Creatinine b. Blood urea nitrogen (BUN) c. Complete blood count (CBC) d. Urine for culture and sensitivity e. AST and ALT

a. Creatinine b. Blood urea nitrogen (BUN)

10. 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.) a. Heart rate b. Respiratory rate c. Heart rhythm d. Character of apical and peripheral pulses e. Lung sounds

a. Heart rate c. Heart rhythm d. 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.

1. A patient is being seen at the clinic on a monthly basis for assessment of blood pressure. The patient 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 patient is experiencing? a. Isolated systolic hypertension b. Secondary hypertension c. Primary hypertension d. Hypertensive urgency

a. Isolated systolic hypertension 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).

11. 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? a. Lowering and controlling the blood pressure without adverse effects and without undue cost b. Making sure that the patient adheres to the therapeutic medication regimen c. Instructing the patient to enter a weight loss program and begin an exercise regimen d. Scheduling the patient for all follow-up visits and making phone calls to the home to ensure adherence

a. Lowering and controlling the blood pressure without adverse effects and without undue cost The objective of nursing care for patients with hypertension focuses on lowering and controlling the blood pressure without adverse effects and without undue cost.

14. A patient is brought to the emergency department reporting 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? a. Reduce the blood pressure by 20% to 25% within the first hour of treatment b. Reduce the blood pressure to about 140/80 mm Hg c. Rapidly reduce the blood pressure so the patient will not suffer a stroke d. Reduce the blood pressure by 50% within the first hour of treatment

a. 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.

4. A patient with long-standing hypertension is admitted to the hospital with hypertensive urgency. The healthcare provider orders a chest x-ray, which reveals an enlarged heart. What diagnostic test does the nurse anticipate preparing the patient for to determine left ventricular enlargement? a. Cardiac catheterization b. Echocardiography c. Stress test d. Tilt-table test

b. Echocardiography

6. A patient is taking amiloride and lisinopril for the treatment of hypertension. What laboratory studies should the nurse monitor while the patient is taking these two medications together? a. Magnesium level b. Potassium level c. Calcium level d. Sodium level

b. 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.

13. 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? a. Isolated systolic hypertension b. Rebound hypertension c. Angina d. Left ventricular hypertrophy

b. Rebound hypertension 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.

8. A patient has been diagnosed with prehypertension and has been encouraged to exercise regularly and begin a weight loss program. After what period of time does the nurse inform the patient to return for a follow-up visit? a. 2 months b. 6 months c. 1 year d. 2 years

c. 1 year A client with an initial BP in the prehypertension range should have another BP check in 1 year. A normal BP should be rechecked in 2 years. Grade 1 hypertension should be confirmed and followed up within 2 months. Grade 2 hypertension should be evaluated or referred to a source of care within 1 month.

5. A patient with hypertension has been able to maintain a blood pressure of 130/70 mm Hg for 1 year while reducing dietary sodium and taking hydrochlorothiazide and atenolol. What treatment plan will the nurse educate the patient about? a. Continuing the medication and reducing dietary sodium b. Discontinuing the hydrochlorothiazide and atenolol and continuing to reduce sodium intake c. Gradually reducing the hydrochlorothiazide and the atenolol and continuing to reduce sodium intake d. Gradually reducing the atenolol and continuing the hydrochlorothiazide.

c. Gradually reducing the hydrochlorothiazide and the atenolol and continuing to reduce sodium intake When the blood pressure is less than 140/90 mm Hg for at least 1 year, gradual reduction of the types and doses of medication is indicated. Continuing to reduce sodium intake is a healthy lifestyle measure than anyone with hypertension should make.

12. A patient informs the nurse, "I can't adhere to the dietary sodium decrease that is required for the treatment of my hypertension." What can the nurse educate the client about regarding this statement? a. If dietary sodium isn't restricted, the patient will be unable to control the blood pressure and will be at risk for stroke b. The patient can speak to the healthcare provider about increasing the dosage of medication instead of reducing the added salt c. It takes 2 to 3 months for the taste buds to adapt to changes in salt intake d. The patient should use other methods of flavoring foods

c. It takes 2 to 3 months for the taste buds to adapt to changes in salt intake The program usually consists of restricting sodium and fat intake, increasing intake of fruits and vegetables, and implementing regular physical activity. Explaining that it takes 2 to 3 months for the taste buds to adapt to changes in salt intake may help the client adjust to reduced salt intake.

9. The nurse is assessing the blood pressure for a patient who has hypertension and the nurse does not hear an auscultatory gap. What outcome may be documented in this circumstance? a. A low diastolic reading b. A high systolic pressure reading c. A normal reading d. A high diastolic or low systolic reading

d. A high diastolic or low systolic reading An auscultatory gap is when the Korotkoff sounds disappear for a brief period as the cuff is being deflated. Failure to notice an auscultatory gap can result in erroneously high diastolic or low systolic pressure readings (Ogedegbe & Pickering, 2010).

15. 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 mm Hg but finds no evidence of impending or progressive organ damage when performing the assessment on the patient. What situation does the nurse determine this patient is experiencing? a. Hypertensive emergency b. Primary hypertension c. Secondary hypertension d. Hypertensive urgency

d. Hypertensive urgency 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).

2. The nurse is assessing a patient with severe hypertension. When performing a focused assessment of the eyes, what may be observed related to the hypertension? a. Cataracts b. Glaucoma c. Retinal detachment d. Papilledema

d. Papilledema