ch 31 hypertension

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

2 or fewer

Approximately what percentage of adults in the United States have hypertension?

30

According to the DASH diet, how many servings of vegetables should a person consume each day?

4 or 5

Which of the following would be inconsistent with a hypertensive urgency?

Intracranial hemorrhage

Which diuretic medication conserves potassium?

Spironolactone

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

Hypertensive urgency

A nurse is discussing with students how to accurately measure blood pressures. Which of the following information is the nurse certain to emphasize

Routinely calibrate the sphygmomanometer

A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. For a client without diabetes mellitus, the target blood pressure is 140/90 or lower. Because this client has diabetes mellitus, the target blood pressure will be which of the following?

130/80 or lower P888

patient has severe coronary artery disease (CAD) and hypertension. Which medication order should the nurse consult with the physician about that is contraindicated for a patient with severe CAD?

Clonidine (catapres)

A nurse is providing education about hypertension to a community group. One client reports that his doctor has diagnosed him with hypertension, but that he feels just fine. He asks, "What would happen if I did not treat my hypertension?" Which of the following are possible consequences of untreated hypertension? Choose all that apply.

Coronary artery disease Myocardial infarction Stroke

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 amounts of fruits and vegetables you eat each day

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 patient is taking amiloride (Midamor) and lisinopril (Zestril) for the treatment of hypertension. What laboratory studies should the nurse monitor while the patient is taking these two medications together?

k+ level

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

Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through:

ophthalmic examination

The nurse is seeing a client for the first time and has just checked the client's blood pressure. The nurse would consider the client prehypertensive if:

systolic BP is between 120 and 139 mm Hg.

Which adrenergic inhibitor acts directly on the blood vessels, producing vasodilation?

Pazosin

A nursing class is practicing measurement of blood pressure. One otherwise healthy participant, 46 years old, is 138/90. This man requires follow-up. In which classification of hypertension is he according to the JNC 7 (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood pressure) recommendation?

Stage 1

Instructions for the client regarding measuring the blood pressure at home include the following:

(1) Avoid smoking cigarettes or drinking caffiene 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.

The nurse is explaining the DASH diet to a patient diagnosed with hypertension. The patients inquires about how many servings of fruit per day can be consumed on the diet. The nurse would be correct in stating which of the following?

4 or 5

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."

While in nursing school, you discover the prevalence of high blood pressure in the United States and are amazed at its frequency of occurrence. Which of the following is closest to approximately how many people have high blood pressure?

1 in 4 adults

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 tell the patient to return for a follow-up visit?

1 year

During a routine physical examination, the nurse assesses a blood pressure reading of 150/90 mm Hg. The patient's blood work indicates several abnormal results. The health care provider informs the nurse that he suspects that the patient has metabolic syndrome. The nurse knows that this diagnosis is associated with three classic signs/symptoms. Select all that apply.

A blood pressure reading greater than 130/85 mm Hg Dyslipidemia and/or abdominal obesity Insulin resistance

You are teaching a health class at the local YMCA. What body system would you explain regulates arterial blood pressure?

ANS The kidneys, and various endocrine glands regulate arterial pressure

The nurse is caring for a client with hypertension. The nurse is correct to realize that a 24-hour urine is ordered to determine if the cause of hypertension is related to the dysfunction of which of the following?

Adrenal gland

Which condition contributes to secondary hypertension?

Arterial vasoconstriction p886

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 (antihypertensive) twice daily. Which question is mostimportant for the nurse to ask the client next?

Have you taken your prescribed clonidine today?

A nurse providing education about hypertension to a community group is reviewing consequences of the disease. Which of the following would the nurse identify as target organs for hypertensive damage? Choose all that apply.

Heart Kidneys Brain Eyes

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

Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage?

Hypertensive emergency

Aging is positively correlated to the incidence of hypertension. This is due to three of the following four structural or functional changes. Which choice is not considered a cause?

Increased ability to exert diastolic pressure

a patient is brought to the emergency department with complaints 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.

Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress

Reduced stress decreases the production of neurotransmitters that constrict peripheral arterioles. Reduced stress may assist in reducing blood volume and resistance to the heart

A client comes to the emergency department complaining of visual changes and a severe headache. The nurse measures the client's blood pressure at 210/120 mm Hg. However, the client denies having hypertension or any other disorder. After diagnosing malignant hypertension (hypertensive emergency), a life-threatening disorder, the physician initiates emergency intervention. What is the most common cause of malignant hypertension (hypertensive emergency)?

Untreated hypertension

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.

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 high diastolic or low systolic reading

41s The nurse is caring for a patient with an intracranial hemorrhage. The patient is having a hypertensive emergency. Which of the following nursing intervention would take priority in this patient?

avoid lowering the BP too quickly

A nurse is caring for a client with hypertension. The physician orders furosemide (lasix) 2 mg/kg to be given intravenously. The client weighs 24 kg. The medication comes in a single-use vial that contains 40 mg in 4 mL (10 mg/mL). How much will the nurse draw up for this client's dose?

4.8 ml

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

A nurse is teaching a 38-year-old man with newly diagnosed hypertension who asks if there is any harm in stopping his antihypertensive medication if he decides to discontinue it. The correct reply addresses the consequence of stopping antihypertensive medications abruptly. Which of the following statements from the nurse would be appropriate?

rebound hypertension

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. He asks the nurse what his blood pressure should be. The nurse's most appropriate response is:

"Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg."

A client with high blood pressure is receiving an antihypertensive drug. The nurse knows that antihypertensive drugs commonly cause fatigue and dizziness, especially on rising. 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." p897

The nurse is working on a busy cardiac unit caring for four hypertensive clients. Which client description would the nurse assess first because the client is at an increased risk for malignant hypertension?

A client with anorexia and history of no healthcare insurance

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

A patient is being seen at the clinic on a monthly basis for assessment of blood pressure. The patient has been checking her 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?

Isolated systolic hypertension

A nurse is educating about lifestyle modifications for a group of clients with newly diagnosed hypertension. While discussing dietary changes, which of the following points would the nurse emphasize?

It takes 2 to 3 months for the taste buds to adapt to decreased salt intake.

The nurse is caring for an 82-year-old male client who has come to the clinic for a yearly physical. When assessing the client, the nurse notes the blood pressure (BP) is 140/93. The nurse knows that in older clients what happens that may elevate the systolic BP?

Loss of arterial elasticity

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

The nurse teaches the client which guidelines regarding lifestyle modifications for hypertension?

Maintain adequate dietary intake of fruits and vegetables

When measuring the blood pressure in each arm of a healthy adult client, the nurse recognizes that which statement is true?

Pressures should not differ more than 5 mm Hg between arms.

A client with severe hypertension states, "I feel fine; I'm not really sick at all." The nurse will teach the client that the system/organs particularly targeted for damage by severe hypertension include which of the following?

Sensory

A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. Which of the following are risk factors for cardiovascular problems in clients with hypertension? Choose all that apply.

Smoking Diabetes mellitus Physical inactivity

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

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

two or three servings of low-fat or fat-free dairy foods, four or five servings of fruits and vegetables, and seven or eight servings of grains and grain products.

A patient is being treated for hypertensive emergency. When treating this patient, the priority goal is to lower the mean blood pressure (BP) by which percentage in the first hour?

up to 25%

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

be lower than the actual BP

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

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

When treating hypertensive emergencies, the nurse identifies the most appropriate route of administration for antihypertensive agents as being which of the following?

continuous IV infusion

The nurse is caring for a client with essential hypertension. The nurse reviews labwork and assesses kidney function. Which action of the kidney would the nurse evaluate as the body's attempt to regulate high blood pressure

excretes sodium and water

The nurse observes a certified nursing assistant (CNA) obtaining a blood pressure reading with a cuff that is too small for the patient. The nurse informs the CNA that using a cuff that is too small can affect the reading results in what way?

falsely elevated

Which of the following would be inconsistent as a component of metabolic syndrome?

hypotension

A nurse educator is providing information to a small group of clients about hypertension. A participant asks what her target blood pressure should be. The nurse is aware of the target goals of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). Which of the following reflects the goal for blood pressure readings for people without co-morbidities?

140/90 or lower

The treatment goal for those with stage 2 hypertension (hypertension with compelling indications or complications) includes lifestyle modifications and multiple drug therapies. Thiazide diuretics are part of this treatment approach for most complications except for

CKD

Which of the following is the nurse most correct to recognize as a direct effect of client hypertension?

Renal dysfunction resulting from atherosclerosis

Which finding indicates that hypertension is progressing to target organ damage?

Retinal blood vessel damage 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.

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.

Recommmended lifestye modifications to prevent and manage hypertension include

include 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, and engaging in aerobic activity at least 30 minutes per day most days of the week.

a client is being seen at the clinic for a routine physical when the nurse notes the client's blood pressure is 150/97. The client is considered to be a healthy, well-nourished young adult. What type of hypertension does this client have?

primary