Chapter 27- Assessment and Management of Patients with Hypertension
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?" "Are you able to get to your pharmacy to pick up your medications?" "What medications are you prescribed?" "Are you having trouble paying for your medications?"
"Can you tell me the reasons you aren't taking your medications?"
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? "Take this medication before going to bed." "Increase the amount of fruits and vegetables you eat." "You may drink alcohol while taking this medication." "You may develop nasal congestion or depression while taking this medication."
"Increase the amount of fruits and vegetables you eat."
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 135/80 or lower 145/95 or lower 135/85 or lower
140/90 or lower
The nurse is evaluating the types of medications prescribed for a client's hypertension. Which of the following medication classifications establishes an action on vasoconstrictive hormones in the blood stream? Loop diuretic Calcium channel blocker Beta-blocker ACE inhibitor
ACE inhibitor
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 hypertension and resulting injury Rebound hypertension Sexual dysfunction Postural hypotension and resulting injury
Postural hypotension and resulting injury
Which finding indicates that hypertension is progressing to target organ damage? Chest x-ray showing pneumonia Retinal blood vessel damage Urine output of 60 mL over 2 hours Blood urea nitrogen concentration of 12 mg/dL
Retinal blood vessel damage
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? calcium deficit acid-base imbalance hepatic function arterial vasoconstriction
arterial vasoconstriction
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? limbic system parasympathetic nervous system kidneys lungs
kidneys
The nurse is teaching a client about chronic untreated hypertension. What complication will the nurse explain to the client? right-sided heart failure stroke peripheral edema pulmonary insufficiency
stroke
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." "Rest between demanding activities, eat plenty of fruits and vegetables, and drink 6 to 8 cups of fluid daily." "Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising." "Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night."
"Flex your calf muscles, avoid alcohol, and change positions slowly."
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? "Did you take any medication for your headache?" "Do you have a dry mouth or nasal congestion?" "Are you having chest pain or shortness of breath?" "Have you taken your prescribed clonidine today?"
"Have you taken your prescribed clonidine today?"
Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension? "A glass of red wine each day will lower my blood pressure." "Limiting my salt intake to 2 grams per day will improve my blood pressure." "I should eliminate caffeine from my diet to lower my blood pressure." "If I include less fat in my diet, I'll lower my blood pressure."
"Limiting my salt intake to 2 grams per day will improve my blood pressure."
According to the DASH diet, how many servings of vegetables should a person consume each day? 2 or fewer 2 or 3 4 or 5 7 or 8
4 or 5
The nurse is explaining the DASH diet to a client diagnosed with hypertension. The client inquires about how many servings of fruit per day can be consumed on the diet. What is the nurse's best response? 7 or 8 servings per day 2 or fewer servings per day 4 or 5 servings per day 2 or 3 servings per day
4 or 5 servings per day
Which condition(s) indicates target organ damage from untreated/undertreated hypertension? Select all that apply. Heart failure Retinal damage Hyperlipidemia Diabetes Stroke
Heart failure Retinal damage Stroke
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 Respiratory rate Lung sounds
Heart rhythm Character of apical and peripheral pulses Heart rate
When administering benazepril with spironolactone, the nurse should be aware that which electrolyte imbalance may occur? Hypercalcemia Hypocalcemia Hypokalemia Hyperkalemia
Hyperkalemia
Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress increases blood volume and improves the potential for greater cardiac output. decreases the production of neurotransmitters that constrict peripheral arterioles. increases the resistance that the heart must overcome to eject blood. increases the production of neurotransmitters that constrict peripheral arterioles.
decreases the production of neurotransmitters that constrict peripheral arterioles
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? "Your blood pressure is fine. Just keep doing what you're doing." "Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg." "The lower the better. Blood pressure of 130/80 mm Hg is best for everyone." "The current recommendation is for everyone to have blood pressure of 140/90 mm Hg or lower."
"Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg."
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 can still eat a ham-and-cheese sandwich with potato chips for lunch." "I'm glad I can still have chicken bouillon." "I chose a tossed salad with sardines and oil and vinegar dressing for lunch." "I chose broiled chicken with a baked potato for dinner."
"I chose broiled chicken with a baked potato for dinner."
The nurse teaches the client which guidelines regarding lifestyle modifications for hypertension? Limit aerobic physical activity to 15 minutes, three times per week Maintain adequate dietary intake of fruits and vegetables Reduce smoking to no more than four cigarettes per day Stop alcohol intake
Maintain adequate dietary intake of fruits and vegetables
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 lose weight, achieve a body mass index of 24 or less, and to eat a diet rich in fruits and vegetables To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less To stop smoking and increase physical activity to 30 minutes/day most days of the week To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less
To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less
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 Palpates the systolic pressure before auscultating blood pressure Wraps the blood pressure cuff firmly around the arm Centers the blood pressure cuff bladder directly over the brachial artery
provide time for the heart to increase the rate of contraction to resupply oxygen to the brain.
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 145/95 or lower 125/85 or lower 150/95 or lower
130/80 or lower
A nurse is educating a client about monitoring blood pressure readings at home. What will the nurse be sure to emphasize? "Avoid smoking cigarettes for 8 hours prior to taking blood pressure." "Be sure the forearm is well supported above heart level while taking blood pressure." "Sit quietly for 5 minutes prior to taking blood pressure." "Sit with legs crossed when taking your blood pressure."
Sit quietly for 5 minutes prior to taking blood pressure."
It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position help reduce the work required by the heart to resupply oxygen to the brain. provide time for the heart to reduce the rate of contraction to resupply oxygen to the brain. help reduce the blood pressure to resupply oxygen to the brain. provide time for the heart to increase the rate of contraction to resupply oxygen to the brain.
provide time for the heart to increase the rate of contraction to resupply oxygen to the brain
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's BP should be measured 1 hour before consuming alcohol. The client should sit quietly while BP is being measured. Using a BP cuff that is too large will give a higher BP measurement.
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.
A diabetic client visits a walk-in clinic and asks the nurse to take a blood pressure (BP) reading. The measurements are 150/90 mm Hg. Which of the following would the nurse expect as the treatment to normalize the client's BP? Low-fat diet Daily exercise Drug therapy Smoking cessation programs
Drug therapy
A nurse is providing education about hypertension to a community group. What are possible consequences of untreated hypertension? Select all that apply. Pancreatitis Coronary artery disease Stroke Tension pneumothorax Myocardial infarction
Coronary artery disease Myocardial infarction Stroke
The nurse is discussing aging and the incidence of hypertension with an older adult. What lifestyle change will lower blood pressure for the older adult? Exercise once a week. Sleep four hours each night. Add salt to foods for taste. Keep weight stable.
Keep weight stable.
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? Instructing the patient to enter a weight loss program and begin an exercise regimen Scheduling the patient for all follow-up visits and making phone calls to the home to ensure adherence Making sure that the patient adheres to the therapeutic medication regimen Lowering and controlling the blood pressure without adverse effects and without undue cost
Lowering and controlling the blood pressure without adverse effects and without undue cost
Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through: laboratory tests. an MRI. using a sphygmomanometer. ophthalmic examination.
ophthalmic examination
Hypertension that can be attributed to an underlying cause is termed essential hypertension. isolated systolic hypertension. secondary hypertension. primary hypertension.
secondary hypertension
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? Hypernatremia Hypokalemia Hyperkalemia Hyponatremia
Hyperkalemia
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 Administering glycemic control Discussing methods for stress reduction Advising smoking cessation
Purchasing a self-monitoring BP cuff
