Chapter 27: Assessment and Management of Patients with Hypertension

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? "You may develop nasal congestion or depression while taking this medication." "You may drink alcohol while taking this medication." "Increase the amount of fruits and vegetables you eat." "Take this medication before going to bed."

"Increase the amount of fruits and vegetables you eat."

A nurse is teaching a client with newly diagnosed hypertension who asks if there is any harm in stopping antihypertensive medication. What is the nurse's best response?

"Rebound hypertension can occur."

Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension? A-"A glass of red wine each day will lower my blood pressure." B-"If I include less fat in my diet, I'll lower my blood pressure." C-"Limiting my salt intake to 2 grams per day will improve my blood pressure." D-"I should eliminate caffeine from my diet to lower my blood pressure."

C- "Limiting my salt intake to 2 grams per day will improve my blood pressure."

A nurse is educating about lifestyle modifications for a group of clients with newly diagnosed hypertension. While discussing dietary changes, which point would the nurse emphasize? There is usually no need to change alcohol consumption for clients with hypertension. The taste buds never adapt to decreased salt intake. It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. A person with hypertension should never consume alcohol.

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

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.

A nurse is providing education about hypertension to a community group. What are possible consequences of untreated hypertension? Select all that apply. Pancreatitis Myocardial infarction Stroke Coronary artery disease Tension pneumothorax

Myocardial infarction Stroke Coronary artery disease

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

Potassium level

Which of the following is the nurse most correct to recognize as a direct effect of client hypertension? Hyperglycemia resulting from insulin receptor resistance Renal dysfunction resulting from atherosclerosis Anemia resulting from bone marrow suppression Emphysema related to poor gas exchange

Renal dysfunction resulting from atherosclerosis

Which finding indicates that hypertension is progressing to target organ damage? Retinal blood vessel damage Urine output of 60 mL over 2 hours Blood urea nitrogen concentration of 12 mg/dL Chest x-ray showing pneumonia

Retinal blood vessel damage

The nurse is caring for a client with a blood pressure of 210/100 mm Hg in the emergency room. What is the most appropriate route of administration for antihypertensive agents?

continuous IV infusion

Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress decreases the production of neurotransmitters that constrict peripheral arterioles. increases the production of neurotransmitters that constrict peripheral arterioles. increases the resistance that the heart must overcome to eject blood. increases blood volume and improves the potential for greater cardiac output.

decreases the production of neurotransmitters that constrict peripheral arterioles.

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. decreases circulating blood volume. decreases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. increases the heart rate, constricts arterioles, and increases the heart's ability to eject blood.

increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood.

Hypertension that can be attributed to an underlying cause is termed essential hypertension. isolated systolic hypertension. primary hypertension. secondary hypertension.

secondary hypertension.

The nurse is caring for a patient with systolic blood pressure of 135 mm Hg. This finding would be classified as normal.-SYSTOLIC LESS THAN 120 elevated.- SYSTOLIC BETWEEN 120-129 stage 1 hypertension. SYSTOLIC BETWEEN 130-139 stage 2 hypertension.- SYSTOLIC >140

stage 1 hypertension.

The nurse encourages the client diagnosed with hypertension 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.

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'm glad I can still have chicken bouillon." "I chose broiled chicken with a baked potato for dinner." "I chose a tossed salad with sardines and oil and vinegar dressing for lunch." "I can still eat a ham-and-cheese sandwich with potato chips for lunch."

"I chose broiled chicken with a baked potato for dinner."

A patient is being treated for hypertensive emergency. When treating this patient, the priority goal is to lower the mean blood pressure (BP) by up to which percentage in the first hour? 25% 45% 35% 40%

25%

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? "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." "The lower the better. Blood pressure of 130/80 mm Hg is best for everyone." "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."; An individual with diabetes mellitus should strive for blood pressure of 120/80 mm Hg or less. An individual without diabetes should strive for blood pressure of 140/90 mm Hg or less.

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? "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." "Flex your calf muscles, avoid alcohol, and change positions slowly." "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 nurse is teaching a client with newly diagnosed hypertension who asks if there is any harm in stopping antihypertensive medication. What is the nurse's best response? "Postural hypotension can occur." "Postural hypertension can occur." "Rebound hypertension can occur." "Rebound hypotension can occur."

"Rebound hypertension can occur."

A nurse educator is providing information to a small group of clients about hypertension without comorbidities. What does the nurse explain about the target goals of the Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC8)? 135/85 or lower 135/80 or lower 150/90 or lower 140/90 or lower

150/90 or lower: The goal of hypertension treatment is to prevent complications and death by achieving and maintaining the arterial blood pressure at 150/90 or lower. The JNC8 specifies a lower goal pressure of 140/90 for people with diabetes mellitus or chronic kidney disease.

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 3 servings per day 4 or 5 servings per day 2 or fewer servings per day

4 or 5 servings per day

Which of the following client scenarios would be correct for the nurse to identify as a client with secondary hypertension? A client of advanced age A client with excessive alcohol intake A client experiencing depression A client diagnosed with kidney disease

A client diagnosed with kidney disease

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? A-"Can you tell me the reasons you aren't taking your medications?" B-"What medications are you prescribed?" C-"Are you having trouble paying for your medications?" D-"Are you able to get to your pharmacy to pick up your medications?"

A- "Can you tell me the reasons you aren't taking your medications?"

An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed the client hydrochlorothiazide and enalapril. What will the nurse be sure to include in educating this client? A- Change positions (lying or sitting to standing) slowly. B- Do not become dependent on canes, walkers, or handrails. C-Eat plenty of salty food to prevent hypotension. D- Check blood pressure every day for signs of rebound hypertension.

A- Change positions (lying or sitting to standing) slowly

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-A blood pressure reading greater than 130/85 mm Hg B-Dyslipidemia and/or abdominal obesity C-Increased blood urea nitrogen and serum creatinine levels D-Insulin resistance

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

The nurse is creating a community teaching demonstration focusing on the cause of blood pressure. When completing the visual aid, which body structures represent the mechanism of blood pressure? A-Heart and blood vessels B-Kidneys and autonomic nervous system C-Brain and sympathetic nervous system D-Lung and arteries

A-Heart and blood vessels

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? ACE inhibitor Beta-blocker Calcium channel blocker Loop diuretic

ACE inhibitor: The angiotensin-converting enzyme (ACE) inhibitor's primary action is to prevent the conversion of angiotensin I to angiotensin II, a potent vasoconstricting hormone in the blood.

The nurse is instructing a client who is newly prescribed an antihypertensive medication. Which nursing instruction is emphasized to maintain client safety? A-Use a pillbox to store daily medication. B-Sit on the edge of the chair and rise slowly. C-Do not operate a motor vehicle. D-Take the medication at the same time daily.

B- Sit on the edge of the chair and rise slowly

When measuring the blood pressure in each arm of a healthy adult client, the nurse recognizes that which statement is true? A-Pressures may vary, with the higher pressure found in the left arm. B-Pressures should not differ more than 5 mm Hg between arms. C-Pressures must be equal in both arms. D-Pressures may vary 10 mm Hg or more between arms.

B-Pressures should not differ more than 5 mm Hg between arms

A client, newly admitted to the nursing unit, has a primary diagnosis of renal failure. When assessing the client, the nurse notes a blood pressure (BP) of 180/100. The nurse knows that this is what kind of hypertension? A-Malignant B-Essential C-Secondary D-Primary

C-Secondary: Secondary hypertension is elevated BP that results from or is secondary to some other disorder

Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through: A-laboratory tests. B-an MRI. C-ophthalmic examination. D-using a sphygmomanometer.

C-ophthalmic examination: Papilledema is an edema of the optic nerves, and thus needs an ophthalmic examination for detection

When administering benazepril with spironolactone, the nurse should be aware that which electrolyte imbalance may occur? Hypercalcemia Hypokalemia Hyperkalemia Hypocalcemia

Hyperkalemia

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? A-Pathologic B-Malignant C-Secondary D-Essential (primary)

D- Essential (primary): Essential or primary hypertension, about 95% of cases, is sustained elevated BP with no known cause.

A client has just been diagnosed with prehypertension. What would the nurse instruct this client to do to restore blood pressure below hypertensive levels?

Decrease sodium intake

Which diagnostic method is recommended to determine whether left ventricular hypertrophy has occurred? Electrocardiography Blood chemistry Echocardiography Blood urea nitrogen

Echocardiography: An echocardiogram is recommended method of determining whether hypertrophy has occurred.

Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage? Hypertensive emergency Primary hypertension Secondary hypertension Hypertensive urgency

Hypertensive emergency- A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage.

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 Respiratory rate Character of apical and peripheral pulses Lung sounds

Heart rate Heart rhythm Character of apical and peripheral pulses

A client is admitted to the intensive care unit (ICU) with a diagnosis of hypertension emergency/crisis. The client's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV nitroprusside. Upon assessment, which finding requires immediate intervention by the nurse? Urine output of 40 mL over the past hour Numbness and weakness in the left arm Nausea and severe headache Chest pain score of 3 (on a scale of 1 to 10)

Numbness and weakness in the left arm

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 Sexual dysfunction Postural hypotension and resulting injury Rebound hypertension

Postural hypotension and resulting injury

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

Reduce the blood pressure by 20% to 25% within the first hour of treatment.

The nurse is teaching a client about chronic untreated hypertension. What complication will the nurse explain to the client? stroke right-sided heart failure pulmonary insufficiency peripheral edema

STROKE- A stroke occurs if vessels in the brain rupture and bleed.

A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. What are risk factors for cardiovascular problems in clients with hypertension? Select all that apply. Smoking Frequent upper respiratory infections Gallbladder disease Diabetes mellitus Physical inactivity

Smoking Diabetes mellitus Physical inactivity

The nurse is caring for a client who is prescribed medication for the treatment of hypertension. The nurse recognizes that which medication conserves potassium? Chlorthalidone Furosemide Spironolactone Chlorothiazide

Spironolactone

Which statements are true when the nurse is measuring blood pressure (BP)? Select all that apply. 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. 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 should sit quietly while BP is being measured.

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 a client with hypertension. Which actions will the nurse take when measuring the client's blood pressure? Select all that apply. Center the cuff bladder over the brachial artery. Wrap the cuff firmly around the arm. Measure two readings, 1 to 2 minutes apart. Place the client's arm at the level of the heart. Have the client sit with legs crossed.

Wrap the cuff firmly around the arm. Measure two readings, 1 to 2 minutes apart. Place the client's arm at the level of the heart. Center the cuff bladder over the brachial artery.

A client who is newly diagnosed with hypertension is going to be starting antihypertensive medicine. What is one of the main things the client and the client's spouse should watch for? dizziness tremor blurred vision persistent cough

dizziness

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 reduce the rate of contraction to resupply oxygen to the brain. help reduce the work required by the heart to resupply oxygen to the brain. provide time for the heart to increase 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.