Chapter 27: Caring for Clients with Hypertension

Which term describes high blood pressure from an identified cause, such as renal disease? a. Primary hypertension b. Secondary hypertension c. Rebound hypertension d. Hypertensive emergency

b Secondary hypertension is high blood pressure from an identified cause, such as renal disease. Primary hypertension denotes high blood pressure form an unidentified source. Rebound hypertension is pressure that is controlled with therapy and becomes uncontrolled (abnormally high) when that therapy is discontinued. A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage.

A client newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the client and advises that the client should avoid tobacco use. What is the primary rationale behind that advice to the client? a. Quitting smoking will cause the client's hypertension to resolve. b. Tobacco use increases the client's concurrent risk of heart disease. c. Tobacco use is associated with a sedentary lifestyle. d. Tobacco use causes ventricular hypertrophy.

b Smoking increases the risk for heart disease, for which a client with hypertension is already at an increased risk. Quitting will not necessarily cause hypertension to resolve and smoking does not directly cause ventricular hypertrophy. The association with a sedentary lifestyle is true, but this is not the main rationale for the nurse's advice; the association with heart disease is more salient.

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

c Secondary hypertension may be caused by a tumor of the adrenal gland (e.g., pheochromocytoma). Primary, or essential, hypertension has no known underlying cause. 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).

A nurse on a busy medical unit is aware of the importance of accurate blood pressure (BP) measurement. To ensure accuracy when assessing patients' blood pressures, the nurse should always: a. Use a manual, rather than automated, sphygmomanometer b. Alternate blood pressure readings between patients' right and left arms c. Take serial blood pressure readings on each patient d. Ensure that the correct cuff size is used for each patient

d Correct cuff size is essential to obtaining accurate BP readings. Repeated readings are not necessarily required to obtain accurate blood pressure. As well, it is not always necessary to alternate arms or to use a manual sphygmomanometer.

A client in hypertensive emergency is being cared for in the ICU. The client has become hypovolemic secondary to natriuresis. What is the nurse's most appropriate action? a. Add sodium to the client's IV fluid, as prescribed. b. Administer a vasoconstrictor, as prescribed. c. Promptly cease antihypertensive therapy. d. Administer normal saline IV, as prescribed.

d If there is volume depletion secondary to natriuresis caused by the elevated BP, then volume replacement with normal saline can prevent large, sudden drops in BP when antihypertensive medications are given. Sodium administration, cessation of antihypertensive therapy, and administration of vasoconstrictors are not normally indicated.

Much information can be gained from comparing blood pressure measurements. What does a blood pressure reading indicate? a. All of the options are correct. b. arterial ability to stretch and fill with blood c. pumping efficacy of the heart d. circulating blood volume

a The measured BP reflects the ability of the arteries to stretch and fill with blood, the efficiency of the heart as a pump, and the volume of circulating blood.

The nurse is caring for a patient with systolic blood pressure of 135 mm Hg. This finding would be classified as a. normal. b. prehypertension. c. stage 1 hypertension. d. stage 2 hypertension.

b A systolic blood pressure of 135 mm Hg is classified as prehypertension. A systolic BP less than 120 mm Hg is normal. A systolic BP of 140 to 159 mm Hg is stage I hypertension. A systolic BP greater than or equal to 160 is classified as stage II hypertension.

A patient has been diagnosed with prehypertension and has been encouraged to exercise regularly and begin a weight loss program. What other healthcare professional may be helpful for the client to see? a. Occupational therapist b. Dietician c. Pharmacist d. Social worker

b Clients with prehypertension and a need to lose weight will benefit from a dietician for food selections and menu planning. An occupational therapist works with clients for meaning activites for daily tasks. The pharmacist deals with medications and the social worker will help with dealing with problems to improve life.

During an adult client's last two office visits, the nurse obtained BP readings of 122/84 mm Hg and 130/88 mm Hg, respectively. How would this client's BP be categorized? a. Normal b. Prehypertensive c. Stage 1 hypertensive d. Stage 2 hypertensive

b Prehypertension is defined systolic BP of 120 to 139 mm Hg or diastolic BP of 80 to 89 mm Hg.

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

a A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage. Hypertensive urgency is a situation in which blood pressure is severely elevated but there is no evidence of actual or probable target organ damage. Secondary hypertension is high blood pressure from an identified cause, such as renal disease. Primary hypertension denotes high blood pressure from an unidentified source.

A client with newly diagnosed hypertension asks what to do to decrease the risk for related cardiovascular problems. Which risk factor is not modifiable by the client? a. Age b. Obesity c. Inactivity d. Dyslipidemia

a Age and family history for cardiovascular disease are risk factors that cannot be changed. Obesity, inactivity, and disylipidemia are risk factors that can be improved by the client through dietary changes, exercise, and other healthy lifestyle choices.

The nurse is developing a nursing care plan for a client who is being treated for hypertension. What is a measurable client outcome that the nurse should include? a. Client will reduce Na+ intake to no more than 2.4 g daily. b. Client will have a stable BUN and serum creatinine levels. c. Client will abstain from fat intake and reduce calorie intake. d. Client will maintain a normal body weight.

a Dietary sodium intake of no more than 2.4 g daily is recommended as a dietary lifestyle modification to prevent and manage hypertension. Giving a specific amount of allowable sodium intake makes this a measurable goal. None of the other listed goals is quantifiable and measurable.

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

a, b, e People with hypertension may remain asymptomatic for many years. When specific signs and symptoms appear, however, they usually indicate vascular damage. Coronary artery disease with angina and myocardial infarction are common consequences of hypertension. Cerebrovascular involvement may lead to a stroke. Tension pneumothorax and pancreatitis are not directly related to hypertension.

A nurse is assisting with with checking blood pressures at a local health care fair. To which client would the nurse pay particular attention? a. A 16-year-old girl b. A 40-year-old African-American man c. A 50-year-old Caucasian woman d. An Asian adult man

b Prevalence of hypertension varies by ethnicity, with African Americans having the highest prevalence.

It is important for the nurse to encourage the cltient diagnosed with hypertension to rise slowly from a sitting or lying position because gradual changes in position a. help reduce the blood pressure to resupply oxygen to the brain. b. help reduce the work required by the heart to resupply oxygen to the brain. c. provide time for the heart to increase the rate of contraction to resupply oxygen to the brain. d. provide time for the heart to reduce the rate of contraction to resupply oxygen to the brain.

c 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 its rate of contraction to resupply oxygen to the brain, not blood pressure or heart rate.

A client's recently elevated BP has prompted the primary care provider to prescribe furosemide. The nurse should closely monitor which of the following? a. The client's oxygen saturation level b. The client's red blood cells, hematocrit, and hemoglobin c. The client's level of consciousness d. The client's potassium level

d Loop diuretics can cause potassium depletion. They do not normally affect level of consciousness, erythrocytes, or oxygen saturation.

A client with primary hypertension reports dizziness with ambulation when taking the prescribed alpha-adrenergic blocker. When teaching this client, what should the nurse emphasize? a. Rising slowly from a lying or sitting position b. Increasing fluids to maintain BP c. Stopping medication if dizziness persists d. Taking medication first thing in the morning

a Clients who experience postural hypotension should be taught to rise slowly from a lying or sitting position and use a cane or walker if necessary for safety. It is not necessary to teach these clients about increasing fluids or taking medication in the morning (this would increase the effects of dizziness). Clients should not be taught to stop the medication if dizziness persists because this is unsafe and beyond the nurse's scope of practice.

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

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

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? a. dizziness b. persistent cough c. blurred vision d. tremor

a A common adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. The client and the client's spouse should be alerted to this possibility and provided with some tips for managing dizziness.

A patient comes to the walk-in clinic. While assessing the patient's vital signs, the nurse assesses the patient's blood pressure at 128/89 mm Hg. According to JNC7, how would this patient's blood pressure be classified? a. Hypertensive b. Normal c. Slightly hypertensive d. Prehypertensive

d JNC7 defines a blood pressure of less than 120/80 mm Hg diastolic as normal, 120 to 129/80 to 89 mm Hg as prehypertension, and 140/90 mm Hg or higher as hypertensive.

High blood pressure is highly prevalent in the United States. Approximately how many people have high blood pressure in the United States? a. 1 in 3 adults b. 1 in 6 adults c. 1 in 7 adults d. 1 in 10 adults

a Approximately 68 million people, or 1 in 3 adults, in the United States have high blood pressure. (Centers for Disease Control and Prevention, 2016).

Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through: a. ophthalmic examination. b. using a sphygmomanometer. c. laboratory tests. d. an MRI.

a Papilledema is an edema of the optic nerves, and thus needs an ophthalmic examination for detection.

A newly diagnosed client with hypertension is prescribed a thiazide diuretic. What client education should the nurse provide to this client? a. "Eat a banana every day because this medication causes moderate hyperkalemia." b. "Take over-the-counter potassium pills because this medication causes your kidneys to lose potassium." c. "This medication can cause low blood pressure and dizziness, especially when you get up suddenly." d. "This medication increases sodium levels in your blood, so cut down on your salt."

c Thiazide diuretics can cause postural hypotension, which may be potentiated by alcohol, barbiturates, opioids, or hot weather. Thiazide diuretics do not cause either moderate hyperkalemia or severe hypokalemia and they do not result in hypernatremia.

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? a. kidneys b. parasympathetic nervous system c. limbic system d. lungs

a The autonomic nervous system, the kidneys, and various endocrine glands regulate arterial pressure.

The DASH (Dietary Approaches to Stop Hypertension) diet has been recommended to a 58-year-old woman with a recent diagnosis of primary hypertension. What dietary component will the woman consume most if she adheres to this diet? a. Grains and grain products b. Fruits c. Vegetables d. Low-fat dairy products

a The DASH diet recommends 7 to 8 daily servings of grain products, 4 to 5 servings each of fruits and vegetables, and 2 to 3 servings of low-fat dairy products.

The nurse is completing a cardiac assessment on a client. The patient has a blood pressure (BP) reading of 126/80. What would the nurse would identify this blood pressure reading as? a. Prehypertension b. Normal c. Stage 1 hypertension d. Stage 2 hypertension

a A systolic BP of 128 mm Hg is classified as prehypertension. A systolic BP of less than 120 mm Hg is normal. A systolic BP of 140 to 159 mm Hg is Stage I hypertension. A systolic BP of greater than or equal to 160 is classified as Stage 2 hypertension.

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? a. Purchasing a self-monitoring BP cuff b. Discussing methods for stress reduction c. Advising smoking cessation d. Administering glycemic control

a Because this client finds visiting the doctor time-consuming just for a BP reading, as the nurse, you can suggest the use of an automatic cuff at a local pharmacy, or purchasing a self-monitoring cuff. Discussing methods to reduce stress, advising smoking cessation, and achieving glycemic control would constitute client education in managing hypertension.

A client who is newly diagnosed with high blood pressure has a 20-pack-year tobacco history. The nurse recommends smoking cessation for this client because nicotine: a. raises heart rate, constricts arterioles, and reduces the heart's ability to eject blood. b. decreases heart rate, constricts arterioles, and reduces the heart's ability to eject blood. c. increases heart rate, constricts arterioles, and increases the heart's ability to eject blood. d. decreases circulating blood volume.

a Nurses recommend smoking cessation for clients with hypertension because nicotine raises the heart rate, constricts arterioles, and reduces the heart's ability to eject blood.

A client has come to the clinic for a follow-up assessment that will include a BP reading. To ensure an accurate reading, the nurse should confirm that the client has done which of the following? a. Tried to rest quietly for 5 minutes before the reading is taken b. Refrained from smoking for at least 8 hours c. Drank adequate fluids during the day prior d. Avoided drinking coffee for 12 hours before the visit

a Prior to the nurse assessing the client's BP, the client should try to rest quietly for 5 minutes. The forearm should be positioned at heart level. Caffeine products and cigarette smoking should be avoided for at least 30 minutes prior to the visit. Recent fluid intake is not normally relevant.

A nurse is teaching a client with severe hypertension about the damage this condition can cause to the body. What system/organs will the nurse note are particularly targeted for damage due to severe hypertension? a. Sensory b. Musculoskeletal c. Gastrointestinal d. Integumentary

a Prolonged elevated blood pressure eventually damages blood vessels throughout the body, particularly in target organs such as the heart, kidneys, brain, and eyes. The usual consequences of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, renal failure, strokes, and impaired vision.

A client with secondary hypertension has come into the clinic for a routine check-up. When comparing this client's diagnosis to primary hypertension, the nurse recognizes that secondary hypertension: a. has a specific cause. b. has a more gradual onset than primary hypertension. c. does not normally cause target organ damage. d. does not normally respond to antihypertensive drug therapy.

a Secondary hypertension has a specific identified cause. A cause could include narrowing of the renal arteries, renal parenchymal disease, hyperaldosteronism, certain medications, pregnancy, and coarctation of the aorta. Secondary hypertension does respond to antihypertensive drug therapy and can cause target organ damage if left untreated.

It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine a. increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. b. decreases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. c. increases the heart rate, constricts arterioles, and increases the heart's ability to eject blood. d. decreases circulating blood volume.

a The nurse recommends smoking cessation for clients with hypertension because nicotine raises the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. Reduced oral fluids decrease the circulating blood volume.

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

A client newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a client with prolonged, uncontrolled hypertension is at risk for developing what health problem? a. Acute kidney injury b. Right ventricular hypertrophy c. Glaucoma d. Anemia

a When uncontrolled hypertension is prolonged, it can result in acute kidney injury, myocardial infarction, stroke, impaired vision, left ventricular hypertrophy, and cardiac failure. Glaucoma and anemia are not directly associated with hypertension.

A patient newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a patient with prolonged uncontrolled hypertension is at risk for developing what health problem? a. Renal failure b. Right ventricular hypertrophy c. Glaucoma d. Anemia

a When uncontrolled hypertension is prolonged, it can result in renal failure, myocardial infarction, stroke, impaired vision, left ventricular hypertrophy, and cardiac failure. Glaucoma and anemia are not associated with hypertension.

Which condition(s) indicates target organ damage from untreated/undertreated hypertension? Select all that apply. a. Heart failure b. Retinal damage c. Diabetes d. Hyperlipidemia e. Stroke

a, b, e Target organs include the heart, kidney, brain, and eyes. Hyperlipidemia and diabetes are risk factors for development of hypertension.

Which statements are true when the nurse is measuring blood pressure (BP)? Select all that apply. a. Using a BP cuff that is too small will give a higher BP measurement. b. The client's arm should be positioned at the level of the heart. c. Using a BP cuff that is too large will give a higher BP measurement. d. The client's BP should be measured 1 hour before consuming alcohol. e. The client should sit quietly while BP is being measured.

a, b, e These statements are all true when measuring a BP. When using a BP cuff that is too large, the reading will be lower than the actual BP. The client should avoid smoking cigarettes or drinking caffeine for 30 minutes before BP is measured.

The nurse is providing care for a client with a new diagnosis of hypertension. How can the nurse best promote the client's adherence to the prescribed therapeutic regimen? a. Screen the client for visual disturbances regularly. b. Have the client participate in monitoring his or her own BP. c. Emphasize the dire health outcomes associated with inadequate BP control. d. Encourage the client to lose weight and exercise regularly.

b Adherence to the therapeutic regimen increases when clients actively participate in self-care, including self-monitoring of BP and diet. Dire warnings may motivate some clients, but for many clients this is not an appropriate or effective strategy. Screening for vision changes and promoting healthy lifestyle are appropriate nursing actions, but do not necessarily promote adherence to a therapeutic regimen.

A 40-year-old man newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the patient and advises that the patient should avoid tobacco use. What is the rationale behind that advice to the patient? a. Smoking directly causes high blood pressure. b. Smoking increases the risk of heart disease. c. Smoking causes obesity, which exacerbates hypertension. d. Smoking increases cardiac output.

b Smoking does not cause high blood pressure, but it does increase the risk for heart disease. A patient with hypertension is already at an increased risk of heart disease. Smoking does not directly cause obesity and it does not increase cardiac output.

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

b Spironolactone is known as a potassium-sparing diuretic. Furosemide causes loss of potassium from the body. Chlorothiazide and chlorthalidone cause mild hypokalemia.

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? a. 145/95 or lower b. 130/80 or lower c. 150/95 or lower d. 125/85 or lower

b The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) specifies a lower goal pressure of 130/80 for people with diabetes mellitus.

The nurse is reviewing the medication administration record of a client who takes a variety of medications for the treatment of hypertension. What potential therapeutic benefits of antihypertensives should the nurse identify? Select all that apply. a. Increased venous return b. Decreased peripheral resistance c. Decreased blood volume d. Decreased strength and rate of myocardial contractions e. Decreased blood viscosity

b, c, d The medications used for treating hypertension decrease peripheral resistance, blood volume, or the strength and rate of myocardial contraction. Antihypertensive medications do not increase venous return or decrease blood viscosity.

The nurse is assessing a client new to the clinic. Records brought to the clinic show that the client's hypertension has not improved. What contributing factor should the nurse first explore in an effort to identify the cause of the client's inadequate BP control? a. Progressive target organ damage b. Possibility of medication interactions c. Lack of adherence to prescribed drug therapy d. Possible heavy alcohol use or use of recreational drugs

c Deviation from the therapeutic program is a significant problem for people with hypertension and other chronic conditions requiring lifetime management. An estimated 50% of clients discontinue their medications within 1 year of beginning to take them. Consequently, this is a more likely problem than substance use, organ damage, or adverse drug interactions.

According to the DASH diet, how many servings of vegetables should a person consume each day? a. 2 or fewer b. 2 or 3 c. 4 or 5 d. 7 or 8

c Four or five servings of vegetables are recommended in the DASH diet. The diet recommends two or fewer servings of lean meat, fish, and poultry; two or three servings of low-fat or fat-free dairy foods; and seven or eight servings of grains and grain products.

The nurse is providing health education to an older adult client. What should the nurse teach the client about the relationship between hypertension and age? a. "Because of reduced smooth muscle tone in blood vessels, blood pressure tends to go down with age, not up." b. "Decreases in the strength of arteries and the presence of venous insufficiency cause hypertension in the elderly." c. "Structural and functional changes in the cardiovascular system that occur with age contribute to an increase in blood pressure." d. "The neurologic system of older adults is less efficient at monitoring and regulating blood pressure."

c Structural and functional changes in the heart and blood vessels contribute to an increase in BP that occurs with aging. Venous insufficiency does not cause hypertension, however. Increased BP is not primarily a result of neurologic changes.

A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective assessment data from a client with hypertension, the nurse learns that the client has a family history of hypertension and she herself has high cholesterol and lipid levels. The client says she smokes one pack of cigarettes daily and drinks "about a pack of beer" every day. The nurse notes what nonmodifiable risk factor for hypertension? a. Hyperlipidemia b. Excessive alcohol intake c. A family history of hypertension d. Closer adherence to medical regimen

c Unlike cholesterol levels, alcohol intake, and adherence to treatment, family history is not modifiable.

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? a. "Your blood pressure is fine. Just keep doing what you're doing." b. "The current recommendation is for everyone to have blood pressure of 140/90 mm Hg or lower." c. "The lower the better. Blood pressure of 120/80 mm Hg is best for everyone." d. "Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg."

d An individual with diabetes mellitus should strive for blood pressure of 130/80 mm Hg or less. An individual without diabetes should strive for blood pressure of 140/90 mm Hg or less.

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? a. Postural hypertension and resulting injury b. Rebound hypertension c. Sexual dysfunction d. Postural hypotension and resulting injury

d Antihypertensive medication can cause hypotension, especially postural hypotension that may result in injury. Rebound hypertension occurs when antihypertensive medication is stopped abruptly. Sexual dysfunction may occur, especially with beta blockers, but other medications are available should this problem ensue. This is not immediately a priority concern. Antihypertensive medications do not usually cause postural hypertension.

The nurse teaches the client which guidelines regarding lifestyle modifications for hypertension? a. Reduce smoking to no more than four cigarettes per day b. Limit aerobic physical activity to 15 minutes, three times per week c. Stop alcohol intake d. Maintain adequate dietary intake of fruits and vegetables

d Guidelines include adopting the Dietary Approaches to Stop Hypertension (DASH) eating plan: consume a diet rich in fruits, vegetables, and low-fat dairy products and reduced amounts of saturated and total fat; reduce dietary sodium intake to no more than 100 mmol/day (2.4 g sodium or 6 g sodium chloride); engage in regular aerobic physical activity such as brisk walking (at least 30 min/day, most days of the week); moderate alcohol consumption, limiting 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 one drink per day in women and lighter-weight people. Tobacco should be avoided because anyone with high blood pressure is already at increased risk for heart disease, and smoking amplifies this risk.

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

d 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).

An adult patient's blood pressure readings have ranged from 138/92 to 154/100 during the past several weeks. As a result, the patient's nurse practitioner has ordered diagnostic follow-up. Which of the following diagnostic tests should the nurse prioritize when assessing the patient for target organ damage? a. C-reactive protein (CRP) levels b. Sodium, chloride, and potassium levels c. Arterial blood gas (ABG) results d. Blood urea nitrogen (BUN) and creatinine levels

d Nephropathy is a common consequence of hypertension; this problem would be manifested by increased BUN and creatinine levels. Electrolyte levels are also assessed, but these are less sensitive and specific to target organ damage. Abnormal ABGs and CRP levels are not common indicators of target organ damage.

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

d Physical examination may reveal no abnormalities other than elevated blood pressure. Occasionally, retinal changes such as hemorrhages, exudates (fluid accumulation), arteriolar narrowing, and cotton-wool spots (small infarctions) occur. In severe hypertension, papilledema (swelling of the optic disc) may be seen.

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

d 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 nurse educator is providing information to a small group of clients about hypertension without comorbities. 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)? a. 135/80 or lower b. 135/85 or lower c. 140/90 or lower d. 150/90 or lower

d 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.

Officially, hypertension is diagnosed when the client demonstrates a systolic blood pressure greater than ______ mm Hg and a diastolic blood pressure greater than _____ mm Hg over a sustained period. a. 140, 90 b. 130, 80 c. 110, 60 d. 120, 70

a According to the categories of blood pressure levels established by the 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 prehypertension classification range for an adult. Pressures of 110 systolic and 60 diastolic, and of 120 systolic and 70 diastolic, fall within the normal range for an adult.

The nurse is reviewing the diet of a client who has been diagnosed with hypertension. The nurse recommends reducing or avoiding caffeine because caffeine: a. increases the heart rate and causes vasoconstriction. b. reduces the heart rate and leads to a coronary artery disease. c. reduces the heart rate and causes low blood pressure. d. increases the heart rate and causes angina.

a The nurse recommends reducing or avoiding caffeine for clients with hypertension because caffeine increases the heart rate and causes vasoconstriction. Angina and coronary artery disease are the result of arteries becoming blocked by a substance called plaque.

The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in what way? a. The BP is always higher in a hypertensive emergency. b. Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies. c. Hypertensive urgency is treated with rest and benzodiazepines to lower BP. d. Hypertensive emergencies are associated with evidence of target organ damage.

d 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. Blood pressures are extremely elevated in both urgency and emergencies, but there is no evidence of target organ damage in hypertensive urgency. Extremely close hemodynamic monitoring of the client's BP is required in both situations. The medications of choice in hypertensive emergencies are those with an immediate effect, such as IV vasodilators. Oral doses of fast-acting agents, such as beta-adrenergic blocking agents, angiotensin-converting enzyme inhibitors, or alpha-agonists, are recommended for the treatment of hypertensive urgencies.

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

a 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).

The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. What should the nurse integrate into the management of this client's hypertension? a. Ensure that the client receives a larger initial dose of antihypertensive medication due to impaired absorption. b. Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion. c. Recognize that an older adult is less likely to adhere to the medication regimen than a younger client. d. Carefully assess for weight loss because of impaired kidney function resulting from normal aging.

b Older adults have impaired cardiovascular reflexes and thus are more sensitive to extracellular volume depletion caused by diuretics. The nurse needs to assess hydration status, low BP, and postural hypotension carefully. Older adults may have impaired absorption, but they do not need a higher initial dose of an antihypertensive than a younger person. Adherence to treatment is not necessarily linked to age. Kidney function and absorption decline with age; less, rather than more antihypertensive medication is prescribed. Weight gain is not necessarily indicative of kidney function decline.

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. "I should eliminate caffeine from my diet to lower my blood pressure." c. "If I include less fat in my diet, I'll lower my blood pressure." d. "Limiting my salt intake to 2 grams per day will improve my blood pressure."

d To lower blood pressure, a client should limit daily salt intake to 2 g or less. Alcohol intake is associated with a higher incidence of hypertension, poor compliance with treatment, and refractory hypertension. Chronic, moderate caffeine intake and fat intake don't affect blood pressure

A client experiences orthostatic hypotension while receiving furosemide to treat hypertension. How will the nurse intervene? a. Administer I.V. fluids as ordered. b. Administer an isosorbide as ordered. c. Insert an indwelling urinary catheter as ordered. d. Instruct the client to sit for several minutes before standing.

d To minimize the effects of orthostatic hypotension, the nurse should instruct the client to rise slowly, such as by sitting for several minutes before standing. Administering I.V. fluids would be inappropriate (unless the client were dehydrated) because doing so would counteract the effects of furosemide and could cause fluid imbalance. Administering a vasodilator, isosorbide, would further reduce the client's blood pressure, worsening orthostatic hypotension. Inserting an indwelling urinary catheter would make it easier to monitor urine output, but wouldn't minimize the effects of orthostatic hypotension.

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

b The client's choice of a baked potato with broiled chicken indicates effective nutrition teaching because potatoes and chicken are relatively low in sodium. Ham, sardines, and bouillon are extremely high in sodium and shouldn't be included in a low-sodium diet.

A client with primary hypertension comes to the clinic reporting a gradual onset of blurry vision and decreased visual acuity over the past several weeks. The nurse is aware that these symptoms could be indicative of what? a. Retinal blood vessel damage b. Glaucoma c. Cranial nerve damage d. Hypertensive emergency

a Blurred vision, spots in front of the eyes, and diminished visual acuity can mean retinal blood vessel damage indicative of damage elsewhere in the vascular system as a result of hypertension. Glaucoma and cranial nerve damage do not normally cause these symptoms. A hypertensive emergency would have a more rapid onset.

The nurse is teaching a client who is experiencing dizziness to rise slowly from a sitting or lying position. What is the rationale for the teaching? a. Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. b. Gradual changes in position help reduce the blood pressure to resupply oxygen to the brain. c. Gradual changes in position help reduce the heart's work to resupply oxygen to the brain. d. Gradual changes in position provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain.

a 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. Blood pressure and heart rate do not affect this process.

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

a Symptoms suggesting that hypertension is progressing to the extent that target organ damage is occurring must be detected early so that appropriate treatment can be initiated. All body systems must be assessed to detect any evidence of vascular damage. An eye examination with an ophthalmoscope is important because retinal blood vessel damage indicates similar damage elsewhere in the vascular system. 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. A BUN concentration of 12 mg/dL and urine output of 60 mL over 2 hours are normal findings. The presence of pneumonia does not indicate target organ damage.

A client who has just been diagnosed with hypertension has been instructed to take a daily blood pressure measurement. The systolic blood pressure reading measures the volume of blood ejected from the: a. left ventricle. b. right ventricle. c. left atrium. d. right atrium.

a Systolic blood pressure is determined by the force and volume of blood that the left ventricle ejects during systole and the ability of the arterial system to distend at the time of ventricular contraction.

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? a. To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less b. To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less c. To stop smoking and increase physical activity to 30 minutes/day most days of the week d. To lose weight, achieve a body mass index of 24 or less, and to eat a diet rich in fruits and vegetables

a The end goal of hypertension treatment is to prevent complications and death by achieving and maintaining arterial blood pressure at 140/90 or lower for most people. To achieve this end goal, the client is taught to make the following lifestyle changes (these are not end goals; they are ways to reach the end goal listed above): (1) 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; engaging in aerobic activity at least 30 minuetes per day most days of the week.

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, c, d 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.

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 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.

A nurse is teaching about lifestyle modifications to a group of clients with known hypertension. Which statement would the nurse include in the education session? a. Maintain a body mass index between 30 and 35. b. Engage in aerobic activity at least 30 minutes/day most days of the week. c. Maintain a waist circumference of 45 inches (114 cm) (men) and 40 inches (102 cm) (women) or less. d. Limit alcohol consumption to no more that 3 drinks per day.

b Recommmended lifestye modifications to prevent and manage hypertension 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.

Mr. Faulkner is a 69-year-old man who has enjoyed generally good health for his entire adult life. As a result, he has been surprised to receive a new diagnosis of hypertension after a series of visits to his primary care provider. The nurse who is working with Mr. Faulkner should recognize which of the following aspects of aging and hypertension? a. The diagnostic criteria for hypertension in adults over 65 differ from those for younger adults. b. The incidence and prevalence of hypertension increase with age. c. Blood pressure remains stable throughout adulthood but tends to be assessed more often by health care providers of older adults. d. Older adults are less vulnerable to the pathophysiological effects of hypertension than are younger adults.

b The prevalence of hypertension increases with aging. Aging causes structural and functional changes in the heart and blood vessels, including atherosclerosis and decreased elasticity of the major blood vessels. The diagnostic criteria between older and younger adults do not differ. Older adults are not more immune to the damaging effects of high blood pressure.

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

b Thiazide diuretics cause loss of sodium, potassium, and magnesium. The client should be encouraged to eat fruits and vegetables that are high in potassium. Diuretics cause increased urination; the client should not take the medication before going to bed. Thiazide diuretics to not cause dry mouth or nasal congestion. Postural hypotension (side effect) may be potentiated by alcohol.

A client's medication regimen for the treatment of hypertension includes hydrochlorothiazide. Following administration of this medication, the nurse should anticipate what effect? a. Drowsiness or lethargy b. Increased urine output c. Decreased heart rate d. Mild agitation

b Thiazide diuretics lower BP by reducing circulating blood volume; this results in a short-term increase in urine output. These drugs do not cause bradycardia, agitation, or drowsiness.

A blood pressure (BP) of 140/90 mm Hg is considered to be a. normal. b. prehypertension. c. hypertension. d. a hypertensive emergency.

c A BP of 140/90 mm Hg or higher is hypertension. A blood pressure less than 120/80 mm Hg is considered normal. A BP of 120 to 139/80 to 89 mm Hg is prehypertension. Hypertensive emergency is a situation in which BP is severely elevated and there is evidence of actual or probable target organ damage.

A diastolic blood pressure of 90 mm Hg is classified as a. normal. b. prehypertension. c. stage 1 hypertension. d. stage 2 hypertension.

c A diastolic BP of 80 to 80 mm Hg is classified as prehypertension. A diastolic BP less than 80 mm Hg is normal. A diastolic BP of 90 to 99 mm Hg is stage I hypertension. A diastolic BP of 100 mm Hg or above is classified as stage 2 hypertension.

A 56-year-old male client at a screening event has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, the client states, "My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it?" What is the nurse's best response? a. "Yes. Hypertension is prevalent among men; it is fortunate we caught this during your routine examination." b. "We will need to reevaluate your blood pressure because your age places you at high risk for hypertension." c. "A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made." d. "You have no need to worry. Your pressure is probably elevated because you are being tested."

c Hypertension is confirmed by two or more readings with systolic pressure of at least 140 mm Hg and diastolic pressure of at least 90 mm Hg. An age of 56 does not constitute a risk factor in and of itself. The nurse should not tell the student that there is no need to worry.

A 56-year-old man visits his primary care provider infrequently but has now presented with complaints of transient visual disturbances. Assessment of the patient has yielded few remarkable findings with the exception of blood pressure (BP) of 169/106 mm Hg. When do signs and symptoms of hypertension typically appear? a. Once the patient's average BP crosses the threshold of 140/90 mm Hg b. During the prehypertension stage of the disease c. After target organ damage has occurred d. After hypertension becomes an irreversible condition

c Hypertension may be asymptomatic and remain so for many years; however, when signs and symptoms appear, vascular damage related to the organs served by the involved vessels has occurred. This fact underlies the need for screening and early intervention.

A client in a hypertensive emergency is admitted to the ICU. The nurse anticipates that the client will be treated with IV vasodilators, and that the primary goal of treatment is what? a. Lower the BP to reduce onset of neurologic symptoms, such as headache and vision changes. b. Decrease the BP to a normal level based on the client's age. c. Decrease the mean arterial pressure between 20% and 25% in the first hour of treatment. d. Reduce the BP to ≤ 120/75 mm Hg as quickly as possible.

c Initially, the treatment goal in hypertensive emergencies is to reduce the mean arterial pressure by 25% in the first hour of treatment, with further reduction over the next 24 hours. Lowering the BP too fast may cause hypotension in a client whose body has adjusted to hypertension and could cause a stroke, MI, or visual changes. Neurologic symptoms should be addressed, but this is not the primary focus of treatment planning.

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: a. diastolic BP is between 70 and 79 mm Hg. b. diastolic BP is 100 mm Hg. c. systolic BP is between 120 and 139 mm Hg. d. systolic BP is above 180 mm Hg.

c Once the systolic BP goes above 120 mm Hg, the patient is considered prehypertensive, according to the National Heart, Lung, and Blood Institute's (2015) definition.

The home health nurse is caring for a client who has a diagnosis of hypertension. What assessment question most directly addresses the possibility of worsening hypertension? a. "Are you eating less salt in your diet?" b. "How is your energy level these days?" c. "Do you ever get chest pain when you exercise?" d. "Do you ever see spots in front of your eyes?"

d To identify complications or worsening hypertension, 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, but angina pain and decreased energy are not normally suggestive of worsening hypertension. Sodium limitation is a beneficial lifestyle modification, but nonadherence to this is not necessarily a direct sign of worsening symptoms.