Chapter 27- Prep U

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

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

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

A. Echocardiography Rationale: An echocardiogram is recommended method of determining whether hypertrophy has occurred. Electrocardiography and blood chemistry are part of the routine workup. Renal damage may be suggested by elevations in blood urea nitrogen and creatinine concentrations.

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. systolic BP is above 180 mm Hg. C. systolic BP is between 120 and 139 mm Hg. D. diastolic BP is 100 mm Hg.

C. systolic BP is between 120 and 139 mm Hg. Rationale: 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 nurse and a dietitian are instructing the client on a low-sodium diet needed to lower the blood pressure. Which question is most important for the nurse to ask? A. "How do you prepare your food?" B. "Who eats meals with you?" C. "Do you snack in the evening?" D. "Do you eat three meals per day?"

A. "How do you prepare your food?" Rationale: Asking the client how food is prepared, gives the nurse and dietitian the ability to judge the sodium content. Typically, canned or prepared food and food from a restaurant will have elevated sodium levels. Sodium content in food prepared from fresh ingredients is usually minimal. Asking about whom the client eats with or the client's eating patterns are not as helpful in determining sodium content.

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? A. 25% B. 45% C. 40% D. 35%

A. 25% Rationale: The therapeutic goals are reduction of the mean BP by up to 25% within the first hour of treatment, a further reduction to a goal pressure of about 160/100 mm Hg over a period of 2 to 6 hours, and then a more gradual reduction in pressure to the target goal over a period of days.

An older adult client visits the clinic for a blood pressure check. The client's hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about blood pressure medicine? A. A possible adverse effect of blood pressure medicine is dizziness when you stand. B. A severe drop in blood pressure is possible. C. Take the medicine on an empty stomach. D. There are no adverse effects from blood pressure medicine.

A. A possible adverse effect of blood pressure medicine is dizziness when you stand. Rationale: A possible adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. Teaching should include tips for managing syncope and dizziness. The nurse would not teach the client to take the medicine on an empty stomach.

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. Tension pneumothorax C. Myocardial infarction D. Stroke E. Pancreatitis

A. Coronary artery disease C. Myocardial infarction D. Stroke Rationale: 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.

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 Rationale: Blood pressure is the force produced by the volume of the blood in arterial walls. It is represented by the formula: BP = CO (cardiac output) * PR (peripheral resistance). To highlight the mechanism of cardiac output, a heart would be on the visual aid and blood vessels.

Management of hypertension includes three of the following four goals, depending on the primary and secondary causes. Select all that apply. A. Impairing the synthesis of norepinephrine. B. Decreasing renal absorption of sodium. C. Increasing the force of cardiac output to overcome peripheral resistance. D. Modifying the rate of myocardial contraction.

A. Impairing the synthesis of norepinephrine. B. Decreasing renal absorption of sodium. D. Modifying the rate of myocardial contraction. Rationale: Increasing the force of cardiac output would only increase peripheral resistance, thus increasing blood pressure. The other actions would all help regulate hypertension.

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. A. Physical inactivity B. Gallbladder disease C. Frequent upper respiratory infections D. Smoking E. Diabetes mellitus

A. Physical inactivity D. Smoking E. Diabetes mellitus Rationale: Risk factors for cardiovascular problems in clients with hypertension include smoking, dyslipidemia, diabetes mellitus, impaired renal function, obesity, physical inactivity, age, and family history.

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. Postural hypotension and resulting injury D. Sexual dysfunction

A. Postural hypertension and resulting injury Rationale: 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.

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? A. Reduce the blood pressure by 20% to 25% within the first hour of treatment. B. Reduce the blood pressure by 50% within the first hour of treatment. C. Reduce the blood pressure to about 140/80 mm Hg. D. Rapidly reduce the blood pressure so the client will not suffer a stroke.

A. Reduce the blood pressure by 20% to 25% within the first hour of treatment. Rationale: A hypertensive emergency is a situation in which blood pressures are extremely elevated and must be lowered immediately (not necessarily to less than 140/90 mm Hg) to halt or prevent damage to the target organs (Chobanian et al., 2003; Rodriguez et al., 2010). Hypertensive emergencies are acute, life-threatening blood pressure elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. The therapeutic goals are reduction of the mean blood pressure by 20% to 25% within the first hour of treatment, a further reduction to a goal pressure of about 160/100 mm Hg over a period of up to 6 hours, and then a more gradual reduction in pressure over a period of days.

The nurse is caring for a client newly diagnosed with secondary hypertension. Which condition contributes to the development of secondary hypertension? A. Renal disease B. Calcium deficit C. Acid-based imbalance D. Hepatic function

A. Renal disease Rationale: Secondary hypertension occurs when a cause for the high blood pressure can be identified. These causes include renal parenchymal disease, narrowing of the renal arteries, hyperaldosteronism (mineralocorticoid hypertension), pheochromocytoma, certain medications (e.g., prednisone, epoetin alfa), and coarctation of the aorta. High blood pressure can also occur with pregnancy; women who experience high blood pressure during pregnancy are at increased risk of ischemic heart disease, heart attack, stroke, kidney disease, diabetes, and death from heart attack. Calcium deficiency or acid-based imbalance does not contribute to hypertension.

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

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

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

A. secondary hypertension. Rationale: 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).

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

B. A client diagnosed with kidney disease Rationale: Secondary hypertension is an elevated blood pressure that results from or is secondary to some other disorder such as kidney disease, a tumor of the adrenal medulla, or atherosclerosis. Depression alone is typically not associated with hypertension. Advanced age and alcohol intake are considered factors for essential hypertension.

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. Primary hypertension B. Isolated systolic hypertension C. Hypertensive urgency D. Secondary hypertension

B. Isolated systolic hypertension Rationale: 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).

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

B. Renal dysfunction resulting from atherosclerosis Rationale: The nurse is most correct to realize high blood pressure damages the arterial vascular system and accelerates atherosclerosis. The effect of the atherosclerosis impairs circulation to the kidney, resulting in renal failure. Neither anemia, hyperglycemia, nor emphysema occurs as a direct effect of hypertension.

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

B. Retinal blood vessel damage Rationale: 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, 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. Essential B. Secondary C. Malignant D. Primary

B. Secondary Rationale: Secondary hypertension is elevated BP that results from or is secondary to some other disorder. This type of hypertension is not primary, essential, or malignant.

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. persistent cough B. dizziness C. tremor D. blurred vision

B. dizziness Rationale: 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.

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? A. Walking as far as the client is able every day B. Being sure to keep follow-up appointments C. Changing positions slowly related to possible hypotension D. Eating extra potassium due to loss of potassium related to medications

C. Changing positions slowly related to possible hypotension Rationale: The elderly have impaired cardiovascular reflexes and thus are more sensitive to the extracellular volume depletion caused by diuretics and to the sympathetic inhibition caused by adrenergic antagonists. The nurse teaches clients to change positions slowly when moving from a lying or sitting position to a standing position. This will help prevent falls. Eating extra potassium is not a good idea if taking a potassium-sparing diuretic. The other choices are good teaching points, but not necessarily safety precautions.

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? A. Hypokalemia B. Hypernatremia C. Hyperkalemia D. Hyponatremia

C. Hyperkalemia Rationale: Potassium-sparing diuretics, such as spironolactone, can cause hyperkalemia, especially if given with an ACE inhibitor. Signs of hyperkalemia are nausea, diarrhea, abdominal cramps, and peaked narrow T-waves.

Which term is refers to hypertension in which blood pressure that is controlled with therapy becomes uncontrolled (abnormally high) when the therapy is discontinued? A. Secondary B. Essential C. Rebound D. Primary

C. Rebound Rationale: Rebound hypertension may precipitate a hypertensive crisis. Essential or primary hypertension denotes high blood pressure from an unidentified source. Secondary hypertension denotes high blood pressure from an identified cause, such as renal disease.

An older African American client is found to have a blood pressure of 150/90 mm Hg during a work-site health screening. What should the nurse do? A. Recommend the client see a health care provider immediately for further evaluation. B. Consider this to be a normal finding for the client's age and race. C. Recommend the client have blood pressure rechecked within 2 weeks. D. Recommend the client have blood pressure rechecked in 1 year.

C. Recommend the client have blood pressure rechecked within 2 weeks. Rationale: The nurse should recommend the client have blood pressure rechecked within 2 weeks because a blood pressure of 150/90 mm Hg isn't considered normal. One year is too long to wait. The client need not see a health care provider yet.

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

C. Sit on the edge of the chair and rise slowly. Rationale: The nursing instruction emphasized to maintain client safety is to sit on the edge of the chair before rising slowly. By doing so, the client reduces the possibility of falls related to postural hypotension. Using a pillbox to store medications and taking the medication at the same time daily is good medication management instruction, but not necessarily related to safety. When taking antihypertensive medications, there is no reason to restrict driving.

The nurse is caring for a client with essential hypertension. The nurse reviews lab work and assesses kidney function. Which action of the kidney would the nurse evaluate as the body's attempt to regulate high blood pressure? A. The kidney retains water and excretes sodium. B. The kidney retains sodium and water. C. The kidney excretes sodium and water. D. The kidney retains sodium and excretes water.

C. The kidney excretes sodium and water. Rationale: Hypernatremia (elevated serum sodium level) increases blood volume, which raises blood pressure. The kidney's response to the elevation in blood pressure is to excrete sodium and excess water. Any retention of sodium and water would increase blood volume and, thus, blood pressure. Sodium and water move together.

A 65-year-old client is beginning medical management of recently diagnosed hypertension. The most important strategy in this client's treatment is reducing: A. systolic pressure below 130 mm Hg. B. diastolic pressure below 80 mm Hg. C. systolic pressure below 150 mm Hg. D. diastolic pressure below 90 mm Hg.

C. systolic pressure below 150 mm Hg. Rationale: Currently, it is believed that in persons younger than 60 years of age, reducing the systolic pressure below 140 mm Hg is more important than decreasing the diastolic blood pressure. In persons older than 60 years, the goal is below 150 mm Hg.

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

D. "Limiting my salt intake to 2 grams per day will improve my blood pressure." Rationale: 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. Moderate caffeine and fat intake don't significantly affect blood pressure

The nurse is caring for an older adult 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? A. Decrease in blood volume B. Decrease in cardiac output C. Increase in calcium intake D. Loss of arterial elasticity

D. Loss of arterial elasticity Rationale: In older clients, systolic BP may be elevated because of loss of arterial elasticity (arteriosclerosis). Systolic BP would not become elevated by a decrease in blood volume, an increase in calcium intake, or a decrease in cardiac output.

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? A. Urine output of 40 mL over the past hour B. Nausea and severe headache C. Chest pain score of 3 (on a scale of 1 to 10) D. Numbness and weakness in the left arm

D. Numbness and weakness in the left arm Rationale: 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. The finding of numbness and weakness in left arm may indicate the client is experiencing neurological symptoms associated with an ischemic stroke because of the severely elevated BP; immediate intervention is required. Urine output of 40 mL/h is within normal limits. The other findings are likely caused by the hypertension and require intervention, but they do not require action as urgently as the neurologic changes.

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

D. Pressures should not differ more than 5 mm Hg between arms. Rationale: Normally, in the absence of any disease of the vasculature, arm pressures differ by no more than 5 mm Hg. The pressures in each arm do not have to be equal to be considered normal. Pressures that vary more than 10 mm Hg between arms are an abnormal finding. The left arm pressure is not anticipated to be higher than the right as a normal anatomic variant.

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. Chlorthalidone C. Chlorothiazide D. Spironolactone

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

The nurse is employed in a physician's office and is caring for a client present for an annual exam. A blood pressure of 124/84 mm Hg is documented. Following revised guidelines for identifying hypertension, which educational pamphlet is helpful? A. Increasing fluids for low blood pressure B. Use of beta-blockers for treatment of hypertension C. Diagnostic testing for determining cardiac functioning D. Stress reduction to lower prehypertensive state

D. Stress reduction to lower prehypertensive state Rationale: A blood pressure of 124/84 mm Hg is now considered to be in the lower range of prehypertension. Knowledge of stress reduction may be helpful in lowering the blood pressure without medication therapy. A blood pressure of 124/84 mm Hg is not considered a low blood pressure or in need of medication therapy due to hypertension. Diagnostic testing for cardiac functioning is not typical for a client with prehypertension.

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

D. stroke Rationale: A stroke occurs if vessels in the brain rupture and bleed. If an aneurysm has developed in the aorta from chronic hypertension, it may burst and cause hemorrhage and shock. Peripheral edema, right-sided heart failure, and pulmonary insufficiency are not usually consequences of untreated chronic hypertension.