Chapter 31: Assessment and Management of Patients With Hypertension

A 66-year-old client presents to the emergency room (ER) complaining of a severe headache and mild nausea for the last 6 hours. Upon assessment, the patient's BP is 210/120 mm Hg. The patient has a history of HTN for which he takes 1.0 mg clonidine (Catapres) twice daily for. Which of the following questions is most important for the nurse to ask the patient next? a) "Are you having chest pain or shortness of breath?" b) "Have you taken your prescribed Catapres today?" c) "Did you take any medication for your headache?" d) "Do you have a dry mouth or nasal congestion?"

b) "Have you taken your prescribed Catapres today?" The nurse must ask if the patient has taken his prescribed Catapres. Patients need to be informed that rebound hypertension can occur if antihypertensive medications are suddenly stopped. Specifically, a side effect of Catapres is rebound or withdrawal hypertension. Although the other questions may be asked, it is most important to inquire if the patient has taken his prescribed HTN medication given the patient's severely elevated BP.

A nurse providing education to a community group about hypertension is reviewing appropriate lifestyle modifications. Which of the following are among changes that can help prevent and control hypertension? Choose all that apply. a) Increased intake of dietary sodium b) Weight reduction c) Increased physical activity d) Increased intake of dietary protein e) Substitution of low-fat for whole dairy products in diet

b) Weight reduction c) Increased physical activity e) Substitution of low-fat for whole dairy products in diet Lifestyle modifications to prevent and manage hypertension include weight reduction, adopting the Dietary Approaches to Stop Hypertension (DASH) diet, dietary sodium reduction, physical activity, and moderation of alcohol consumption.

When monitoring a patient who has hypertension and chronic kidney disease, the target pressure for this individual should be less than which blood pressure reading? a) 120/70 mm Hg b) 110/60 mm Hg c) 130/80 mm Hg d) 140/90 mm Hg

c) 130/80 mm Hg For individuals with diabetes or chronic kidney disease, JNC 7 specifies a target pressure of less than 130/80 mm Hg.

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) Kidneys and autonomic nervous system b) Brain and sympathetic nervous system c) Heart and blood vessels d) Lung and arteries

c) Heart and blood vessels 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.

A 44-year-old client has a history of hypertension. As her nurse, you engage her in client education to make her aware of structures that regulate arterial pressure. Which of the following structures is a component of that process? a) Parasympathetic nervous system b) Lungs c) Kidneys d) Limbic system

c) Kidneys The autonomic nervous system, the kidneys, and various endocrine glands regulate arterial pressure.

The treatment goal for those with stage 2 hypertension (hypertension with compelling indications or complications) includes lifestyle modifications and multiple drug therapies. Thiazide diuretics are part of this treatment approach for most complications except for: a) Diabetes mellitus b) Heart failure c) Recurrent stroke prevention d) Chronic kidney disease

d) Chronic kidney disease Since thiazides are diuretics, they would not be the drugs of choice for patients with chronic kidney disease, in whom renal function is already compromised.

You are part of a group of nursing students who are making a presentation on chronic hypertension. What is one subject you would need to include in your presentation as a possible consequence of untreated chronic hypertension? a) Right-sided heart failure b) Pulmonary insufficiency c) Peripheral edema d) Stroke

d) Stroke 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. Options A, B, and D are not usually consequences of untreated chronic hypertension.

A nurse is educating a client about monitoring blood pressure readings at home. Which of the following will the nurse be sure to emphasise? a) "Sit quietly for 5 minutes prior to taking blood pressure." b) "Be sure the forearm is well supported above heart level while taking blood pressure." c) "Avoid smoking cigarettes for 8 hours prior to taking blood pressure." d) "Sit with legs crossed when taking your blood pressure."

a) "Sit quietly for 5 minutes prior to taking blood pressure." Instructions for the client regarding measuring the blood pressure at home include the following: (1) Avoid smoking cigarettes or drinking caffiene for 30 minutes before measuring blood pressure. (2) Sit quietly for 5 minutes before the measurement. (3) Have the forearm supported at heart level, with both feet on the ground during the measurement of the blood pressure.

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) Modifying the rate of myocardial contraction. c) Decreasing renal absorption of sodium. d) Increasing the force of cardiac output to overcome peripheral resistance.

a) Impairing the synthesis of norepinephrine. b) Modifying the rate of myocardial contraction. c) Decreasing renal absorption of sodium. Increasing the force of cardiac output would only increase peripheral resistance, thus increasing blood pressure. The other actions would all help regulate hypertension.

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

a) Maintain adequate dietary intake of potassium In general, one serving of a potassium-rich food such as banana, kale, broccoli, or orange juice will meet the daily need for potassium. The patient should be guided to stop smoking. The general guideline is to advise the patient to increase aerobic activity to 30 to 45 minutes most days of the week. In general, alcohol intake should be limited to no more than 1 oz of ethanol per day.

A 77-year-old client has newly diagnosed stage 2 hypertension for which the physician has prescribed a thiazide and an angio-converting enzyme inhibitor. The nurse is concerned about the client's risk for postural hypotension because of these medications, as well as for what other reason? a) Older adults have impaired cardiovascular reflexes. b) Older adults require large doses of these medications to control their blood pressure. c) Older adults have trouble remembering to measure their blood pressure at home. d) These medications often cause rebound hypertension.

a) Older adults have impaired cardiovascular reflexes. Antihypertensive medications can cause hypotension, especially postural hypotension that may result in injury. Older adults 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. Rebound hypertension occurs when antihypertensive medications are stopped abruptly. Older adults are more sensitive to the effects of these medications and so usually require lower doses. Most older clients can remember very well to measure their blood pressure at home.

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

a) Renal dysfunction resulting from atherosclerosis 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.

A nurse is teaching the Dietary Approaches To Stop Hypertension (DASH) diet to clients who have been newly diagnosed with hypertension. Which of the following information will the nurse include? a) Seven to eight whole grain products per day b) Seven to eight fruits per day c) Three to four regular dairy foods per day d) Four to five servings of meat, fish, or poultry per day

a) Seven to eight whole grain products per day The DASH diet is based on 2,000 calories per day and includes: 7 to 8 whole servings of whole-grain products per day 4 to 5 servings of vegetables per day 4 to 5 servings of fruits per day 2 to 3 servings of low-fat or fat-free dairy foods per day 2 or fewer servings of meat, fish, or poultry per day 4 to 5 servings of nuts, seeds, and dry beans per week.

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

b) 4 or 5 Four or five servings of vegetables are recommended in the DASH diet.

When measuring the blood pressure in each of the patient's arms, the nurse recognizes that in the healthy adult, which of the following is true? a) Pressures may vary 10 mm Hg or more between arms. b) Pressures should not differ more than 5 mm Hg between arms. c) Pressures must be equal in both arms. d) Pressures may vary, with the higher pressure found in the left arm.

b) Pressures should not differ more than 5 mm Hg between arms. Normally, in the absence of disease of the vasculature, there is a difference of no more than 5 mm Hg between arm pressures. The pressures in each arm do not have to be equal in order to be considered normal. Pressures that vary more than 10 mm Hg between arms indicate an abnormal finding. The left arm pressure is not anticipated to be higher than the right as a normal anatomic variant. (

A patient is brought to the emergency department with complaints of a bad headache and an increase in blood pressure. The blood pressure reading obtained by the nurse is 260/180 mm Hg. What is the therapeutic goal for reduction of the mean blood pressure? a) Reduce the blood pressure by 50% within the first hour of treatment. b) Reduce the blood pressure by 20% to 25% within the first hour of treatment. c) Rapidly reduce the blood pressure so the patient will not suffer a stroke. d) Reduce the blood pressure to about 140/80 mm Hg.

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

A client in a clinic setting has just been diagnosed with hypertension. She asks what the end goal is for treatment. The correct reply from the nurse is which of the following? a) To stop smoking and increase physical activity to 30 minutes/day most days of the week b) To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less c) To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less d) To lose weight, achieve a body mass index of 24 or less, and to eat a diet rich in fruits and vegetables

b) To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less 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.

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

c) It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. It takes 2 to 3 months for the taste buds to adapt to changes in salt intake. Knowing this may help the client adjust to reduced salt intake. The client should be advised to limit alcohol intake.

A nurse is providing education about lifestyle modifications to a group of clients who have been newly diagnosed with hypertension. The nurse would include all the following statements except: a) Engage in aerobic activity at least 30 minutes/day most days of the week. b) Maintain a waist circumference of 40 (men) and 35 (women) inches or less. c) Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women. d) Maintain a normal body mass index of about 24.

c) Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women. 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 per day to no more than 2 drinks for men and 1 drink for women, and engaging in aerobic activity at least 30 minutes per day most days of the week.

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

c) Prehypertension 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.

Target organ damage from untreated/undertreated hypertension includes which of the following? Select all that apply. a) Diabetes b) Hyperlipidemia c) Stroke d) Heart failure e) Retinal damage

c) Stroke d) Heart failure e) Retinal damage Target organ systems include cardiac, cerebrovascular, peripheral vascular, renal, and the eye. Hyperlipidemia and diabetes are risk factors for development of hypertension.

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

c) Untreated hypertension Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as those that occur with monoamine oxidase inhibitors and aged cheeses).

Lifestyle modifications are recommended to prevent and manage hypertension. Select the modification that has been found to have the greatest effect in reducing blood pressure measurements. a) Sodium reduction b) Adopting the DASH approach to eating c) Weight reduction d) Physical activity

c) Weight reduction Although all approaches are effective modifications to manage hypertension, weight reduction can result in a 5 to 20 mm Hg/10 kg lowering of blood pressure readings.

A client with high blood pressure is receiving an antihypertensive drug. The nurse knows that antihypertensive drugs commonly cause fatigue and dizziness, especially on rising. When developing a client teaching plan to minimize orthostatic hypotension, which instruction should the nurse include? a) "Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night." b) "Rest between demanding activities, eat plenty of fruits and vegetables, and drink 6 to 8 cups of fluid daily." c) "Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising." d) "Flex your calf muscles, avoid alcohol, and change positions slowly."

d) "Flex your calf muscles, avoid alcohol, and change positions slowly." Measures that minimize orthostatic hypotension include flexing the calf muscles to boost blood return to the heart, avoiding alcohol and straining at stool, changing positions slowly, eating a high-protein snack at night, wearing elastic stockings, and holding onto a stationary object when rising. Although the client should rest between demanding activities and consume plenty of fluids and fiber (contained in fruits and vegetables) to maintain a balanced diet, these measures don't directly relieve orthostatic hypotension.

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) Secondary hypertension b) Hypertensive emergency c) Primary hypertension d) Hypertensive urgency

d) Hypertensive urgency 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).