Chapter 32 Hypertension EAQ

A nurse provides education to a hypertensive patient related to lifestyle modifications to reduce cardiovascular risks associated with high blood pressure (BP). Which statement made by the patient indicates effective learning? Select all that apply. 1. "I should achieve and maintain a healthy weight." 2. "I can continue to smoke, because nicotine does not affect blood pressure." 3. "I should exercise for at least 30 minutes daily." 4. "I can have up to five alcoholic drinks per day." 5. "I should restrict my salt intake to less than 1500 mg/day."

1. "I should achieve and maintain a healthy weight." 3. "I should exercise for at least 30 minutes daily." 5. "I should restrict my salt intake to less than 1500 mg/day." Lifestyle modifications play a vital role in reducing blood pressure and cardiovascular risk. Overweight people are at higher risk of cardiovascular disease. A weight loss of 22 lb may decrease systolic blood pressure by approximately 5 to 20 mm Hg. Being physically active is essential to maintain good health. It decreases the cardiovascular risk of hypertension. Sodium reduction helps to control blood pressure. A hypertensive patient should lower salt intake to 1500 mg/day. The nicotine in tobacco causes vasoconstriction and increases blood pressure. Therefore, smokers who are hypertensive should stop smoking. Excessive alcohol consumption increases the risk of hypertension. Consuming three or more drinks per day increases the risk of cardiovascular disease and stroke. Text Reference - p. 715

A patient is diagnosed with primary hypertension and asks the nurse what caused this condition. Which is the best response by the nurse? 1. "There is no one identifiable reason." 2. "Kidney disease is the most common reason." 3. "It is caused by a decrease in plasma renin levels." 4. "There is too much plaque in the blood vessels."

1. "There is no one identifiable reason." There is not one exact cause of primary hypertension; there are several contributing factors. Renal or kidney disease is a cause of secondary hypertension. An increase, not a decrease, in plasma renin levels is a contributing factor in the development of primary hypertension. Hypertension speeds up the process of atherosclerosis in the peripheral blood vessels. Text Reference - p. 712

The nurse is obtaining a health history from a patient with hypertension. Nonmodifiable risk factors for the development of hypertension include which of these? Select all that apply. 1. Age 65 years 2. Excessive dietary sodium 3. African American ethnicity 4. Excessive alcohol consumption 5. A family history of hypertension

1. Age 65 years 3. African American ethnicity 5. A family history of hypertension Nonmodifiable risk factors for hypertension include increasing age, African American ethnicity, and a family history of hypertension. Consumption of excessive dietary sodium and excessive alcohol consumption are considered modifiable risk factors. Text Reference - p. 713

The nurse is taking the blood pressure of an older patient and compares the result to the previous reading. The nurse observes that the systolic blood pressure of the previous reading was 30 mm Hg higher than the reading the nurse just obtained. Which of these is a possible explanation? 1. An aucultatory gap may be present. 2. The patient's hypertension is improving. 3. The equipment the nurse used is not working properly. 4. The patient was more relaxed with the most recent blood pressure measurement.

1. An aucultatory gap may be present. Careful technique is important in assessing blood pressure in older adults. Some older people have a wide gap between the first Korotkoff sound and subsequent beats. This is called the auscultatory gap. Failure to inflate the cuff high enough may result in underestimating systolic blood pressure. Text Reference - p. 725

The nurse is creating a plan of care for a patient with a new diagnosis of hypertension. Which is a potential nursing diagnosis for the patient taking antihypertensive medications? Select all that apply. 1. Anxiety 2. Constipation 3. Impaired memory 4. Sexual dysfunction 5. Urge urinary incontinence

1. Anxiety 4. Sexual dysfunction Nursing diagnoses associated with patients taking medications for hypertension include anxiety (related to complexity of management regimen) and sexual dysfunction (related to side effects of antihypertensive drugs). Constipation, impaired memory, and urge urinary incontinence are not side effects of antihypertensive drugs. Text Reference - p. 720

A nurse is caring for a patient admitted to the health care facility with acute ischemic stroke. The patient is receiving IV antihypertensive drugs. Which interventions should the nurse perform for this patient? Select all that apply. 1. Assess blood pressure (BP) and pulse every 30 minutes. 2. Titrate drug according to mean arterial pressure (MAP) or BP as prescribed. 3. Measure hourly urine output. 4. Provide assistance to get up as patient desires. 5. Perform frequent neurologic checks.

1. Assess blood pressure (BP) and pulse every 30 minutes. 2. Titrate drug according to mean arterial pressure (MAP) or BP as prescribed. 5. Perform frequent neurologic checks. Drugs should be titrated according to MAP or BP as prescribed. The nurse should measure hourly urine output to assess renal perfusion and should perform frequent neurologic checks. Antihypertensive IV drugs have a rapid onset of action; hence BP and pulse should be assessed every two to three minutes using a noninvasive BP machine. The patient should be restricted to bed; severe cerebral ischemia or fainting may result if the patient tries to get up. Text Reference - p. 272

The nurse providing dietary instruction to a patient with hypertension would advise the patient to cut down on the intake of which foods? Select all that apply. 1. Canned vegetables 2. Red meat 3. Baked chicken 4. Canned fruit 5. Processed cheeses

1. Canned vegetables 2. Red meat 5. Processed cheeses Foods high in fat and sodium—including canned vegetables, red meat, and processed cheeses—should be avoided by the patient with hypertension. Baked chicken and canned fruit are low in sodium and fat. Text Reference - p. 716

A patient has a prescription for nadolol 50 mg by mouth (PO) daily. The nurse questions the prescription after noting which medical diagnosis in the patient's health record? 1. Chronic obstructive pulmonary disease (COPD) 2. Renal insufficiency 3. Diabetes mellitus 4. Hypertension

1. Chronic obstructive pulmonary disease (COPD) Nadolol is a nonselective β1-adrenergic-blocking agent that reduces blood pressure and could affect the β2 receptors in the lungs with larger doses or with drug accumulation. It should be used cautiously in patients with COPD, because it could trigger bronchospasm, a potentially life-threatening adverse effect. Nadolol will not worsen renal insufficiency and diabetes and will treat, not worsen, hypertension. Text Reference - p. 718

A patient whose blood pressure is 200/120 mm Hg is diagnosed with hypertensive crisis. The patient receives a prescription for clonidine. The nurse instructs the patient to avoid engaging in hazardous activities like operating machinery. What is the reason for this instruction? 1. Clonidine causes drowsiness. 2. Clonidine causes orthostatic hypotension. 3. Clonidine causes a rapid decrease in BP. 4. Clonidine causes rebound hypertension

1. Clonidine causes drowsiness. Clonidine is an adrenergic inhibitor that reduces sympathetic outflow from the central nervous system. It lowers BP by reducing peripheral sympathetic tone, dilating the blood vessels, and decreasing the systemic vascular resistance. Drowsiness is a side effect of the drug, and the patient is advised to avoid engaging in hazardous activities, because this can increase the risk of injury. The drug also causes orthostatic hypotension, so the patient is advised to change position slowly. The drug does not cause a rapid decrease in BP. The drug can cause rebound hypertension if discontinued abruptly. Text Reference - p. 717

A patient is prescribed lisinopril for the treatment of hypertension. The patient asks about side effects of this medication. Which side effects should the nurse include? Select all that apply. 1. Cough 2. Edema 3. Dizziness 4. Impotence 5. Hypotension 6. Muscle stiffness

1. Cough 3. Dizziness 4. Impotence Cough, dizziness, and hypotension are side effects of angiotensin-converting enzyme (ACE) inhibitors. Peripheral edema is a side effect of calcium channel blockers. Impotence is a side effect of thiazide diuretics, aldosterone receptor blockers, central-acting alpha-adrenergic antagonists, peripheral-acting alpha-adrenergic antagonists, beta-adrenergic blockers, and mixed alpha 1 and beta 1 blockers. Muscle stiffness is not associated with an ACE inhibitor. Test-Taking Tip: Avoid spending excessive time on any one question. Most questions can be answered in one to two minutes. Text Reference - p. 724

A patient is being discharged from the hospital. The primary health care provider prescribes propranolol for hypertension. Which instruction should the nurse include in the patient's discharge teaching plan? 1. Do not stop taking abruptly. 2. Take initial doses at bedtime. 3. Monitor for peripheral edema. 4. Take with orange juice.

1. Do not stop taking abruptly. Patients should not stop taking this medication abruptly, because this may cause rebound hypertension. The initial dose of alpha-1 adrenergic blockers should be taken at bedtime because of the possible profound orthostatic hypotension with syncope within 90 minutes after the initial dose. Calcium channel blockers may cause peripheral edema. Beta blockers are not potassium wasting, so it is not necessary to take them with orange juice. Text Reference - p. 725

A nurse is monitoring the blood pressure (BP) of a patient visiting the health care facility. What should the nurse ensure when recording the BP? Select all that apply. 1. Ensure the patient has not exercised within 30 minutes. 2. Seat the patient and begin measurement. 3. Support the patient's arm at heart level. 4. Palpate the radial pulse for auscultatory measurement. 5. Deflate the cuff at the rate of 5 mm Hg/sec.

1. Ensure the patient has not exercised within 30 minutes. 3. Support the patient's arm at heart level. 4. Palpate the radial pulse for auscultatory measurement. The nurse should ensure that the patient has not exercised, smoked, or ingested caffeine within 30 minutes before measurement. The patient's arm should be supported at heart level. The radial pulse is palpated for auscultatory measurement. The nurse should begin measurement only after the patient has rested patiently for 5 minutes after sitting. The cuff should be deflated at a rate of 2 to 3 mm Hg/sec. Text Reference - p. 723

The nurse teaches a patient with hypertension that symptoms of uncontrolled hypertension may include which of the following? Select all that apply. 1. Fatigue 2. Dizziness 3. Palpitations 4. Shortness of breath 5. Cluster headaches

1. Fatigue 2. Dizziness 3. Palpitations Uncontrolled hypertension may result in fatigue, dizziness, and palpitations. Cluster headaches and shortness of breath do not occur with uncontrolled hypertension. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation. Text Reference - p. 713

The nurse teaches a patient with hypertension that uncontrolled hypertension may damage organs in the body primarily by which mechanism? 1. Hypertension promotes atherosclerosis and damage to the walls of the arteries. 2. Hypertension causes direct pressure on organs, resulting in necrosis and replacement of cells with scar tissue. 3. Hypertension causes thickening of the capillary membranes, leading to hypoxia of organ systems. 4.Hypertension increases blood viscosity, which contributes to intravascular coagulation and tissue necrosis distal to occlusions.

1. Hypertension promotes atherosclerosis and damage to the walls of the arteries. Hypertension is a major risk factor for the development of atherosclerosis by mechanisms not yet fully known. However, once atherosclerosis develops, it damages the walls of arteries and reduces circulation to target organs and tissues.

A nurse is preparing to measure the blood pressure of a patient who is lying down on a bed. What technique should the nurse use to ensure that the BP reading is accurate? 1. Measure the BP twice, waiting one minute between measurements. 2. Rest the patient's arms on the bed during the BP measurement. 3. Measure the BP in both arms and record the lowest reading. 4. Place the BP cuff on the forearm when measuring the BP.

1. Measure the BP twice, waiting one minute between measurements. When recording BP, two measurements should be taken one minute apart. This allows the blood to drain from the arm and prevents inaccurate readings. If the patient is in a lying down position, the arm should be placed on a pillow so that it is at the heart level. Atherosclerosis in the subclavian artery may result in a falsely low BP in the affected side; therefore, the arm which has the highest recording of the BP should be used for further measurements. The upper arm, not the forearm, is the preferred site of BP cuff placement due to its accuracy of recordings. Text Reference - p. 723

A nurse works in a medical unit. The nurse has assessed the patients and planned care for them. Which activities can be delegated to unlicensed assistive personnel (UAP)? Select all that apply. 1. Report high or low BP readings to the registered nurse. 2. Make appropriate referrals to other health care professionals. 3. Teach patients about lifestyle management and medication use. 4. Check for postural changes in BP. 5. Assess patients for hypertension risk factors and develop risk modification plans.

1. Report high or low BP readings to the registered nurse. 4. Check for postural changes in BP. Reporting high or low BP readings and checking for postural changes in BP are repetitive activities and do not require nursing judgment. Therefore, these activities can be delegated to unlicensed assistive personnel. Making appropriate referrals requires understanding of the collaborative care and judgment regarding the requirement of the referrals; this activity cannot be delegated and is the role of a registered nurse. Patient education about lifestyle management and medication use requires sound knowledge; therefore, this activity should be performed by the nurse. Assessment and development of risk modification plans requires assessment and planning skills; this activity should not be delegated and should be performed by the nurse. Text Reference - p. 724

A nurse is preparing discharge teaching for a patient with orthostatic hypotension. Which instructions should be a part of the discharge plan? Select all that apply. 1. Rise slowly from a supine to sitting position. 2. Avoid sleeping with the head elevated. 3. Lie down or sit if dizziness occurs. 4. Do not stand still for prolonged periods. 5. Perform leg exercises to increase venous return.

1. Rise slowly from a supine to sitting position. 3. Lie down or sit if dizziness occurs. 4. Do not stand still for prolonged periods. 5. Perform leg exercises to increase venous return. Orthostatic hypotension is a condition in which there is a decrease in blood pressure upon rising to a standing position from a lying down or sitting position. The patient should be instructed to rise slowly from the sitting and lying down positions and to move only when no dizziness occurs. The patient should sit or lie down if there is dizziness. This prevents the risk of falling. Standing still for prolonged periods may cause venous stasis and worsen hypotension. Doing leg exercises helps to increase venous return to the heart and lowers blood pressure. Sleeping with the head elevated helps to keep the blood flow to the brain uniform and prevents orthostatic hypotension. Text Reference - p. 723

The nurse is teaching the male patient about the most common side effects of antihypertensive medications. Which information would the nurse discuss with the patient? Select all that apply. 1. Sexual dysfunction 2. Resistant hypertension 3. Orthostatic hypotension 4. Frequent voiding and dry mouth 5. Rebound hypotension if the drug is stopped abruptly

1. Sexual dysfunction 3. Orthostatic hypotension 4. Frequent voiding and dry mouth Reduced libido or erectile dysfunction are examples of sexual dysfunction as a side effect of antihypertensive medications. Alteration of the autonomic nervous system mechanism by antihypertensive medications leads to orthostatic hypotension. Diuretics are one class of medications for treatment of hypertension that cause frequent urination and dry mouth. "Resistant hypertension" is a term used to describe failure to reach desired blood pressure (BP) in the patient who takes multiple antihypertensive medications. Rebound hypertension results from abrupt stopping of antihypertensive medication use. Text Reference - p. 721

The nurse is preparing a presentation on complications of hypertension. Which information would the nurse include? Select all that apply. 1. Stroke as a result of carotid artery atherosclerosis 2. Heart failure as a result of increased heart contractility 3. Blurred vision or loss of vision secondary to retinal damage 4. Right ventricular hypertrophy as a result of increased workload 5. Coronary artery disease caused by an increase in the elasticity of arterial walls

1. Stroke as a result of carotid artery atherosclerosis 3. Blurred vision or loss of vision secondary to retinal damage Embolic stroke may be a result of cerebral blood flow obstruction by a portion of atherosclerotic plaque or a blood clot formed in the carotid arteries. Hypertension leads to retinal damage that is manifested by blurred vision or loss of vision and retinal hemorrhage. Heart failure is a result of decreased heart contractility along with decreased stroke volume and cardiac output. Hypertension leads to increased cardiac workload that causes left ventricular hypertrophy. Coronary artery disease is caused by decreased elasticity of arterial walls and narrowing of the lumen. Text Reference - p. 713

A patient arrives at a medical clinic for a check-up. The patient's blood pressure (BP) is 150/94 mm Hg. All other assessment findings are within normal limits. The nurse reviews the patient's file from previous visits, and there is no history of elevated blood pressure. What could be the reason for a falsely high blood pressure? 1. The blood pressure cuff might have been too small. 2. There may be atherosclerosis in the subclavian artery. 3. The patient may have smoked the day before the BP measurement. 4. The patient may have engaged in strenuous exercises the day before the BP measurement.

1. The blood pressure cuff might have been too small. BP measurements should be performed using proper technique to get an accurate reading. BP measurements may be falsely high if the BP cuff is too small as it puts undue pressure on the artery. If the subclavian artery has atherosclerosis, the BP measurement would be falsely low. Smoking and engaging in strenuous exercise should be avoided 30 minutes before the BP measurement, because they can alter the measurement. Smoking or engaging in strenuous exercise one day before a BP measurement will not affect the readings. Text Reference - p. 723

Which test result would indicate the presence of target organ damage resulting from uncontrolled hypertension? 1. Urine protein 3+ 2. Blood urea nitrogen (BUN) 18 mg/dL 3. Uric acid 8.2 mg/dL 4. Triglycerides 144 mg/dL

1. Urine protein 3+ Urine protein should not be present. This increased level indicates target organ damage to the kidneys. The BUN is normal, the elevated uric acid level indicates gout, and the triglyceride level is normal. Test-Taking Tip: Avoid taking a wild guess at an answer. However, should you feel insecure about a question, eliminate the alternatives that you believe are definitely incorrect, and reread the information given to make sure you understand the intent of the question. This approach increases your chances of randomly selecting the correct answer or getting a clearer understanding of what is being asked. Although there is no penalty for guessing on the NCLEX examination, the subsequent question will be based, to an extent, on the response you give to the question at hand; that is, if you answer a question incorrectly, the computer will adapt the next question accordingly based on your knowledge and skill performance on the examination up to that point. Text Reference - p. 714

In reviewing medication instructions with a patient prescribed lisinopril, the nurse should include which statement? 1. "You should not take this medication if you have asthma." 2. "You may develop a dry cough while taking this medication." 3. "Never take this medication on an empty stomach." 4. "Discontinue use of this medication if you develop a drop in your blood pressure."

2. "You may develop a dry cough while taking this medication." Lisinopril is an ACE-inhibitor. A common side effect is a dry cough. This medication is safe for use with asthma, can be taken on an empty stomach, and should not be discontinued unless instructed to do so by a health care provider. Text Reference - p. 719

The nurse records normal blood pressure (BP) for a patient with a family history of hypertension and diabetes. What should the nurse teach the patient to specifically address the risks of hypertension? Select all that apply. 1. Increase caloric intake. 2. Avoid foods high in sodium. 3. Reduce the use of tobacco products. 4. Take brisk walks. 5. Avoid overexertion with muscle-strengthening activities

2. Avoid foods high in sodium. 4. Take brisk walks. The nurse should teach the patient to adopt lifestyle changes, such as avoiding foods high in sodium and taking brisk walks. A decrease in caloric intake helps to reduce weight and prevent hypertension. The patient should completely avoid use of tobacco products, because the nicotine contained in tobacco causes vasoconstriction and increases BP. All adults should perform muscle-strengthening activities to maintain and increase endurance and strength of muscles. Text Reference - p. 716

The nurse is caring for a patient admitted with a history of hypertension. The patient's medication history includes hydrochlorothiazide daily for the past 10 years. Which parameter would indicate the optimal intended effect of this drug therapy? 1. Weight loss of 2 lb 2. Blood pressure 128/86 3. Absence of ankle edema 4. Output of 600 mL per eight hours

2. Blood pressure 128/86 Hydrochlorothiazide may be used alone as monotherapy to manage hypertension or in combination with other medications if not effective alone. After the first few weeks of therapy, the diuretic effect diminishes, but the antihypertensive effect remains. Because the patient has been taking this medication for 10 years, the most direct measurement of its intended effect would be the blood pressure. Text Reference - p. 717

A nurse is providing care for a patient who continues to experience hypertension despite taking a calcium channel blocker daily. A diuretic has been prescribed. How does a diuretic help control blood pressure? Select all that apply. 1. It causes vasodilation. 2. It reduces plasma volume. 3. It promotes sodium and water excretion. 4. It reduces the vascular response to catecholamines. 5. It prevents extracellular calcium from moving into the cells.

2. It reduces plasma volume. 3. It promotes sodium and water excretion. 4. It reduces the vascular response to catecholamines. Diuretics are an important component of BP treatment. Diuretics tend to reduce the plasma volume by promoting excretion of sodium and water. The net result is a reduction in the circulating volume, which causes a decrease in the BP. Diuretics also reduce the vascular response to catecholamines. The blood vessels do not constrict in response to catecholamines; as a result, the BP is reduced. Diuretics do not cause vasodilation or prevent the movement of extracellular calcium into the cells; these effects are brought about by calcium channel blockers. Text Reference - p. 720

The nurse understands that which medication may increase the risk of hypoglycemia unawareness in a patient with diabetes mellitus? 1. Cardizem 2. Metoprolol 3. Prednisone 4. Hydromorphone

2. Metoprolol Metoprolol, a beta blocker, slows the heart rate. Tachycardia is a classic symptom of hypoglycemia; therefore patients must be made aware of failure of the heart rate to respond to decreasing blood sugars and should be instructed to look for other signs of hypoglycemia. Cardizem and hydromorphone will not affect blood sugars or signs/symptoms of hypoglycemia. Prednisone will increase, not decrease, blood sugar levels. Text Reference - p. 718

The nurse is obtaining data from a patient who has been on medication for hypertension and diabetes for four years. The patient has been experiencing blurred vision due to retinal damage caused by hypertension. What are the other manifestations of target organ disease? Select all that apply. 1. Pneumonia 2. Nocturia 3. Aneurysm 4. Transient ischemic attack 5. Anemia

2. Nocturia 3. Aneurysm 4. Transient ischemic attack Hypertension affects the kidneys; the earliest manifestation of renal disease is nocturia. Hypertension speeds up the process of atherosclerosis in the peripheral blood vessels, leading to aneurysms. Adequate control of blood pressure (BP) reduces the risk of transient ischemic attack. Pneumonia and anemia are not manifestations of target organ disease. Text Reference - p. 714

When teaching a patient about dietary management of stage 1 hypertension, which instruction is most appropriate? 1. Restrict all caffeine 2. Restrict sodium intake 3. Increase protein intake 4. Use calcium supplements

2. Restrict sodium intake The patient should decrease intake of sodium. This will help to control hypertension, which can be aggravated by excessive salt intake, which in turn leads to fluid retention. Caffeine and protein intake do not affect hypertension. Calcium supplements are not recommended to lower blood pressure. Text Reference - p. 712

When providing dietary instruction to a patient with hypertension, the nurse would advise the patient to restrict intake of which meat? 1. Broiled fish 2. Roasted duck 3. Roasted turkey 4. Baked chicken breast

2. Roasted duck Roasted duck is high in fat, which should be avoided by the patient with hypertension. Weight loss may slow the progress of atherosclerosis and overall cardiovascular disease risk. Broiled fish, roasted turkey, and baked chicken breast are lower in fat and are therefore acceptable in the diet. Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks "why," be sure the response you have chosen is a reason. If the question stem is singular, then be sure the option is singular, and the same for plural stems and plural responses. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer. Text Reference - p. 715

A patient has been asked to monitor blood pressure (BP) levels at home twice a day. What should the nurse teach the patient about measuring BP in the supine position? 1. Take at least two consecutive readings one after another. 2. Support the arm with a pillow during measurement. 3. Take the reading immediately after lying down. 4. Use the arm with the lowest BP for all future measurements.

2. Support the arm with a pillow during measurement. When measuring BP in a supine position, the patient should support the arm with a small pillow to raise the position of the hand to the level of the heart. Record the average pressure by taking two consecutive readings at least one minute apart; this allows the blood to drain from the arm and prevents inaccurate readings. The first reading should be taken after two to three minutes of rest in a supine position. If bilateral BP measurements are not equal, the patient should use the arm with the highest BP for all future measurements. Text Reference - p. 723

The nurse is teaching the patient about the Dietary Approaches to Stop Hypertension (DASH) diet. Which statement indicates that the patient understood the teaching? 1. "I should eat more red meat, such as pork or beef." 2. "I should drink no more than three glasses of whole milk per day." 3. "I should include four to five servings of fruits and vegetables daily." 4. "I should consume whole grain products no more than once per week."

3. "I should include four to five servings of fruits and vegetables daily." The DASH diet encourages consumption of fruits and vegetables. Pork and beef are high in fat and therefore have to be restricted according to the DASH diet; poultry and fish have to be consumed instead of red meat. Fat-free or low-fat milk has to be used instead of whole milk according to the DASH recommendations. The DASH diet recommends a few servings of whole grain products daily. Text Reference - p. 715

A patient has a new prescription for doxazosin. When providing education about this drug, the nurse will include which instructions? 1. "Weigh yourself daily, and report any weight loss to your prescriber." 2. "Increase your potassium intake by eating more bananas and apricots." 3. "Take this drug at bedtime because of the risk of orthostatic hypotension." 4. "The impaired taste associated with this medication usually goes away in two to three weeks."

3. "Take this drug at bedtime because of the risk of orthostatic hypotension." A patient who is starting doxazosin should take the first dose while lying down because there is a first-dose hypotensive effect with this medication. Taking the drug at bedtime reduces risks associated with orthostatic hypotension. The patient does not need to increase potassium intake. Doxazosin does not cause impaired taste. It does not cause weight loss, because it is not a diuretic. Test-Taking Tip: Relax during the last hour before an exam. Your brain needs some recovery time to function effectively. Text Reference - p. 723

For what change in vital signs would the nurse assess a patient experiencing postural hypotension? 1. Increased systolic blood pressure, decreased pulse rate 2. Increased diastolic blood pressure, increased pulse rate 3. Decreased systolic blood pressure, decreased diastolic blood pressure, increased pulse rate 4. Decreased systolic blood pressure, increased diastolic blood pressure, no change in pulse rate

3. Decreased systolic blood pressure, decreased diastolic blood pressure, increased pulse rate A decrease in both systolic and diastolic blood pressure and an increase in pulse would be seen in a patient with postural hypotension. Blood pressure drops as the volume of circulating blood decreases when a patient abruptly stands from a lying or sitting position. The pulse rate increases as the heart attempts to compensate by increasing the amount of circulating blood by increasing cardiac output. Increased systolic blood pressure and decreased pulse rate; increased diastolic blood pressure and increased pulse rate; and decreased systolic blood pressure, increased diastolic blood pressure, and no change in pulse rate are all incorrect. Text Reference - p. 723

The patient has chronic hypertension. Today the patient has gone to the emergency department and the patient's blood pressure has risen to 200/140. What is the priority assessment for the nurse to make? 1. Is the patient pregnant? 2.Does the patient need to urinate? 3. Does the patient have a headache or confusion? 4. Is the patient taking antiseizure medications as prescribed?

3. Does the patient have a headache or confusion? The nurse's priority assessments include neurologic deficits, retinal damage, heart failure, pulmonary edema, and renal failure. The headache or confusion could be seen with hypertensive encephalopathy, from increased cerebral capillary permeability leading to cerebral edema. Pregnancy can lead to secondary hypertension. Needing to urinate and taking antiseizure medication do not indicate a hypertensive emergency. Text Reference - p. 726

A patient is scheduled a dose of metoprolol. The nurse should withhold the dose and consult the health care provider after noting which assessment finding? 1. Migraine headache 2. Pulse 112 beats/minute 3. Expiratory wheezing 4. Blood sugar 217 mg/dL

3. Expiratory wheezing Metoprolol is a β-adrenergic-blocking agent that reduces blood pressure and could affect the β2 receptors in the lungs with larger doses or with drug accumulation. It should be used cautiously in patients with wheezing or respiratory disorders because it could cause bronchospasm, a potentially life-threatening adverse effect. Metoprolol will not worsen migraine, will decrease the elevated pulse rate, and will not lower or further elevate the blood sugar. Text Reference - p. 718

The nurse is assessing a patient and auscultates a "swooshing" sound heard over the chest wall when the stethoscope is lifted just off of the chest. The nurse would document this finding as a(n): 1. Severe bruit 2. Atrial gallop 3. Grade VI murmur 4. Pericardial friction rub

3. Grade VI murmur A murmur is classified as turbulent blood flow, which produces the classic swooshing sound as it passes through the valve and is graded on a scale of I toVI, with VI being the loudest, heard when the stethoscope is not touching the chest wall. A bruit is auscultated over arteries. An atrial gallop is an extra heart sound and is not associated with turbulent blood flow. A pericardial friction rub is a scratching sound caused when inflamed surfaces of the pericardium move against each other, indicating cardiac inflammation. Text Reference - p. 726

When teaching how lisinopril will help lower the patient's blood pressure, which mechanism of action should the nurse use to explain it? 1. Blocks β-adrenergic effects 2. Relaxes arterial and venous smooth muscle 3. Inhibits conversion of angiotensin I to angiotensin II 4. Reduces sympathetic outflow from the central nervous system (CNS)

3. Inhibits conversion of angiotensin I to angiotensin II Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that inhibits the conversion of angiotensin I to angiotensin II, which reduces angiotensin II-mediated vasoconstriction and sodium and water retention. Beta blockers result in vasodilation and decreased heart rate. Direct vasodilators relax arterial and venous smooth muscle. Central acting α-adrenergic antagonists reduce sympathetic outflow from the CNS to produce vasodilation and decreased systemic vascular resistance (SVR) and blood pressure (BP). Test-Taking Tip: Do not read too much into the question or worry that it is a "trick." If you have nursing experience, ask yourself how a classmate who is inexperienced would answer this question from only the information provided in the textbooks or given in the lectures. Text Reference - p. 719

The nurse is teaching a patient, recently diagnosed with hypertension (HTN), about diagnostic studies prescribed by a primary health care provider. Which information would the nurse include? Select all that apply. 1. Echocardiography to evaluate cardiac status 2. ECG to evaluate degree of left ventricular hypertrophy 3. Lipid profile to provide information about the risk factor for HTN 4. Uric acid level because it frequently decreases with diuretic therapy 5. Blood urea nitrogen (BUN) and serum creatinine levels to provide information on renal function

3. Lipid profile to provide information about the risk factor for HTN 5. Blood urea nitrogen (BUN) and serum creatinine levels to provide information on renal function An elevated lipid profile is an additional risk factor for hypertension because having elevated blood lipids leads to development of atherosclerosis. BUN, creatinine, and urinalysis provide information about baseline renal function and help to identify renal damage. Echocardiography evaluates the degree of ventricular hypertrophy, whereas ECG is used to assess baseline cardiac function. Diuretic therapy frequently leads to an increase in uric acid. Text Reference - p. 715

In caring for a patient admitted with poorly controlled hypertension, the nurse should understand that which laboratory test result would indicate the presence of target organ damage? 1. Blood urea nitrogen (BUN) of 15 mg/dL 2. Serum uric acid of 3.8 mg/dL 3. Serum creatinine of 2.6 mg/dL 4. Serum potassium of 3.5 mEq/L

3. Serum creatinine of 2.6 mg/dL The normal serum creatinine level is 0.6 to 1.3 mg/dL. This elevated level indicates target organ damage to the kidneys. BUN of 15 mg/dL, serum uric acid of 3.8 mg/dL, and serum potassium of 3.5 mEq/L are within normal limits. Text Reference - p. 715

A patient reports chest pain and is admitted to the emergency department. The patient is obese, smokes cigarettes, and drinks alcohol in moderate amounts. The patient had taken labetalol for high blood pressure (BP) for one week and then stopped taking the medication the morning of admission. The nurse recognizes that the probable reason for the patient's angina is what? 1. Leading a sedentary lifestyle after a lifetime of obesity 2. Smoking cigarettes 3. Stopping labetalol abruptly after a week of treatment 4. Alcohol consumption

3. Stopping labetalol abruptly after a week of treatment Labetalol is an alpha- and beta-adrenergic blocker and reduces BP by causing vasodilatation and a decrease in heart rate. The patient should not stop the drug abruptly, because it may precipitate angina and heart failure. Obesity, a sedentary lifestyle, smoking, and alcohol consumption are risk factors for cardiovascular disease but are unlikely to cause angina. Text Reference - p. 718

The nurse just received the shift report. Which patient should the nurse assess first? 1. The patient who is complaining about dizziness and whose blood pressure (BP) is 150/92. 2. The patient with a hip fracture who is complaining about pain 2 out of 10 3. The patient who is complaining about severe headache and has a nose bleed 4. The patient complaining of fatigue and who just received an angiotensin-converting enzyme (ACE) inhibitor.

3. The patient who is complaining about severe headache and has a nose bleed Severe headache and nose bleed are signs of hypertensive crisis that is an emergency situation, and therefore the nurse has to see this patient first. Dizziness is one of the symptoms of hypertension and the patient has an elevated blood pressure, but it is not an emergency situation. Pain 2 out of 10 is mild pain and therefore this patient is not a priority. Fatigue is one of the symptoms of hypertension, but the patient just received antihypertensive medication. Text Reference - p. 714

In reviewing medication instructions with a patient being discharged on antihypertensive medications, which statement would be most appropriate for the nurse to make when discussing guanethidine? 1. "A fast heart rate is a side effect to watch for while taking guanethidine." 2. "Stop the drug and notify your health care provider if you experience any nausea or vomiting." 3. "Because this drug may affect the lungs in large doses, it also may help your breathing." 4. "Make position changes slowly, especially when rising from lying down to a standing position."

4. "Make position changes slowly, especially when rising from lying down to a standing position." Guanethidine is a peripheral-acting α-adrenergic antagonist and can cause marked orthostatic hypotension. For this reason, the patient should be instructed to rise slowly, especially when moving from a recumbent to a standing position. Support stockings also may be helpful. Tachycardia or lung effects are not evident with guanethidine, nor are nausea and vomiting. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten. Text Reference - p. 718

A 65-year-old patient without any past medical problems has his or her blood pressure checked at a primary health care provider's office during an annual physical examination. The blood pressure (BP) reading is 158/92. The patient is asking the nurse who was checking the blood pressure: "Does this mean that I have hypertension?" What is the most appropriate answer from the nurse? 1. "Do not worry, everything is fine." 2. "It is a normal blood pressure reading for a person of your age." 3. "Yes, you have hypertension, because your blood pressure is over 140/90." 4. "You need to have a follow-up appointment to recheck your blood pressure."

4. "You need to have a follow-up appointment to recheck your blood pressure." The diagnosis of hypertension is made based on two or more elevated blood pressure readings. Considering the fact that the patient does not have any medical problems and that this reading is the first elevated blood pressure reading, a follow-up office visit is required. Providing false reassurance to the patient is leading to misinformation. For any person of age 18 and older, BP higher than 140/90 is considered elevated. Diagnosing the patient with a medical diagnosis is not within the nursing scope of practice and cannot be done based on one elevated BP reading. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. Text Reference - p. 715

The nurse is checking blood pressure for people at a health fair. Which patient is at higher risk to develop primary hypertension? 1. 65-year-old retired Caucasian with a body mass index (BMI) of 15 2. 60-year-old who has chronic pain caused by cancer 3. 45-year-old blue collar worker who smokes one pack of cigarettes per day 4. 59-year-old African American with a BMI of 35 who has a high stress job

4. 59-year-old African American with a BMI of 35 who has a high stress job The patient has four risk factors for primary hypertension: advanced age, African American race, morbid obesity with a BMI of 35, and a high level of stress. All of the other patients have fewer risk factors for primary hypertension: in the 45-year-old smoker, smoking is the only risk factor; in the 60-year-old with cancer, advanced age and pain are the only risk factors; and in the 65-year-old retiree, the only risk factor is advanced age. Text Reference - p. 713

Which test result would indicate the presence of target organ damage resulting from uncontrolled hypertension? 1. Check for history of depression. 2. Do not give with grapefruit juice. 3. Monitor for cardiac dysrhythmias. 4. Assess for orthostatic hypotension

4. Assess for orthostatic hypotension Low blood pressure or postural hypotension can cause a fall from dizziness. The peripheral-acting alpha-adrenergic antagonist reserpine is contraindicated in patients with a history of depression. Administrating grapefruit juice with certain calcium channel blockers may increase the serum concentrations, resulting in toxicity. The direct vasodilator minoxidil may cause EKG changes of flattened and inverted T waves. Text Reference - p. 718

The patient with osteoporosis and hypertension understands dietary teaching when the patient selects which meal for dinner? 1. Ham and Swiss cheese sandwich on whole-wheat bread, steamed broccoli, and an apple 2. Baked chicken with one cup of yogurt and steamed rice 3. A two-egg omelet with 2 oz. of American cheese, one slice of whole-wheat toast, and half a grapefruit 4. Baked salmon with one cup of spinach and steamed carrots

4. Baked salmon with one cup of spinach and steamed carrots The highest calcium content is present in the dinner containing salmon and spinach, also taking into account fat and sodium restrictions required to manage hypertension. Ham and cheese are both high in sodium and should be avoided in the patient with hypertension. Eggs are not a large source of calcium, and chicken, yogurt, and rice, although lower in sodium, do not have the highest calcium content. Text Reference - p. 716

A nurse is measuring the blood pressure (BP) of a 68-year-old patient. What intervention should the nurse perform for this patient? 1. Measure BP one hour after eating. 2. Inflate the cuff until the pulse disappears. 3. Recommend a BP goal of 120/80 mm Hg. 4. Check for an auscultatory gap

4. Check for an auscultatory gap The nurse measuring the BP of a 68-year-old patient should check for an auscultatory gap. Some elderly patients have a wide gap between the first Korotkoff sound and subsequent beats. Elderly patients experience a postprandial drop in BP; the greatest drop occurs approximately one hour after eating. The BP returns to preprandial levels three to four hours after eating. When measuring BP, the nurse should inflate the cuff 20 to 30 mm Hg after the radial pulse disappears. The recommended BP goal for this patient would be less than 140/90 mm Hg. Text Reference - p. 725

Which item on the patient's dinner tray should not be taken in large quantities by the patient prescribed furosemide for hypertension? 1. Coffee 2. Ice cream 3. Grapefruit juice 4. Chicken noodle soup

4. Chicken noodle soup Furosemide, a diuretic, causes fluid loss to decrease blood pressure. Chicken noodle soup is high in sodium and may cause increased fluid retention, negating the effects of the medication and increasing the blood pressure. Ice cream, grapefruit juice, and coffee will not decrease the effectiveness of furosemide. Text Reference - p. 717

A nurse provides care to a patient who is admitted to an emergency department with hypertensive crisis. The patient had been taking sodium nitroprusside for the past three days. What is the reason that blood tests to assess thiocyanate levels are prescribed for this patient? 1. The patient may have very low BP due to the sodium nitroprusside. 2. The patient may have adverse effects on target organs. 3. The patient may have reduced excretion of sodium nitroprusside. 4. The patient may have toxic levels of sodium nitroprusside.

4. The patient may have toxic levels of sodium nitroprusside. Sodium nitroprusside causes arterial vasodilation and reduces systemic vascular resistance. This in turn decreases the blood pressure. Sodium nitroprusside is metabolized to cyanide and then to thiocyanate, which can reach lethal levels. Therefore, thiocyanate levels should be monitored in patients receiving the drug for more than three days or at doses greater than 4mcg/kg/min. In hypertensive crisis, the patient usually has very high BP despite the BP-lowering effect of sodium nitroprusside. Serum thiocyanate levels do not indicate adverse effects of hypertension on target organs or reduced excretion of sodium nitroprusside. Text Reference - p. 719

The nurse understands that catapres has which side effects? 1. Cough and confusion 2. Sweating and shaking 3. Dry mouth and sedation 4. Gynecomastia and dizziness

3. Dry mouth and sedation Dry mouth and sedation are side effects of central-acting alpha-adrenergic antagonists. Cough is a possible side effect of angiotensin-converting enzyme inhibitors. Confusion, sweating, and shaking are not common side effects for hypertension drug therapy. Gynecomastia is a side effect of aldosterone receptor blockers. Dizziness is a side effect for hypertension drug therapy; gynecomastia is not. Text Reference - p. 717