Final Exam Chapter 31: Assessment and Management of Patients With Hypertension
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) Emphysema related to poor gas exchange c) Hyperglycemia resulting from insulin receptor resistance d) Renal dysfunction resulting from atherosclerosis
Renal dysfunction resulting from atherosclerosis Explanation: 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.
According to the DASH diet, how many servings of vegetables should a person consume per day? a) 2 or 3 b) 4 or 5 c) 7 or 8 d) 2 or fewer
4 or 5 Explanation: Four or five servings of vegetables are recommended in the DASH diet.
A patient is taking amiloride (Midamor) and lisinopril (Zestril) for the treatment of hypertension. What laboratory studies should the nurse monitor while the patient is taking these two medications together? a) Potassium level b) Magnesium level c) Sodium level d) Calcium level
Potassium level Correct Explanation: Amiloride (Midamor) is a potassium-sparing diuretic, meaning that it causes potassium retention. The nurse should monitor for hyperkalemia (elevated potassium level) if given with an ACE inhibitor (such as lisinopril) or angiotensin receptor blocker.
A nurse is caring for a client who has hypertension and diabetes mellitus. The client's blood pressure this morning was 150/92 mm Hg. He asks the nurse what his blood pressure should be. The nurse's most appropriate response is: a) "The current recommendation is for everyone to have blood pressure of 140/90 mm Hg or lower." b) "Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg." c) "The lower the better. Blood pressure of 120/80 mm Hg is best for everyone." d) "Your blood pressure is fine. Just keep doing what you're doing."
"Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg." Explanation: An individual with diabetes mellitus should strive for blood pressure of 130/80 mm Hg or less. An individual without diabetes should strive for blood pressure of 140/90 mm Hg or less.
Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension? a) "A glass of red wine each day will lower my blood pressure." b) "I should eliminate caffeine from my diet to lower my blood pressure." c) "Limiting my salt intake to 2 grams per day will improve my blood pressure." d) "If I include less fat in my diet, I'll lower my blood pressure."
"Limiting my salt intake to 2 grams per day will improve my blood pressure." Explanation: To lower blood pressure, a client should limit daily salt intake to 2 g or less. Alcohol intake is associated with a higher incidence of hypertension, poor compliance with treatment, and refractory hypertension. Chronic, moderate caffeine intake and fat intake don't affect blood pressure
While in nursing school, you discover the prevalence of high blood pressure in the United States and are amazed at its frequency of occurrence. Which of the following is closest to approximately how many people have high blood pressure? a) 1 in 10 adults b) 1 in 7 adults c) 1 in 4 adults d) 1 in 5 adults
1 in 4 adults Explanation: Approximately 50 million people, or 1 in 4 adults, in the United States have high blood pressure.
Which of the following diagnostic tests may reveal an enlarged left ventricle? a) Fluorescein angiography b) Echocardiography c) Positron emission tomography (PET) scan d) Computed tomographic scan
Echocardiography Explanation: Echocardiography reveals an enlarged left ventricle. Fluorescein angiography reveals leaking retinal blood vessels, and a PET scan is used to reveal abnormalities in blood pressure. A CT scan reveals structural abnormalities.
It is important for the nurse to encourage the patient to rise slowly from a sitting or lying position because a) gradual changes in position help reduce the blood pressure to resupply oxygen to the brain. b) gradual changes in position help reduce the heart's work to resupply oxygen to the brain. c) gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. d) gradual changes in position provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain.
Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. Correct Explanation: It is important for the nurse to encourage the patient to rise slowly from a sitting or lying position because gradual changes in position provide time for the heart to increase its rate of contraction to resupply oxygen to the brain and not blood pressure or heart rate.
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) Hyperkalemia b) Hyponatremia c) Hypokalemia d) Hypernatremia
Hyperkalemia Explanation: 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
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 statesments except: a) Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women. b) Engage in aerobic activity at least 30 minutes/day most days of the week. c) Maintain a waist circumference of 40 (men) and 35 (women) inches or less. d) Maintain a normal body mass index of about 24.
Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women. Correct Explanation: 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 caring for an 82-year-old male 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) Increase in calcium intake b) Decrease in cardiac output c) Loss of arterial elasticity d) Decrease in blood volume
Loss of arterial elasticity Explanation: 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
You are caring for a client with hypertension who is experiencing complications. What diagnostic test evaluates the efficiency or inefficiency of the heart to pump blood? a) Computed tomography scan b) Chest radiography c) Multiple gated acquisition (MUGA) scan d) Echocardiography
Multiple gated acquisition (MUGA) scan Explanation: The MUGA is a test that detects how efficiently or inefficiently the heart pumps blood. Echocardiography and chest radiography are used to reveal an enlarged left ventricle. The computed tomography scan is used to reveal abnormalities in blood pressure.
Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through: a) An MRI b) Laboratory tests c) Ophthalmic examination d) Using a sphygmomanometer
Ophthalmic examination Explanation: Papilledema is an edema of the optic nerves, and thus needs an ophthalmic examination for detection.
A nursing class is practicing the measurement of blood pressure. The finding in one otherwise healthy man, 36 years old, is 130/88. This man requires follow-up for prehypertension. Which of the following lifestyle factors would the nurse discuss with the client? a) Weight reduction, the DASH diet, and physical activity b) Physical activity, dietary sodium, and the DASH diet c) Physical activity, needed medication, and the DASH diet d) The DASH diet, sexual dysfunction related to required medications, and physical activity
Physical activity, dietary sodium, and the DASH diet Explanation: Lifestyle modifications to prevent and mange hypertension include weight reduction, adoption of the DASH diet, reduction of dietary sodium, physical activity, and moderation of alcohol consumption. It is not within the nursing scope of practice to decide what medications are needed. There is no evidence that this man is overweight
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) Stage 2 hypertension d) Prehypertension
Prehypertension Explanation: A systolic BP of 128 mm Hg is classified as prehypertension. A systolic BP of less than 120 mm Hg is normal. A systolic BP of 140 to 159 mm Hg is Stage I hypertension. A systolic BP of greater than or equal to 160 is classified as Stage 2 hypertension.
A 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) Rapidly reduce the blood pressure so the patient will not suffer a stroke. c) Reduce the blood pressure to about 140/80 mm Hg. d) Reduce the blood pressure by 20% to 25% within the first hour of treatment.
Reduce the blood pressure by 20% to 25% within the first hour of treatment. Correct Explanation: 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 who is prescribed diuretic medication for the treatment of hypertension. The nurse recognizes that which of the following medications conserves potassium? a) Spironolactone (Aldactone) b) Chlorthalidone (Hygroton) c) Furosemide (Lasix) d) Chlorothiazide (Diuril)
Spironolactone (Aldactone) Explanation: Aldactone is known as a potassium-sparing diuretic. Lasix causes loss of potassium from the body. Diuril causes mild hypokalemia. Hygroton causes mild hypokalemia.
The nurse is caring for a client with hypertension. The nurse is correct to realize that a 24-hour urine is ordered to determine if the cause of hypertension is related to the dysfunction of which of the following? a) The adrenal gland b) The thymus c) The thyroid gland d) The pituitary gland
The adrenal gland Correct Explanation: The 24-hour urine collection specimen is ordered to determine dysfunction of the adrenal gland. The 24-hour urine detects elevated catecholamines. The other options are not evaluated by a 24-hour urine.
The nurse is explaining the DASH diet to a patient diagnosed with hypertension. The patients inquires about how many servings of fruit per day can be consumed on the diet. The nurse would be correct in stating which of the following? a) 7 or 8 b) 2 or fewer c) 2 or 3 d) 4 or 5
The patient can consume 4 or 5 servings of fruit per day on the DASH diet. The servings for grains and grain product is 7 or 8. Two or 3 servings of low-fat or fat-free dairy foods can be consumed per day. Meat, fish, and poultry servings are 2 or fewer per day.
The nurse is performing an assessment on a patient to determine the effects of hypertension on the heart and blood vessels. What specific assessment data will assist in determining this complication? (Select all that apply.) a) Respiratory rate b) Heart rhythm c) Lung sounds d) Heart rate e) Character of apical and peripheral pulses
• Heart rhythm • Heart rate • Character of apical and peripheral pulses Correct Explanation: During the physical examination, the nurse must also pay specific attention to the rate, rhythm, and character of the apical and peripheral pulses to detect the effects of hypertension on the heart and blood vessels
A female client, aged 82 years, visits the clinic for a blood pressure (BP) check. Her hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about her blood pressure medicine? a) A possible adverse effect of blood pressure medicine is dizziness when you stand. b) There are no adverse effects from blood pressure medicine. c) A severe drop in blood pressure is possible. d) Take the medicine on an empty stomach.
A possible adverse effect of blood pressure medicine is dizziness when you stand. Explanation: 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. You would not teach the client to take the medicine on an empty stomach.
The nurse is administering medications on a medical surgical unit. A patient is ordered to receive 40 mg of oral Corgard (nadolol) for the treatment of hypertension. Prior to administering the medication, the nurse should complete which of the following? a) Checking the patient's heart rate b) Checking the patient's urine output c) Weighing the patient d) Checking the patient's serum K+ level
Checking the patient's heart rate Explanation: Corgard is a beta-blocker. A desired effect of this medication is to reduce the pulse rate in patients with tachycardia and an elevated blood pressure (BP). The nurse should check the patient's heart rate (HR) prior to administering Corgard to ensure that the patient's pulse rate is not below 60 (beats per minute (bpm). The other interventions are not indicated prior to administering a beta-blocker medication.