Management of Patients with Hypertension (Chapter 31)
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?
"Flex your calf muscles, avoid alcohol, and change positions slowly."
A 66-year-old client presents to the emergency department reporting severe headache and mild nausea for the past 6 hours. Upon assessment, the client's BP is 210/120 mm Hg. The client has a history of hypertension and takes 1.0 mg clonidine twice daily. Which question is most important for the nurse to ask the client next?
"Have you taken your prescribed clonidine today?"
A nurse working in the clinic is seeing a client who has just been prescribed a new medication for hypertension. The client asks why hypertension is sometimes called the "silent killer." The nurse's correct response is which of the following?
"Hypertension often causes no symptoms."
Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension?
"Limiting my salt intake to 2 grams per day will improve my blood pressure."
A nurse is teaching a 38-year-old man with newly diagnosed hypertension who asks if there is any harm in stopping his antihypertensive medication if he decides to discontinue it. The correct reply addresses the consequence of stopping antihypertensive medications abruptly. Which of the following statements from the nurse would be appropriate?
"Rebound hypertension can occur."
A nurse is educating a client about monitoring blood pressure readings at home. Which of the following will the nurse be sure to emphasize?
"Sit quietly for 5 minutes [ropr tp taking blood pressure."
A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. For a client without diabetes mellitus, the target blood pressure is 140/90 or lower. Because this client has diabetes mellitus, the target blood pressure will be which of the following?
130/80 or lower
According to the DASH diet, how many servings of vegetables should a person consume each day?
4 or 5
A nurse is caring for a client with hypertension. The physician orders furosemide (lasix) 2 mg/kg to be given intravenously. The client weighs 24 kg. The medication comes in a single-use vial that contains 40 mg in 4 mL (10 mg/mL). How much will the nurse draw up for this client's dose?
4.8 mL
A female client, aged 82, 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 possible adverse effect of blood pressure medicine is dizziness when you stand
A client with newly diagnosed hypertension asks what she can do to decrease the risk for related cardiovascular problems. Which of the following risk factors is not modifiable by the client?
age
The nurse is caring for a patient with an intracranial hemorrhage. The patient is having a hypertensive emergency. Which of the following nursing intervention would take priority in this patient?
avoid lowering the blood pressure (BP) too quickly
The nurse is administering medications on a medical-surgical unit. A client is ordered to receive 40 mg oral nadolol for the treatment of hypertension. Before administering the medication, the nurse should
check the client's heart rate
When treating hypertensive emergencies, the nurse identifies the most appropriate route of administration for antihypertensive agents as being which of the following?
continuous IV infusion
A nurse is providing education about hypertension to a community group. One client reports that his doctor has diagnosed him with hypertension, but that he feels just fine. He asks, "What would happen if I did not treat my hypertension?" Which of the following are possible consequences of untreated hypertension? Choose all that apply.
coronary artery disease; myocardial infarction; stroke
Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress
decreases the production of neurotransmitters that constrict peripheral arterioles
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?
dizziness
Which of the following diagnostic tests may reveal an enlarged left ventricle?
echocardiogram
A nurse is teaching about lifestyle modifications to a group of clients with known hypertension. Which of the following statements would the nurse include in the education session?
engage in aerobic activity at least 30 minutes/day most days a week
A client is being seen at the clinic for a routine physical when the nurse notes the client's blood pressure is 150/97. The client is considered to be a healthy, well-nourished young adult. What type of hypertension does this client have?
essential (primary)
When administering an angiotensin-converting enzyme (ACE) inhibitor with spironolactone, the nurse should be aware that which electrolyte imbalance may occur?
hyperkalemia
A blood pressure (BP) of 140/90 mm Hg is considered to be
hypertension
Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage?
hypertensive emergency
Which of the following would be inconsistent as a component of metabolic syndrome?
hypotension
Aging is positively correlated to the incidence of hypertension. This is due to three of the following four structural or functional changes. Which choice is not considered a cause?
increases ability to exert diastolic pressure
It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine
increases the heart rate, constricts the arterioles, and reduces the heart's ability to eject blood
A patient is being seen at the clinic on a monthly basis for assessment of blood pressure. The patient has been checking her 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 patient is experiencing?
isolated systolic hypertension
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?
it takes 2 to 3 months for the taste buds to adapt to decreased salt intake
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?
loss of arterial elasticity
Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through:
ophthalmic examination
The nurse is instructing a student on the proper technique for measuring blood pressure (BP). Which of the following would indicate a need for further teaching?
positions the arm at waist level
A 77-year-old client has newly diagnosed stage 2 hypertension. The physician has prescribed a thiazide and an angio-converting enzyme inhibitor. About what is the nurse most concerned?
postural hypotension and resulting injury
A systolic blood pressure of 135 mm Hg would be classified as
prehypertension
When measuring the blood pressure in each arm of a healthy adult client, the nurse recognizes that which statement is true?
pressures should not differ more than 5 mmHg between arms
Which term is refers to hypertension in which blood pressure that is controlled with therapy becomes uncontrolled (abnormally high) when the therapy is discontinued?
rebound
A patient is flying overseas for 1 week for business and packed antihypertensive medications in a suitcase. After arriving at the intended destination, the patient found that the luggage had been stolen. If the patient cannot take the medication, what condition becomes a concern?
rebound 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?
reduce the blood pressure by 20% to 25% within the first hour of treatment
The nurse is caring for a client newly diagnosed with secondary hypertension. Which condition contributes to the development of secondary hypertension?
renal disease
Which of the following is the nurse most correct to recognize as a direct effect of client hypertension?
renal dysfunction resulting from atherosclerosis
Which finding indicates that hypertension is progressing to target organ damage?
retinal blood vessel 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?
secondary
According to the classification of hypertension diagnosed in older adults, hypertension that can be attributed to an underlying cause is termed
secondary
The nurse is caring for a client who is prescribed medication for the treatment of hypertension. The nurse recognizes that which medication conserves potassium?
spironolactone
A nursing class is practicing measurement of blood pressure. One otherwise healthy participant, 46 years old, is 138/90. This man requires follow-up. In which classification of hypertension is he according to the JNC 7 (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood pressure) recommendation?
stage 1
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?
the adrenal gland
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.
weight reduction