PrepU 31: Assessment and Management of Patients with Hypertension
A client with high blood pressure is receiving an antihypertensive drug. 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 client is placed on a low-sodium (500 mg/day) diet. Which client statement indicates that the nurse's nutrition teaching plan has been effective?
"I chose broiled chicken with a baked potato for dinner."
The nurse is caring for a client who has had 25 mg of oral hydrochlorothiazide added to the medication regimen for the treatment of hypertension. Which instruction should the nurse give the client?
"Increase the amount of fruits and vegetables you eat."
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 educating a client about monitoring blood pressure readings at home. What will the nurse be sure to emphasize?
"Sit quietly for 5 minutes prior to taking blood pressure."
A 55-year-old male client newly diagnosed with hypertension returns to the physician's office for a routine follow-up appointment after several months of treatment with metoprolol. During the initial assessment, the nurse records the client's blood pressure (BP) as 180/90 mm Hg. The client states that the medication is not taken as prescribed. Which is the best response by the nurse?
"The medication you were prescribed may cause sexual dysfunction; are you experiencing this side effect?"
A nurse is providing education about hypertension to a community group. What are possible consequences of untreated hypertension? Select all that apply.
- Coronary artery disease - Myocardial infarction - Stroke
The nurse is conducting a service project for a local elderly community group on the topic of hypertension. The nurse will relay that which risk factors and cardiovascular problems are related to hypertension? Select all that apply.
- Overweight/obesity - Smoking - Age ≥65 in women
A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. What are risk factors for cardiovascular problems in clients with hypertension? Select all that apply.
- Physical inactivity - Smoking - Diabetes mellitus
Which statements are true when the nurse is measuring blood pressure (BP)? Select all that apply.
- The client should sit quietly while BP is being measured. - The client's arm should be positioned at the level of the heart. - Using a BP cuff that is too small will give a higher BP measurement.
A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. What will the nurse specify about this client's target blood pressure?
130/80 or lower
A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. What will the nurse specify about this client's target blood pressure?
140/90 or lower
A patient is being treated for hypertensive emergency. When treating this patient, the priority goal is to lower the mean blood pressure (BP) by up to which percentage in the first hour?
25%
According to the DASH diet, how many servings of vegetables should a person consume each day?
4 or 5
The nurse is explaining the DASH diet to a client diagnosed with hypertension. The client inquires about how many servings of fruit per day can be consumed on the diet. What is the nurse's best response?
4 or 5 servings per day
A nurse is discussing with a nursing student how to accurately measure blood pressure. What statement by the student indicates an understanding of the education?
A cuff that is too small will give a false high blood pressure.
An older adult client visits the clinic for a blood pressure (BP) check. The client's hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about the blood pressure medicine?
A possible adverse effect of blood pressure medicine is dizziness when you stand.
An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed the client hydrochlorothiazide and enalapril. What will the nurse be sure to include in educating this client?
Change positions (lying or sitting to standing) slowly.
A client has severe coronary artery disease (CAD) and hypertension. Which medication order should the nurse consult with the health care provider about that is contraindicated for a client with severe CAD?
Clonidine
A patient has been diagnosed with prehypertension and has been encouraged to exercise regularly and begin a weight loss program. What other healthcare professional may be helpful for the client to see?
Dietician
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)
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?
Hyperkalemia
When administering benazepril with spironolactone, the nurse should be aware that which electrolyte imbalance may occur?
Hyperkalemia
Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage?
Hypertensive emergency
The nurse is planning the care of a patient admitted to the hospital with hypertension. What objective will help to meet the needs of this patient?
Lowering and controlling the blood pressure without adverse effects and without undue cost
The nurse teaches the client which guidelines regarding lifestyle modifications for hypertension?
Maintain adequate dietary intake of fruits and vegetables
An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for?
Postural hypotension and resulting injury
A client is taking amiloride and lisinopril for the treatment of hypertension. What laboratory studies should the nurse monitor while the client is taking these two medications together?
Potassium level
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 mm Hg between arms.
A 35-year-old client has been diagnosed with hypertension. The client is a stock broker, smokes daily, and has diabetes. During a follow-up appointment, the client states that regular visits to the doctor just to check blood pressure (BP) are cumbersome and time consuming. As the nurse, which aspect of client teaching would you recommend?
Purchasing a self-monitoring BP cuff
A client is brought to the emergency department with reports of a bad headache and an increase in blood pressure. The blood pressure reading obtained by the nurse is 260/180 mm Hg. What is the therapeutic goal for reduction of the mean blood pressure?
Reduce the blood pressure by 20% to 25% within the first hour of treatment.
Which finding indicates that hypertension is progressing to target organ damage?
Retinal blood vessel damage
The nurse is instructing a client who is newly prescribed an antihypertensive medication. Which nursing instruction is emphasized to maintain client safety?
Sit on the edge of the chair and rise slowly.
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
Primary or essential hypertension accounts for about 95% of all hypertension diagnoses with an unknown etiology. Secondary hypertension accompanies specific conditions that create hypertension as a result of tissue damage. Which condition contributes to secondary hypertension?
arterial vasoconstriction
The nurse is caring for a client with a blood pressure of 210/100 mm Hg in the emergency room. What is the most appropriate route of administration for antihypertensive agents?
continuous IV infusion
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
A client with a history of hypertension is receiving client education about structures that regulate arterial pressure. Which structure is a component of that process?
kidneys
A client who was recently diagnosed with prehypertension is to meet with a dietitian and return for a follow-up with the cardiologist in 6 months. What would this client's treatment likely include?
nonpharmacological interventions
Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through:
ophthalmic examination.
It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position
provide time for the heart to increase the rate of contraction to resupply oxygen to the brain.
The nurse encourages the client diagnosed with hypertension to rise slowly from a sitting or lying position because gradual changes in position
provide time for the heart to increase the rate of contraction to resupply oxygen to the brain.
Hypertension that can be attributed to an underlying cause is termed
secondary hypertension.
According to the classification of hypertension diagnosed in older adults, hypertension that can be attributed to an underlying cause is termed
secondary.
What risk factors would cause the nurse to become concerned that the client may have atherosclerotic heart disease? Select all that apply.
- family history of early cardiovascular events - diabetes - hypertension - obesity
The nurse is teaching a client who is experiencing dizziness to rise slowly from a sitting or lying position. What is the rationale for the teaching?
Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain.
