PREPU - Chapter 31: Assessment and Management of Patients With Hypertension

A nurse educator is providing information to a small group of clients about hypertension. A participant asks what her target blood pressure should be. The nurse is aware of the target goals of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). Which of the following reflects the goal for blood pressure readings for people without co-morbidities?

140/90 or lower The goal of hypertension treatment is to prevent complications and death by achieving and maintaining the arterial blood pressure at 140/90 or lower. The JNC7 specifies a lower goal pressure of 130/80 for people with diabetes mellitus or chronic kidney disease.

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? a) 4.8 mL b) 0.24 mL c) 0.48 mL d) 2.4 mL

4.8 mL The formula is as follows: 24Kg X 2 mg = 48 mg total dose 48 mg / 10mg/mL = 4.8 mL amount to be drawn up

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.)

Heart rate Heart rhythm Character of apical and peripheral pulses 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 client is already being treated for hypertension. The doctor is concerned about the potential for heart failure, and has the client return for regular check-ups. What does hypertension have to do with heart failure?

Hypertension causes the heart's chambers to enlarge and weaken. Hypertension causes the heart's chambers to enlarge and weaken, making it impossible for the ventricles to eject all the blood they receive.

The nurse teaches the client which guidelines regarding lifestyle modifications for hypertension?

Maintain adequate dietary intake of fruits and vegetables Guidelines include adopting the Dietary Approaches to Stop Hypertension (DASH) eating plan: consume a diet rich in fruits, vegetables, and low-fat dairy products and reduced amounts of saturated and total fat; reduce dietary sodium intake to no more than 100 mmol/day (2.4 g sodium or 6 g sodium chloride); engage in regular aerobic physical activity such as brisk walking (at least 30 min/day, most days of the week); moderate alcohol consumption, limiting consumption to no more than two drinks (eg, 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and to no more than one drink per day in women and lighter-weight people. Tobacco should be avoided because anyone with high blood pressure is already at increased risk for heart disease, and smoking amplifies this risk.

The nurse is caring for a client prescribed bumetanide for the treatment of stage 2 hypertension. Which finding indicates the client is experiencing an adverse effect of the medication?

Serum potassium value of 3.0 mEq/L Bumetanide is a loop diuretic that can cause fluid and electrolyte imbalances. Clients taking these medications may experience a low serum potassium concentration. ECG changes associated with an elevated serum potassium concentration include peaked T waves. Diuresis is a desired effect postadministration of bumetanide. The serum glucose concentration is elevated and requires intervention; however, this elevation is not associated with the administration of bumetanide.

A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. Which of the following are risk factors for cardiovascular problems in clients with hypertension? Choose all that apply. a) Gallbladder disease b) Physical inactivity c) Frequent upper respiratory infections d) Smoking e) Diabetes mellitus

Smoking Diabetes mellitus Physical inactivity Risk factors for cardiovascular problems in clients with hypertension include smoking, dyslipidemia, diabetes mellitus, impaired renal function, obesity, physical inactivity, age, and family history.

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 Spironolactone is known as a potassium-sparing diuretic. Furosemide causes loss of potassium from the body. Chlorothiazide and chlorthalidone cause mild hypokalemia.

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) Aldactone b) Lasix c) Diuril d) Spironolactone e) Hygroton

Spironolactone (Aldactone) Aldactone is known as a potassium-sparing diuretic. Lasix causes loss of potassium from the body. Diuril causes mild hypokalemia. Hygroton causes mild hypokalemia.

Which statements are true when the nurse is measuring blood pressure (BP)? Select all that apply.

Using a BP cuff that is too small will give a higher BP measurement. The client's arm should be positioned at the level of the heart. The client should sit quietly while BP is being measured. These statements are all true when measuring a BP. When using a BP cuff that is too large, the reading will be lower than the actual BP. The client should avoid smoking cigarettes or drinking caffeine for 30 minutes before BP is measured.

A nurse is assisting with with checking blood pressures at a local health care fair. To which client would the nurse pay particular attention? a) A 40-year-old African-American man b) A 50-year-old Caucasian woman c) A 16-year-old girl d) An Asian adult man

a) A 40-year-old African-American man

A community health nurse is screening for hypertension. Which of the following clients would the nurse focus on most intensively? a) A middle-aged African-American man b) A Hispanic teenager c) A 45-year-old Asian woman d) A postmenopausal Caucasian woman

a) A middle-aged African-American man

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) Anemia resulting from bone marrow suppression c) Emphysema related to poor gas exchange d) Hyperglycemia resulting from insulin receptor resistance

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.

The nurse is evaluating the types of medications prescribed for a client's hypertension. Which of the following medication classifications establishes an action on vasoconstrictive hormones in the blood stream? a) Loop diuretic b) ACE inhibitor c) Beta-blocker d) Calcium channel blocker

b) ACE inhibitor

A patient is being treated for hypertensive emergency. When treating this patient, the priority goal is to lower the mean blood pressure (BP) by which percentage in the first hour? a) 40% b) Up to 25% c) 35% d) 45%

b) Up to 25%

According to the classification of hypertension diagnosed in older adults, hypertension that can be attributed to an underlying cause is termed a) isolated systolic. b) essential. c) secondary. d) primary.

c) secondary. Secondary hypertension may be caused by a tumor of the adrenal gland (e.g., pheochromocytoma). Primary, or essential, hypertension has no known underlying cause. Isolated systolic hypertension is demonstrated by readings in which the systolic pressure exceeds 140 mm Hg and the diastolic measurement is normal or near normal (less than 90 mm Hg).

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. Nadolol is a beta-blocker. A desired effect of this medication is to reduce the pulse rate in clients with tachycardia and elevated blood pressure (BP). The nurse should check the client's heart rate (HR) before administering nadolol to ensure that the pulse is not less than 60 beats per minute. The other interventions are not indicated before administering a beta-blocker medication.

Hypertension that can be attributed to an underlying cause is termed which of the following? a) Isolated systolic b) Primary c) Essential d) Secondary

d) Secondary Secondary hypertension may be caused by a tumor of the adrenal gland (eg, pheochromocytoma). Primary hypertension has no known underlying cause. Essential hypertension has no known underlying cause. Isolated systolic hypertension is demonstrated by readings in which the systolic pressure exceeds 140 mm Hg and the diastolic measurement is normal or near normal (less than 90 mm Hg).

It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine a) decreases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. b) decreases circulating blood volume. c) increases the heart rate, constricts arterioles, and increases the heart's ability to eject blood. d) increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood.

d) increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. The nurse recommends smoking cessation for clients with hypertension because nicotine raises the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. Reduced oral fluids decrease the circulating blood volume.

The nurse is caring for a patient with systolic blood pressure of 135 mm Hg. This finding would be classified as

prehypertension. A systolic blood pressure of 135 mm Hg is classified as prehypertension. A systolic BP less than 120 mm Hg is normal. A systolic BP of 140 to 159 mm Hg is stage I hypertension. A systolic BP greater than or equal to 160 is classified as stage II hypertension.

The nurse is seeing a client for the first time and has just checked the client's blood pressure. The nurse would consider the client prehypertensive if:

systolic BP is between 120 and 139 mm Hg. Once the systolic BP goes above 120 mm Hg, the patient is considered prehypertensive, according to the National Heart, Lung, and Blood Institute's (2015) definition.

The nurse is conducting a service project for a local elderly community group on the topic of hypertension. The nurse will relay that risk factors and cardiovascular problems related to hypertension include which of the following? Select all that apply. a) Age ≥55 in men b) Obesity (BMI ≥ 30 kg/m2) c) Elevated high-density lipoprotein (HDL) cholesterol d) Decreased low-density lipoprotein (LDL) levels. e) Smoking

• Age ≥55 in men • Obesity (BMI ≥ 30 kg/m2) • Smoking Major risk factors (in addition to hypertension) include smoking, dyslipidaemia (high LDL, low HDL cholesterol), diabetes mellitus, impaired renal function, obesity, physical inactivity, age (older than 55 years for men, 65 years for women), and family history of cardiovascular disease.

Which of the following client scenarios would be correct for the nurse to identify as a client with secondary hypertension? a) A client diagnosed with kidney disease b) A client with excessive alcohol intake c) A client experiencing depression d) A client of advanced age

a) A client diagnosed with kidney disease Secondary hypertension is an elevated blood pressure that results from or is secondary to some other disorder such as kidney disease, a tumor of the adrenal medulla, or atherosclerosis. Depression alone is typically not associated with hypertension. Advanced age and alcohol intake are considered factors for essential hypertension.

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? a) Age b) Dyslipidemia c) Obesity d) Inactivity

a) Age Age and family history for cardiovascular disease are risk factors that cannot be changed. Obesity, inactivity, and disylipidemia are risk factors that can be improved by the client through dietary changes, exercise, and other healthy lifestyle choices.

Which of the following would be inconsistent as a component of metabolic syndrome? a) Hypotension b) Elevated triglyceride levels c) Hypertension d) Abdominal obesity

a) Hypotension Diabetes, obesity, dyslipidemia, hypertension, and elevated triglycerides are components of metabolic syndrome. Hypotension is not a component of metabolic syndrome.

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) Kidneys b) Limbic system c) Lungs d) Parasympathetic nervous system

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

A systolic blood pressure of 135 mm Hg would be classified as a) Prehypertension b) Stage 1 hypertension c) Normal d) Stage 2 hypertension

a) Prehypertension. A systolic blood pressure of 135 mm Hg is classified as prehypertension. A systolic BP less than 120 mm Hg is normal. A systolic BP of 140 to 159 mm Hg is stage I hypertension. A systolic BP greater than or equal to 160 is classified as stage 2 hypertension.

Which term is refers to hypertension in which blood pressure that is controlled with therapy becomes uncontrolled (abnormally high) when the therapy is discontinued? a) Rebound b) Essential c) Secondary d) Primary

a) Rebound Rebound hypertension may precipitate a hypertensive crisis. Essential or primary hypertension denotes high blood pressure from an unidentified source. Secondary hypertension denotes high blood pressure from an identified cause, such as renal disease.

A patient has severe CAD and HTN. Which medication order should the nurse consult with the physician about that is contraindicated for a patient with severe CAD? a) clonidine (catapres) b) amiloride (midamor) c) bumetanide (bumex) d) methyldopa (aldomet)

a) clonidine (catapres)

A patient with hypertension is waking up several times a night to urinate. The nurse knows that what laboratory studies may indicate pathologic changes in the kidneys due to the hypertension? (Select all that apply) a) creatinine b) blood urea nitrogen (BUN) c) complete blood count (CBC) d) urine for culture and sensitivity e) AST and ALT

a) creatinine b) blood urea nitrogen (BUN)

A patient being seen at the clinic on a monthly basis for assessment of BP. The patient has been checking her Bp 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? a) isolated systolic hypertension b) secondary hypertension c) primary hypertension d) hypertensive urgency

a) isolated systolic hypertension

The nurse is caring for an elderly client with a diagnosis of hypertension, who is taking several antihypertensive medications. Which saftey precaution is the nurse most likely to reinforce? a) Eating extra potassium due to loss of potassium related to medications b) Changing positions slowly related to possible hypotension c) Being sure to keep follow-up appointments d) Walking as far as the client is able every day

b) Changing positions slowly related to possible hypotension The elderly 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. The nurse teaches clients to change positions slowly when moving from a lying or sitting position to a standing position. This will help prevent falls. Eating extra potassium is not a good idea if taking a potassium-sparing diuretic. The other choices are good teaching points, but not necessarily safety precautions.

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) Character of apical and peripheral pulses c) Lung sounds d) Heart rhythm e) Heart rate

b) Character of apical and peripheral pulses d) Heart rhythm e) Heart rate

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 provide time for the heart to increase rate of contraction to resupply oxygen to the brain. c) Gradual changes in position provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain. d) Gradual changes in position help reduce the heart's work to resupply oxygen to the brain.

b) Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. 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) Hypernatremia b) Hyperkalemia c) Hyponatremia d) Hypokalemia

b) Hyperkalemia 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.

An 87-year-old client was just recently diagnosed with prehypertension. She is to meet with a dietitian and return for a follow-up with her cardiologist in 6 months. As her nurse, what would you expect her treatment to include? a) Procedural interventions b) Nonpharmacological interventions c) Pharmacological interventions d) No intervention, just observation

b) Nonpharmacological interventions Nonpharmacologic interventions are used for clients with prehypertension.

When measuring the blood pressure in each arm of a healthy adult client, the nurse recognizes that which statement 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 may vary, with the higher pressure found in the left arm. d) Pressures must be equal in both arms.

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

The nurse is caring for a client newly diagnosed with secondary hypertension. Which of the following conditions contributes to the development of secondary hypertension? a) Calcium deficit b) Renal disease c) Hepatic function d) Acid-based imbalance

b) Renal disease

The nurse is instructing a client who is newly prescribed an antihypertensive medication. Which nursing instruction is emphasized to maintain client safety? a) Do not operate a motor vehicle. b) Sit on the edge of the chair and rise slowly. c) Take the medication at the same time daily. d) Use a pillbox to store daily medication.

b) Sit on the edge of the chair and rise slowly. The nursing instruction emphasized to maintain client safety is to sit on the edge of the chair before rising slowly. By doing so, the client reduces the possibility of falls related to postural hypotension. Using a pillbox to store medications and taking the medication at the same time daily is good medication management instruction. There is no reason when taking antihypertensive medications to restrict driving.

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? a) Stage 1 with compelling indications b) Stage 1 c) Stage 2 d) Stage 2 with compelling indications

b) Stage 1 Stage 1 hypertension is a blood pressure of 140 to 159 systolic or 90 to 99 diastolic. Stage 2 hypertension is a blood pressure greater than 160 systolic or greater than 100 diastolic. Compelling indications include heart failure, post-myocardial infarction, high cardiovascular disease risk, diabetes, chronic kidney disease, and previous stroke.

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

b) 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. The other options are not usually consequences of untreated chronic hypertension.

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 prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less b) To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less c) To stop smoking and increase physical activity to 30 minutes/day most days of the week 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.

The nurse understands that an overall goal of hypertension management is that a) The patient maintains a normal blood pressure reading. b) There is no indication of target organ damage. c) There is no complaint of postural hypotension. d) There are no complaints of sexual dysfunction.

b) there is no indication of target organ damage. Prolonged blood pressure elevation gradually damages blood vessels throughout the body, particularly in target organs such as the heart, kidneys, brain, and eyes. The overall goal of management is that the client does not experience target organ damage. The desired effects of antihypertensives are to maintain a normal blood pressure. Postural hypotension and sexual dysfunction are side effects of certain antihypertension medications.

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? a) 150/95 or lower b) 145/95 or lower c) 130/80 or lower d) 125/85 or lower

c) 130/80 or lower The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) specifies a lower goal pressure of 130/80 for people with diabetes mellitus.

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? a) Tremor b) Blurred vision c) Dizziness d) Persistent cough

c) Dizziness A common adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. The client and the client's spouse should be alerted to this possibility and provided with some tips for managing dizziness.

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

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.

Which of the following nursing diagnosis is the nurse most correct to choose when caring for a client with long-standing hypertension? a) Risk for Decreased Cardiac Output b) Impaired Gas Exchange c) Ineffective Tissue Perfusion d) Activity Intolerance

c) Ineffective Tissue Perfusion

The nurse is developing a teaching plan for a patient diagnosed with hypertension. It would be important to emphasise which of the following as part of the plan of care? a) Limiting activity to prevent over exertion b) Limiting cigarette smoking to 1 pack a week c) Limiting sodium intake in the diet d) Limiting alcohol to a can of beer to four times a day to thin the blood

c) Limiting sodium intake in the diet Research findings indicate that smoking cessation, weight loss, reduced alcohol and sodium intake, and regular physical activity are effective lifestyle adaptations to reduce blood pressure. Limiting one's daily alcohol to 24 ounces of beer for men is recommended. Table salt should be limited to 1 teaspoon daily.

The physician is ordering a test for the hypertensive client that will be able to evaluate whether the client has experienced heart damage. Which diagnostic test would the nurse anticipate to determine heart damage? a) Blood chemistry b) Chest radiograph c) Multiple gated acquisition scan (MUGA) d) Fluorescein angiography

c) Multiple gated acquisition scan (MUGA)

A client is admitted to the intensive care unit (ICU) with a diagnosis of hypertension emergency/crisis. The client's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV nitroprusside. Upon assessment, which finding requires immediate intervention by the nurse? a) Urine output of 40 mL over the past hour b) Chest pain score of 3 (on a scale of 1 to 10) c) Numbness and weakness in the left arm d) Nausea and severe headache

c) Numbness and weakness in the left arm Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. The finding of numbness and weakness in left arm may indicate the client is experiencing neurological symptoms associated with an ischemic stroke because of the severely elevated BP; immediate intervention is required. Urine output of 40 mL/h is within normal limits. The other findings are likely caused by the hypertension and require intervention, but they do not require action as urgently as the neurologic changes.

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 thymus b) The pituitary gland c) The adrenal gland d) The thyroid gland

c) The adrenal gland 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.

A blood pressure (BP) of 140/90 mm Hg is considered to be a) prehypertension. b) a hypertensive emergency. c) hypertension. d) normal.

c) hypertension. A BP of 140/90 mm Hg or higher is hypertension. A blood pressure less than 120/80 mm Hg is considered normal. A BP of 120 to 139/80 to 89 mm Hg is prehypertension. Hypertensive emergency is a situation in which BP is severely elevated and there is evidence of actual or probable target organ damage.

The nurse is caring for a patient newly diagnosed with hypertension. Which of the following statements if made by the patient indicates the need for further teaching? a) "When getting up from bed, I will sit for a short period prior to standing up." b) "I will consult a dietician to help get my weight under control." c) "I think I'm going to sign up for a yoga class twice a week to help reduce my stress." d) "If I take my blood pressure and it is normal, I don't have to take my BP pills."

d) "If I take my blood pressure and it is normal, I don't have to take my BP pills." The patient needs to understand the disease process and how lifestyle changes and medications can control hypertension. The patient must take his/her medication as directed. A normal BP indicates the medication is producing its desired effect. The other responses do not indicate the need for further teaching.

Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension? a) "I should eliminate caffeine from my diet to lower my blood pressure." b) "If I include less fat in my diet, I'll lower my blood pressure." c) "A glass of red wine each day will lower my blood pressure." d) "Limiting my salt intake to 2 grams per day will improve my blood pressure."

d) "Limiting my salt intake to 2 grams per day will improve my blood pressure." 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

A recommended follow-up for a person initially diagnosed with prehypertension is for a blood pressure (BP) recheck within which timeframe? a) 2 year b) Confirm within 2 months c) Evaluate within 1 month d) 1 year

d) 1 year A patient with an initial BP in the prehypertension range should have her BP rechecked in 1 year. A normal BP should be rechecked in 2 years. Grade 1 hypertension should be confirmed and followed-up within 2 months. Grade 2 hypertension should be evaluated or referred to a source of care within 1 month.

A client, newly prescribed a low-sodium diet due to hypertension, is asking for help with meal choices. The client provides four meal choices, which are favorites. Which selection would be best? a) Hot dog with ketchup and relish on whole wheat bun b) Creamed chipped beef over toast with mashed potatoes c) Toasted cheese sandwich on whole wheat toast with tomato soup d) Green pepper stuffed with diced tomatoes and chicken

d) Green pepper stuffed with diced tomatoes and chicken Fresh vegetables are low in sodium with diced tomatoes (fresh) and chicken is a good low-sodium, high vegetable and protein selection. Cheese and soup (tomato and creamed) are high in sodium. Processed meats such as a hot dog and condiments such as ketchup are high in sodium

Which of the following describes a situation in which blood pressure is very elevated but there is no evidence of impending or progressive target organ damage? a) Primary hypertension b) Secondary hypertension c) Hypertensive emergency d) Hypertensive urgency

d) Hypertensive urgency Hypertensive urgency is a situation in which blood pressure is severely elevated but there is no evidence of actual or probable target organ damage. Secondary hypertension is high blood pressure from an identified cause, such as renal disease. Primary hypertension denotes high blood pressure from an unidentified source. A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage.

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) Magnesium level b) Calcium level c) Sodium level d) Potassium level

d) Potassium level

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? a) Isolated systolic hypertension b) Left ventricular hypertrophy c) Angina d) Rebound hypertension

d) Rebound hypertension Patients need to be informed that rebound hypertension can occur if antihypertensive medications are suddenly stopped. Thus, patients should be advised to have an adequate supply of medication, particularly when traveling and in case of emergencies such as natural disasters. If traveling by airplane, patients should pack the medication in their carry-on luggage.

Which term describes high blood pressure from an identified cause, such as renal disease? a) Primary hypertension b) Rebound hypertension c) Hypertensive emergency d) Secondary hypertension

d) Secondary hypertension Secondary hypertension is high blood pressure from an identified cause, such as renal disease. Primary hypertension denotes high blood pressure form an unidentified source. Rebound hypertension is pressure that is controlled with therapy and becomes uncontrolled (abnormally high) when that therapy is discontinued. A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage.

A nurse is educating a client about monitoring blood pressure readings at home. Which of the following will the nurse be sure to emphasize? 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) "Sit with legs crossed when taking your blood pressure." d) "Avoid smoking cigarettes for 8 hours prior to taking 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.

A client experiences orthostatic hypotension while receiving frusemide (Lasix) to treat hypertension. How should the nurse intervene? a) Administer I.V. fluids as ordered. b) Instruct the client to sit for several minutes before standing. c) Insert an indwelling urinary catheter as ordered. d) Administer a vasodilator as ordered.

b) Instruct the client to sit for several minutes before standing. To minimize the effects of orthostatic hypotension, the nurse should instruct the client to rise slowly, such as by sitting for several minutes before standing. Administering I.V. fluids would be inappropriate (unless the client were dehydrated) because doing so would counteract the effects of furosemide and could cause fluid imbalance. Administering a vasodilator would further reduce the client's blood pressure, worsening orthostatic hypotension. Inserting an indwelling urinary catheter would make it easier to monitor urine output but wouldn't minimize the effects of orthostatic hypotension.

A patient is admitted to the intensive care unit (ICU) with a diagnosis of hypertension emergency/crisis. The patient's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV Nitropress (nitroprusside). Upon assessment, which of the following patient findings requires immediate intervention by the nurse? a) Chest pain score of 3/10 (on a scale of 1 to 10) b) Left arm numbness and weakness c) Urine output of 40 cc/mL over the last hour d) Nausea and severe headache

b) Left arm numbness and weakness

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) Decrease in blood volume b) Loss of arterial elasticity c) Increase in calcium intake d) Decrease in cardiac output

b) Loss of arterial elasticity 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.

A client diagnosed with hypertension begins drug therapy using an antihypertensive agent. The nurse instructs the client's spouse to remove any objects in the home that can lead to falls. The nurse knows that the teaching has been successful when the client restates which of the following? a) "Insomnia is a common side effect of antihypertensive medications." b) "Constant thirst is a common side effect of antihypertensive therapy." c) "Antihypertensive drugs can lead to falls." d) "Antihypertensives can lead to memory loss."

c) "Antihypertensive drugs can lead to falls." One of the side effects of all antihypertensive drugs is hypotension, which can lead to falls. A major concern regarding side effects of all antihypertensive drugs is hypotension, which can lead to falls

Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through: a) Laboratory tests b) Using a sphygmomanometer c) Ophthalmic examination d) An MRI

c) Ophthalmic examination Papilledema is an edema of the optic nerves, and thus needs an ophthalmic examination for detection.

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? a) Centers the blood pressure cuff bladder directly over the brachial artery b) Wraps the blood pressure cuff firmly around the arm c) Positions the arm at waist level d) Palpates the systolic pressure before auscultating blood pressure

c) Positions the arm at waist level Positioning the arm above the heart level will give a falsely low reading. Placing the arm below the heart will falsely elevate the reading. All other options are correct steps in achieving an accurate blood pressure.

A 35-year-old female patient has been diagnosed with hypertension. The patient is a stock broker, smokes daily, and is also a diabetic. During a follow-up appointment, the patient states that she finds it cumbersome and time consuming to visit the doctor regularly just to check her blood pressure (BP). As the nurse, which of the following aspects of patient teaching would you recommend? a) Advising a smoking cessation b) Discussing methods for stress reduction c) Purchasing a self-monitoring BP cuff d) Administering glycemic control

c) Purchasing a self-monitoring BP cuff Because this patient finds it time consuming to visit the doctor just for a blood pressure reading, as the nurse, you can suggest the use of an automatic cuff at a local pharmacy, or purchasing a self-monitoring cuff. Discussing methods for stress reduction, advising a smoking cessation, and administering glycemic control would constitute patient education in managing hypertension.

Which of the following conditions contributes to secondary hypertension? a) Arterial vasoconstriction b) Acid-based imbalance c) Calcium deficit d) Hepatic function

a) Arterial vasoconstriction Secondary hypertension may accompany any primary condition that affects fluid volume or renal function or causes arterial vasoconstriction. Calcium deficiency or acid-based imbalance does not contribute to hypertension.

A diastolic blood pressure of 90 mm Hg is classified as which of the following? a) Normal b) Prehypertension c) Grade 2 hypertension d) Grade 1 hypertension

d) Grade 1 hypertension A diastolic BP of less than 80 mm Hg is normal. A diastolic BP of 80 to 80 mm Hg is classified as prehypertension. A diastolic BP of 90 to 99 mm Hg is grade I hypertension. A diastolic BP of 100 mm Hg or above is classified as grade 2 hypertension.

A patient arrives at the clinic for a follow-up visit for treatment of HTN. The nurse obtains a BP 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) hypertensive emergency b) primary hypertension c) secondary hypertension d) hypertensive urgency

d) hypertensive urgency

The nurse is assessing a patient with severe hypertension. When performing a focused assessment of the eyes, what does the nurse understand may be observed related to the hypertension? a) cataracts b) glaucoma c) retinal detachment d) papilledema

d) papilledema

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) "Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg." b) "Your blood pressure is fine. Just keep doing what you're doing." c) "The current recommendation is for everyone to have blood pressure of 140/90 mm Hg or lower." d) "The lower the better. Blood pressure of 120/80 mm Hg is best for everyone."

a) "Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg." 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 of the following would be inconsistent with a hypertensive urgency? a) Severe headache b) Epistaxis c) Anxiety d) Intracranial hemorrhage

d) Intracranial hemorrhage Elevated blood pressure in hypertensive urgency is associated with severe headache, epistaxis, and anxiety. An example of a hypertensive emergency is a myocardial infarction, intracranial hemorrhage, or dissecting aortic aneurysm.

When treating hypertensive emergencies, the nurse identifies the most appropriate route of administration for antihypertensive agents as being which of the following? a) Continuous IV infusion b) Intramuscular c) Oral d) Sublingual

a) Continuous IV infusion The medications of choice in hypertensive emergencies are best managed through the continuous IV infusion of a short-acting titratable antihypertensive agent. The nurse avoids the sublingual and IM routes as their absorption and dynamics are unpredictable. The oral route would not have as quick an onset as a continuous IV infusion.

Which diagnostic method is recommended to determine whether left ventricular hypertrophy has occurred? a) Echocardiogram b) ECG c) BUN d) Blood chemistry

a) Echocardiogram An echocardiogram is recommended method of determining whether hypertrophy has occurred. Electrocardiography and blood chemistry are part of the routine workup. Renal damage may be suggested by elevations in blood urea nitrogen and creatinine concentrations.

Which of the following diagnostic tests may reveal an enlarged left ventricle? a) Echocardiography b) Fluorescein angiography c) Positron emission tomography (PET) scan d) Computed tomographic scan

a) Echocardiography 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.

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? a) Engage in aerobic activity at least 30 minutes/day most days of the week. b) Maintain a waist circumference of 45 (men) and 40 (women) inches or less. c) Maintain a body mass index between 30 and 35. d) Limit alcohol consumption to no more that 3 drinks per day.

a) Engage in aerobic activity at least 30 minutes/day most days of the week. 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 to no more than 2 drinks for men and 1 drink for women per day, and engaging in aerobic activity at least 30 minutes per day most days of the week.

Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage? a) Hypertensive emergency b) Primary hypertension c) Hypertensive urgency d) Secondary hypertension

a) Hypertensive emergency A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage. Hypertensive urgency is a situation in which blood pressure is severely elevated but there is no evidence of actual or probable target organ damage. Secondary hypertension is high blood pressure from an identified cause, such as renal disease. Primary hypertension denotes high blood pressure from an unidentified source.

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) It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. b) A person with hypertension should never consume alcohol. c) The taste buds never adapt to decreased salt intake. d) There is usually no need to change alcohol consumption for clients with hypertension.

a) 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

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? a) Lowering and controlling the BP without adverse effects and without undue cost b) making sure that the patient adheres to the therapeutic medication regimen c) instructing the patient to enter a weight loss program and begin an exercise regimen d) scheduling the patient for all follow-up visits and making phone calls to the home to ensure adherence

a) Lowering and controlling the blood pressure without adverse effects and without undue cost The objective of nursing care for patients with hypertension focuses on lowering and controlling the blood pressure without adverse effects and without undue cost.

A nurse is discussing with a group of nursing students how to accurately measure blood pressure. The nurse is sure to include all the following information except: a) Position the forearm above the level of the heart. b) Center the cuff bladder directly over the brachial artery. c) Routinely calibrate the sphygmomanometer. d) Initially take the blood pressure in both arms.

a) Position the forearm above the level of the heart. The cuff bladder must be centered over the brachial artery, and the client's forearm must be positioned at heart level. The nurse must routinely calibrate the sphygmomanometer. Initially, the nurse should record the blood pressure results in both arms and take subsequent measurements from the arm with the higher reading.

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? a) Postural hypertension and resulting injury b) Sexual dysfunction c) Postural hypotension and resulting injury d) Rebound hypertension

a) Postural hypotension and resulting injury Antihypertensive medication can cause hypotension, especially postural hypotension that may result in injury. Rebound hypertension occurs when antihypertensive medication is stopped abruptly. Sexual dysfunction may occur, especially with beta blockers, but other medications are available should this problem ensue. This is not immediately a priority concern. Antihypertensive medications do not usually cause postural hypertension.

Which of the following findings indicates that hypertension is progressing to target organ damage? a) Retinal blood vessel damage b) Chest x-ray showing pneumonia c) Urine output of 60 cc/mL over 2 hours d) Blood urea nitrogen (BUN) level of 12 mg/dL

a) Retinal blood vessel damage Symptoms suggesting that hypertension is progressing to the extent that target organ damage is occurring must be detected early so that appropriate treatment can be initiated. All body systems must be assessed to detect any evidence of vascular damage. An eye examination with an ophthalmoscope is important because retinal blood vessel damage indicates similar damage elsewhere in the vascular system. The patient is questioned about blurred vision, spots in front of the eyes, and diminished visual acuity. The heart, nervous system, and kidneys are also carefully assessed. A BUN level and 60 cc/mL over 2 hours are normal findings. The presence of pneumonia does not indicate target organ damage.

When measuring blood pressure in each arm of a healthy adult, the nurse recognizes that the pressures a) differ no more than 5 mm Hg between arm pressures. b) may vary, with the higher pressure found in the left arm. c) must be equal in both arms. d) may vary 10 mm Hg or more between arms.

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

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) "Do you have a dry mouth or nasal congestion?" d) "Did you take any medication for your headache?"

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.

The public health nurse is presenting a workshop on hypertension for the Parent Teacher Organization of the local elementary school. A parent asks the nurse who is at risk for hypertension. What would be the nurse's best answer? a) "People at highest risk for hypertension include clients younger than 18 years." b) "People at highest risk for hypertension include those with diabetes." c) "People at highest risk for hypertension include Asians." d) "People at highest risk for hypertension include the immune-compromised."

b) "People at highest risk for hypertension include those with diabetes." Screening of BP is an important method for identifying people at risk for heart failure, renal failure, and stroke. Those at highest risk are older adults, African Americans, and clients with diabetes mellitus. Therefore options A, C, and D are incorrect.

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) 140/90 mm Hg b) 130/80 mm Hg c) 110/60 mm Hg d) 120/70 mm Hg

b) 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 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) 2 or 3 b) 4 or 5 c) 2 or fewer d) 7 or 8

b) 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.

A nurse is discussing with a nursing student how to accurately measure blood pressure. Which of the following points does the nurse emphasize? a) The size of the cuff does not matter as long as it fits snugly around the arm. b) A cuff that is too small will give a false high blood pressure. c) A cuff that is too small will give a false low blood pressure. d) A cuff that is too large will give a false high blood pressure.

b) A cuff that is too small will give a false high blood pressure. Using a cuff that is too small will give a false high blood pressure measurement, while using a cuff that is too large results in a false low blood pressure measurement.

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. 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. a) Pancreatitis b) Coronary artery disease c) Tension pneumothorax d) Myocardial infarction e) Stroke

b) Coronary artery disease d) Myocardial infarction e) Stroke People with hypertension may remain asymptomatic for many years. When specific signs and symptoms appear, however, they usually indicate vascular damage. Coronary artery disease with angina and myocardial infarction are common consequences of hypertension. Cerebrovascular involvement may lead to a stroke. Tension pneumothorax and pancreatitis are not directly related to hypertension.

A patient with long-standing hypertension is admitted to the hospital with hypertensive urgency. The physician orders a chest x-ray, which reveals an enlarged heart. What diagnostic test does the nurse anticipate preparing the patient for to determine left ventricular enlargement? a) Cardiac catheterization b) Echocardiography c) Stress test d) Tilt-table test

b) Echocardiography Left ventricular hypertrophy can be assessed by echocardiography, but not by any of the other measures listed.

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? a) Secondary b) Essential (primary) c) Malignant d) Pathologic

b) Essential (primary) Essential or primary hypertension, about 95% of cases, is sustained elevated BP with no known cause. This client does not have secondary, pathologic, or malignant hypertension.

The nurse is caring for a client with accelerated hypertension. Which body system would the nurse assess to identify early signs of blood pressure progression? a) Musculoskeletal system b) Eyes c) Kidney d) Heart

b) Eyes Accelerated hypertension is defined as a markedly elevated blood pressure with symptoms of hemorrhages and exudates in the eyes. If the hypertension is untreated, accelerated hypertension progresses to malignant hypertension with symptoms of papilledema. Long-standing hypertension can produce changes in the kidney, heart, and musculoskeletal system.

The nurse understands that patient education related to antihypertensive medication should include all of the following instructions except which of the following? a) Avoid over the counter (OTC) cold, weight reduction, and sinus medications. b) If a dosage of medication is missed, double up on the next one to catch up. c) Avoid hot baths, exercise, and alcohol within 3 hours of taking vasodilators. d) Do not stop antihypertensive medication abruptly.

b) If a dosage of medication is missed, double up on the next one to catch up. Doubling doses could cause serious hypotension (HTN) and is not recommended. Medications should be taken as prescribed. Hot baths, strenuous exercise, and excessive alcohol are all vasodilators and should be avoided. Many OTC preparations can precipitate HTN. Stopping antihypertensives abruptly can precipitate a severe hypertensive reaction and is not recommended.

The nurse in an oncology clinic notes that the client being treated has hypertension. What tumor is a predisposing condition for secondary hypertension? a) Wilm's tumor b) Pheochromocytoma c) Astrocytoma d) Lymphoma

b) Pheochromocytoma Predisposing conditions include kidney disease, pheochromocytoma (a tumor of the adrenal medulla), hyperaldosteronism (increased secretion of mineralcorticoid by the adrenal cortex), atherosclerosis, use of cocaine or other cardiac stimulants (e.g., weight-control drugs, caffeine), and use of oral contraceptives. Wilms' tumors, astrocytomas, and lymphomas are not predisposing conditions for secondary hypertension.

Which of the following adrenergic inhibitors acts directly on the blood vessels, producing vasodilation? a) Reserpine (Serpasil) b) Prazosin hydrochloride (Minipress) c) Propranolol (Inderal) d) Clonidine hydrochloride (Catapres)

b) Prazosin hydrochloride (Minipress) Minipress is peripheral vasodilator acting directly on the blood vessel. It is not used in angina and coronary artery disease, however, because it induces tachycardia if not preceded by administration of propranolol and a diuretic. Serpasil impairs synthesis and reuptake of norepinephrine. Inderal blocks the beta-adrenergic receptors of the sympathetic nervous system, especially the sympathetics to the heart, producing a slower heart rate and lowered blood pressure. Catapres acts through the central nervous system, apparently through centrally mediated alpha-adrenergic stimulation in the brain, producing blood pressure reduction

A nurse is discussing with students how to accurately measure blood pressures. Which of the following information is the nurse certain to emphasize? a) Center the cuff bladder directly over the radial artery. b) Routinely calibrate the sphygmomanometer. c) Position the client's forearm above the level of the heart. d) The size of the cuff does not matter as long as it fits snugly around the arm.

b) Routinely calibrate the sphygmomanometer. The nurse must routinely calibrate the sphygmomanometer to ensure accuracy of readings. Using a cuff that is too small will give a false high blood pressure measurement, and using a cuff that is too large results in a false low blood pressure measurement. The cuff bladder must be centered over the brachial artery, and the client's forearm must be positioned at heart level.

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? a) "I'm glad I can still have chicken bouillon." b) "I chose a tossed salad with sardines and oil and vinegar dressing for lunch." c) "I chose broiled chicken with a baked potato for dinner." d) "I can still eat a ham-and-cheese sandwich with potato chips for lunch."

c) "I chose broiled chicken with a baked potato for dinner." The client's choice of a baked potato with broiled chicken indicates effective nutrition teaching because potatoes and chicken are relatively low in sodium. Ham, sardines, and bouillon are extremely high in sodium and shouldn't be included in a low-sodium diet.

Officially, hypertension is diagnosed when the client demonstrates a systolic blood pressure greater than ______ mm Hg and a diastolic blood pressure greater than _____ mm Hg over a sustained period. a) 110, 60 b) 120, 70 c) 140, 90 d) 130, 80

c) 140, 90 According to the categories of blood pressure levels established by the JNC VI, stage 1 hypertension is demonstrated by a systolic pressure of 140 to 159, or a diastolic pressure of 90 to 99. Pressure of 130 systolic and 80 diastolic falls within the prehypertension classification range for an adult. Pressures of 110 systolic and 60 diastolic, and of 120 systolic and 70 diastolic, fall within the normal range for an adult.

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

c) 4 or 5 Four or five servings of vegetables are recommended in the DASH diet. The diet recommends two or fewer servings of lean meat, fish, and poultry; two or three servings of low-fat or fat-free dairy foods; and seven or eight servings of grains and grain products.

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) Take the medicine on an empty stomach. b) There are no adverse effects from blood pressure medicine. c) A possible adverse effect of blood pressure medicine is dizziness when you stand. d) A severe drop in blood pressure is possible.

c) A possible adverse effect of blood pressure medicine is dizziness when you stand.

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? a) Reduction of the mean BP by up to 50% within the first hour of treatment b) Maintaining the BP at a significantly higher than normal level to prevent orthostatic hypotension. c) Avoid lowering the blood pressure (BP) too quickly d) Reduction of the BP to 160/100 mm Hg within the half hour of treatment

c) Avoid lowering the blood pressure (BP) too quickly It is important not to become over eager and lower the BP too quickly, thus reducing tissue perfusion and causing a myocardial infarction (MI) or cerebrovascular accident. Among the therapeutic goals are a reduction of the mean BP by up to 25% within the first hour of treatment, and a further reduction of a goal pressure to about 160/110 mm Hg over a period of 2 to 6 hours. Maintaining the BP at a significantly higher than normal level can precipitate a stroke or MI.

You are the triage nurse in a walk-in clinic when a diabetic client visits the clinic and asks you to take her blood pressure (BP). The measurements are 150/90 mm Hg. Which of the following would the nurse expect as the treatment to normalize the client's BP? a) Daily exercise b) Smoking cessation programs c) Drug therapy d) Low-fat diet

c) Drug therapy The nurse would expect drug therapy to be recommended for the client. Smoking cessation, a low-fat diet, and daily exercise may be useful in the prehypertension stage. A client with diabetes should have BP levels below 139/80 mm Hg to avoid drug therapy.

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 modifiable by the client? a) Age b) Impaired renal function c) Dyslipidemia d) Family history

c) Dyslipidemia

When administering an angiotensin-converting enzyme (ACE) inhibitor with spironolactone, the nurse should be aware that which electrolyte imbalance may occur? a) Hypokalemia b) Hypocalcemia c) Hyperkalemia d) Hypercalcemia

c) Hyperkalemia ACE inhibitors and angiotensin receptor blocker (ARBs) block aldosterone and may cause hyperkalemia when used with a potassium sparing diuretic such as spironolactone. Hypercalcemia and hypocalcemia would not occur as an imbalance.

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? a) Decreased elasticity of the major blood vessels b) Atherosclerosis c) Increased ability to exert diastolic pressure d) Increased arterial resistance to left ventricular ejection

c) Increased ability to exert diastolic pressure Aging causes increased blood vessel stiffness, which results in arteries that are less able to buffer the pressure created as blood is ejected from the left ventricle and therefore unable to store energy to exert diastolic pressure.

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 to about 140/80 mm Hg. b) Rapidly reduce the blood pressure so the patient will not suffer a stroke. c) Reduce the blood pressure by 20% to 25% within the first hour of treatment. d) Reduce the blood pressure by 50% within the first hour of treatment.

c) 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.

Decreasing hypertension is the main focus of the medical cardiology practice where you practice nursing. Different goals apply to different age groups for managing and reducing blood pressures. Angie Dodd, a 54-year-old nurse, is beginning medical management of her recently diagnosed hypertension. What is considered the most important strategy in her treatment? a) Reducing her diastolic pressure below 90 mmHg b) Reducing her diastolic pressure below 80 mmHg c) Reducing her systolic pressure below 140 mmHg d) Reducing her systolic pressure below 130 mmHg

c) Reducing her systolic pressure below 140 mmHg Currently, it is believed that in persons older than 50 years of age, reducing the systolic pressure below 140 mm Hg is more important than decreasing the diastolic blood pressure.

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? a) Essential b) Primary c) Secondary d) Malignant

c) Secondary Secondary hypertension is elevated BP that results from or is secondary to some other disorder. This type of hypertension is not primary, essential, or malignant.

A client with severe hypertension states, "I feel fine; I'm not really sick at all." The nurse will teach the client that the system/organs particularly targeted for damage by severe hypertension include which of the following? a) Integumentary b) Gastrointestinal c) Sensory d) Musculoskeletal

c) Sensory Prolonged elevated blood pressure eventually damages blood vessels throughout the body, particularly in target organs such as the heart, kidneys, brain, and eyes. The usual consequences of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, renal failure, strokes, and impaired vision.

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) Dissecting aortic aneurysm b) Pyelonephritis c) Untreated hypertension d) Pheochromocytoma

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)

The nurse understands that client education related to antihypertensive medication should include which of the following? a) inform client that recommended lifestyle changes are not necessary b) inform client to discontinue antihypertensives once blood pressure is normal c) inform client to avoid over-the-counter cold and sinus medications d) inform client if a dosage of medication is missed , to double the next scheduled dose

c) inform client to avoid over-the-counter cold and sinus medications Doubling doses could cause serious hypotension (HTN) and is not recommended. Medications should be taken as prescribed. Many over-the-counter preparations can precipitate HTN. Stopping antihypertensives abruptly can precipitate a severe hypertensive reaction and is not recommended. Patients with hypertension must make considerable effort to adhere recommended lifestyle modifications.

Hypertension that can be attributed to an underlying cause is termed a) isolated systolic. b) essential. c) secondary. d) primary.

c) secondary. Secondary hypertension may be caused by a tumor of the adrenal gland (e.g., pheochromocytoma). Primary, or essential, hypertension has no known underlying cause. Isolated systolic hypertension is demonstrated by readings in which the systolic pressure exceeds 140 mm Hg and the diastolic measurement is normal or near normal (less than 90 mm Hg).

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 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? a) "Hypertension often causes no pain." b) "Hypertension is difficult to diagnose." c) "Hypertension often kills early in the disease process." d) "Hypertension often causes no symptoms."

d) "Hypertension often causes no symptoms." Hypertension is sometimes called the "silent killer" because people with it are often symptom free. Physical examination may reveal no abnormalities other than elevated blood pressure. People with hypertension may remain asymptomatic for many years. The usual consequences of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, renal failure, strokes, and impaired vision. Pain is not usually an issue, but that is not why hypertension is called the "silent killer." Hypertension is easily diagnosed by taking a series of blood pressure readings.

The nurse is administering the morning mediations to a patient on the cardiac telemetry unit. Atenolol has been prescribed for this patient. Prior to administration, the nurse would tell the patient that the medication is which type of antihypertensive? a) Vasodilator b) Angiotensin-converting enzyme (ACE) inhibitor c) Diuretic d) Beta blocker

d) Atenolol is classified as a beta blocker. Beta blockers block beta adrenergic receptors of the sympathetic nervous system, causing vasodilation and decreased cardiac output and heart rate. Atenolol is not classified as a diuretic, ACE inhibitor, or vasodilator.

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 urine output b) Checking the patient's serum K+ level c) Weighing the patient d) Checking the patient's heart rate

d) Checking the patient's heart rate 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.

A client has just been diagnosed with prehypertension. What would the nurse instruct this client to do to restore his blood pressure below hypertensive levels? a) Increase iodine intake b) Avoid over-the-counter decongestants c) Increase fluid intake d) Decrease sodium intake

d) Decrease sodium intake The nurse should instruct clients with prehypertension to avoid or decrease sodium and iodine intake. Increasing fluid intake raises circulating blood volume and systemic vascular resistance. Over-the-counter decongestants decrease pulmonary congestion and not hypertension.

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 2 hypertension b) Stage 1 hypertension c) Normal d) Prehypertension

d) 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

When caring for a client with essential hypertension what instruction should the nurse provide to the client to normalise blood pressure? a) Increase intake of fluids. b) Avoid intake of low-fat diet. c) Increase iodine intake. d) Reduce sodium intake.

d) Reduce sodium intake. The nurse advises the client with essential hypertension to reduce sodium intake. The nurse also advises the client to reduce oral fluid to decrease circulating blood volume and systemic vascular resistance and adhere to a low-fat diet.

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) Three to four regular dairy foods per day b) Four to five servings of meat, fish, or poultry per day c) Seven to eight fruits per day d) Seven to eight whole grain products per day

d) 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

Which diuretic medication conserves potassium? a) Chlorothiazide b) Furosemide c) Chlorthalidone d) Spironolactone

d) Spironolactone Spironolactone is known as a potassium-sparing diuretic. Furosemide causes loss of potassium from the body. Chlorothiazide and chlorthalidone cause mild hypokalemia.

Why is it important for the nurse to implement measures to relieve emotional stress for patients with hypertension? a) The reduction of stress increases the production of neurotransmitters that constrict peripheral arterioles. b) The reduction of stress increases the resistance that the heart must overcome to eject blood. c) The reduction of stress increases the blood volume and improves the potential for greater cardiac output. d) The reduction of stress decreases the production of neurotransmitters that constrict peripheral arterioles.

d) The reduction of stress decreases the production of neurotransmitters that constrict peripheral arterioles. Reduced stress decreases the production of neurotransmitters that constrict peripheral arterioles. Reduced stress may assist in reducing blood volume and resistance to the heart.

The nurse observes a certified nursing assistant (CNA) obtaining a blood pressure reading with a cuff that is too small for the patient. The nurse informs the CNA that using a cuff that is too small can affect the reading results in what way? a) It will be significantly different with each reading. b) It will give an accurate reading. c) The results will be falsely decreased. d) The results will be falsely elevated.

d) The results will be falsely elevated.

The nurse is assessing BP for a pt who has HTN and the nurse does not hear an auscultatory gap. What outcome may be documented in this circumstance? a) a low diastolic reading b) a high systolic pressure reading c) a normal reading d) a high diastolic or low systolic reading

d) a high diastolic or low systolic reading

Which of the following statements are true when the nurse is measuring blood pressure (BP)? Select all that apply. a) Using a BP cuff that is too large will give a higher BP measurement. b) Ask the patient to sit quietly while the BP is being measured. c) The patient's arm should be positioned at the level of the heart. d) Using a BP cuff that is too small will give a higher BP measurement. e) The patient's BP should be taken 1 hour after the consumption of alcohol.

• Ask the patient to sit quietly while the BP is being measured. • The patient'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. These statements are all true when measuring a BP. When using a BP cuff that is too large the reading will be lower than the actual BP. The patient should avoid smoking cigarettes or drinking caffeine for 30 minutes before BP is measured.

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) Weight reduction b) Increased intake of dietary sodium c) Increased physical activity d) Substitution of low-fat for whole dairy products in diet e) Increased intake of dietary protein

• Weight reduction • Increased physical activity • 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.