PrepU Chapter 31: Hypertension (Exam 1)
While in nursing school, you discover the prevalence of high blood pressure in the United States and are amazed at its frequency of occurrence. Which of the following is closest to approximately how many people have high blood pressure? -1 in 4 adults -1 in 5 adults -1 in 7 adults -1 in 10 adults
-1 in 4 adults Approximately 50 million people, or 1 in 4 adults, in the United States have high blood pressure.
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: -"Your blood pressure is fine. Just keep doing what you're doing." -"The current recommendation is for everyone to have blood pressure of 140/90 mm Hg or lower." -"The lower the better. Blood pressure of 120/80 mm Hg is best for everyone." -"Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg."
-"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.
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? -Cataracts -Glaucoma -Retinal detachment -Papilledema
-Papilledema Physical examination may reveal no abnormalities other than elevated blood pressure. Occasionally, retinal changes such as hemorrhages, exudates (fluid accumulation), arteriolar narrowing, and cotton-wool spots (small infarctions) occur. In severe hypertension, papilledema (swelling of the optic disc) may be seen.
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 -pharmacological interventions -procedural interventions -observation only
-nonpharmacological interventions Nonpharmacologic interventions are used for clients with prehypertension.
When treating hypertensive emergencies, the nurse identifies the most appropriate route of administration for antihypertensive agents as being which of the following? -Continuous IV infusion -Sublingual -Intramuscular -Oral
-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 describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage? -Hypertensive emergency -Hypertensive urgency -Primary hypertension -Secondary hypertension
-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.
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 -Respiratory rate -Heart rhythm -Character of apical and peripheral pulses -Lung sounds
-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.
When measuring blood pressure in each arm of a healthy adult, the nurse recognizes that the pressures -must be equal in both arms. -may vary 10 mm Hg or more between arms. -differ no more than 5 mm Hg between arms. -may vary, with the higher pressure found in the left arm.
-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.
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. -140, 90 -130, 80 -110, 60 -120, 70
-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.
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? -Magnesium level -Potassium level -Calcium level -Sodium level
-Potassium level Amiloride (Midamor) is a potassium-sparing diuretic, meaning that it causes potassium retention. The nurse should monitor for hyperkalemia (elevated potassium level) if given with an ACE inhibitor (such as lisinopril) or angiotensin receptor blocker.
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? -4 or 5 -7 or 8 -2 or 3 -2 or fewer
-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.
Which condition contributes to secondary hypertension? -Hepatic function -Arterial vasoconstriction -Calcium deficit -Acid-based imbalance
-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.
The nurse is caring for a patient with an intracranial hemorrhage. The patient is having a hypertensive emergency. Which of the following nursing intervention would take priority in this patient? -Avoid lowering the blood pressure (BP) too quickly -Reduction of the mean BP by up to 50% within the first hour of treatment -Reduction of the BP to 160/100 mm Hg within the half hour of treatment -Maintaining the BP at a significantly higher than normal level to prevent orthostatic hypotension.
-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.
When assessing your client, you note a blood pressure (BP) of 205/115. The client has had BP's within normal limits up until this time. The client complains of a sudden onset severe headache. The nurse recognizes this as probable malignant hypertension. What would be the nurse's first action? -Give ordered antihypertensive. -Notify the physician. -Call a code. -Wait 15 minutes and reassess the vital signs.
-Notify the physician. Malignant hypertension is fatal unless BP is quickly reduced. Even with intensive treatment, the kidneys, brain, and heart may be permanently damaged.
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? -Beta-blocker -ACE inhibitor -Loop diuretic -Calcium channel blocker
-ACE inhibitor The angiotensin-converting enzyme (ACE) inhibitor's primary action is to prevent the conversion of angiotensin I to angiotensin II, a potent vasoconstricting hormone in the blood. A beta-blocker blocks the beta-adrenergic receptors decreasing sympathetic nervous system stimulation. Loop diuretics excrete water from the loop of Henle, reducing circulating blood volume. Calcium channel blockers dilate coronary and peripheral arteries.
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? -Up to 25% -35% -40% -45%
-Up to 25% The therapeutic goals are reduction of the mean BP by up 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 2 to 6 hours, and then a more gradual reduction in pressure to the target goal over a period of days.
Which diuretic medication conserves potassium? -Furosemide -Spironolactone -Chlorothiazide -Chlorthalidone
-Spironolactone Spironolactone is known as a potassium-sparing diuretic. Furosemide causes loss of potassium from the body. Chlorothiazide and chlorthalidone cause mild hypokalemia.
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? -"Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night." -"Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising." -"Flex your calf muscles, avoid alcohol, and change positions slowly." -"Rest between demanding activities, eat plenty of fruits and vegetables, and drink 6 to 8 cups of fluid daily."
-"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 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?" -"Do you have a dry mouth or nasal congestion?" -"Are you having chest pain or shortness of breath?" -"Did you take any medication for your headache?"
-"Have you taken your prescribed clonidine today?" The nurse must ask whether the client has taken his prescribed clonidine. Clients need to be informed that rebound hypertension can occur if antihypertensive medications are suddenly stopped. Specifically, a side effect of clonidine is rebound or withdrawal hypertension. Although the other questions may be asked, it is most important to inquire whether the client has taken the prescribed hypertension medication given the client's severely elevated BP.
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 can still eat a ham-and-cheese sandwich with potato chips for lunch." -"I chose broiled chicken with a baked potato for dinner." -"I chose a tossed salad with sardines and oil and vinegar dressing for lunch." -"I'm glad I can still have chicken bouillon."
-"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.
Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension? -"A glass of red wine each day will lower my blood pressure." -"I should eliminate caffeine from my diet to lower my blood pressure." -"If I include less fat in my diet, I'll lower my blood pressure." -"Limiting my salt intake to 2 grams per day will improve my blood pressure."
-"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 nurse is educating a client about monitoring blood pressure readings at home. Which of the following will the nurse be sure to emphasize? -"Avoid smoking cigarettes for 8 hours prior to taking blood pressure." -"Sit quietly for 5 minutes prior to taking blood pressure." -"Sit with legs crossed when taking your blood pressure." -"Be sure the forearm is well supported above heart level while taking blood pressure."
-"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 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? -145/95 or lower -130/80 or lower -150/95 or lower -125/85 or lower
-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.
According to the DASH diet, how many servings of vegetables should a person consume each day? -2 or fewer -2 or 3 -4 or 5 -7 or 8
-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, 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? -Take the medicine on an empty stomach. -A possible adverse effect of blood pressure medicine is dizziness when you stand. -There are no adverse effects from blood pressure medicine. -A severe drop in blood pressure is possible.
-A possible adverse effect of blood pressure medicine is dizziness when you stand. A possible adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. Teaching should include tips for managing syncope and dizziness. You would not teach the client to take the medicine on an empty stomach.
The nurse is caring for an elderly client with a diagnosis of hypertension, who is taking several antihypertensive medications. Which safety precaution is the nurse most likely to reinforce? -Changing positions slowly related to possible hypotension -Eating extra potassium due to loss of potassium related to medications -Being sure to keep follow-up appointments -Walking as far as the client is able every day
-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.
Which diagnostic method is recommended to determine whether left ventricular hypertrophy has occurred? -Echocardiography -Electrocardiography -Blood chemistry -Blood urea nitrogen
-Echocardiography 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.
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? -Secondary -Pathologic -Malignant -Essential (primary)
-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.
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 rate of contraction to resupply oxygen to the brain. -Gradual changes in position help reduce the blood pressure to resupply oxygen to the brain. -Gradual changes in position help reduce the heart's work to resupply oxygen to the brain. -Gradual changes in position provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain.
-Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. 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 blood pressure (BP) of 140/90 mm Hg is considered to be -normal. -prehypertension. -hypertension. -a hypertensive emergency.
-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.
A nurse educator is teaching a small group of clients about hypertension and dietary changes that will assist in lowering blood pressure readings. The nurse is specifically discussing the (Dietary Approaches to Stop Hypertension (DASH) diet and teaches the clients that the food group with the largest number of servings per day is which of the following? -Grains and grain products -Vegetables -Fruits -Low-fat or fat-free dairy foods
-Grains and grain products The DASH diet includes (per day) 7 to 8 servings of grains or grain products, 4 to 5 servings of vegetables, 4 to 5 servings of fruits, 2 to 3 servings of low-fat or fat-free dairy products, 2 or fewer servings of meat, fish, and poultry, and 2 to 4 servings of nuts, seeds, and dry beans per week.
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? -Lung and arteries -Heart and blood vessels -Brain and sympathetic nervous system -Kidneys and autonomic nervous system
-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.
When administering an angiotensin-converting enzyme (ACE) inhibitor with spironolactone, the nurse should be aware that which electrolyte imbalance may occur? -Hyperkalemia -Hypokalemia -Hypercalcemia -Hypocalcemia
-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.
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 -Hypokalemia -Hypernatremia -Hyponatremia
-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.
Which term describes a situation in which blood pressure is very elevated but there is no evidence of impending or progressive target organ damage? -Hypertensive urgency -Hypertensive emergency -Primary hypertension -Secondary hypertension
-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. A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage. Primary hypertension denotes high blood pressure from an unidentified source. Secondary hypertension is high blood pressure from an identified cause, such as renal disease.
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? -Atherosclerosis -Decreased elasticity of the major blood vessels -Increased ability to exert diastolic pressure -Increased arterial resistance to left ventricular ejection
-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 nurse is providing education about lifestyle modifications to a group of clients who have been newly diagnosed with hypertension. The nurse would include all the following statesments except: -Maintain a normal body mass index of about 24. -Engage in aerobic activity at least 30 minutes/day most days of the week. -Maintain a waist circumference of 40 (men) and 35 (women) inches or less. -Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women.
-Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women. Recommmended lifestye modifications to prevent and manage hypertension include maintaining a normal body mass index (about 24; greater than 25 is considered overweight), maintaining a waist circumference of less than 40 inches for men and 35 inches for women, limiting alcohol intake per day to no more than 2 drinks for men and 1 drink for women, and engaging in aerobic activity at least 30 minutes per day most days of the week.
The nurse is caring for an 82-year-old male client who has come to the clinic for a yearly physical. When assessing the client, the nurse notes the blood pressure (BP) is 140/93. The nurse knows that in older clients what happens that may elevate the systolic BP? -Loss of arterial elasticity -Decrease in blood volume -Increase in calcium intake -Decrease in cardiac output
-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 hospitalized for treatment of hypertension is being prepared for discharge. Which teaching topic should the nurse should be sure to cover? -Maintaining a low-potassium diet -Skipping a medication dose if dizziness occurs -Maintaining a low-sodium diet -Receiving I.V. antihypertensive medications
-Maintaining a low-sodium diet The nurse must teach the hypertensive client how to modify his diet to restrict sodium and saturated fats. In addition to teaching about adverse effects of ordered antihypertensives, she must discuss the actions and dosages of these drugs. A client receiving antihypertensives may also take a diuretic as part of the drug regimen and thus may require dietary potassium supplements and high-potassium foods to avoid electrolyte disturbances. Instead of skipping medication if dizziness occurs, the client should notify the physician of this symptom. The client receiving antihypertensives at home takes them by mouth, not I.V.
A nursing class is practicing measurement of blood pressure. One otherwise healthy participant, 46 years old, is 138/90. This man requires follow-up. In which classification of hypertension is he according to the JNC 7 (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood pressure) recommendation? -Stage 1 -Stage 2 -Stage 1 with compelling indications -Stage 2 with compelling indications
-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.
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? -Numbness and weakness in the left arm -Nausea and severe headache -Chest pain score of 3 (on a scale of 1 to 10) -Urine output of 40 mL over the past hour
-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.
A 77-year-old client has newly diagnosed stage 2 hypertension for which the physician has prescribed a thiazide and an angio-converting enzyme inhibitor. The nurse is concerned about the client's risk for postural hypotension because of these medications, as well as for what other reason? -Older adults have impaired cardiovascular reflexes. -These medications often cause rebound hypertension. -Older adults require large doses of these medications to control their blood pressure. -Older adults have trouble remembering to measure their blood pressure at home.
-Older adults have impaired cardiovascular reflexes. Antihypertensive medications can cause hypotension, especially postural hypotension that may result in injury. Older adults 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. Rebound hypertension occurs when antihypertensive medications are stopped abruptly. Older adults are more sensitive to the effects of these medications and so usually require lower doses. Most older clients can remember very well to measure their blood pressure at home.
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: -Routinely calibrate the sphygmomanometer. -Center the cuff bladder directly over the brachial artery. -Position the forearm above the level of the heart. -Initially take the blood pressure in both arms.
-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? -Postural hypertension and resulting injury -Rebound hypertension -Sexual dysfunction -Postural hypotension and resulting injury
-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.
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? -Prehypertension -Normal -Stage 1 hypertension -Stage 2 hypertension
-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 measuring the blood pressure in each arm of a healthy adult client, the nurse recognizes that which statement is true? -Pressures must be equal in both arms. -Pressures may vary 10 mm Hg or more between arms. -Pressures should not differ more than 5 mm Hg between arms. -Pressures may vary, with the higher pressure found in the left arm.
-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.
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 -Discussing methods for stress reduction -Advising smoking cessation -Administering glycemic control
-Purchasing a self-monitoring BP cuff Because this client finds visiting the doctor time-consuming just for a BP 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 to reduce stress, advising smoking cessation, and achieving glycemic control would constitute client education in managing hypertension.
As recommended follow-up for a client initially diagnosed with prehypertension, the client should get his or her blood pressure rechecked within which time frame? -Recheck in 1 year -Recheck in 2 years -Confirm within 2 months -Evaluate within 1 month
-Recheck in 1 year A client with an initial blood pressure (BP) in the prehypertension range should have his or her BP rechecked in 1 year. A normal BP should be rechecked in 2 years. Stage 1 hypertension should be confirmed and followed up within 2 months. Stage 2 hypertension should be evaluated or referred to a source of care within 1 month.
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 -persistent cough -blurred vision -tremor
-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.
A patient is brought to the emergency department with complaints of a bad headache and an increase in blood pressure. The blood pressure reading obtained by the nurse is 260/180 mm Hg. What is the therapeutic goal for reduction of the mean blood pressure? -Reduce the blood pressure by 20% to 25% within the first hour of treatment. -Reduce the blood pressure to about 140/80 mm Hg. -Rapidly reduce the blood pressure so the patient will not suffer a stroke. -Reduce the blood pressure by 50% within the first hour of treatment.
-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.
Which of the following is the nurse most correct to recognize as a direct effect of client hypertension? -Renal dysfunction resulting from atherosclerosis -Anemia resulting from bone marrow suppression -Hyperglycemia resulting from insulin receptor resistance -Emphysema related to poor gas exchange
-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.
Which finding indicates that hypertension is progressing to target organ damage? -Retinal blood vessel damage -Urine output of 60 mL over 2 hours -Blood urea nitrogen concentration of 12 mg/dL -Chest x-ray showing pneumonia
-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 client 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 concentration of 12 mg/dL and urine output of 60 mL over 2 hours are normal findings. The presence of pneumonia does not indicate target organ damage.
A nurse is discussing with students how to accurately measure blood pressures. Which of the following information is the nurse certain to emphasize? -Routinely calibrate the sphygmomanometer. -Center the cuff bladder directly over the radial artery. -Position the client's forearm above the level of the heart. -The size of the cuff does not matter as long as it fits snugly around the arm.
-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, 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? -Primary -Essential -Secondary -Malignant
-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.
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 -Electrocardiogram (EGG) tracing demonstrating peaked T waves -Urine output of 90 mL 1 hour after medication administration -Blood glucose value of 160 mg/dL
-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.
The nurse is instructing a client who is newly prescribed an antihypertensive medication. Which nursing instruction is emphasized to maintain client safety? -Use a pillbox to store daily medication. -Sit on the edge of the chair and rise slowly. -Do not operate a motor vehicle. -Take the medication at the same time daily.
-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.
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. -Smoking -Elevated high-density lipoprotein (HDL) cholesterol -Overweight/obesity -Age ≥65 in women Decreased low-density lipoprotein (LDL) levels
-Smoking -Overweight/obesity -Age ≥65 in women Major risk factors (in addition to hypertension) include smoking, dyslipidemia (high LDL, low high-density lipoprotein cholesterol), diabetes mellitus, impaired renal function, obesity, physical inactivity, age (younger than 45 years for men, 65 years and older for women), and family history of cardiovascular disease.
The nurse is caring for a client who is prescribed medication for the treatment of hypertension. The nurse recognizes that which medication conserves potassium? -Furosemide -Spironolactone -Chlorothiazide -Chlorthalidone
-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 employed in a physician's office and is caring for a client present for an annual exam. A blood pressure of 124/84 mm Hg is documented. Following revised guidelines for identifying hypertension, which educational pamphlet is help? -Increasing fluids for low blood pressure -Stress reduction to lower prehypertensive state -Use of beta-blockers for treatment of hypertension -Diagnostic testing for determining cardiac functioning
-Stress reduction to lower prehypertensive state A blood pressure of 124/84 mm Hg is now considered to be in the lower range of prehypertension. Knowledge of stress reduction may be helpful in lowering the blood pressure without medication therapy. A blood pressure of 124/84 mm Hg is not considered a low blood pressure or in need of medication therapy due to hypertension. Diagnostic testing for cardiac functioning is not typical for a client with prehypertension.
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? -Peripheral edema -Right-sided heart failure -Stroke -Pulmonary insufficiency
-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.
During the physical assessment of a client with hypertension, what would you expect to be the most obvious finding? -Sustained increase of either one or both systolic or diastolic measurements. -Hypotension in either one or both systolic or diastolic measurements. -Client is underweight. -Client is anemic.
-Sustained increase of either one or both systolic or diastolic measurements. The most obvious finding during a physical assessment is a sustained elevation of one or both blood pressure measurements. A client being overweight might depict having hypertension. An anemic client does not display any traits of having hypertension.
The nurse is caring for a client with hypertension. The nurse is correct to realize that a 24-hour urine is ordered to determine if the cause of hypertension is related to the dysfunction of which of the following? -The thyroid gland -The adrenal gland -The pituitary gland -The thymus
-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 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 (hypertensive emergency), a life-threatening disorder, the physician initiates emergency intervention. What is the most common cause of malignant hypertension (hypertensive emergency)? -Pyelonephritis -Dissecting aortic aneurysm -Pheochromocytoma -Untreated hypertension
-Untreated hypertension Untreated hypertension is the most common cause of malignant hypertension (hypertensive emergency). 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).
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 (hypertensive emergency), a life-threatening disorder, the physician initiates emergency intervention. What is the most common cause of malignant hypertension (hypertensive emergency)? -Pyelonephritis -Dissecting aortic aneurysm -Pheochromocytoma -Untreated hypertension
-Untreated hypertensionUntreated hypertension is the most common cause of malignant hypertension (hypertensive emergency). 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).
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. -Using a BP cuff that is too large will give a higher BP measurement. -The client's BP should be measured 1 hour before consuming alcohol. -The client should sit quietly while BP is being measured.
-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.
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. -check the client's serum K+ level. -check the client's urine output. -weigh the client.
-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.
Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress -increases the production of neurotransmitters that constrict peripheral arterioles. -increases the resistance that the heart must overcome to eject blood. -increases blood volume and improves the potential for greater cardiac output. -decreases the production of neurotransmitters that constrict peripheral arterioles.
-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.
It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine -increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. -decreases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. -increases the heart rate, constricts arterioles, and increases the heart's ability to eject blood. -decreases circulating blood volume.
-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.
Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through: -ophthalmic examination. -using a sphygmomanometer. -laboratory tests. -an MRI.
-ophthalmic examination. Papilledema is an edema of the optic nerves, and thus needs an ophthalmic examination for detection.
A systolic blood pressure of 135 mm Hg would be classified as -normal. -prehypertension. -stage 1 hypertension. -stage 2 hypertension.
-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.
The nurse is caring for a patient with systolic blood pressure of 135 mm Hg. This finding would be classified as -normal. -prehypertension. -stage 1 hypertension. -stage 2 hypertension.
-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.
It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position -help reduce the blood pressure to resupply oxygen to the brain. -help reduce the work required by the heart to resupply oxygen to the brain. -provide time for the heart to increase the rate of contraction to resupply oxygen to the brain. -provide time for the heart to reduce the rate of contraction to resupply oxygen to the brain.
-provide time for the heart to increase the rate of contraction to resupply oxygen to the brain. 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 its rate of contraction to resupply oxygen to the brain, not blood pressure or heart rate.
It is important for the nurse to encourage the cltient diagnosed with hypertension to rise slowly from a sitting or lying position because gradual changes in position -help reduce the blood pressure to resupply oxygen to the brain. -help reduce the work required by the heart to resupply oxygen to the brain. -provide time for the heart to increase the rate of contraction to resupply oxygen to the brain. -provide time for the heart to reduce the rate of contraction to resupply oxygen to the brain.
-provide time for the heart to increase the rate of contraction to resupply oxygen to the brain. 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 its rate of contraction to resupply oxygen to the brain, not blood pressure or heart rate.
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: -diastolic BP is between 70 and 79 mm Hg. -diastolic BP is 100 mm Hg. -systolic BP is between 120 and 139 mm Hg. -systolic BP is above 180 mm Hg.
-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.
