PrepU Hypertension Chapter 31 Questions
A client with high blood pressure is receiving an antihypertensive drug. The nurse knows that antihypertensive drugs commonly cause fatigue and dizziness, especially on rising. When developing a client teaching plan to minimize orthostatic hypotension, which instruction should the nurse include?
"Flex your calf muscles, avoid alcohol, and change positions slowly." Explanation: 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.
Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension?
"Limiting my salt intake to 2 grams per day will improve my blood pressure." Explanation: To lower blood pressure, a client should limit daily salt intake to 2 g or less. Alcohol intake is associated with a higher incidence of hypertension, poor compliance with treatment, and refractory hypertension. Chronic, moderate caffeine intake and fat intake don't affect blood pressure
A nurse is educating a client about monitoring blood pressure readings at home. Which of the following will the nurse be sure to emphasize?
"Sit quietly for 5 minutes prior to taking blood pressure." Explanation: 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.
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?
130/80 mm Hg Explanation: For individuals with diabetes or chronic kidney disease, JNC 7 specifies a target pressure of less than 130/80 mm Hg.
Officially, hypertension is diagnosed when the patient demonstrates a systolic blood pressure greater than ______ mm Hg and a diastolic blood pressure greater than _____ mm Hg over a sustained period.
140, 90
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 Explanation: 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.
According to the DASH diet, how many servings of vegetables should a person consume per day?
4 or 5
The nurse is assessing the blood pressure for a patient who has hypertension and the nurse does not hear an auscultatory gap. What outcome may be documented in this circumstance?
A high diastolic or low systolic reading Explanation: An auscultatory gap is when the Korotkoff sounds disappear for a brief period as the cuff is being deflated. Failure to notice an auscultatory gap can result in erroneously high diastolic or low systolic pressure readings
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 Explanation: 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 treating hypertensive emergencies, the nurse identifies the most appropriate route of administration for antihypertensive agents as being which of the following?
Continuous IV Infusion Explanation: 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.
Hypertension is defined as "sustained elevations in systolic or diastolic blood pressures that exceed prehypertension levels." What are some of the consequences of hypertension that make it such a health menace in the United States?
Healthcare professionals have revised guidelines for identifying hypertension because hypertension places people at risk for heart disease, heart failure, stroke, and kidney disease.
Which of the following describes a situation in which the blood pressure is severely elevated and there is evidence of actual or probable target organ damage?
Hypertensive emergency Explanation: 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.
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?
Increased ability to exert diastolic pressure Explanation: 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 informs the nurse, "I can't adhere to the dietary sodium decrease that is required for the treatment of my hypertension." What can the nurse educate the client about regarding this statement?
It takes 2 to 3 months for the taste buds to adapt to changes in salt intake. Explanation: The program usually consists of restricting sodium and fat intake, increasing intake of fruits and vegetables, and implementing regular physical activity. Explaining that it takes 2 to 3 months for the taste buds to adapt to changes in salt intake may help the patient adjust to reduced salt intake.
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?
Potassium level Explanation: Amiloride (Midamor) is a potassium-sparing diuretic, meaning that it causes potassium retention. The nurse should monitor for hyperkalemia (elevated potassium level) if given with an ACE inhibitor (such as lisinopril) or angiotensin receptor blocker.
The nurse is instructing a client who is newly prescribed an antihypertensive medication. Which nursing instruction is emphasized to maintain client safety?
Sit on the edge of the chair and rise slowly. Explanation: 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?
Stage 1 Explanation: 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 nurse is seeing a client for the first time and has just checked the client's blood pressure. For what value would the nurse consider the client prehypertensive?
Systolic BP is between 120 and 130 mm Hg.
A patient is flying overseas for 1 week for business and packed antihypertensive medications in a suitcase. After arriving at the intended destination, the patient found that the luggage had been stolen. If the patient cannot take the medication, what condition becomes a concern?
Rebound hypertension Explanation: 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.
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.
• Smoking • Physical inactivity • Diabetes mellitus Explanation: Risk factors for cardiovascular problems in clients with hypertension include smoking, dyslipidemia, diabetes mellitus, impaired renal function, obesity, physical inactivity, age, and family history.
Which of the following findings indicates that hypertension is progressing to target organ damage?
Retinal blood vessel damage Explanation: 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. Normal BUN levels range from 7-20 mg/dL.
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 Explanation: During the physical examination, the nurse must also pay specific attention to the rate, rhythm, and character of the apical and peripheral pulses to detect the effects of hypertension on the heart and blood vessels.
A female client, aged 82 years, visits the clinic for a blood pressure (BP) check. Her hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about her blood pressure medicine?
A possible adverse effect of blood pressure medicine is dizziness when you stand. Explanation: A possible adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. Teaching should include tips for managing syncope and dizziness. You would not teach the client to take the medicine on an empty stomach.
You are doing the final checklist before sending home a 63-year-old female who has been newly diagnosed with hypertension. She is going to be starting her first antihypertensive medicine. What is one of the main things you should tell her and her husband to watch for?
Dizziness Explanation: A common adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. Therefore, you should both alert the patient and her husband to this possibility and provide them with some tips for managing dizziness.
Which of the following diagnostic tests may reveal an enlarged left ventricle?
Echocardiography Explanation: Echocardiography reveals an enlarged left ventricle. Fluorescein angiography reveals leaking retinal blood vessels, and a PET scan is used to reveal abnormalities in blood pressure. A CT scan reveals structural abnormalities.
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 Explanation: 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.
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?
Green pepper stuffed with diced tomatoes and chicken. Explanation: 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 would be inconsistent as a component of metabolic syndrome?
Hypotension Explanation: Diabetes, obesity, dyslipidemia, hypertension, and elevated triglycerides are components of metabolic syndrome. Hypotension is not a component of metabolic syndrome.
A systolic blood pressure of 135 mm Hg would be classified as which of the following?
Prehypertension
When measuring the blood pressure in each of the patient's arms, the nurse recognizes that in the healthy adult, which of the following is true?
Pressures should not differ more than 5 mm Hg between arms. Explanation: Normally, in the absence of disease of the vasculature, there is a difference of no more than 5 mm Hg between arm pressures. The pressures in each arm do not have to be equal in order to be considered normal. Pressures that vary more than 10 mm Hg between arms indicate an abnormal finding. The left arm pressure is not anticipated to be higher than the right as a normal anatomic variant.
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. Correct Explanation: A hypertensive emergency is a situation in which blood pressures are extremely elevated and must be lowered immediately (not necessarily to less than 140/90 mm Hg) to halt or prevent damage to the target organs. 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.
A client, newly admitted to the nursing unit, has a primary diagnosis of renal failure. When assessing the client, the nurse notes a blood pressure (BP) of 180/100. The nurse knows that this is what kind of hypertension?
Secondary Explanation: 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.
Hypertension that can be attributed to an underlying cause is termed which of the following?
Secondary Explanation: 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).
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?
Stress reduction to lower prehypertensive state Explanation: 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 nurse is caring for a client with hypertension. The nurse is correct to realize that a 24-hour urine is ordered to determine if the cause of hypertension is related to the dysfunction of which of the following?
The adrenal gland Explanation: The 24-hour urine collection specimen is ordered to determine dysfunction of the adrenal gland. The 24-hour urine detects elevated catecholamines. The other options are not evaluated by a 24-hour urine.
