Sherpath - ChAPTER 36 - Primary Hypertension and Hypertensive Crisis Care

Which information would the nurse include when teaching nursing students how to measure blood pressure in older patients? "Eating does not affect an elderly patient's BP." "Older adults are less likely to have white coat syndrome." "Assess for orthostatic hypotension." "Hypertensive drugs should be started at high doses and titrated down."

"Assess for orthostatic hypotension."Elderly patients are at risk for orthostatic hypotension due to impaired baroreceptor reflexes.

Which statement would the nurse include when teaching a patient newly diagnosed with hypertension about the recommended diagnostic studies? Select all that apply. One, some, or all responses may be correct.

"Blood urea nitrogen (BUN) and serum creatinine levels are drawn to provide information about renal function." "Lipid profile is used to provide information about risk factors related to atherosclerosis and cardiovascular disease."

Which instruction would the nurse include when teaching an older patient with hypertension about developing an exercise program?"Perform balance exercises daily." "Perform flexibility exercises twice each day." "Perform muscle-strengthening activities twice a week." "Perform high-intensity activity for 30 minutes on most days."

"Perform muscle-strengthening activities twice a week." All adults should perform muscle-strengthening activities using the major muscles of the body at least twice a week.

Which information would the nurse include in the teaching for a patient who has been newly prescribed lisinopril for management of hypertension? "Never take this medication on an empty stomach." "You should not take this medication if you have asthma." "Discontinue this medication if you develop a drop in your blood pressure." "You may develop a dry cough while taking this medication."

"You may develop a dry cough while taking this medication." Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. A common side effect is a dry cough.

The nurse would advise a patient to measure and record their blood pressure at home for which length of time before initiating a dosage or medication change? 1 week 1 month 3 months 2 weeks

1 week Patients should take BP readings for 1 week for any changes in dosage or when starting a new drug. They should bring the log to their providers office.

For which adverse effect is the patient at risk if they have chronic obstructive pulmonary disease (COPD), angina, and hypertension and just started taking Atenolol 100 mg PO? Hypocapnia Tachycardia Bronchospasm Nausea and vomiting

BronchospasmAtenolol is a cardioselective β1-adrenergic blocker that reduces blood pressure and could affect the β2-receptors in the lungs with larger doses or with drug accumulation. Although the risk of bronchospasm is less with cardioselective β-blockers than nonselective β-blockers, atenolol should be used cautiously in patients with COPD.

Which class of medications used to treat hypertension work by increasing sodium excretion and cause arteriolar vasodilation by preventing the movement of calcium into cells? Adrenergic-inhibiting agents Angiotensin-converting enzyme (ACE) inhibitors Calcium channel blockers (CCB) Diuretics

Calcium channel blockers (CCB) CCB increase sodium excretion and cause arteriolar vasodilation by preventing movement of calcium into the cells.

Which diet is recommended to help patients decrease their blood pressure?DASHKetoAtkinsPaleo

DASH The Dietary Approaches to Stop Hypertension (DASH) is recommended for patients to help them decrease their BP. It focuses on eliminating foods that are high in saturated fats.

Which condition can be caused by target organ damage related to a hypertensive crisis? Select all that apply. One, some, or all responses may be correct. Encephalopathy Heart failure (HF) Myocardial infarction (MI) Renal failure Dissecting aortic aneurysm Cataracts

Encephalopathy Encephalopathy can be caused by target organ damage related to hypertensive crisis. This can cause changes in brain structure or function. Heart failure (HF) Hypertensive crisis can cause organ damage to the heart, resulting in HF. Myocardial infarction (MI) MI can result from the target organ damage related to hypertensive crisis. Renal failure Hypertensive crisis can cause damage to the kidneys, resulting in renal failure. Dissecting aortic aneurysm A dissecting aortic aneurysm is a tear in the aorta of the heart. This is a life-threatening emergency that can be caused by target organ damage from a hypertensive crisis.

Which condition would the nurse suspect in a patient with a systolic BP greater than 180 mm Hg? Hypertensive crisis Hypertensive urgency Resistant hypertension Secondary hypertension

Hypertensive crisisA hypertensive crisis occurs when a patient's systolic BP is greater than 180 mm Hg and/or their diastolic BP is greater than 120 mm Hg.

The goal in treatment of a hypertensive crisis is to decrease the mean arterial pressure (MAP) by no more than %. Record your answer as a range.

20-25When a patient is undergoing treatment for a hypertensive crisis, the goal is to decrease the map by no more than 20-25% or to decrease the map to 110 to 115 mm Hg. A rapid decrease in BP can cause decreased perfusion or other complications.

Which patient would the nurse assess first? A patient with a BP of 110/70 who reports a pain level of 2 on a 1-to-10 scale A patient who reports a severe headache and has begun vomiting A patient who reports dizziness with a BP of 150/92 mm Hg A patient who received an angiotensin-converting enzyme (ACE) inhibitor 30 minutes previously and reports fatigue

A patient who reports a severe headache and has begun vomiting Severe headache and vomiting are signs of a hypertensive crisis, which is an emergency situation. The nurse must assess this patient first.

Which factor is a cause of psuedoresistant hypertension? Select all that apply. One, some, or all responses may be correct. Improper BP measurements Inadequate drug doses Inappropriate drug therapy Poor adherence to drug regimen White coat syndrome

All are correct

Which diagnostic test does the nurse anticipate the provider will order for the patient who comes to the medical clinic with a BP of 150/99, but has a BP 120/80 when he takes it at home? Ambulatory BP monitoring Periodic BP monitoring Stress test 24-hour urine clearance

Ambulatory BP monitoringSome patients have high BP readings in a clinical setting and normal readings when BP is measured elsewhere. This phenomenon is referred to as "white coat" hypertension. Ambulatory BP monitoring (ABPM) is one method for diagnosing white coat hypertension.

Which parameter would the nurse evaluate to indicate the effectiveness of drug therapy in a patient admitted with a history of hypertension who has been taking hydrochlorothiazide daily for the past 10 years? BP of 118/76 mm Hg Weight loss of 2 lb Absence of ankle edema Urine output of 600ml per 8 hours

BP of 118/76 mm Hg Because the patient has been taking this medication for 10 years, the most direct measurement of its long-term intended effect would be normal BP.

Which finding in the patient's history is the cause of resistant hypertension? Increasing obesity Excess pepper intake Use of erectile dysfunction (ED) medication Consumption of peppermints

Increasing obesity An increase in obesity is one of the causes of resistant hypertension.

Which precaution would the nurse take while administering the prescribed IV labetalol? Monitoring for tachycardia Maintaining seizure precautions Keeping the patient supine Taking BP every 5 minutes

Keeping the patient supine The patient is experiencing a hypertensive crisis. Labetalol is an α- and β-adrenergic blocker and reduces BP by causing vasodilation and a decrease in heart rate. Patients must be kept supine during IV administration because of the severe orthostatic hypotension that occurs with the medication.

Which data collected just before administration indicates the nurse should consult the prescribing provider before administering a dose of metoprolol tartrate? O2 saturation 93% Pulse 48 beats/min Respirations 24 breaths/min Blood pressure 118/74 mm Hg

Pulse 48 beats/min Because metoprolol is a β1-adrenergic blocking agent, it can cause hypotension and bradycardia as adverse effects. The nurse should withhold the dose and consult with the health care provider for parameters regarding pulse rate limits.

Place the steps for measuring blood pressure in the order they would be performed.

Seat patient with legs uncrossed, feet on the floor, and back supported.Begin measurement after the patient has rested quietly for 5 minutes.For auscultatory measurement, estimate systolic BP (SBP) by palpating the radial pulse and inflating the cuff until the pulse disappears. Inflate the cuff 20-30 mm Hg above this level.Deflate the cuff at a rate of 2-3 mm Hg/sec.Record the SBP and DBP. Note the SBP when the first of 2 or more Korotkoff sounds are heard and the diastolic BP (DBP) when sound disappears.

The nurse would instruct the patient to reduce their intake of which dietary substance as part of the teaching plan for hypertension?Sodium Protein Potassium Calcium

Sodium Reducing sodium in the patient's diet can help control or prevent hypertension.

Which medication is the most effective IV drug to treat hypertensive emergencies? Labetalol Sodium nitroprusside Esmolol Cleviprex

Sodium nitroprusside Sodium nitroprusside is a vasodilator. It is the most effective IV drug to treat hypertensive emergencies.

For which reason would the nurse monitor thiocyanate levels in a patient treated with sodium nitroprusside for three days following a hypertensive crisis? The medication has a long half-life. An increased level indicates interactions with other drugs the patient is taking. The medication is metabolized to cyanide and then thiocyanate. An increased level indicates target organ damage.

The medication is metabolized to cyanide and then thiocyanate.Sodium nitroprusside causes arterial vasodilation and reduces systemic vascular resistance. This, in turn, decreases the BP. Sodium nitroprusside is metabolized to cyanide and then to thiocyanate, which can reach lethal levels. Therefore, thiocyanate levels should be monitored in patients receiving the drug for more than three days or at doses greater than or equal to 4 mcg/kg/min.

Which clinical manifestation would the nurse monitor for in a patient taking clonidine for 10 years and who reports to the nurse, "I decided to quit taking the medication a few days ago"? Lethargy Dysphasia Bradycardia Tremors

Tremors Sudden discontinuation of clonidine may cause withdrawal syndrome, including rebound hypertension, tachycardia, headache, tremors, apprehension, and sweating.

Which action would the nurse take first when a patient with hypertension reports taking antihypertensive medications every other day? Verify the patient's prescription Assess the patient's blood pressure Document the patient's information Administer a dose of the medication

Verify the patient's prescriptionMost antihypertensives are taken daily. The nurse should verify the patient's prescription and ensure it is prescribed to be taken every other day.