Ch. 31 Assessment and Management of Patients with Hypertension
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 hypotension and resulting injury b) Postural hypertension and resulting injury c) Rebound hypertension d) Sexual dysfunction
A
A 77-year-old client has newly diagnosed stage 2 hypertension. The physician has prescribed the client a thiazide and an angio-converting enzyme inhibitor. The nurse is concerned about postural hypotension. Which of the following will the nurse be sure to include in education for this client? a) Change positions (lying or sitting to standing) slowly. b) Check blood pressure every day for signs of rebound hypertension. c) Eat plenty of salty food to prevent hypotension. d) Do not become dependent on canes, walkers, or handrails.
A
A nurse is teaching an adult female patient about the risk factors for hypertension. What should the nurse explain as risk factors for primary hypertension? A)Obesity and high intake of sodium and saturated fat B)Diabetes and use of oral contraceptives C)Metabolic syndrome and smoking D)Renal disease and coarctation of the aorta
A
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 symptoms." b) "Hypertension often causes no pain." c) "Hypertension often kills early in the disease process." d) "Hypertension is difficult to diagnose."
A
A patient has been prescribed antihypertensives. After assessment and analysis, the nurse has identified a nursing diagnosis of risk for ineffective health maintenance related to nonadherence to therapeutic regimen. When planning this patient's care, what desired outcome should the nurse identify? A)Patient takes medication as prescribed and reports any adverse effects. B)Patient's BP remains consistently below 140/90 mm Hg. C)Patient denies signs and symptoms of hypertensive urgency. D)Patient is able to describe modifiable risk factors for hypertension.
A
A patient has come to the clinic for a follow-up assessment that will include a BP reading. To ensure an accurate reading, the nurse should confirm that the patient has done which of the following? A)Tried to rest quietly for 5 minutes before the reading is taken B)Refrained from smoking for at least 8 hours C)Drunk adequate fluids during the day prior D)Avoided drinking coffee for 12 hours before the visit
A
A patient with primary hypertension comes to the clinic complaining of a gradual onset of blurry vision and decreased visual acuity over the past several weeks. The nurse is aware that these symptoms could be indicative of what? A)Retinal blood vessel damage B)Glaucoma C)Cranial nerve damage D)Hypertensive emergency
A
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 systolic pressure below 140 mmHg b) Reducing her systolic pressure below 130 mmHg c) Reducing her diastolic pressure below 80 mmHg d) Reducing her diastolic pressure below 90 mmHg
A
The nurse is caring for a client with essential hypertension. The nurse reviews labwork and assesses kidney function. Which action of the kidney would the nurse evaluate as the body's attempt to regulate high blood pressure? a) The kidney excretes sodium and water. b) The kidney retains sodium and excretes water. c) The kidney retains sodium and water. d) The kidney retains water and excretes sodium.
A
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 adrenal gland b) The thymus c) The thyroid gland d) The pituitary gland
A
The nurse is developing a nursing care plan for a patient who is being treated for hypertension. What is a measurable patient outcome that the nurse should include? A)Patient will reduce Na+ intake to no more than 2.4 g daily. B)Patient will have a stable BUN and serum creatinine levels. C)Patient will abstain from fat intake and reduce calorie intake. D)Patient will maintain a normal body weight.
A
The nurse is developing a teaching plan for a patient diagnosed with hypertension. It would be important to emphasize which of the following as part of the plan of care? a) Limiting sodium intake in the diet b) Limiting cigarette smoking to 1 pack a week c) Limiting activity to prevent over exertion d) Limiting alcohol to a can of beer to four times a day to thin the blood
A
The nurse is teaching a patient diagnosed with hypertension about the DASH diet. How many servings of meat, fish, and poultry should a patient consume per day? a) 2 or fewer b) 7 or 8 c) 4 or 5 d) 2 or 3
A
The nurse understands that patient education related to antihypertensive medication should include all of the following instructions EXCEPT which of the following? a) If a dosage of medication is missed, double up on the next one to catch up. b) Avoid over the counter (OTC) cold, weight reduction, and sinus medications. c) Avoid hot baths, exercise, and alcohol within 3 hours of taking vasodilators. d) Do not stop antihypertensive medication abruptly.
A
Why is it important for the nurse to implement measures to relieve emotional stress for patients with hypertension? a) The reduction of stress decreases the production of neurotransmitters that constrict peripheral arterioles. b) The reduction of stress increases the blood volume and improves the potential for greater cardiac output. c) The reduction of stress increases the resistance that the heart must overcome to eject blood. d) The reduction of stress increases the production of neurotransmitters that constrict peripheral arterioles.
A
You're seeing a patient in a low-income clinic for the first time and have just checked her BP. You're entering her as prehypertensive because: a) Her diastolic blood pressure is between 80 and 89 mm Hg. b) Her systolic BP is above 180 mm Hg. c) Her diastolic blood pressure is at 100 mm Hg. d) Her systolic BP is between 120 and 130 mm Hg.
A
A 59-year-old client has just received a diagnosis of hypertension from his cardiologist after the completion of diagnostics. After discussing the diagnosis and its consequences with the physician, the client asks you questions regarding his condition. What can the client do to decrease the consequences of his hypertension? Select all that apply. a) Manage stress effectively. b) Use smokeless tobacco. c) Lose weight. d) Get plenty of rest.
AC
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) Green pepper stuffed with diced tomatoes and chicken c) Creamed chipped beef over toast with mashed potatoes d) Toasted cheese sandwich on whole wheat toast with tomato soup
B
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) A possible adverse effect of blood pressure medicine is dizziness when you stand. c) There are no adverse effects from blood pressure medicine. d) A severe drop in blood pressure is possible.
B
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? a) Low-fat or fat-free dairy foods b) Grains and grain products c) Fruits d) Vegetables
B
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 low blood pressure. c) A cuff that is too large will give a false high blood pressure. d) A cuff that is too small will give a false high blood pressure.
B
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 2 with compelling indications b) Stage 1 c) Stage 1 with compelling indications d) Stage 2
B
A patient's medication regimen for the treatment of hypertension includes hydrochlorothiazide. Following administration of this medication, the nurse should anticipate what effect? A)Drowsiness or lethargy B)Increased urine output C)Decreased heart rate D)Mild agitation
B
As recommended follow-up for a person diagnosed with prehypertension initially, it's recommended the person gets his or her blood pressure rechecked within which timeframe? a) Confirm within 2 months b) 1 year c) Evaluate within 1 month d) 2 year
B
The hospital nurse cares for many patients who have hypertension. What nursing diagnosis is most common among patients who are being treated for this health problem? A)Deficient knowledge regarding the lifestyle modifications for management of hypertension B)Noncompliance with therapeutic regimen related to adverse effects of prescribed therapy C)Deficient knowledge regarding BP monitoring D)Noncompliance with treatment regimen related to medication costs
B
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) Hepatic function b) Renal disease c) Acid-based imbalance d) Calcium deficit
B
The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. Which of the following should the nurse integrate into the management of this client's hypertension? A)Ensure that the patient receives a larger initial dose of antihypertensive medication due to impaired absorption. B)Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion. C)Recognize that an older adult is less likely to adhere to his or her medication regimen than a younger patient. D)Carefully assess for weight loss because of impaired kidney function resulting from normal aging.
B
The nurse is providing care for a patient with a new diagnosis of hypertension. How can the nurse best promote the patient's adherence to the prescribed therapeutic regimen? A)Screen the patient for visual disturbances regularly. B)Have the patient participate in monitoring his or her own BP. C)Emphasize the dire health outcomes associated with inadequate BP control. D)Encourage the patient to lose weight and exercise regularly.
B
The nursing lab instructor is teaching student nurses how to take blood pressure. To ensure accurate measurement, the lab instructor would teach the students to AVOID which of the following actions? A)Measuring the BP after the patient has been seated quietly for more than 5 minutes B)Taking the BP at least 10 minutes after nicotine or coffee ingestion C)Using a cuff with a bladder that encircles at least 80% of the limb D)Using a bare forearm supported at heart level on a firm surface
B
When teaching a patient about hypertension and lifestyle changes the nurse emphasizes that which of the following should be included in the diet? a) Chloride-containing foods b) Fresh fruits and vegetables c) Whole milk and cheeses d) A glass of red wine
B
Which of the following nursing diagnosis is the nurse most correct to choose when caring for a client with long-standing hypertension? a) Impaired Gas Exchange b) Ineffective Tissue Perfusion c) Risk for Decreased Cardiac Output d) Activity Intolerance
B
Which of the following terms is given to hypertension in which blood pressure that is controlled with therapy becomes uncontrolled (abnormally high) with the discontinuation of therapy? a) Primary b) Rebound c) Essential d) Secondary
B
Choose the statements that correctly match the hypertensive medication with its side effect. Select all that apply. a) Beta-blockers may cause sedation. b) With thiazide diuretics, monitor serum potassium levels. c) Direct vasodilators may cause headache and tachycardia. d) With ACE inhibitors, assess for bradycardia. e) With adrenergic inhibitors, cough is a common side effect.
BC
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) Stroke c) Myocardial infarction d) Coronary artery disease e) Tension pneumothorax
BCD
The nurse is reviewing the medication administration record of a patient who takes a variety of medications for the treatment of hypertension. What potential therapeutic benefits of antihypertensives should the nurse identify? Select all that apply. A)Increased venous return B)Decreased peripheral resistance C)Decreased blood volume D)Decreased strength and rate of myocardial contractions E)Decreased blood viscosity
BCD
The nurse will relay that risk factors and cardiovascular problems related to hypertension include which of the following? Select all that apply. a) Decreased low-density lipoprotein (LDL) levels. b) Obesity (BMI ≥ 30 kg/m2) c) Smoking d) Age ≥55 in men e) Elevated high-density lipoprotein (HDL) cholesterol
BCD
A nurse providing education about hypertension to a community group is reviewing consequences of the disease. Which of the following would the nurse identify as target organs for hypertensive damage? Choose all that apply. a) Stomach b) Kidneys c) Brain d) Eyes e) Heart
BCDE
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) The patient's arm should be positioned at the level of the heart. c) The patient's BP should be taken 1 hour after the consumption of alcohol. d) Using a BP cuff that is too small will give a higher BP measurement. e) Ask the patient to sit quietly while the BP is being measured.
BDE
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
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 telemetry strip shows a peaked, narrow T-wave, which is a change. What electrolye imbalance does the nurse suspect? a) Hyponatremia b) Hypernatremia c) Hyperkalemia d) Hypokalemia
C
A group of student nurses are practicing taking blood pressure. A 56-year-old male student has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, he exclaims, "My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it?" Which of the following responses by the nursing instructor would be best? A)"Yes. Hypertension is prevalent among men; it is fortunate we caught this during your routine examination." B)"We will need to reevaluate your blood pressure because your age places you at high risk for hypertension." C)"A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made." D) "You have no need to worry. Your pressure is probably elevated because you are being tested."
C
A newly diagnosed patient with hypertension is prescribed Diuril, a thiazide diuretic. What patient education should the nurse provide to this patient? A)Eat a banana every day because Diuril causes moderate hyperkalemia. B)Take over-the-counter potassium pills because Diuril causes your kidneys to lose potassium. C)Diuril can cause low blood pressure and dizziness, especially when you get up suddenly. D)Diuril increases sodium levels in your blood, so cut down on your salt.
C
A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective assessment data from a patient with hypertension, the nurse learns that the patient has a family history of hypertension and she herself has high cholesterol and lipid levels. The patient says she smokes one pack of cigarettes daily and drinks about a pack of beer every day. The nurse notes what nonmodifiable risk factor for hypertension? A)Hyperlipidemia B)Excessive alcohol intake C)A family history of hypertension D)Closer adherence to medical regimen
C
A nurse is teaching a 38-year-old man with newly diagnosed hypertension who asks if there is any harm in stopping his antihypertensive medication if he decides to discontinue it. The correct reply addresses the consequence of stopping antihypertensive medications abruptly. Which of the following statements from the nurse would be appropriate? a) "Rebound hypotension can occur." b) "Postural hypertension can occur." c) "Rebound hypertension can occur." d) "Postural hypotension can occur."
C
A patient in a hypertensive emergency is admitted to the ICU. The nurse anticipates that the patient will be treated with IV vasodilators, and that the primary goal of treatment is what? A)Lower the BP to reduce onset of neurologic symptoms, such as headache and vision changes. B)Decrease the BP to a normal level based on the patient's age. C)Decrease the mean arterial pressure between 20% and 25% in the first hour of treatment. D)Reduce the BP to £ 120/75 mm Hg as quickly as possible.
C
A student nurse is taking care of an elderly patient with hypertension during a clinical experience. The instructor asks the student about the relationships between BP and age. What would be the best answer by the student? A)Because of reduced smooth muscle tone in blood vessels, blood pressure tends to go down with age, not up. B)Decreases in the strength of arteries and the presence of venous insufficiency cause hypertension in the elderly. C)Structural and functional changes in the cardiovascular system that occur with age contribute to increases in blood pressure. D)The neurologic system of older adults is less efficient at monitoring and regulating blood pressure.
C
A systolic blood pressure of 135 mm Hg would be classified as which of the following? a) Stage 2 hypertension b) Stage 1 hypertension c) Prehypertension d) Normal
C
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) No intervention, just observation c) Nonpharmacological interventions d) Pharmacological interventions
C
An older adult is newly diagnosed with primary hypertension and has just been started on a beta-blocker. The nurse's health education should include which of the following? A)Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the beta-blocker B)Maintaining a diet high in dairy to increase protein necessary to prevent organ damage C)Use of strategies to prevent falls stemming from postural hypotension D)Limiting exercise to avoid injury that can be caused by increased intracranial pressure
C
It is appropriate for the nurse to recommend smoking cessation for patients 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 reduces the heart's ability to eject blood. d) increases the heart rate, constricts arterioles, and increases the heart's ability to eject blood.
C
Primary or essential hypertension accounts for about 95% of all hypertension diagnoses—with an unknown etiology. Secondary hypertension accompanies specific conditions that create hypertension as a result of tissue damage. Which of the following conditions contribute to secondary hypertension? a) Calcium deficit b) Hepatic function c) Arterial vasoconstriction d) Acid-base imbalance
C
The best way to detect PAPILLEDEMA is through: a) An MRI b) Laboratory tests c) Ophthalmic examination d) Using a sphygmomanometer
C
The critical care nurse is caring for a patient just admitted in a hypertensive emergency. The nurse should anticipate the administration of what medication? A)Warfarin (Coumadin) B)Furosemide (Lasix) C)Sodium nitroprusside (Nitropress) D)Ramipril (Altace)
C
The nurse is assessing a patient new to the clinic. Records brought to the clinic with the patient show the patient has hypertension and that her current BP readings approximate the readings from when she was first diagnosed. What contributing factor should the nurse first explore in an effort to identify the cause of the client's inadequate BP control? A)Progressive target organ damage B)Possibility of medication interactions C)Lack of adherence to prescribed drug therapy D)Possible heavy alcohol use or use of recreational drugs
C
The nurse is caring for a patient prescribed loop diuretic Bumex (bumetanide) for the treatment of stage 2 hypertension. Which of the following indicates the patient is experiencing an adverse effect of the medication? a) Urine output of 90 cc/mL 1 hour after medication administration b) Blood glucose value of 160 mg/dL c) Serum potassium value of 3.0 mEq/L d) Electrocardiogram (EGG) tracing demonstrating peaked T waves
C
The nurse is collaborating with the dietitian and a patient with hypertension to plan dietary modifications. These modifications should include which of the following? A)Reduced intake of protein and carbohydrates B) Increased intake of calcium and vitamin D C)Reduced intake of fat and sodium D)Increased intake of potassium, vitamin B12 and vitamin D
C
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? a) Use of beta-blockers for treatment of hypertension b) Diagnostic testing for determining cardiac functioning c) Stress reduction to lower prehypertensive state d) Increasing fluids for low blood pressure
C
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) Calcium channel blocker b) Loop diuretic c) ACE inhibitor d) Beta-blocker
C
The nurse is obtaining a healthy history from a client with blood pressure of 146/88 mm Hg. The client states that lifestyle changes have not been effective in lowering the blood pressure. Which medication classification does the nurse anticipate first? a) Beta-blocker b) ACE inhibitors c) Thiazide diuretic d) Calcium channel blocker
C
The nurse is providing care for a patient with a diagnosis of hypertension. The nurse should consequently assess the patient for signs and symptoms of which other health problem? A)Migraines B)Atrial-septal defect C)Atherosclerosis D)Thrombocytopenia
C
The nurse understands that an overall goal of hypertension management includes which of the following? a) The patient maintains a normal blood pressure reading. b) There are no complaints of sexual dysfunction. c) There is no indication of target organ damage. d) There is no complaint of postural hypotension.
C
Which ethnic background would the nurse screen for hypertension at an early age? a) Mexican population b) Japanese population c) African American population d) Asian population
C
Which of the following conditions contributes to secondary hypertension? a) Acid-based imbalance b) Calcium deficit c) Arterial vasoconstriction d) Hepatic function
C
Which of the following diagnostic tests may reveal an enlarged left ventricle? a) Fluorescein angiography b) Positron emission tomography (PET) scan c) Echocardiography d) Computed tomographic scan
C
Which of the following findings indicates that hypertension is progressing to target organ damage? a) Blood urea nitrogen (BUN) level of 12 mg/dL b) Chest x-ray showing pneumonia c) Retinal blood vessel damage d) Urine output of 60 cc/mL over 2 hours
C
Which of the following is the nurse most correct to recognize as a direct effect of client hypertension? a) Hyperglycemia resulting from insulin receptor resistance b) Emphysema related to poor gas exchange c) Renal dysfunction resulting from atherosclerosis d) Anemia resulting from bone marrow suppression
C
A 55-year-old patient comes to the clinic for a routine check-up. The patient's BP is 159/100 mm Hg and the physician diagnoses hypertension after referring to previous readings. The patient asks why it is important to treat hypertension. What would be the nurse's best response? A)Hypertension can cause you to develop dangerous blood clots in your legs that can migrate to your lungs. B)Hypertension puts you at increased risk of type 1 diabetes and cancer in your age group. C)Hypertension is the leading cause of death in people your age. D)Hypertension greatly increases your risk of stroke and heart disease.
D
A 77-year-old woman presents to the local community center for a blood pressure screening. The women's blood pressure is recorded as 180/90 mm Hg. The woman has a history of hypertension, but she currently is not taking her medications. Which of the following questions is most appropriate for the nurse to ask the patient first? a) "Are you having trouble paying for your medication?" b) "What medications are you prescribed?" c) "Are you able to get to your pharmacy to pick up your medications?" d) "Why is it that you are not taking your medications?"
D
A community health nurse teaching a group of adults about preventing and treating hypertension. The nurse should encourage these participants to collaborate with their primary care providers and regularly monitor which of the following? A)Heart rate B)Sodium levels C)Potassium levels D)Blood lipid levels
D
A nurse is discussing with students how to accurately measure blood pressures. Which of the following information is the nurse certain to emphasize? a) Position the client's forearm above the level of the heart. b) Center the cuff bladder directly over the radial artery. c) The size of the cuff does not matter as long as it fits snugly around the arm. d) Routinely calibrate the sphygmomanometer.
D
A patient in hypertensive emergency is being cared for in the ICU. The patient has become hypovolemic secondary to natriuresis. What is the nurse's most appropriate action? A)Add sodium to the patient's IV fluid, as ordered. B)Administer a vasoconstrictor, as ordered. C)Promptly cease antihypertensive therapy. D)Administer normal saline IV, as ordered
D
A patient in hypertensive urgency is admitted to the hospital. The nurse should be aware of what goal of treatment for a patient in hypertensive urgency? A)Normalizing BP within 2 hours B)Obtaining a BP of less than 110/70 mm Hg within 36 hours C)Obtaining a BP of less than 120/80 mm Hg within 36 hours D)Normalizing BP within 24 to 48 hours
D
A patient with newly diagnosed hypertension has come to the clinic for a follow-up visit. The patient asks the nurse why she has to come in so often. What would be the nurse's best response? A)We do this so you don't suffer a stroke. B)We do this to determine how your blood pressure changes throughout the day. C)We do this to see how often you should change your medication dose. D)We do this to make sure your health is stable. We'll then monitor it at routinely scheduled intervals.
D
A patient's recently elevated BP has prompted the primary care provider to prescribe furosemide (Lasix). The nurse should closely monitor which of the following? A)The client's oxygen saturation level B)The patient's red blood cells, hematocrit, and hemoglobin C)The patient's level of consciousness D)The patient's potassium level
D
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 provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain. b) Gradual changes in position help reduce the blood pressure to resupply oxygen to the brain. c) Gradual changes in position help reduce the heart's work to resupply oxygen to the brain. d) Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain.
D
The home health nurse is caring for a patient who has a comorbidity of hypertension. What assessment question most directly addresses the possibility of worsening hypertension? A)Are you eating less salt in your diet? B)How is your energy level these days? C)Do you ever get chest pain when you exercise? D)Do you ever see spots in front of your eyes?
D
The nurse in an oncology clinic notes that the client being treated has hypertension. What tumor is a predisposing condition for secondary hypertension? a) Wilms' tumor b) Astrocytoma c) Lymphoma d) Pheochromocytoma
D
The nurse is caring for a female client who has had 25 mg of oral hydrochlorothiazide added to her medication regimen for the treatment of hypertension (HTN). Which of the following instructions should the nurse give the patient? a) "You may drink alcohol while taking this medication." b) "Take this medication before going to bed." c) "You may develop dry mouth or nasal congestion while on this medication." d) "Increase the amount of fruits and vegetables you eat."
D
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) Maintaining the BP at a significantly higher than normal level to prevent orthostatic hypotension. b) Reduction of the BP to 160/100 mm Hg within the half hour of treatment c) Reduction of the mean BP by up to 50% within the first hour of treatment d) Avoid lowering the blood pressure (BP) too quickly
D
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) Use a pillbox to store daily medication. c) Take the medication at the same time daily. d) Sit on the edge of the chair and rise slowly.
D
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) Fluorescein angiography c) Chest radiograph d) Multiple gated acquisition scan (MUGA)
D
The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in what way? A)The BP is always higher in a hypertensive emergency. B)Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies. C)Hypertensive urgency is treated with rest and benzodiazepines to lower BP. D)Hypertensive emergencies are associated with evidence of target organ damage
D
Which diagnostic is the recommended method of determining whether left ventricular hypertrophy has occurred? a) ECG b) Blood chemistry c) BUN d) Echocardiogram
D
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? a) Hypertensive urgency b) Secondary hypertension c) Primary hypertension d) Hypertensive emergency
D
Which of the following is true regarding the African American population and the development of hypertension? a) Higher incidence of nonfatal stroke b) Decreased rate of stage 2 hypertension c) Later onset of disease d) Greater rate of stage 2 hypertension
D
Which of the following would be inconsistent as a component of metabolic syndrome? a) Elevated triglyceride levels b) Abdominal obesity c) Hypertension d) Hypotension
D
Which of the following would be inconsistent with a hypertensive urgency? a) Severe headache b) Epistaxis c) Anxiety d) Intracranial hemorrhage
D
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? a) Tremor b) Persistent cough c) Blurred vision d) Dizziness
D
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 by 50% within the first hour of treatment. b) Reduce the blood pressure by 20% to 25% within the first hour of treatment. c) Rapidly reduce the blood pressure so the patient will not suffer a stroke. d) Reduce the blood pressure to about 140/80 mm Hg.
Reduce the blood pressure by 20% to 25% within the first hour of treatment.
A nurse is educating a client about monitoring blood pressure readings at home. Which of the following will the nurse be sure to emphasise? 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) "Avoid smoking cigarettes for 8 hours prior to taking blood pressure." d) "Sit with legs crossed when taking your blood pressure."
a) "Sit quietly for 5 minutes prior to taking blood pressure."
Management of hypertension includes three of the following four goals, depending on the primary and secondary causes. Select all that apply. a) Impairing the synthesis of norepinephrine. b) Modifying the rate of myocardial contraction. c) Decreasing renal absorption of sodium. d) Increasing the force of cardiac output to overcome peripheral resistance.
a) Impairing the synthesis of norepinephrine. b) Modifying the rate of myocardial contraction. c) Decreasing renal absorption of sodium.
The nurse teaches the patient which of the following guidelines regarding lifestyle modifications for hypertension? a) Maintain adequate dietary intake of potassium b) Stop alcohol intake c) Limit aerobic physical activity to 15 minutes, three times per week d) Reduce smoking to no more than four cigarettes per day
a) Maintain adequate dietary intake of potassium
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? a) Older adults have impaired cardiovascular reflexes. b) Older adults require large doses of these medications to control their blood pressure. c) Older adults have trouble remembering to measure their blood pressure at home. d) These medications often cause rebound hypertension.
a) Older adults have impaired cardiovascular reflexes.
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) Purchasing a self-monitoring BP cuff b) Advising a smoking cessation c) Discussing methods for stress reduction d) Administering glycemic control
a) Purchasing a self-monitoring BP cuff
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) Emphysema related to poor gas exchange c) Hyperglycemia resulting from insulin receptor resistance d) Anemia resulting from bone marrow suppression
a) Renal dysfunction resulting from atherosclerosis
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) Seven to eight whole grain products per day b) Seven to eight fruits per day c) Three to four regular dairy foods per day d) Four to five servings of meat, fish, or poultry per day
a) Seven to eight whole grain products per day
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) "Did you take any medication for your headache?" d) "Do you have a dry mouth or nasal congestion?"
b) "Have you taken your prescribed Catapres today?"
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. a) 120, 70 b) 140, 90 c) 130, 80 d) 110, 60
b) 140, 90
According to the DASH diet, how many servings of vegetables should a person consume per day? a) 7 or 8 b) 4 or 5 c) 2 or fewer d) 2 or 3
b) 4 or 5
When treating hypertensive emergencies, the nurse identifies the most appropriate route of administration for antihypertensive agents as being which of the following? a) Sublingual b) Continuous IV infusion c) Oral d) Intramuscular
b) Continuous IV infusion
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) Impaired renal function b) Dyslipidemia c) Age d) Family history
b) Dyslipidemia
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? 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 must be equal in both arms. d) Pressures may vary, with the higher pressure found in the left arm.
b) Pressures should not differ more than 5 mm Hg between arms.
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 stop smoking and increase physical activity to 30 minutes/day most days of the week b) To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less c) To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less 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
Which of the following are among the lifestyle changes that can help prevent and control hypertension? Choose all that apply. a) Increased intake of dietary sodium b) Weight reduction c) Increased physical activity d) Increased intake of dietary protein e) Substitution of low-fat for whole dairy products in diet
b) Weight reduction c) Increased physical activity e) Substitution of low-fat for whole dairy products in diet
When monitoring a patient who has HYPERTENSION & CHRONIC KIDNEY DISEASE, the target pressure for this individual should be less than which blood pressure reading? a) 120/70 mm Hg b) 110/60 mm Hg c) 130/80 mm Hg d) 140/90 mm Hg
c) 130/80 mm Hg
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) Limit alcohol consumption to no more that 3 drinks per day. b) Maintain a waist circumference of 45 (men) and 40 (women) inches or less. c) Engage in aerobic activity at least 30 minutes/day most days of the week. d) Maintain a body mass index between 30 and 35.
c) Engage in aerobic activity at least 30 minutes/day most days of the 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? a) Kidneys and autonomic nervous system b) Brain and sympathetic nervous system c) Heart and blood vessels d) Lung and arteries
c) Heart and blood vessels
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) The taste buds never adapt to decreased salt intake. b) A person with hypertension should never consume alcohol. c) It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. d) There is usually no need to change alcohol consumption for clients with hypertension.
c) It takes 2 to 3 months for the taste buds to adapt to decreased salt intake.
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) Parasympathetic nervous system b) Lungs c) Kidneys d) Limbic system
c) Kidneys
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 statements except: a) Engage in aerobic activity at least 30 minutes/day most days of the week. b) Maintain a waist circumference of 40 (men) and 35 (women) inches or less. c) Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women. d) Maintain a normal body mass index of about 24.
c) Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women.
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 1 hypertension b) Normal c) Prehypertension d) Stage 2 hypertension
c) Prehypertension
Target organ damage from untreated/undertreated hypertension includes which of the following? Select all that apply. a) Diabetes b) Hyperlipidemia c) Stroke d) Heart failure e) Retinal damage
c) Stroke d) Heart failure e) Retinal damage
What is the most common cause of malignant hypertension? a) Pheochromocytoma b) Dissecting aortic aneurysm c) Untreated hypertension d) Pyelonephritis
c) Untreated hypertension
modification that has been found to have the greatest effect in reducing blood pressure measurements. a) Sodium reduction b) Adopting the DASH approach to eating c) Weight reduction d) Physical activity
c) Weight reduction
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."
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? a) Cerebrovascular accident b) Cardiac failure c) Renal disease d) All options are correct.
d) All options are correct.
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) Being sure to keep follow-up appointments b) Walking as far as the client is able every day c) Eating extra potassium due to loss of potassium related to medications d) Changing positions slowly related to possible hypotension
d) Changing positions slowly related to possible hypotension
Thiazide diuretics are part of this treatment approach for most complications except for: a) Diabetes mellitus b) Heart failure c) Recurrent stroke prevention d) Chronic kidney disease
d) Chronic kidney disease
A patient arrives at the clinic for a follow-up visit for treatment of hypertension. The nurse obtains a blood pressure 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) Secondary hypertension b) Hypertensive emergency c) Primary hypertension d) Hypertensive urgency
d) Hypertensive urgency
A patient is admitted to the 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) Nausea and severe headache b) Chest pain score of 3/10 (on a scale of 1 to 10) c) Urine output of 40 cc/mL over the last hour d) Left arm numbness and weakness
d) Left arm numbness and weakness
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: a) Maintain a waist circumference of 40 (men) and 35 (women) inches or less. b) Engage in aerobic activity at least 30 minutes/day most days of the week. c) Maintain a normal body mass index of about 24. d) Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women.
d) Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women.
You are part of a group of nursing students who are making a presentation on chronic hypertension. What is one subject you would need to include in your presentation as a possible consequence of untreated chronic hypertension? a) Right-sided heart failure b) Pulmonary insufficiency c) Peripheral edema d) Stroke
d) Stroke
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) 45% b) 35% c) 40% d) Up to 25%
d) Up to 25%
