Ch. 31: Hypertension

What is the action of Thiazide diuretics?

1. Decrease of blood volume, renal blood flow, and cardiac output 2. Depletion of extracellular fluid 3. Negative sodium balance (from natriuresis), mild hypokalemia 4. Directly affect vascular smooth muscle

What is the plan to reduce BP in a hypertensive emergency?

1. Reduce blood pressure 25% in first hour. 2. Reduce to 160/100 over 6 hours. 3. Then gradual reduction to normal over a period of days

What is the ranges for systolic and diastolic for prehypertension?

120-139 or 80-89

What is the lower goal pressure for people with diabetes or chronic kidney disease?

130/80 mmHg

What are the ranges for systolic and diastolic for stage 1 hypertension?

140-159 or 90-99

What is the normal level that blood pressure should be maintained for patients with hypertension?

140/90 mmHg or lower

What is the goal for limiting alcohol to reduce the systolic BP?

2-4 mmHg

What is the goal for lowering sodium in the diet to reduce the systolic BP?

2-8 mmHg

What is the goal for physical activity to reduce the systolic BP?

4-9 mmHg

What is the goal of weight reduction for the systolic BP?

5-20 mmHg/10 kg

What is the goal for DASH diet to reduce the systolic BP?

8-14 mmHg

What is a normal blood pressure?

<120 and <80

Who has the highest prevalence for getting hypertension?

African Americans and Hispanics

What hormone helps regulate blood volume, BP and levels of Na+ and K+?

Aldosterone

What is a hypertensive emergency?

Blood pressure >180/120 mm Hg and must be lowered immediately to prevent damage to target organs

What is a hypertensive urgency?

Blood pressure is very high but no evidence of immediate or progressive target organ damage

Hypertension is a major contributor to death related to:

Cardiac, cerebrovascular, renal and peripheral vascular disease

What is a DASH eating plan?

Consume a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat

Major actions of Thiazide Diuretics

Decrease of blood volume, renal blood flow, and cardiac output Depletion of extracellular fluid Negative sodium balance (from natriuresis), mild hypokalemia Directly affect vascular smooth muscle

How can left ventricular hypertrophy be assessed?

Echocardiography

The nurse is preparing an education plan for a patient newly diagnosed with hypertension. What should be included in the education plan? a) Engage in regular aerobic physical activity such as brisk walking (at least 30 min/day most days of the week). b) Eliminate alcoholic beverages from the diet. c)Reduce sodium intake to no more than 200 mmol/day. d) Maintain a normal body weight with BMI between 18 and 30 kg/m2.

Engage in regular aerobic physical activity such as walking (at least 30 min/day most days of the week)

What are the medications used in a hypertensive urgency?

Fast-acting oral agents: beta-adrenergic blocker— labetalol; angiotensin-converting enzyme inhibitor— captopril; or alpha2-agonist—clonidine

What is the purpose for weight reduction?

Maintain normal body weight (body mass index 18.5-24.9 kg/m2)

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 production of neurotransmitters that constrict peripheral arterioles. c) The reduction of stress increases the blood volume and improves the potential for greater cardiac output. d) The reduction of stress increases the resistance that the heart must overcome to eject blood.

The reduction of stress decreases the production of neurotransmitters that constrict peripheral arterioles.

What is the first medication used to treat hypertension?

Thiazide diuretics

What are the laboratory tests done if target organ changes have occurred?

Urinalysis Blood Chemistry: analysis of sodium, potassium, creatinine, fasting glucose and total and HDL cholesterol levels ECG

A patient with hypertension has been able to maintain a blood pressure of 130/70 mm Hg for 1 year while reducing dietary sodium and taking hydrochlorothiazide (HCTZ) and atenolol (Tenormin). What treatment plan will the nurse educate the patient about? a) Gradual reducing the HCTZ and the atenolol and continuing to reduce sodium intake b) Continuing the medication and reducing dietary sodium c) Discontinuing the HCTZ and atenolol and continuing to reduce sodium intake d) Gradually reducing the atenolol and continuing the HCTZ

a) Gradual reducing the HCTZ and the atenolol and continuing to reduce sodium intake

Which of the following would be inconsistent with a hypertensive urgency? a) Intracranial hemorrhage b) Severe headache c) Anxiety d) Epistaxis

a) Intracranial hemorrhage

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) These medications often cause rebound hypertension. c) Older adults require large doses of these medications to control their blood pressure. d) Older adults have trouble remembering to measure their blood pressure at home.

a) Older adults have impaired cardiovascular reflexes.

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

a) Papilledema

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

a) Sensory

What are the three organs or systems that regulate arterial pressure?

autonomic nervous system, the kidneys, and various endocrine glands

The nurse is caring for a patient with an intracranial hemorrhage. The patient is having a hypertensive emergency. Which of the following nursing intervention would take priority in this patient? a) Reduction of the mean BP by up to 50% within the first hour of treatment b) Reduction of the BP to 160/100 mm Hg within the half hour of treatment c) Avoid lowering the blood pressure (BP) too quickly d) Maintaining the BP at a significantly higher than normal level to prevent orthostatic hypotension.

c) Avoid lowering the blood pressure (BP) too quickly

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) Primary hypertension b) Secondary hypertension c) Hypertensive emergency d) Hypertensive urgency

c) Hypertensive emergency

A client comes to the emergency department complaining of visual changes and a severe headache. The nurse measures the client's blood pressure at 210/120 mm Hg. However, the client denies having hypertension or any other disorder. After diagnosing malignant hypertension, a life-threatening disorder, the physician initiates emergency intervention. What is the most common cause of malignant hypertension? a) Pheochromocytoma b) Dissecting aortic aneurysm c) Untreated hypertension d) Pyelonephritis

c) Untreated hypertension

A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. For a client without diabetes mellitus, the target blood pressure is 140/90 or lower. Because this client has diabetes mellitus, the target blood pressure will be which of the following? a) 150/95 or lower b) 145/95 or lower c) 125/85 or lower d) 130/80 or lower

d) 130/80 or lower

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 retains sodium and excretes water. b) The kidney retains sodium and water. c) The kidney retains water and excretes sodium. d) The kidney excretes sodium and water.

d) The kidney excretes sodium and water.

What is Primary Hypertension?

defined as HBP from an unidentified cause

What are side effects of thiazide diuretics?

dry mouth, thirst, weakness, drowsiness, lethargy, muscle aches, muscular fatigue, tachycardia, GI disturbances

What are the symptoms related to organ damage for hypertension?

i. Retinal and other eye changes --> hemorrhages, exudates, arteriolar narrowing, and cotton wool spots (small infarctions) ii. Renal damage or failure iii. Myocardial infarction iv. Cardiac hypertrophy: thickening of the ventricular heart walls happens due a response to the increased workload placed on the ventricle as it contracts against higher systemic pressure v. Stroke vi. Coronary artery disease with angina (severe pain in the chest)

What are the risk factors for hypertension?

i. Smoking ii. Dyslipidemia (elevated LDL [or total] cholesterol and/or low HDL cholesterol) iii. Diabetes iv. Impaired renal function (GFR <60 mL/min and/or microalbuminuria) v. Obesity (BMI ≥30 kg/m2) vi. Physical inactivity vii. Age (>55 years for men, >65 years for women) viii. Family history of cardiovascular disease (in female relative <65 years or male relative <55 years)

What should be the limit of alcohol per day for men and women?

less than or equal to 2 drinks per day for men less than or equal to 1 drink per day for women

What is Secondary Hypertension?

occurs when a cause for the HBP can be identified

What is rebound hypertension?

occurs when blood pressure rises after you stop taking or lower the dose of a drug

What is papilledema?

optic disc swelling that is caused by increased intracranial pressure

When would diuretics not be used as the drug of choice to treat hypertension?

patients with chronic kidney disease --> renal function is already compromised

What is a common adverse effect of all antihypertensive drugs?

postural hypotension

How do calcium channel blockers work?

prevent calcium from entering cells of the heart and blood vessel walls, resulting in lower blood pressure

How much should sodium be reduced in your diet?

reduce dietary sodium intake to less than or equal to 100 mmil/day (2.4 g sodium or 6 g sodium chloride)

What is postural hypotension?

reduction in systolic blood pressure of 20mmHg or more after standing for at least one minute (also known as orthostatic hypotension)

How do angiotensin converting enzyme inhibitors (ACE's) effect BP?

slow (inhibit) the activity of the enzyme ACE, which decreases the production of angiotensin II. As a result, blood vessels enlarge or dilate, and blood pressure is reduced

What are the medications used in a hypertensive emergency?

IV vasodilators

A patient has severe coronary artery disease (CAD) and hypertension. Which medication order should the nurse consult with the physician about that is contraindicated for a patient with severe CAD? a) Clonidine (Catapres) b) Bumetanide (Bumex) c) Amiloride (Midamor) d) Methyldopa (Aldomet

a) Clonidine (Catapres)

The treatment goal for those with stage 2 hypertension (hypertension with compelling indications or complications) includes lifestyle modifications and multiple drug therapies. Thiazide diuretics are part of this treatment approach for most complications except for: a) Heart failure b) Chronic kidney disease c) Recurrent stroke prevention d) Diabetes mellitus

b) Chronic kidney disease

The nurse is caring for a client who is prescribed diuretic medication for the treatment of hypertension. The nurse recognizes that which of the following medications conserves potassium? a) Furosemide (Lasix) b) Spironolactone (Aldactone) c) Chlorothiazide (Diuril) d) Chlorthalidone (Hygroton)

b) Spironolactone (Aldactone)

Lifestyle modifications are recommended to prevent and manage hypertension. Select the modification that has been found to have the greatest effect in reducing blood pressure measurements. a) Physical activity b) Weight reduction c) Sodium reduction d) Adopting the DASH approach to eating

b) Weight reduction

What is the recommended cuff size for patients?

bladder width of at least 40% of limb circumference and length at least 80% limb circumference

How do angiotensin ll receptor blockers (ARB's) work?

block the action of angiotensin II by preventing angiotensin II from binding to angiotensin II receptors on the muscles surrounding blood vessels. As a result, blood vessels enlarge (dilate) and blood pressure is reduced

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) Acid-base imbalance b) Hepatic function c) Arterial vasoconstriction d) Calcium deficit

c) Arterial vasoconstriction

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) "Rest between demanding activities, eat plenty of fruits and vegetables, and drink 6 to 8 cups of fluid daily." b) "Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night." 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."

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) Beta-blocker d) ACE inhibitor

d) ACE inhibitor

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

d) Continuous IV infusion

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

d) Dizziness

A client is taking 50 mg of oral spironolactone twice a day to assist with blood pressure control. While the nurse is performing the morning assessment, the client reports nausea, general muscle cramps, and weakness. The ECG strip shows a peaked, narrow T-wave, which is a change. What electrolyte imbalance does the nurse suspect? a) Hypokalemia b) Hypernatremia c) Hyponatremia d) Hyperkalemia

d) Hyperkalemia

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

d) Kidneys

A 77-year-old client has newly diagnosed stage 2 hypertension. The physician has prescribed a thiazide and an angio-converting enzyme inhibitor. About what is the nurse most concerned? a) Postural hypertension and resulting injury b) Sexual dysfunction c) Rebound hypertension d) Postural hypotension and resulting injury

d) Postural hypotension and resulting injury

What should you monitor for with thiazide diuretics?

electrolyte imbalance due to loss of Na+, K+ and Mg2+

What situations are considered hypertensive urgencies?

elevated blood pressure due to severe headaches, nosebleeds, or anxiety

How is renal failure found?

elevations in BUN and creatinine levels or by microalbuminuria or macroalbuminuria

When would drug therapy be expected for a patient with hypertension?

for hypertension in stage 1 and 2

It is important for the nurse to encourage the patient to rise slowly from a sitting or lying position because a) gradual changes in position help reduce the heart's work to resupply oxygen to the brain. b) gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. c) gradual changes in position help reduce the blood pressure to resupply oxygen to the brain. d) 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

What are the ranges for systolic and diastolic for stage 2 hypertension?

greater than or equal to 160 or greater than or equal to 100

What is a priority nursing assessment when caring for the patient in a hypertensive crisis receiving intravenous vasodilators? a) Pain b) I&O c) Vision d) Family history

I&O

How much should a person with hypertension exercise?

Regular aerobic physical activity (atleast 30 minutes a day, most days of the week)

For patients with uncomplicated hypertension and no specific indications for another medication, what is the initial medication? a) Thiazide diuretic b) Calcium channel blockers c) Vasodilators d) Angiotensin-converting enzyme inhibitors

Thiazide diuretic

What are the four classes of Hypertension drugs?

Thiazide diuretics, calcium channel blockers (CCB), angiotensin converting enzyme inhibitors (ACE's), Angiotensin ll Receptor Blockers (ARB's)

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) Brain b) Stomach c) Eyes d) Heart e) Kidneys

• Heart • Kidneys • Brain • Eyes