Chapter 13: Hypotension
It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine
increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood.
The nurse is performing patient education for a patient who has been prescribed hydrochlorothiazide and metoprolol (Lopressor) for the treatment of hypertension. What teaching point should the nurse emphasize when teaching the patient about this medication regimen?
"Avoid taking over-the-counter decongestants because they can increase your blood pressure (BP)."
A nurse is caring for a client who has hypertension and diabetes mellitus. The client's blood pressure this morning was 150/92 mm Hg. When the client asks the nurse what his or her blood pressure should be, what is the nurse's most appropriate response?
"Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg."
A 66-year-old client presents to the emergency department reporting severe headache and mild nausea for the past 6 hours. Upon assessment, the client's BP is 210/120 mm Hg. The client has a history of hypertension and takes 1.0 mg clonidine twice daily. Which question is most important for the nurse to ask the client next?
"Have you taken your prescribed clonidine today?"
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
A client has severe coronary artery disease (CAD) and hypertension. Which medication order should the nurse consult with the health care provider about that is contraindicated for a client with severe CAD?
Clonidine
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
When administering benazepril with spironolactone, the nurse should be aware that which electrolyte imbalance may occur?
Hyperkalemia
A team of public health nurses are strategizing around a new initiative that will address screening, education, and management of hypertension in residents of the community. Which of the following facts surrounding hypertension should underlie the nurses' design of this health initiative?
Hypertension tends to be inadequately managed in many of the people who have been diagnosed with the problem.
As recommended follow-up for a client initially diagnosed with prehypertension, the client should get his or her blood pressure rechecked within which time frame?
Recheck in 1 year (A client with an initial blood pressure (BP) in the prehypertension range should have his or her BP rechecked in 1 year. A normal BP should be rechecked in 2 years. Stage 1 hypertension should be confirmed and followed up within 2 months. Stage 2 hypertension should be evaluated or referred to a source of care within 1 month)
Which finding indicates that hypertension is progressing to target organ damage?
Retinal blood vessel damage
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 condition contributes to secondary hypertension?
arterial vasoconstriction (Secondary hypertension may accompany any primary condition that affects fluid volume or renal function, or causes arterial vasoconstriction.)
Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress
decreases the production of neurotransmitters that constrict peripheral arterioles.
Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress
decreases the production of neurotransmitters that constrict peripheral arterioles. (Reduced stress decreases the production of neurotransmitters that constrict peripheral arterioles. Reduced stress may assist in reducing blood volume and resistance to the heart.)
It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position
provide time for the heart to increase the rate of contraction to resupply oxygen to the brain.
The nurse is teaching a client about chronic untreated hypertension. What complication will the nurse explain to the client?
stroke
A client with newly diagnosed hypertension asks how to decrease the risk for related cardiovascular problems. What risk factor is modifiable by the client?
Dyslipidemia
A client is taking 50 mg of oral spironolactone twice a day to assist with blood pressure control. While the nurse is performing the morning assessment, the client reports nausea, general muscle cramps, and weakness. The ECG strip shows a peaked, narrow T-wave, which is a change. What electrolyte imbalance does the nurse suspect?
Hyperkalemia (Potassium-sparing diuretics, such as spironolactone, can cause hyperkalemia, especially if given with an ACE inhibitor. Signs of hyperkalemia are nausea, diarrhea, abdominal cramps, and peaked narrow T-waves.)
Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage?
Hypertensive emergency
A client hospitalized for treatment of hypertension is being prepared for discharge. Which teaching topic should the nurse be sure to cover?
Maintaining a low-sodium diet
A patient comes to the walk-in clinic. While assessing the patient's vital signs, the nurse assesses the patient's blood pressure at 128/89 mm Hg. According to JNC7, how would this patient's blood pressure be classified?
Prehypertensive
When measuring the blood pressure in each arm of a healthy adult client, the nurse recognizes that which statement is true?
Pressures should not differ more than 5 mm Hg between arms.
The nurse is caring for a client prescribed bumetanide for the treatment of stage 2 hypertension. Which finding indicates the client is experiencing an adverse effect of the medication?
Serum potassium value of 3.0 mEq/L
The nurse is conducting a service project for a local elderly community group on the topic of hypertension. The nurse will relay that which risk factors and cardiovascular problems are related to hypertension? Select all that apply.
Smoking, Obesity, woman over the age of 65, elevated cholesterol
The nurse is caring for a client with essential hypertension. The nurse reviews lab work and assesses kidney function. Which action of the kidney would the nurse evaluate as the body's attempt to regulate high blood pressure?
The kidney excretes sodium and water
The nurse is obtaining a health history from a client with a blood pressure of 146/88 mm Hg. The client states that lifestyle changes have not been effective in lowering blood pressure. Which medication classification does the nurse anticipate first?
Thiazide diuretic
A client in a clinic setting has just been diagnosed with hypertension. When the client asks what the end goal is for treatment, what is the nurse's best response?
To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less
A client with a history of hypertension is receiving client education about structures that regulate arterial pressure. Which structure is a component of that process?
kidneys
The nurse is performing health education-related lifestyle modifications for a patient who has been newly diagnosed with hypertension. As a component of these modifications, the DASH (Dietary Approaches to Stop Hypertension) eating plan has been recommended to the patient. Which of the nurse's recommendations is most congruent with this eating plan?
"Try to reduce the overall amount of fat that is in your diet."
According to the DASH diet, how many servings of vegetables should a person consume each day?
4 or 5
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?
ACE inhibitor
After a series of visits to her care provider, a 40-year-old woman has been diagnosed with primary hypertension and metabolic syndrome. In addition to her persistently high blood pressure (BP) readings, what criterion would contribute to the woman's diagnosis of metabolic syndrome?
Abnormal lipid levels (Metabolic syndrome, or syndrome X, occurs when three of the following symptoms are present: BP elevation greater than 130/85, insulin resistance, dyslipidemia, and/or abdominal obesity.)
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 what?
Adrenal gland (The 24-hour urine collection specimen is ordered to determine dysfunction of the adrenal gland. The 24-hour urine detects elevated catecholamines.)
The nurse is teaching a client who is experiencing dizziness to rise slowly from a sitting or lying position. What is the rationale for the teaching?
Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain.
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?
Hypertensive urgency (Hypertensive urgency describes a situation in which blood pressure is very elevated but there is no evidence of impending or progressive target organ damage. Elevated blood pressures associated with severe headaches, nosebleeds, or anxiety are classified as urgencies. In these situations, oral agents can be administered with the goal of normalizing blood pressure within 24 to 48 hours).
Which statements are true when the nurse is measuring blood pressure (BP)? Select all that apply
Using a BP cuff that is too small will give a higher BP measurement. The client's arm should be positioned at the level of the heart. The client should sit quietly while BP is being measured
A 56-year-old man visits his primary care provider infrequently but has now presented with complaints of transient visual disturbances. Assessment of the patient has yielded few remarkable findings with the exception of blood pressure (BP) of 169/106 mm Hg. When do signs and symptoms of hypertension typically appear?
After target organ damage has occurred
A client 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.
The nurse is discussing aging and the incidence of hypertension with an older adult. What lifestyle change will lower blood pressure for the older adult?
Keep weight stable.
The nurse is planning the care of a patient admitted to the hospital with hypertension. What objective will help to meet the needs of this patient?
Lowering and controlling the blood pressure without adverse effects and without undue cost
Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through:
ophthalmic examination.
An older African American client is found to have a blood pressure of 150/90 mm Hg during a work-site health screening. What should the nurse do?
Recommend the client have blood pressure rechecked within 2 weeks.
A client is brought to the emergency department with reports 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.