chapter 27 caring for clients with hypertension

The home health nurse is caring for a client who has a diagnosis of hypertension. What assessment question most directly addresses the possibility of worsening hypertension?

"Do you ever see spots in front of your eyes?"

Hypernatremia

(elevated serum sodium level) increases blood volume, which raises BP

prehypertension is

120-139/80-89

Stage 1 hypertension

140-159/90-99

The nurse is explaining the DASH diet to a client diagnosed with hypertension. The client inquires about how many servings of fruit per day can be consumed on the diet. What is the nurse's best response?

4 or 5 servings per day

Stage 2 hypertension

>160/>100

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 in hypertensive emergency is being cared for in the ICU. The client has become hypovolemic secondary to natriuresis. What is the nurse's most appropriate action?

Administer normal saline IV, as prescribed.

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

Which condition contributes to secondary hypertension?

Arterial vasoconstriction

BP is the force produced by the volume of blood in arterial walls.

BP = CO (cardiac output) × PR (peripheral resistance)

Angiotensin-converting enzyme (ACE) inhibitors

Block conversion of angiotensin I to angiotensin II

renin-angiotensin-aldosterone system

Defects in BP regulation may result from an impairment in the

A client comes to the emergency department complaining of visual changes and severe headache and denies past medical history. The nurse measures the client's blood pressure at 210/120 mm Hg. What question will the nurse ask to explore the hypertension situation?

Do you have hypertension in your family?"

The nurse is providing care for a client with a new diagnosis of hypertension. How can the nurse best promote the client's adherence to the prescribed therapeutic regimen?

Have the client participate in monitoring his or her own BP.

Which condition(s) indicates target organ damage from untreated/undertreated hypertension? Select all that apply.

Heart failure Retinal damage Stroke

Aldosterone

Hormone that stimulates the kidney to retain sodium ions and water hormone that causes salt and water to be reabsorbed increasing BP

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

A client's medication regimen for the treatment of hypertension includes hydrochlorothiazide. Following administration of this medication, the nurse should anticipate what effect?

Increased urine output

A client is being seen at the clinic on a monthly basis for assessment of blood pressure. The client has been checking blood pressure at home as well and has reported a systolic pressure of 158 and a diastolic pressure of 64. What does the nurse suspect this client is experiencing?

Isolated systolic hypertension occur with aging, the aorta and large arteries are less able to accommodate the volume of blood pumped out by the heart (stroke volume), and the energy that would have stretched the vessels instead elevates the systolic blood pressure, resulting in an elevated systolic pressure without a change in diastolic pressure.

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

The nurse teaches the client which guidelines regarding lifestyle modifications for hypertension?

Maintain adequate dietary intake of fruits and vegetables

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?

Papilledema

The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. What should the nurse integrate into the management of this client's hypertension?

Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion.

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

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 with primary hypertension comes to the clinic reporting 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?

Retinal blood vessel damage

A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. What are risk factors for cardiovascular problems in clients with hypertension? Select all that apply.

Smoking Diabetes mellitus Physical inactivity

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 action?

Taking the BP 10 minutes after nicotine or coffee ingestion

Isolated systolic hypertension

a condition most commonly seen in the older adult in which the systolic pressure is greater than 140 mm Hg and the diastolic pressure is within normal limits (less than 90 mm Hg)

white-coat hypertension

a term describing elevated BP that develops during evaluation by healthcare providers who traditionally have worn a white coat.

Accelerated hypertension and malignant hypertension

are more serious forms of elevated BP that develop in clients with either essential or secondary hypertension

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

essential hypertension

chronic high blood pressure with no single known cause about 95% of cases, is sustained elevated BP with no known cause.

A client has been recently diagnosed with hypertension and is having a difficult time adjusting emotionally to the condition. It is important to implement measures to relieve emotional stress for clients with hypertension because reduced stress:

decreases the production of neurotransmitters that constrict peripheral arterioles.

natriuretic factor

hormone produced by the heart, results in an elevation of BP because its role is to promote the excretion of sodium by the kidneys

Renin

hormone secreted by the kidney that raises blood pressure is a chemical that the kidneys release to raise BP and increase vascular fluid volume in response to renal hypoperfusion.

Systolic Blood Pressure (SBP)

is determined by the force and volume of blood that the left ventricle ejects during systole and the ability of the arterial system to distend at the time of ventricular contraction

A client who has just been diagnosed with hypertension has been instructed to take a daily blood pressure measurement. The systolic blood pressure reading measures the volume of blood ejected from the:

left ventricle.

Angiotensinogen

liver serum globulin that renin converts to angiotensin I

Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through:

ophthalmic examination.

Normal BP for adults

ranges from 100/60 to 119/79 mm Hg.

Diastolic Blood Pressure (DBP)

reflects arterial pressure during ventricular relaxation. It depends on the resistance of the arterioles and the diastolic filling times. If arterioles are resistant (constricted), blood is under greater pressure.

ophthalmic examination.

reveals vascular changes; retinal hemorrhages; and papilledema

papilledema

swelling of the optic disc Peripheral edema may be present. An ophthalmic examination may reveal vascular changes in the eyes, retinal hemorrhages, or edema of the optic nerves known as

Central aortic systolic pressure (CASP)

the pressure of blood at the root of the aorta as blood is pumped from the left ventricle, can be lower by as much as 30 mm Hg than the corresponding brachial arm systolic pressure

A client who has just been diagnosed with hypertension has been instructed to take a daily blood pressure measurement. Diastolic blood pressure reading measures arterial pressure during:

ventricular relaxation.