Chapter 31: Hypertension PrepU

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?

"Rebound hypertension can occur."

A nurse is assisting with with checking blood pressures at a local health care fair. To which client would the nurse pay particular attention? A 40-year-old African-American man A 50-year-old Caucasian woman A 16-year-old girl An Asian adult man

A 40-year-old African-American man

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? Age Impaired renal function Dyslipidemia Family history

Dyslipidemia

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? Green pepper stuffed with diced tomatoes and chicken Toasted cheese sandwich on whole wheat toast with tomato soup Creamed chipped beef over toast with mashed potatoes Hot dog with ketchup and relish on whole wheat bun

Green pepper stuffed with diced tomatoes and chicken

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.) Respiratory rate Character of apical and peripheral pulses Lung sounds Heart rhythm Heart rate

Heart rate Heart rhythm Character of apical and peripheral pulses

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? Limiting activity to prevent over exertion Limiting cigarette smoking to 1 pack a week Limiting sodium intake in the diet Limiting alcohol to a can of beer to four times a day to thin the blood

Limiting sodium intake in the diet

The nurse in an oncology clinic notes that the client being treated has hypertension. What tumor is a predisposing condition for secondary hypertension? Wilm's tumor Pheochromocytoma Astrocytoma Lymphoma

Pheochromocytoma

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? Postural hypertension and resulting injury Sexual dysfunction Postural hypotension and resulting injury Rebound hypertension

Postural hypotension and resulting injury

A systolic blood pressure of 135 mm Hg would be classified as which of the following? Stage 1 hypertension Prehypertension Stage 2 hypertension Normal

Prehypertension

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? Prehypertension Stage 2 hypertension Normal Stage 1 hypertension

Prehypertension

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? 4 or 5 7 or 8 2 or 3 2 or fewer

2 or fewer

Which of the following would be inconsistent as a component of metabolic syndrome? Elevated triglyceride levels Abdominal obesity Hypotension Hypertension

Hypotension

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? Loop diuretic ACE inhibitor Beta-blocker Calcium channel blocker

ACE inhibitor

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? Procedural interventions Nonpharmacological interventions Pharmacological interventions No intervention, just observation

Nonpharmacological interventions

Which of the following nursing diagnosis is the nurse most correct to choose when caring for a client with long-standing hypertension? Risk for Decreased Cardiac Output Impaired Gas Exchange Ineffective Tissue Perfusion Activity Intolerance

Ineffective Tissue Perfusion

Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension? "If I include less fat in my diet, I'll lower my blood pressure." "I should eliminate caffeine from my diet to lower my blood pressure." "Limiting my salt intake to 2 grams per day will improve my blood pressure." "A glass of red wine each day will lower my blood pressure."

"Limiting my salt intake to 2 grams per day will improve my blood pressure."

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? 2 year Evaluate within 1 month Confirm within 2 months 1 year

1 year

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. 110, 60 120, 70 140, 90 130, 80

140, 90

According to the DASH diet, how many servings of vegetables should a person consume per day?

4 or 5

The nurse is explaining the DASH diet to a patient diagnosed with hypertension. The patients inquires about how many servings of fruit per day can be consumed on the diet. The nurse would be correct in stating which of the following? 2 or fewer 7 or 8 2 or 3 4 or 5

4 or 5

A community health nurse is screening for hypertension. Which of the following clients would the nurse focus on most intensively? A middle-aged African-American man A Hispanic teenager A 45-year-old Asian woman A postmenopausal Caucasian woman

A middle-aged African-American man

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? Take the medicine on an empty stomach. There are no adverse effects from blood pressure medicine. A possible adverse effect of blood pressure medicine is dizziness when you stand. A severe drop in blood pressure is possible.

A possible adverse effect of blood pressure medicine is dizziness when you stand.

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

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? Blurred vision Dizziness Persistent cough Tremor

Dizziness

Which diagnostic is the recommended method of determining whether left ventricular hypertrophy has occurred? BUN Blood chemistry ECG Echocardiogram

Echocardiogram

Which of the following diagnostic tests may reveal an enlarged left ventricle? Positron emission tomography (PET) scan Computed tomographic scan Fluorescein angiography Echocardiography

Echocardiography

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? Engage in aerobic activity at least 30 minutes/day most days of the week. Maintain a body mass index between 30 and 35. Limit alcohol consumption to no more that 3 drinks per day. Maintain a waist circumference of 45 inches (114 cm) (men) and 40 inches (102 cm) (women) or less.

Engage in aerobic activity at least 30 minutes/day most days of the week.

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? Primary hypertension Hypertensive emergency Secondary hypertension Hypertensive urgency

Hypertensive emergency

The nurse understands that patient education related to antihypertensive medication should include all of the following instructions except which of the following? If a dosage of medication is missed, double up on the next one to catch up. Avoid hot baths, exercise, and alcohol within 3 hours of taking vasodilators. Do not stop antihypertensive medication abruptly. Avoid over the counter (OTC) cold, weight reduction, and sinus medications.

If a dosage of medication is missed, double up on the next one to catch up.

Aging is positively correlated to the incidence of hypertension. This is due to three of the following four structural or functional changes. Which choice is not considered a cause? Decreased elasticity of the major blood vessels Atherosclerosis Increased ability to exert diastolic pressure Increased arterial resistance to left ventricular ejection

Increased ability to exert diastolic pressure

A patient 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. If dietary sodium isn't restricted, the patient will be unable to control the blood pressure and will be at risk for stroke. The patient can speak to the physician about increasing the dosage of medication instead of reducing the added salt. The patient should use other methods of flavoring foods.

It takes 2 to 3 months for the taste buds to adapt to changes in salt intake.

The nurse is caring for an 82-year-old male client who has come to the clinic for a yearly physical. When assessing the client, the nurse notes the blood pressure (BP) is 140/93. The nurse knows that in older clients what happens that may elevate the systolic BP? Decrease in blood volume Loss of arterial elasticity Decrease in cardiac output Increase in calcium intake

Loss of arterial elasticity

The nurse teaches the patient which of the following guidelines regarding lifestyle modifications for hypertension? Limit aerobic physical activity to 15 minutes, three times per week Reduce smoking to no more than four cigarettes per day Stop alcohol intake Maintain adequate dietary intake of fruits and vegetables

Maintain adequate dietary intake of fruits and vegetables

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? Blood chemistry Chest radiograph Multiple gated acquisition scan (MUGA) Fluorescein angiography

Multiple gated acquisition scan (MUGA)

A patient is taking amiloride (Midamor) and lisinopril (Zestril) for the treatment of hypertension. What laboratory studies should the nurse monitor while the patient is taking these two medications together? Magnesium level Calcium level Sodium level Potassium level

Potassium level

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? Pressures should not differ more than 5 mm Hg between arms. Pressures must be equal in both arms. Pressures may vary 10 mm Hg or more between arms. Pressures may vary, with the higher pressure found in the left arm.

Pressures should not differ more than 5 mm Hg between arms.

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? Advising a smoking cessation Purchasing a self-monitoring BP cuff Administering glycemic control Discussing methods for stress reduction

Purchasing a self-monitoring BP cuff

A patient is flying overseas for 1 week for business and packed antihypertensive medications in a suitcase. After arriving at the intended destination, the patient found that the luggage had been stolen. If the patient cannot take the medication, what condition becomes a concern? Isolated systolic hypertension Left ventricular hypertrophy Angina Rebound hypertension

Rebound hypertension

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? Reduce the blood pressure to about 140/80 mm Hg. Rapidly reduce the blood pressure so the patient will not suffer a stroke. Reduce the blood pressure by 20% to 25% within the first hour of treatment. Reduce the blood pressure by 50% within the first hour of treatment.

Reduce the blood pressure by 20% to 25% within the first hour of treatment.

The nurse is caring for a client newly diagnosed with secondary hypertension. Which of the following conditions contributes to the development of secondary hypertension? Calcium deficit Renal disease Hepatic function Acid-based imbalance

Renal disease

Which of the following is the nurse most correct to recognize as a direct effect of client hypertension? Emphysema related to poor gas exchange Renal dysfunction resulting from atherosclerosis Hyperglycemia resulting from insulin receptor resistance Anemia resulting from bone marrow suppression

Renal dysfunction resulting from atherosclerosis

Which of the following findings indicates that hypertension is progressing to target organ damage? Blood urea nitrogen (BUN) level of 12 mg/dL Urine output of 60 cc/mL over 2 hours Retinal blood vessel damage Chest x-ray showing pneumonia

Retinal blood vessel damage

Which of the following terms describes high blood pressure from an identified cause, such as renal disease? Primary hypertension Rebound hypertension Hypertensive emergency Secondary hypertension

Secondary hypertension

The nurse is instructing a client who is newly prescribed an antihypertensive medication. Which nursing instruction is emphasized to maintain client safety? Take the medication at the same time daily. Do not operate a motor vehicle. Use a pillbox to store daily medication. Sit on the edge of the chair and rise slowly.

Sit on the edge of the chair and rise slowly.

A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. Which of the following are risk factors for cardiovascular problems in clients with hypertension? Choose all that apply. Smoking Diabetes mellitus Frequent upper respiratory infections Physical inactivity Gallbladder disease

Smoking Diabetes mellitus Physical inactivity

Of the following diuretic medications, which conserves potassium?

Spironolactone (Aldactone)

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 (hypertensive emergency), a life-threatening disorder, the physician initiates emergency intervention. What is the most common cause of malignant hypertension (hypertensive emergency)? Pheochromocytoma Dissecting aortic aneurysm Untreated hypertension Pyelonephritis

Untreated hypertension

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? 40% Up to 25% 35% 45%

Up to 25%

Which of the following statements are true when the nurse is measuring blood pressure (BP)? Select all that apply. Ask the patient to sit quietly while the BP is being measured. Using a BP cuff that is too small will give a higher BP measurement. The patient's BP should be taken 1 hour after the consumption of alcohol. The patient's arm should be positioned at the level of the heart. Using a BP cuff that is too large will give a higher BP measurement.

Using a BP cuff that is too small will give a higher BP measurement. The patient's arm should be positioned at the level of the heart. Ask the patient to sit quietly while the BP is being measured

When measuring the blood pressure in each of the patient's arms, the nurse recognizes that in the normal adult, the pressures must be equal in both arms. differ no more than 5 mm Hg between arm pressures. may vary, with the higher pressure found in the left arm. may vary 10 mm Hg or more between arms.

differ no more than 5 mm Hg between arm pressures.

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? "Constant thirst is a common side effect of antihypertensive therapy." "Insomnia is a common side effect of antihypertensive medications." "Antihypertensives can lead to memory loss." "Antihypertensive drugs can lead to falls."

"Antihypertensive drugs can lead to falls."

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. He asks the nurse what his blood pressure should be. The nurse's most appropriate response is: "Your blood pressure is fine. Just keep doing what you're doing." "Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg." "The current recommendation is for everyone to have blood pressure of 140/90 mm Hg or lower." "The lower the better. Blood pressure of 120/80 mm Hg is best for everyone."

"Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg."

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? "Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night." "Flex your calf muscles, avoid alcohol, and change positions slowly." "Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising." "Rest between demanding activities, eat plenty of fruits and vegetables, and drink 6 to 8 cups of fluid daily."

"Flex your calf muscles, avoid alcohol, and change positions slowly."

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? "Hypertension often causes no pain." "Hypertension is difficult to diagnose." "Hypertension often kills early in the disease process." "Hypertension often causes no symptoms."

"Hypertension often causes no symptoms."

A nurse is educating a client about monitoring blood pressure readings at home. Which of the following will the nurse be sure to emphasize? "Be sure the forearm is well supported above heart level while taking blood pressure." "Avoid smoking cigarettes for 8 hours prior to taking blood pressure." "Sit with legs crossed when taking your blood pressure." "Sit quietly for 5 minutes prior to taking blood pressure."

"Sit quietly for 5 minutes prior to taking blood pressure."

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? 145/95 or lower 150/95 or lower 130/80 or lower 125/85 or lower

130/80 or lower

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? Acid-base imbalance Calcium deficit Hepatic function Arterial vasoconstriction

Arterial vasoconstriction

The nurse is administering medications on a medical surgical unit. A patient is ordered to receive 40 mg of oral Corgard (nadolol) for the treatment of hypertension. Prior to administering the medication, the nurse should complete which of the following? Weighing the patient Checking the patient's serum K+ level Checking the patient's heart rate Checking the patient's urine output

Checking the patient's heart rate

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. Pancreatitis Coronary artery disease Tension pneumothorax Myocardial infarction Stroke

Coronary artery disease Myocardial infarction Stroke

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

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? Lung and arteries Brain and sympathetic nervous system Heart and blood vessels Kidneys and autonomic nervous system

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? The taste buds never adapt to decreased salt intake. There is usually no need to change alcohol consumption for clients with hypertension. A person with hypertension should never consume alcohol. It takes 2 to 3 months for the taste buds to adapt to decreased salt intake.

It takes 2 to 3 months for the taste buds to adapt to decreased salt intake.

A patient is admitted to the intensive care unit (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? Chest pain score of 3/10 (on a scale of 1 to 10) Left arm numbness and weakness Urine output of 40 cc/mL over the last hour Nausea and severe headache

Left arm numbness and weakness

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? Stage 2 with compelling indications Stage 1 with compelling indications Stage 1 Stage 2

Stage 1

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? The adrenal gland The pituitary gland The thyroid gland The thymus

The adrenal gland

Why is it important for the nurse to implement measures to relieve emotional stress for patients with hypertension? The reduction of stress increases the resistance that the heart must overcome to eject blood. The reduction of stress increases the blood volume and improves the potential for greater cardiac output. The reduction of stress decreases the production of neurotransmitters that constrict peripheral arterioles. The reduction of stress increases the production of neurotransmitters that constrict peripheral arterioles.

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

The nurse observes a certified nursing assistant (CNA) obtaining a blood pressure reading with a cuff that is too small for the patient. The nurse informs the CNA that using a cuff that is too small can affect the reading results in what way? It will be significantly different with each reading. It will give an accurate reading. The results will be falsely decreased. The results will be falsely elevated.

The results will be falsely elevated.

It is appropriate for the nurse to recommend smoking cessation for patients with hypertension because nicotine decreases circulating blood volume. increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. decreases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. increases the heart rate, constricts arterioles, and increases the heart's ability to eject blood.

increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood.