chapter 31- med surg

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." What is the best response by the nurse? "Hypertension often causes no symptoms." "Hypertension often kills early in the disease process." "Hypertension often causes no pain." "Hypertension is difficult to diagnose."

"Hypertension often causes no symptoms."

The nurse is caring for a client who has had 25 mg of oral hydrochlorothiazide added to the medication regimen for the treatment of hypertension. Which instruction should the nurse give the client?

"Increase the amount of fruits and vegetables you eat."

The nurse is teaching a client diagnosed with hypertension about the DASH diet. How many servings of meat, fish, and poultry should the client consume per day? 2 or fewer 2 or 3 4 or 5 7 or 8

2 or fewer

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

An older adult client visits the clinic for a blood pressure (BP) check. The client's hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about the blood pressure medicine? Take the medicine on an empty stomach. A possible adverse effect of blood pressure medicine is dizziness when you stand. There are no adverse effects from blood pressure medicine. A severe drop in blood pressure is possible.

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

A client 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. What treatment plan will the nurse educate the client about?

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

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 should sit quietly while BP is being measured. The client's arm should be positioned at the level of the heart.

The nurse is completing a cardiac assessment on a client. The patient has a blood pressure (BP) reading of 126/78. What would the nurse identify this blood pressure reading as?

elevated stage 1- between 130-139 over 80-89 stage 2- 140 or greater over 90 or greater

Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage?

hypertensive emergency

Which term describes a situation in which blood pressure is very elevated but there is no evidence of impending or progressive target organ damage? Hypertensive urgency Hypertensive emergency Primary hypertension Secondary hypertension

hypertensive urgency- a situation in which blood pressure is severely elevated but there is no evidence of actual or probably target organ damage

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

pheochromocytoma

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

renal dysfunction resulting from atherosclerosis

Which finding indicates that hypertension is progressing to target organ damage?

retinal blood vessel damage

Which condition(s) indicates target organ damage from untreated/undertreated hypertension? Select all that apply. Heart failure Retinal damage Diabetes Hyperlipidemia Stroke

retinal damage, heart failure, stroke

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 Elevated high-density lipoprotein (HDL) cholesterol Overweight/obesity Age ≥65 in women Decreased low-density lipoprotein (LDL) levels

smoking, age greater than or equal to 65 in women, overweight/obese

A blood pressure (BP) of 140/90 mm Hg is considered to be normal. prehypertension. hypertension. a hypertensive emergency.

hypertension

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 parasympathetic nervous system limbic system lungs

kindeys

A client 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. What treatment plan will the nurse educate the client about? Continuing the medication and reducing dietary sodium Discontinuing the HCTZ and atenolol and continuing to reduce sodium intake Gradual reducing the HCTZ and the atenolol and continuing to reduce sodium intake Gradually reducing the atenolol and continuing the HCTZ

gradual reducing of HCTZ and the atenolol and continuing to reduce sodium intake

The nurse is caring for a client newly diagnosed with hypertension. Which statement by the client indicates the need for further teaching? "If I take my blood pressure and it is normal, I don't have to take my blood pressure pills." "I think I'm going to sign up for a yoga class twice a week to help reduce my stress." "When getting up from bed, I will sit for a short period before standing up." "I will consult a dietician to help get my weight under control."

"If I take my blood pressure and it is normal, I don't have to take my blood pressure pills."

Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension?

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

A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. What will the nurse specify about this client's target blood pressure?

130/80 or lower

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.)

Character of apical and peripheral pulses Heart rate Heart rhythm

A nurse is teaching about lifestyle modifications to a group of clients with known hypertension. Which statement would the nurse include in the education session? Maintain a body mass index between 30 and 35. Engage in aerobic activity at least 30 minutes/day most days of the week. Maintain a waist circumference of 45 inches (114 cm) (men) and 40 inches (102 cm) (women) or less. Limit alcohol consumption to no more that 3 drinks per day.

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

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 Physical inactivity Diabetes mellitus

The nurse is caring for a client with a blood pressure of 210/100 mm Hg in the emergency room. What is the most appropriate route of administration for antihypertensive agents? continuous IV infusion sublingual intramuscular oral

continuous IV infusion

What risk factors would cause the nurse to become concerned that the client may have atherosclerotic heart disease? Select all that apply.

diabetes hypertension obesity family history of early cardiovascular events

When measuring blood pressure in each arm of a healthy adult, the nurse recognizes that the pressures

differ no more than 5 mmhg between arms

A patient with long-standing hypertension is admitted to the hospital with hypertensive urgency. The physician orders a chest x-ray, which reveals an enlarged heart. What diagnostic test does the nurse anticipate preparing the patient for to determine left ventricular enlargement? Cardiac catheterization Echocardiography Stress test Tilt-table test

echocardiography

A client is being seen at the clinic for a routine physical when the nurse notes the client's blood pressure is 150/97. The client is considered to be a healthy, well-nourished young adult. What type of hypertension does this client have? Secondary Pathologic Malignant Essential (primary)

essential primary - sustained elevated BP with no known cause

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 Heart and blood vessels Brain and sympathetic nervous system Kidneys and autonomic nervous system

heart and blood vessels

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

When administering benazepril with spironolactone, the nurse should be aware that which electrolyte imbalance may occur? Hyperkalemia Hypokalemia Hypercalcemia Hypocalcemia

hyperkalemia- ACE inhibitors block aldosterone and may cause hyperkalemia when used with potassium sparing diuretics

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 emergency Primary hypertension Secondary hypertension Hypertensive urgency

hypertensive urgency - situation in which BP is very elevated but there is no impending or progressive target organ damage

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.

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 - elevated systolic pressure without a change in diastolic pressure

A nurse is educating about lifestyle modifications for a group of clients with newly diagnosed hypertension. While discussing dietary changes, which point would the nurse emphasize? It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. 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

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? Add salt to foods for taste. Exercise once a week. Keep weight stable. Sleep four hours each night.

keep weight stable

The nurse is caring for an older adult 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? Loss of arterial elasticity Decrease in blood volume Increase in calcium intake Decrease in cardiac output

loss of arterial elasticity

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 Making sure that the patient adheres to the therapeutic medication regimen Instructing the patient to enter a weight loss program and begin an exercise regimen Scheduling the patient for all follow-up visits and making phone calls to the home to ensure adherence

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

A client with hypertension visits the health clinic for a routine checkup. The nurse measures the client's blood pressure at 184/92 mm Hg and notes a 5-lb (2.3-kg) weight gain within the past month. Which nursing diagnosis reflects the most serious problem in managing a client with hypertension? Noncompliance (nonadherence to therapeutic regimen) Deficient knowledge (disease process) Excess fluid volume Imbalanced nutrition: More than body requirements

noncompliance- non adherence to therapeutic regimen

A client who was recently diagnosed with prehypertension is to meet with a dietitian and return for a follow-up with the cardiologist in 6 months. What would this client's treatment likely include? nonpharmacological interventions pharmacological interventions procedural interventions observation only

nonpharmacological interventions

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? Cataracts Glaucoma Retinal detachment Papilledema

papilledema

The nurse is instructing a student on the proper technique for measuring blood pressure (BP). Which student action indicates a need for further teaching? Positions the arm at waist level Palpates the systolic pressure before auscultating blood pressure Centers the blood pressure cuff bladder directly over the brachial artery Wraps the blood pressure cuff firmly around the arm

positions the arm at waist level

The nurse encourages the client diagnosed with hypertension 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

A 35-year-old client has been diagnosed with hypertension. The client is a stock broker, smokes daily, and has diabetes. During a follow-up appointment, the client states that regular visits to the doctor just to check blood pressure (BP) are cumbersome and time consuming. As the nurse, which aspect of client teaching would you recommend?

purchase a self monitoring BP cuff

A client, newly admitted to the nursing unit, has a primary diagnosis of renal failure. When assessing the client, the nurse notes a blood pressure (BP) of 180/100. The nurse knows that this is what kind of hypertension?

secondary

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 Electrocardiogram (EGG) tracing demonstrating peaked T waves Urine output of 90 mL 1 hour after medication administration Blood glucose value of 160 mg/dL

serum potassium value of 3.0 mEq/L- bumetanide is a loop diuretic that can cause fluid and electrolyte imbalances.

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

sit on the edge of the chair and rise slowly

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? Increasing fluids for low blood pressure Stress reduction to lower prehypertensive state Use of beta-blockers for treatment of hypertension Diagnostic testing for determining cardiac functioning

stress reduction to lower prehypertensive state

The nurse is teaching a client about chronic untreated hypertension. What complication will the nurse explain to the client?

stroke

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 retains sodium and water. The kidney excretes sodium and water. The kidney retains sodium and excretes water. The kidney retains water and excretes sodium.

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? ACE inhibitors Beta-blocker Thiazide diuretic Calcium channel blocker

thiazide diuretics

A 77-year-old client presents to the local community center for a blood pressure (BP) screening; BP is recorded as 180/90 mm Hg. The client has a history of hypertension but currently is not taking the prescribed medications. Which question is most appropriate for the nurse to ask the client first?

"Can you tell me the reasons you aren't taking your medications?"

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?"

A nurse is discussing with a nursing student how to accurately measure blood pressure. What statement by the student indicates an understanding of the education? A cuff that is too small will give a false high blood pressure. A cuff that is too small will give a false low blood pressure. A cuff that is too large will give a false high blood pressure. The size of the cuff does not matter as long as it fits snugly around the arm

A cuff that is too small will give a false high blood pressure

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? Beta-blocker ACE inhibitor Loop diuretic Calcium channel blocker

ACE inhibitor- prevent the conversion of angiotensin 1 to angiotensin 2 a potent vasoconstricting hormone in the blood

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.

The nurse assesses a healthy middle-aged client with a blood pressure of 158/90 mm Hg. In which classification of hypertension is the client according to the latest guidelines? Normal blood pressure Elevated blood pressure Stage 1 hypertension Stage 2 hypertension

stage 2 hypertension