Chapter 32: Hypertension
The nurse obtains a blood pressure of 176/82 mm Hg for a patient. What is the patient's mean arterial pressure (MAP)?
ANSWER: 113 mm Hg (MAP = [SBP + 2 DBP]/3)
The nurse on the intermediate care unit received change-of-shift report on four patients with hypertension. Which patient should the nurse assess first?
a. 48-yr-old with a blood pressure of 160/92 mm Hg who reports chest pain (The patient with chest pain may be experiencing acute myocardial infarction and rapid assessment and intervention are needed. The symptoms of the other patients also show target organ damage but are NOT indicative of acute processes.)
Which nursing action should the nurse take first to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes?
a. Collect a detailed diet history. (The initial nursing action should be assessment of the patient's baseline dietary intake through a thorough diet history.)
The nurse is reviewing the laboratory test results for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider?
a. Serum creatinine of 2.8 mg/dL (The elevated serum creatinine indicates renal damage caused by the hypertension.)
The charge nurse observes a new registered nurse (RN) doing discharge teaching for a patient with hypertension who has a new prescription for enalapril (Vasotec). The charge nurse will need to intervene if the new RN tells the patient to
a. increase the dietary intake of high-potassium foods. (The ACE inhibitors cause retention of potassium by the kidney, so hyperkalemia is a possible adverse effect. The other teaching by the new RN is appropriate for a patient with newly diagnosed hypertension who has just started therapy with enalapril)
A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and nausea and has a blood pressure (BP) of 238/118 mm Hg. Which question should the nurse ask to follow up on these findings?
b. "Have you consistently taken your medications?" (Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do NOT increase BP. Stressful events will increase BP but NOT usually to the level seen in this patient.)
The nurse has just finished teaching a hypertensive patient about the newly prescribed drug, ramipril (Altace). Which patient statement indicates that more teaching is needed?
b. "I can expect some swelling around my lips and face." (Angioedema occurring with angiotensin-converting enzyme [ACE] inhibitor therapy is an indication that the ACE inhibitor should be discontinued. The patient should be taught that if any swelling of the face or oral mucosa occurs, the health care provider should be immediately notified because this could be life threatening. The other patient statements indicate that the patient has an accurate understanding of ACE inhibitor therapy)
Which blood pressure (BP) finding by the nurse indicates that no changes in therapy are needed for a 48-yr-old patient with newly diagnosed hypertension?
b. 128/76 mm Hg (The 8th Joint National Committee's recommended goal for antihypertensive therapy for a 30- to 59-yr-old patient with hypertension is a BP below 140/90 mm Hg. The BP of 98/56 mm Hg may indicate overtreatment of the hypertension and an increased risk for adverse drug effects. The other two blood pressures indicate a need for modifications in the patient's treatment.)
A patient with hypertension who has just started taking atenolol (Tenormin) returns to the health clinic after 2 weeks for a follow-up visit. The blood pressure (BP) is unchanged from the previous visit. Which action should the nurse take first?
b. Ask the patient if the medication is being taken as prescribed. (Because nonadherence with antihypertensive therapy is common, the nurse's initial action should be to determine whether the patient is taking the atenolol as prescribed. The other actions also may be implemented, but these would be done after assessing patient adherence with the prescribed therapy.)
Which action will the nurse in the hypertension clinic take to obtain an accurate baseline blood pressure (BP) for a new patient?
b. Have the patient sit in a chair with the feet flat on the floor. (The patient should be seated with the feet flat on the floor. The BP is obtained in both arms, and the results of the two arms are NOT averaged. The patient does not need to be in the supine position. The cuff should be deflated at 2 to 3 mm Hg per second.)
The nurse obtains the following information from a patient newly diagnosed with prehypertension. Which finding is most important to address with the patient?
b. No regular physical exercise (The recommendations for preventing hypertension include exercising aerobically for 30 minutes most days of the week. A weight that is 5 pounds over the ideal body weight is NOT a risk factor for hypertension. The Dietary Approaches to Stop Hypertension [DASH] diet is high in fiber, but increasing fiber alone will NOT prevent hypertension from developing. The patient's alcohol intake is within guidelines and will NOT increase the hypertension risk.)
Which assessment finding for a patient who is receiving I.V furosemide (Lasix) to treat stage 2 hypertension is most important to report to the health care provider?
b. Serum potassium level of 3.0 mEq/L (Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening dysrhythmias. The health care provider should be notified of the potassium level immediately and administration of potassium supplements initiated.)
An older patient has been diagnosed with possible white coat hypertension. Which planned action by the nurse best addresses the suspected cause of the hypertension?
b. Teach the patient how to self-monitor and record BPs at home. (In the phenomenon of "white coat" hypertension, patients have elevated BP readings in a CLINICAL setting and normal readings when BP is measured elsewhere. Having the patient self-monitor BPs at home will provide a reliable indication about whether the patient has hypertension.)
The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a hypertensive emergency. Which finding is most important to report to the health care provider?
b. The patient cannot move the left arm and leg when asked to do so. (The patient's inability to move the left arm and leg indicates that a stroke may be occurring and will require immediate action to prevent further neurologic damage.)
A patient has just been diagnosed with hypertension and has been started on captopril . Which information is most important to include when teaching the patient about this drug?
c. Change position slowly to help prevent dizziness and falls. (The angiotensin-converting enzyme [ACE] inhibitors frequently cause orthostatic hypotension, and patients should be taught to change position slowly to allow the vascular system time to compensate for the position change.)
Which information is most important for the nurse to include when teaching a patient with newly diagnosed hypertension?
c. Hypertension is usually asymptomatic until target organ damage occurs. (Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle changes [such as, physical activity, dietary changes] are used to help manage BP, but drugs are needed for most patients. Home BP monitoring should be taught to the patient and findings checked by the health care provider frequently when starting treatment for hypertension and then every 3 months when stable.)
After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented, which diet choice indicates that the teaching has been most effective?
c. The patient drinks low-fat milk with each meal. (For the prevention of hypertension, the Dietary Approaches to Stop Hypertension [DASH] recommendations include increasing the intake of calcium-rich foods. Caffeine restriction and decreased protein intake are NOT included in the recommendations. Nuts are high in beneficial nutrients and 4 to 5 servings weekly are recommended in the DASH diet.)
During change-of-shift report, the nurse obtains the following information about a hypertensive patient who received the first dose of nadolol (Corgard) during the previous shift. Which information indicates that the patient needs immediate intervention?
c. The patient has developed wheezes throughout the lung fields. (The most urgent concern for this patient is the wheezes, which indicate that bronchospasm [a common adverse effect of the noncardioselective -blockers] is occurring. The nurse should immediately obtain an O2 saturation measurement, apply supplemental O2, and notify the health care provider.)
A 56-yr-old patient who has no previous history of hypertension or other health problems suddenly develops a blood pressure (BP) of 198/110 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that
c. diagnosis, treatment, and ongoing monitoring will be needed. (A sudden increase in BP in a patient older than age 50 years with no previous hypertension history or risk factors INDICATES that the hypertension may be secondary to some other problem. The BP will need treatment and ongoing monitoring. If the patient has no other risk factors, a stroke in the immediate future is unlikely.)
Propranolol (Inderal) is prescribed for a patient diagnosed with hypertension. The nurse should consult with the health care provider before giving this drug when the patient reveals a history of
c. reactive airway disease. (Nonselective blockers block 1 and 2 adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma. Blockers will have NO effect on the patient's peptic ulcer disease or alcohol use. Blocker therapy is recommended after MI.)
Which action should the nurse take when giving the initial dose of oral labetalol to a patient with hypertension?
d. Ask the patient to request assistance before getting out of bed. (Labetalol decreases sympathetic nervous system activity by blocking both adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension)
The nurse is caring for a 70-yr-old patient who uses hydrochlorothiazide and enalapril (Norvasc) but whose self-monitored blood pressure (BP) continues to be elevated. Which patient information may indicate a need for a change?
d. Patient uses ibuprofen (Motrin) treat osteoarthritis. (Because use of nonsteroidal antiinflammatory drugs [NSAIDs] can prevent adequate BP control, the patient may need to avoid the use of ibuprofen.)
The registered nurse (RN) is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside . Which nursing action can the nurse delegate to an experienced licensed practical/vocational nurse (LPN/LVN)?
d. Set up the automatic noninvasive BP machine to take readings every 15 minutes. (LPN/LVN education and scope of practice include the correct use of common equipment such as automatic noninvasive blood pressure machines. The other actions require advanced nursing judgment and education, and should be done by RNs.)
Which action will be included in the plan of care when the nurse is caring for a patient who is receiving nicardipine (Cardene) to treat a hypertensive emergency?
d. Use an automated noninvasive blood pressure machine to obtain frequent measurements. (Frequent monitoring of BP is needed when the patient is receiving rapid-acting I.V antihypertensive medications. This can be most easily accomplished with an automated BP machine or arterial line. When patients are receiving I.V vasodilators, bed rest is maintained to prevent decreased cerebral perfusion and fainting.)