Chapter 33

The charge nurse observes a new RN doing discharge teaching for a hypertensive patient who has a new prescription for enalapril (Vasotec). The charge nurse will need to intervene if the new RN tells the patient to

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.

A 52-year-old patient who has no previous history of hypertension or other health problems suddenly develops a BP of 188/106 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that

more diagnostic testing may be needed to determine the cause of the hypertension. A sudden increase in BP in a patient over age 50 with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem.

After giving a patient the initial dose of oral labetalol (Normodyne) for treatment of hypertension, which action should the nurse take?

Ask the patient to request assistance when getting out of bed. Labetalol decreases sympathetic nervous system activity by blocking both α- and β-adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension.

Which assessment finding for a patient who is receiving furosemide (Lasix) to treat stage 2 hypertension is most important to report to the health care provider?

Blood potassium level of 3.0 mEq/L Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening dysrhythmias.

A patient has just been diagnosed with hypertension and has a new prescription for captopril (Capoten). Which information is important to include when teaching the patient?

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.

A patient is diagnosed with hypertension and nadolol (Corgard) is prescribed. The nurse should consult with the health care provider before giving this medication upon finding a history of

asthma. Nonselective -blockers block 1- and 2-adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma.

The nurse has just finished teaching a hypertensive patient about the newly prescribed quinapril (Accupril). Which patient statement indicates that more teaching is needed?

"I won't worry if I have a little 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 nurse obtains a blood pressure of 180/75 mm Hg for a patient. What is the patient's mean arterial pressure (MAP)?

110 MAP = (SBP + 2 DBP)/3

Which BP finding by the nurse indicates that no changes in therapy are needed for a patient with stage 1 hypertension who has a history of heart failure?

128/76 mm Hg The goal for antihypertensive therapy for a patient with hypertension and heart failure is a BP of <130/80 mm Hg.

The nurse in the emergency department received change-of-shift report on four patients with hypertension. Which patient should the nurse assess first?

43-year-old with a BP of 190/102 who is complaining of chest pain The patient with chest pain may be experiencing acute myocardial infarction and rapid assessment and intervention is needed.

Which nursing action should the nurse take first in order to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes?

Have the patient record dietary intake for 3 days. The initial nursing action should be assessment of the patient's baseline dietary intake through a 3-day food diary.

Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new patient?

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.

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 has a BP of 240/118 mm Hg. Which question should the nurse ask first?

Have you been consistently taking your medications? Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis.

Which information should the nurse include when teaching a patient with newly diagnosed hypertension?

Hypertension is usually asymptomatic until significant organ damage occurs Hypertension is usually asymptomatic until target organ damage has occurred.

The nurse obtains this information from a patient with prehypertension. Which finding is most important to address with the patient?

No regular aerobic exercise The recommendations for preventing hypertension include exercising aerobically for 30 minutes most days of the week.

When a patient with hypertension who has a new prescription for atenolol (Tenormin) returns to the health clinic after 2 weeks for a follow-up visit, the BP is unchanged from the previous visit. Which action should the nurse take first?

Remind the patient that lifestyle changes also are important in BP control. Since noncompliance with antihypertensive therapy is common, the nurse's initial action should be to determine whether the patient is taking the atenolol as prescribed.

The nurse is reviewing the laboratory tests for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider?

Serum creatinine of 2.6 mg/dL The elevated creatinine indicates renal damage caused by the hypertension.

The RN is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside (Nipride). Which of the following nursing actions can the nurse delegate to an experienced LPN/LVN?

Set up the automatic blood pressure machine to take BP every 15 minutes. LPN/LVN education and scope of practice include correct use of common equipment such as automatic blood pressure machines.

A patient has been diagnosed with possible white coat hypertension. Which action will the nurse plan to take next?

Tell the patient how to self-monitor and record BPs at home. Having the patient self-monitor BPs at home will provide a reliable indication about whether the patient has hypertension.

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 effective?

The patient has a glass of low-fat milk with each meal. The Dietary Approaches to Stop Hypertension (DASH) recommendations for prevention of hypertension include increasing the intake of calcium-rich foods.

During change-of-shift report, the nurse obtains this information about a hypertensive patient who received the first dose of propranolol (Inderal) during the previous shift. Which information indicates that the patient needs immediate intervention?

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 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?

The patient is unable to 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 hemorrhagic stroke may be occurring and will require immediate action to prevent further neurologic damage.

Which action will be included in the plan of care when the nurse is caring for a patient who is receiving sodium nitroprusside (Nipride) to treat a hypertensive emergency?

Use an automated noninvasive blood pressure machine to obtain frequent BP measurements. Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV antihypertensive medications.