Hinkle Ch. 27: Assessment and Management of Patients with Hypertension

A nurse is providing education about hypertension to a community group. What are possible consequences of untreated hypertension? Select all that apply. - Coronary artery disease - Myocardial infarction - Pancreatitis - Tension pneumothorax - Stroke

- Coronary artery disease - Myocardial infarction - Stroke Explanation: People with hypertension may remain asymptomatic for many years. When specific signs and symptoms appear, however, they usually indicate vascular damage. Coronary artery disease with angina and myocardial infarction are common consequences of hypertension. Cerebrovascular involvement may lead to a stroke. Tension pneumothorax and pancreatitis are not directly related to hypertension.

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. Explanation: Obesity can contribute to hypertension, so keeping weight stable is healthy. Salt can add to hypertension. The American Heart Association recommends exercising more than once a week for the older adult. Sleeping for four hours is not enough for rest.

A client who is newly diagnosed with hypertension is going to be starting antihypertensive medicine. What is one of the main things the client and the client's spouse should watch for? - dizziness - persistent cough - blurred vision - tremor

- dizziness Explanation: A common adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. The client and the client's spouse should be alerted to this possibility and provided with some tips for managing dizziness.

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 Explanation: The nurse is most correct to realize high blood pressure damages the arterial vascular system and accelerates atherosclerosis. The effect of the atherosclerosis impairs circulation to the kidney, resulting in renal failure. Neither anemia, hyperglycemia, nor emphysema occurs as a direct effect of hypertension.

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? - "Are you having trouble paying for your medications?" - "Can you tell me the reasons you aren't taking your medications?" - "What medications are you prescribed?" - "Are you able to get to your pharmacy to pick up your medications?"

- "Can you tell me the reasons you aren't taking your medications?" Explanation: It is important for the nurse to first ascertain why the client is not taking prescribed medications. Adherence to the therapeutic program may be more difficult for older adults. The medication regimen can be difficult to remember, and the expense can be a challenge. Monotherapy (treatment with a single agent), if appropriate, may simplify the medication regimen and make it less expensive. The other questions are appropriate, but the priority is to determine why the medication regimen is not being followed.

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

- "Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg." Explanation: An individual with diabetes mellitus should strive for blood pressure of 120/80 mm Hg or less. An individual without diabetes should strive for blood pressure of 140/90 mm Hg or less.

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? - "What have you eaten in the last 24 hours?" - "Do you smoke cigarettes?" - "Do you have hypertension in your family?" - "Did you try an over-the-counter medication?"

- "Do you have hypertension in your family?" Explanation: Asking the client about family history is a pertinent question to help relate the hypertension. Untreated hypertension is the most common cause of malignant hypertension (hypertensive emergency). Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as those that occur with monoamine oxidase inhibitors and aged cheeses).

A client with high blood pressure is receiving an antihypertensive drug. 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." - "Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising." - "Flex your calf muscles, avoid alcohol, and change positions slowly." - "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." Explanation: Measures that minimize orthostatic hypotension include flexing the calf muscles to boost blood return to the heart, avoiding alcohol and straining at stool, changing positions slowly, eating a high-protein snack at night, wearing elastic stockings, and holding onto a stationary object when rising. Although the client should rest between demanding activities and consume plenty of fluids and fiber (contained in fruits and vegetables) to maintain a balanced diet, these measures don't directly relieve orthostatic hypotension.

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?" - "Do you have a dry mouth or nasal congestion?" - "Are you having chest pain or shortness of breath?" - "Did you take any medication for your headache?"

- "Have you taken your prescribed clonidine today?" Explanation: The nurse must ask whether the client has taken his prescribed clonidine. Clients need to be informed that rebound hypertension can occur if antihypertensive medications are suddenly stopped. Specifically, a side effect of clonidine is rebound or withdrawal hypertension. Although the other questions may be asked, it is most important to inquire whether the client has taken the prescribed hypertension medication given the client's severely elevated BP.

A client is placed on a low-sodium (500 mg/day) diet. Which client statement indicates that the nurse's nutrition teaching plan has been effective? - "I can still eat a ham-and-cheese sandwich with potato chips for lunch." - "I chose broiled chicken with a baked potato for dinner." - "I chose a tossed salad with sardines and oil and vinegar dressing for lunch." - "I'm glad I can still have chicken bouillon."

- "I chose broiled chicken with a baked potato for dinner." Explanation: The client's choice of a baked potato with broiled chicken indicates effective nutrition teaching because potatoes and chicken are relatively low in sodium. Ham, sardines, and bouillon are extremely high in sodium and shouldn't be included in a low-sodium diet.

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? - "Take this medication before going to bed." - "Increase the amount of fruits and vegetables you eat." - "You may develop nasal congestion or depression while taking this medication." - "You may drink alcohol while taking this medication."

- "Increase the amount of fruits and vegetables you eat." Explanation: Thiazide diuretics cause loss of sodium, potassium, and magnesium, so the client should be encouraged to eat fruits and vegetables that are high in potassium. Diuretics cause increased urination; the client should not take the medication before going to bed. Thiazide diuretics do not cause dry mouth or nasal congestion; both side effects are associated with alpha2-agonists. Postural hypotension may be potentiated by alcohol.

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

- "Limiting my salt intake to 2 grams per day will improve my blood pressure." Explanation: To lower blood pressure, a client should limit daily salt intake to 2 g or less. Alcohol intake is associated with a higher incidence of hypertension, poor compliance with treatment, and refractory hypertension. Moderate caffeine and fat intake don't significantly affect blood pressure

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

- "Sit quietly for 5 minutes prior to taking blood pressure." Explanation: Instructions for the client regarding measuring the blood pressure at home include the following: (1) Avoid smoking cigarettes or drinking caffeine for 30 minutes before measuring blood pressure. (2) Sit quietly for 5 minutes before the measurement. (3) Have the forearm supported at heart level, with both feet on the ground during the measurement of the 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? - 145/95 or lower - 130/80 or lower - 150/95 or lower - 125/85 or lower

- 130/80 or lower Explanation: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) specifies a lower goal pressure of 130/80 for people with diabetes mellitus.

A patient is being treated for hypertensive emergency. When treating this patient, the priority goal is to lower the mean blood pressure (BP) by up to which percentage in the first hour? - 25% - 35% - 40% - 45%

- 25% Explanation: The therapeutic goals are reduction of the mean BP by up to 25% within the first hour of treatment, a further reduction to a goal pressure of about 160/100 mm Hg over a period of 2 to 6 hours, and then a more gradual reduction in pressure to the target goal over a period of days.

According to the DASH diet, how many servings of vegetables should a person consume each day? - 2 or fewer - 2 or 3 - 4 or 5 - 7 or 8

- 4 or 5 Explanation: Four or five servings of vegetables are recommended in the DASH diet. The diet recommends two or fewer servings of lean meat, fish, and poultry; two or three servings of low-fat or fat-free dairy foods; and seven or eight servings of grains and grain products.

An older adult client visits the clinic for a blood pressure 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 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. Explanation: A possible adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. Teaching should include tips for managing syncope and dizziness. The nurse would not teach the client to take the medicine on an empty stomach.

An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed the client hydrochlorothiazide and enalapril. What will the nurse be sure to include in educating this client? - Change positions (lying or sitting to standing) slowly. - Check blood pressure every day for signs of rebound hypertension. - Do not become dependent on canes, walkers, or handrails. - Eat plenty of salty food to prevent hypotension.

- Change positions (lying or sitting to standing) slowly. Explanation: Antihypertensive medications can cause hypotension, especially postural hypotension that may result in injury. The nurse teaches clients to change positions slowly when moving from a lying or sitting position to a standing position. Rebound hypertension occurs when antihypertensive medications are stopped abruptly. The nurse also counsels elderly clients to use supportive devices such as handrails and walkers to prevent falls that could result from dizziness. Eating salty foods could defeat the purpose of taking the antihypertensive medications.

A client has just been diagnosed with prehypertension. What would the nurse instruct this client to do to restore blood pressure below hypertensive levels? - Increase iodine intake - Decrease sodium intake - Increase fluid intake - Avoid over-the-counter decongestants

- Decrease sodium intake Explanation: The nurse should instruct clients with prehypertension to avoid or decrease sodium and iodine intake. Increasing fluid intake raises circulating blood volume and systemic vascular resistance. Over-the-counter decongestants decrease pulmonary congestion and not hypertension.

Which diagnostic method is recommended to determine whether left ventricular hypertrophy has occurred? - Echocardiography - Electrocardiography - Blood chemistry - Blood urea nitrogen

- Echocardiography Explanation: An echocardiogram is recommended method of determining whether hypertrophy has occurred. Electrocardiography and blood chemistry are part of the routine workup. Renal damage may be suggested by elevations in blood urea nitrogen and creatinine concentrations.

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) Explanation: Essential or primary hypertension, about 95% of cases, is sustained elevated BP with no known cause. This client does not have secondary, pathologic, or malignant hypertension.

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

- Heart rate - Heart rhythm - Character of apical and peripheral pulses Explanation: During the physical examination, the nurse must also pay specific attention to the rate, rhythm, and character of the apical and peripheral pulses to detect the effects of hypertension on the heart and blood vessels.

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

- Hyperkalemia Explanation: ACE inhibitors like benazepril (Lotensin) and angiotensin receptor blockers (ARBs) block aldosterone and may cause hyperkalemia when used with a potassium sparing diuretic such as spironolactone (Aldactone). Hypercalcemia and hypocalcemia would not occur as an imbalance.

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 - Hypokalemia - Hypernatremia - Hyponatremia

- Hyperkalemia Explanation: Potassium-sparing diuretics, such as spironolactone, can cause hyperkalemia, especially if given with an ACE inhibitor. Signs of hyperkalemia are nausea, diarrhea, abdominal cramps, and peaked narrow T-waves.

Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage? - Hypertensive emergency - Hypertensive urgency - Primary hypertension - Secondary hypertension

- Hypertensive emergency Explanation: A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage. Hypertensive urgency is a situation in which blood pressure is severely elevated but there is no evidence of actual or probable target organ damage. Secondary hypertension is high blood pressure from an identified cause, such as renal disease. Primary hypertension denotes high blood pressure from an unidentified source.

A client experiences orthostatic hypotension while receiving furosemide to treat hypertension. How will the nurse intervene? - Administer I.V. fluids as ordered. - Administer an isosorbide as ordered. - Insert an indwelling urinary catheter as ordered. - Instruct the client to sit for several minutes before standing.

- Instruct the client to sit for several minutes before standing. Explanation: To minimize the effects of orthostatic hypotension, the nurse should instruct the client to rise slowly, such as by sitting for several minutes before standing. Administering I.V. fluids would be inappropriate (unless the client were dehydrated) because doing so would counteract the effects of furosemide and could cause fluid imbalance. Administering a vasodilator, isosorbide, would further reduce the client's blood pressure, worsening orthostatic hypotension. Inserting an indwelling urinary catheter would make it easier to monitor urine output, but wouldn't minimize the effects of orthostatic hypotension.

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 - Secondary hypertension - Primary hypertension - Hypertensive urgency

- Isolated systolic hypertension Explanation: As a result of changes that 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. This condition, known as isolated systolic hypertension, is more common in older adults and is associated with significant cardiovascular and cerebrovascular morbidity and mortality (Chobanian et al., 2003).

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. Explanation: It takes 2 to 3 months for the taste buds to adapt to changes in salt intake. Knowing this may help the client adjust to reduced salt intake. The client should be advised to limit alcohol intake.

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 Explanation: In older clients, systolic BP may be elevated because of loss of arterial elasticity (arteriosclerosis). Systolic BP would not become elevated by a decrease in blood volume, an increase in calcium intake, or a decrease in cardiac output.

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 Explanation: The objective of nursing care for patients with hypertension focuses on lowering and controlling the blood pressure without adverse effects and without undue cost.

The nurse is caring for a client with long-standing hypertension. As a client advocate, what should the nurse suggest is most helpful in preventing further complications? - Maintain a healthy diet of fruits and vegetables. - Focus on exercise at least twice a week. - Obtain a regular appointment with eye doctor. - Avoid use of caffeinated beverages.

- Obtain a regular appointment with eye doctor. Explanation: When a client has long-standing hypertension, the high blood pressure damages the arterial vascular system. As a client advocate, the nurse must instruct on not only prevention but also on early identification of complications. Damages may occur to the tiny arteries in the eyes compromising vision. The most helpful instruction is to maintain a regular appointment with an eye doctor. The other options are good instruction for a healthy lifestyle.

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 Explanation: Positioning the arm above the heart level will give a falsely low reading. Placing the arm below the heart will falsely elevate the reading. All other options are correct steps in achieving an accurate blood pressure.

An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for? - Postural hypertension and resulting injury - Rebound hypertension - Sexual dysfunction - Postural hypotension and resulting injury

- Postural hypotension and resulting injury Explanation: Antihypertensive medication can cause hypotension, especially postural hypotension that may result in injury. Rebound hypertension occurs when antihypertensive medication is stopped abruptly. Sexual dysfunction may occur, especially with beta blockers, but other medications are available should this problem ensue. This is not immediately a priority concern. Antihypertensive medications do not usually cause postural hypertension.

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

- Potassium level Explanation: Amiloride (Midamor) is a potassium-sparing diuretic, meaning that it causes potassium retention. The nurse should monitor for hyperkalemia (elevated potassium level) if given with an ACE inhibitor, such as lisinopril (Zestril) or angiotensin receptor blocker.

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

- Purchasing a self-monitoring BP cuff Explanation: Because this client finds visiting the doctor time-consuming just for a BP reading, as the nurse, you can suggest the use of an automatic cuff at a local pharmacy, or purchasing a self-monitoring cuff. Discussing methods to reduce stress, advising smoking cessation, and achieving glycemic control would constitute client education in managing hypertension.

Which term is refers to hypertension in which blood pressure that is controlled with therapy becomes uncontrolled (abnormally high) when the therapy is discontinued? - Essential - Primary - Rebound - Secondary

- Rebound Explanation: Rebound hypertension may precipitate a hypertensive crisis. Essential or primary hypertension denotes high blood pressure from an unidentified source. Secondary hypertension denotes high blood pressure from an identified cause, such as renal disease.

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 - Rebound hypertension - Angina - Left ventricular hypertrophy

- Rebound hypertension Explanation: Patients need to be informed that rebound hypertension can occur if antihypertensive medications are suddenly stopped. Thus, patients should be advised to have an adequate supply of medication, particularly when traveling and in case of emergencies such as natural disasters. If traveling by airplane, patients should pack the medication in their carry-on luggage.

A client is brought to the emergency department with reports 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 by 20% to 25% within the first hour of treatment. - Reduce the blood pressure to about 140/80 mm Hg. - Rapidly reduce the blood pressure so the client will not suffer a stroke. - 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. Explanation: A hypertensive emergency is a situation in which blood pressures are extremely elevated and must be lowered immediately (not necessarily to less than 140/90 mm Hg) to halt or prevent damage to the target organs (Chobanian et al., 2003; Rodriguez et al., 2010). Hypertensive emergencies are acute, life-threatening blood pressure elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. The therapeutic goals are reduction of the mean blood pressure by 20% to 25% within the first hour of treatment, a further reduction to a goal pressure of about 160/100 mm Hg over a period of up to 6 hours, and then a more gradual reduction in pressure over a period of days.

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

- Renal disease Explanation: Secondary hypertension occurs when a cause for the high blood pressure can be identified. These causes include renal parenchymal disease, narrowing of the renal arteries, hyperaldosteronism (mineralocorticoid hypertension), pheochromocytoma, certain medications (e.g., prednisone, epoetin alfa), and coarctation of the aorta. High blood pressure can also occur with pregnancy; women who experience high blood pressure during pregnancy are at increased risk of ischemic heart disease, heart attack, stroke, kidney disease, diabetes, and death from heart attack. Calcium deficiency or acid-based imbalance does not contribute to hypertension.

Which finding indicates that hypertension is progressing to target organ damage? - Retinal blood vessel damage - Urine output of 60 mL over 2 hours - Blood urea nitrogen concentration of 12 mg/dL - Chest x-ray showing pneumonia

- Retinal blood vessel damage Explanation: Symptoms suggesting that hypertension is progressing to the extent that target organ damage is occurring must be detected early so that appropriate treatment can be initiated. All body systems must be assessed to detect any evidence of vascular damage. An eye examination with an ophthalmoscope is important because retinal blood vessel damage indicates similar damage elsewhere in the vascular system. The client is questioned about blurred vision, spots in front of the eyes, and diminished visual acuity. The heart, nervous system, and kidneys are also carefully assessed. A BUN concentration of 12 mg/dL and urine output of 60 mL over 2 hours are normal findings. The presence of pneumonia does not indicate target organ damage.

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? - Primary - Essential - Secondary - Malignant

- Secondary Explanation: Secondary hypertension is elevated BP that results from or is secondary to some other disorder. This type of hypertension is not primary, essential, or malignant.

A nurse is teaching a client with severe hypertension about the damage this condition can cause to the body. What system/organs will the nurse note are particularly targeted for damage due to severe hypertension? - Sensory - Musculoskeletal - Gastrointestinal - Integumentary

- Sensory Explanation: Prolonged elevated blood pressure eventually damages blood vessels throughout the body, particularly in target organs such as the heart, kidneys, brain, and eyes. The usual consequences of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, renal failure, strokes, and impaired vision.

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. Explanation: The nursing instruction emphasized to maintain client safety is to sit on the edge of the chair before rising slowly. By doing so, the client reduces the possibility of falls related to postural hypotension. Using a pillbox to store medications and taking the medication at the same time daily is good medication management instruction, but not necessarily related to safety. When taking antihypertensive medications, there is no reason to restrict driving.

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. - Gallbladder disease - Smoking - Diabetes mellitus - Physical inactivity - Frequent upper respiratory infections

- Smoking - Diabetes mellitus - Physical inactivity Explanation: Risk factors for cardiovascular problems in clients with hypertension include smoking, dyslipidemia, diabetes mellitus, impaired renal function, obesity, physical inactivity, age, and family history.

Which diuretic medication conserves potassium? - Furosemide - Spironolactone - Chlorothiazide - Chlorthalidone

- Spironolactone Explanation: Spironolactone is known as a potassium-sparing diuretic. Furosemide causes loss of potassium from the body. Chlorothiazide and chlorthalidone cause mild hypokalemia.

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 Explanation: The latest guidelines (November 2017) released by the American College of Cardiology and the American Heart Association are: Normal blood pressure: Systolic less than 120 mm Hg and diastolic less than 80 mm Hg. Elevated blood pressure: Systolic between 120 and 129 mm Hg and diastolic less than 80 mm Hg. Stage 1 hypertension: Systolic between 130 and 139 mm Hg or diastolic between 80 and 89 mm Hg. Stage 2 hypertension: Systolic of 140 or greater mm Hg or diastolic of 90 or greater mm Hg.

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. Explanation: Hypernatremia (elevated serum sodium level) increases blood volume, which raises blood pressure. The kidney's response to the elevation in blood pressure is to excrete sodium and excess water. Any retention of sodium and water would increase blood volume and, thus, blood pressure. Sodium and water move together.

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 - To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less - To stop smoking and increase physical activity to 30 minutes/day most days of the week - To lose weight, achieve a body mass index of 24 or less, and to eat a diet rich in fruits and vegetables

- To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less Explanation: The end goal of hypertension treatment is to prevent complications and death by achieving and maintaining arterial blood pressure at 140/90 or lower for most people. To achieve this end goal, the client is taught to make the following lifestyle changes (these are not end goals; they are ways to reach the end goal listed above): (1) maintaining a normal body mass index (about 24; greater than 25 is considered overweight); maintaining a waist circumference of less than 40 inches for men and 35 inches for women; limiting alcohol intake to no more than 2 drinks for men and 1 drink for women per day; engaging in aerobic activity at least 30 minutes per day most days of the week.

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'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. - The client's BP should be measured 1 hour before consuming alcohol. - The client should sit quietly while BP is being measured.

- Using a BP cuff that is too small will give a higher BP measurement. - The client's arm should be positioned at the level of the heart. - The client should sit quietly while BP is being measured. Explanation: These statements are all true when measuring a BP. When using a BP cuff that is too large, the reading will be lower than the actual BP. The client should avoid smoking cigarettes or drinking caffeine for 30 minutes before BP is measured.

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 - hepatic function - calcium deficit - acid-base imbalance

- arterial vasoconstriction Explanation: Secondary hypertension may accompany any primary condition that affects fluid volume or renal function, or causes arterial vasoconstriction.

The nurse is administering medications on a medical-surgical unit. A client is ordered to receive 40 mg oral nadolol for the treatment of hypertension. Before administering the medication, the nurse should - check the client's heart rate. - check the client's serum K+ level. - check the client's urine output. - weigh the client.

- check the client's heart rate. Explanation: Nadolol is a beta-blocker. A desired effect of this medication is to reduce the pulse rate in clients with tachycardia and elevated blood pressure (BP). The nurse should check the client's heart rate (HR) before administering nadolol to ensure that the pulse is not less than 60 beats per minute. The other interventions are not indicated before administering a beta-blocker medication.

Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress - increases the production of neurotransmitters that constrict peripheral arterioles. - increases the resistance that the heart must overcome to eject blood. - increases blood volume and improves the potential for greater cardiac output. - decreases the production of neurotransmitters that constrict peripheral arterioles.

- decreases the production of neurotransmitters that constrict peripheral arterioles. Explanation: Reduced stress decreases the production of neurotransmitters that constrict peripheral arterioles. Reduced stress may assist in reducing blood volume and resistance to the heart.

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

- differ no more than 5 mm Hg between arms. Explanation: Normally, in the absence of disease of the vasculature, arm pressures differ by no more than 5 mm Hg. The pressures in each arm do not have to be equal to be considered normal. Pressures that vary more than 10 mm Hg between arms are an abnormal finding. The left arm pressure is not anticipated to be higher than the right as a normal anatomical variant.

What risk factors would cause the nurse to become concerned that the client may have atherosclerotic heart disease? Select all that apply. - hypertension - diabetes - obesity - lowered triglyceride levels - active lifestyle - family history of early cardiovascular events

- hypertension - diabetes - obesity - family history of early cardiovascular events Explanation: Risk factors for atherosclerotic heart disease include hypertension, dyslipidemia (including high total, low-density lipoprotein [LDL], and triglyceride levels as well as low high-density lipoprotein [HDL] levels), obesity, diabetes, a family history of early cardiovascular events, metabolic syndrome, a sedentary lifestyle, and obstructive sleep apnea.

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

- kidneys Explanation: The autonomic nervous system, the kidneys, and various endocrine glands regulate arterial pressure.

Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through: - ophthalmic examination. - using a sphygmomanometer. - laboratory tests. - an MRI.

- ophthalmic examination. Explanation: Papilledema is an edema of the optic nerves, and thus needs an ophthalmic examination for detection.

It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position - help reduce the blood pressure to resupply oxygen to the brain. - help reduce the work required by the heart to resupply oxygen to the brain. - provide time for the heart to increase the rate of contraction to resupply oxygen to the brain. - provide time for the heart to reduce the rate of contraction to resupply oxygen to the brain.

- provide time for the heart to increase the rate of contraction to resupply oxygen to the brain. Explanation: It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position provide time for the heart to increase its rate of contraction to resupply oxygen to the brain, not blood pressure or heart rate.

Hypertension that can be attributed to an underlying cause is termed - primary hypertension. - essential hypertension. - secondary hypertension. - isolated systolic hypertension.

- secondary hypertension. Explanation: Secondary hypertension may be caused by a tumor of the adrenal gland (e.g., pheochromocytoma). Primary, or essential, hypertension has no known underlying cause. Isolated systolic hypertension is demonstrated by readings in which the systolic pressure exceeds 140 mm Hg and the diastolic measurement is normal or near normal (less than 90 mm Hg).

The nurse is teaching a client about chronic untreated hypertension. What complication will the nurse explain to the client? - peripheral edema - right-sided heart failure - stroke - pulmonary insufficiency

- stroke Explanation: A stroke occurs if vessels in the brain rupture and bleed. If an aneurysm has developed in the aorta from chronic hypertension, it may burst and cause hemorrhage and shock. Peripheral edema, right-sided heart failure, and pulmonary insufficiency are not usually consequences of untreated chronic hypertension.

A 65-year-old client is beginning medical management of recently diagnosed hypertension. The most important strategy in this client's treatment is reducing: - systolic pressure below 150 mm Hg. - systolic pressure below 130 mm Hg. - diastolic pressure below 90 mm Hg. - diastolic pressure below 80 mm Hg.

- systolic pressure below 150 mm Hg. Explanation: Currently, it is believed that in persons younger than 60 years of age, reducing the systolic pressure below 140 mm Hg is more important than decreasing the diastolic blood pressure. In persons older than 60 years, the goal is below 150 mm Hg.