Hypertension NCLEX

The community health nurse is preparing a program geared toward primary prevention of hypertension. When preparing the program, what activities will aid the nurse in meeting the goals of primary prevention? a) providing dietary counseling for clients with hypertension b) offering free blood pressure screenings to participants c) having a contest for participants to win an automatic blood pressure cuff for home use d) providing literature to discuss modifiable risk factors

D Primary prevention activities seek to reduce the incidence of disease. These are risk factors associated with hypertension. Change in modifiable risk factors may result in the reduction of disease incidence. Secondary prevention is the reducing of risks and complications to the client who already has a disorder. Ex- providing dietary counseling, free blood pressure screenings, and a contest for a free BP cuff

An exercise program is prescribed for the client with hypertension. Which intervention would be most likely to assist the client in maintaining an exercise program? a) giving the client a written exercise program b) explaining the exercise program tot eh client's spouse c) reassuring the client that he or she can do the exercise program d) tailoring a program to the client's needs and abilities

D Tailoring or individualizing a program to the client's lifestyle has been shown to be an effective strategy for changing health behaviors. Providing a written program, explaining the program to the client's spouse, and reassuring the client that he or she can do the program may be helpful but are not as likely to promote adherence as individualizing the program.

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? a) check BP daily before taking the medication b) increase fluid intake if dryness of the mouth is a problem c) include high-potassium foods such as bananas in the diet d) change position slowly to help prevent dizziness and falls

D 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. Increasing fluid intake may counteract the effect of themedication, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP does not need to be checked at home by the patient before taking the medication. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.

The nurse is developing a care plan with an older adult and is instructing the client that hypertension can be a silent killer. The nurse should instruct the client to be aware of signs and symptoms of other system failures and encourage the client to report signs of which of the following diseases that are often a result of undeteced high blood pressure? a) cerebrovascular accidents (CVAs) b) Liver disease c) Myocardial Infarction d) Pulmonary disease

A Hypertension is referred to as the silent killer for adults, because until the adult has significant damage to other systems, the hypertension may go undetected. CVAs can be related to long-term hypertension. Liver or pulmonary disease is not generally associated with hypertension. Myocardial infarction is generally related to coronary artery disease.

A client has had hypertension for 20 years. The nurse should asses the client for? a) renal insufficiency and failure b) valvular heart disease c) Endocarditis d) peptic ulcer disease

A Renal disease, including renal insufficiency and failure, is a complication of hypertension. Effective treatment of hypertension assists in preventing this complication.

An industrial health nurse at a larger printing plant finds a male employee's BP to be elevated on two occasions 1 month apart and refers him to his private physician. The employee is about 25 lbs overweight and has smoked a pack of cigarettes daily for more than 20 years. The client was prescribed Atenolol (Tenormin) for the hypertension. The nurse should instruct the client to: a) avoid sudden discontinuation of the drug b) monitor the blood pressure annually c) follow a 2 g sodium diet d) discontinue the medication if severe headaches develop

A Sudden discontinuation of this drug is dangerous because it may exacerbate symptoms. This medication should not be discontinued without a physicians order.

A nurse is teaching a larger female client about alcohol intake and how it affects hypertension. The client asks if drinking two beers at night is an acceptable intake. What answer by the nurse is best? a) no, women should only have one beer a day as a general rule b) no, you should not drink any alcohol with hypertension c) yes, since you are larger, you can have more alcohol d) yes, two beers per day is acceptable amount of alcohol

A Alcohol intake should be limited to 2 drink per day for men and 1 drink per day for women. A "drink" is classified as one beer, 1.5 ox of har liquor, or 5 ounces of wine. Limited alcohol intake is acceptable with hypertension. The women's size does not matter.

When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol: a) Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. b) Increases norepinephrine secretion and thus decreases blood pressure and heart rate. c) Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. d) Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II.

A Propranolol is a beta-adrenergic blocking agent. Actions of propranolol include reducing heart rate, decreasing myocardial contractility, and slowing conduction.

Metoprolol (Toprol XL) is added to the pharmacologic therapy of a diabetic female diagnosed with stage 2 hypertension initially treated with Furosemide (Lasix) and Ramipril (Altace). An expected therapeutic effect is: a) decrease in heart rate b) lessening of fatigue c) improvement in blood sugar levels d) increase in urine output

A The effect of a beta blocker is a decrease in heart rate, contractility, and afterload, which leads to a decrease in blood pressure. The client at first may have an increase in fatigue when starting the beta blocker. The mechanism of action does not improve blood sugar or urine output.

A nurse is educating a group of older adults on the impact of lifestyle changes on hypertension. The nurse includes which of the following in the education? (SATA) a) learn how to read and interpret food labels b) the sodium content of commonly consumed foods c) techniques to incorporate more physical activity into the daily routine d) the actions of calcium channel blocker medications on hypertension e) the importance of adhering to pharmacological regimens for treatment of hypertension

A B C Options A and B address dietary interventions to control hypertension. Option C addresses physical activity. These all involve lifestyle changes to control hypertension. Options D and E are related to pharmacological treatment of hypertension.

When developing a presentation for a local community group on hypertension, the nurse integrates information about the importance of blood pressure control. Which of the following would the nurse include? SATA a) HTN increases the buildup of atherosclerotic plaque b) HTN increases risk of stroke c) HTN increases risk fo colorectal carcinoma d) HTN increases risk fo liver disease e) HTN increases the workload of the heart

A B E Hypertension is serious, because is causes the heart to work too hard and contributes to atherosclerosis. HTN also increases the risk of heart disease, heart failure (HF), kidney disease, blindness, and stroke.

A client is taking clonidine (Catapres) for treatment of hypertension. The nurse should teach the client about which of the following common adverse effects of this drug? SATA a) Dry Mouth b) Hyperkalemia c) Impotence d) Pancreatitis e) Sleep disturbance

A C E Clonidine (Catapres) is a central-acting adrenergic antagonist. It reduces sympathetic outflow from the central nervous system. Dry mouth, impotence, and sleep disturbances are possible adverse effects.

The nurse teaches a client about lifestyle modifications to help manage hypertension. Which client statement indicates teaching has been effective? a) I won't be able to run in marathons anymore b) I know i need to give up my cigarettes and alcohol c) i need to get started on my medications right away d) my father had hypertension, did nothing, and lived to be 90 years old

B Limiting intake of alcohol and discontinuing tobacco products are important nonpharmacological methods for controlling hypertension. Implementing lifestyle modifications may eliminate the need for pharmacotherapy, so the client may not have to take medication right away. Increasing physical activity is an important lifestyle modification for controlling hypertension. The fact that the client's father had hypertension and lived to be 90 years old does not mean that the client will have the same experience; the client is in denial.

A client treated for hypertension with furosemide (Lasix), atenolol (Tenormin), and ramipril (Altace) develops a second degree heart block Mobitz type 1. Which of the following actions should the nurse take? a) administer a 250 mL fluid bolus b) withhold the atenolol c) prepare for cardioversion d) set up for an arterial line

B The client may be asymptomatic and the underlying cause should be assessed. Drugs that block the AV node should be avoided, such as beta blockers (Atenolol), calcium channel blockers, digoxin, and amiodarone. Symptomatic clients are treated with atropine and transcutaneous pacing. There is no indication for a fluid bolus, cardioversion, or arterial line.

The nurse obtains this information from a patient with prehypertension. Which finding is most important to address with the patient? a) low dietary fiber intake b) no regular aerobic exercise c) weight 5 pounds above ideal weight d) drinks wine with dinner once a week

B 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 will not increase the hypertension risk.

In teaching the hypertensive client to avoid orthostatic hypotension, the nurse should emphasize which of the following instructions? SATA a) plan regular times for taking medications b) rise slowly form bed c) avoid standing still for long periods d) avoid excessive alcohol intake e) avoid hot baths

B C Changing positions slowly and avoiding long periods of standing may limit the occurrence of orthostatic hypotension. Scheduling regular medication times is important for blood pressure management but this aspect is not related to the development of orthostatic hypotension.

A patient taking metoprolol (Lopressor) for hypertension reports all of the following side effects. Fo which side effect will you notify the prescriber? a) increased urination during the daytime b) Heart rate of 68/min c) chest pain during exercise d) decreased sexual ability

C

Essential hypertension would be diagnosed in a 40-year-old male whose blood pressure readings were consistently at or above which of the following? a) 120/90 mmHg b) 130/85 mmHg c) 140/90 mmHg d) 160/80 mmHg

C American Heart Association standards define hypertension as a consistent systolic blood pressure level greater than 140 mm Hg and a consistent diastolic blood pressure level greater than 90 mm Hg.

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? a) Organize nursing activities so that the patient has undisturbed sleep for 6 to 8 hours at night. b) Assist the patient up in the chair for meals to avoid complications associated with immobility. c) Use an automated noninvasive blood pressure machine to obtain frequent BP measurements. d) Place the patient on NPO status to prevent aspiration caused by nausea and the associated vomiting.

C Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV antihypertensive medications. This can be most easily accomplished with an automated BP machine or arterial line.

Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new patient? a) obtain a BP reading in each arm and average the result b) deflate the BP cuff at a rate of 5 - 10 mmHg per second c) have the patient sit in a chair with the feet flat on the floor d) assist the patient to the supine position for BP measurements

C The patient should be seated with the feet flat on the floor. The BP is obtained in both arms, but 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 client realizes the importance of quitting smoking, and the nurse develops a plan to help the client achieve this goal. Which of the following nursing interventions should be the initial step in this plan? a) review the negative effects of smoking on the body b) discuss the effects of passive smoking on environmental pollution c) establish the client's daily smoking pattern d) explain how smoking worsens high blood pressure

C A plan to reduce or stop smoking begins with establishing the client's personal daily smoking pattern and activities associated with smoking. It is important that the client understands the associated health and environmental risks, but this knowledge has not been shown to help clients change their smoking behavior.

The most important long-term goal for a client with hypertension would be to: a) learn how to avoid stress b) explore a job change or early retirement c) make a commitment to long-term therapy d) lose weight

C Compliance is the most critical element of hypertension therapy. In most cases, hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully without drug therapy. Stress management is an important component of hypertension therapy, but the priority goal is related to compliance. It is not necessary for the client to change jobs or retire, but rather to learn to manage stress if the job is stressful. Losing weight may be necessary and will contribute to lower blood pressure, but the client must first accept the need for a lifelong management plan to control the hypertension.

After giving a patient the initial dose of oral labetalol (Normodyne) for treatment of hypertension, which action should the nurse take? a) encourage oral fluids to prevent dry mouth or dehydration b) instruct the patient to ask for help if heart palpitations occur c) ask the patient to request assistance when getting out of bed d) teach the patient that headaches may occur with this medication

C 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.

The nurse teaches a client, who has recently been diagnosed with hypertension, about dietary restrictions: a low-calorie, low-fat, low-sodium diet. Which of the following menu selections would best meet the client's needs? a) mixed green salad with blue cheese dressing, crackers, and cold cuts b) ham sandwich on rye bread and an orange c) baked chicken, an apple, and slice of white bread d) hot dogs, baked beans, and celery and carrot sticks

C Processed and cured meat products, such as cold cuts, ham, and hot dogs, are all high in both fat and sodium and should be avoided on a low-calorie, low-fat, low-salt diet. Dietary restrictions of all types are complex and difficult to implement with clients who are basically asymptomatic.

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? a) the patients most recent BP reading is 156/94 mmHg b) the patient pulse has dropped from 64 to 58 beats/min c) the patient has developed wheezes throughout the lung fields d) the patient complains that the fingers and toes feel quite cold

C The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective β-blockers) is occurring. The nurse should immediately obtain an oxygen saturation measurement, apply supplemental oxygen, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes are associated with β-receptor blockade but do not require any change in therapy.

Which precaution is most important for you to teach a patient who has been prescribed a beta blocker drug for hypertension? a) avoid alcoholic beverage while taking this drug b) weigh yourself daily at the same time every morning c) wear gloves and other warm clothing during col weather d) do not suddenly stop taking this drug without notifying your prescriber

D

The nurse has just finished teaching a hypertensive patient about the newly prescribed quinapril (Accupril). Which patient statement indicates that more teaching is needed? a) "The medication may not work as well if I take any aspirin." b) "The doctor may order a blood potassium level occasionally." c) "I will call the doctor if I notice that I have a frequent cough." d) "I won't worry if I have a little swelling around my lips and face."

D 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.

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? a) the patient avoids eating nuts or nut butters b) the patient restricts intake of dietary protein c) the patient has only one cup of coffee in the morning d) the patient has a glass of low fat milk with each meal

D The Dietary Approaches to Stop Hypertension (DASH) recommendations for prevention of hypertension 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.

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 a) a BP recheck should be scheduled in a few weeks b) the dietary sodium and fat content should be decreased c) there is an immediate danger of a stroke and hospitalization will be required d) more diagnostic testing may be needed to determine the cause of the hypertension

D 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. The BP will need rapid treatment and ongoing monitoring.

A client's job involves working in a warm, dry room, frequently bending and crouching to check the underside of a high-speed press, and wearing eye guards. Given this information, the nurse should assess the client for which of the following? a) muscle aches b) thirst c) lethargy d) orthostatic hypotension

D Possible dizziness from orthostatic hypotension when rising from a crouched or bent position increases the client's risk of being injured by the equipment. The nurse should assess the client's blood pressure in all three positions (lying, sitting, and standing) at all routine visits. The client may experience muscle aches, or thirst from working in a warm, dry room, but these are not as potentially dangerous as orthostatic hypotension. The client should not be experiencing lethargy.