Med Surg Exam 2 Question Set

A nurse provides education to a hypertensive patient related to lifestyle modifications to reduce cardiovascular risks associated with high blood pressure (BP). Which statement made by the patient indicates effective learning? Select all that apply. "I should achieve and maintain a healthy weight." "I can continue to smoke, because nicotine does not affect blood pressure. "I should exercise for at least 30 minutes daily." "I can have up to five alcoholic drinks per day." "I should restrict my salt intake to less than 1500 mg/day."

"I should achieve and maintain a healthy weight." "I should exercise for at least 30 minutes daily." "I should restrict my salt intake to less than 1500 mg/day." Lifestyle modifications play a vital role in reducing blood pressure and cardiovascular risk. Overweight people are at higher risk of cardiovascular disease. A weight loss of 22 lb may decrease systolic blood pressure by approximately 5 to 20 mm Hg. Being physically active is essential to maintain good health. It decreases the cardiovascular risk of hypertension. Sodium reduction helps to control blood pressure. A hypertensive patient should lower salt intake to 1500 mg/day. The nicotine in tobacco causes vasoconstriction and increases blood pressure. Therefore, smokers who are hypertensive should stop smoking. Excessive alcohol consumption increases the risk of hypertension. Consuming three or more drinks per day increases the risk of cardiovascular disease and stroke.

The nurse is teaching the patient about the Dietary Approaches to Stop Hypertension (DASH) diet. Which statement indicates that the patient understood the teaching? "I should eat more red meat, such as pork or beef." "I should drink no more than three glasses of whole milk per day." "I should include four to five servings of fruits and vegetables daily." "I should consume whole grain products no more than once per week."

"I should include four to five servings of fruits and vegetables daily." The DASH diet encourages consumption of fruits and vegetables. Pork and beef are high in fat and therefore have to be restricted according to the DASH diet; poultry and fish have to be consumed instead of red meat. Fat-free or low-fat milk has to be used instead of whole milk according to the DASH recommendations. The DASH diet recommends a few servings of whole grain products daily.

In reviewing medication instructions with a patient being discharged on antihypertensive medications, which statement would be most appropriate for the nurse to make when discussing guanethidine? "A fast heart rate is a side effect to watch for while taking guanethidine." "Stop the drug and notify your health care provider if you experience any nausea or vomiting." "Because this drug may affect the lungs in large doses, it also may help your breathing." "Make position changes slowly, especially when rising from lying down to a standing position."

"Make position changes slowly, especially when rising from lying down to a standing position." Guanethidine is a peripheral-acting α-adrenergic antagonist and can cause marked orthostatic hypotension. For this reason, the patient should be instructed to rise slowly, especially when moving from a recumbent to a standing position. Support stockings also may be helpful. Tachycardia or lung effects are not evident with guanethidine, nor are nausea and vomiting.

A 65-year-old patient without any past medical problems has his or her blood pressure checked at a primary health care provider's office during an annual physical examination. The blood pressure (BP) reading is 158/92. The patient is asking the nurse who was checking the blood pressure: "Does this mean that I have hypertension?" What is the most appropriate answer from the nurse? "Do not worry, everything is fine." "It is a normal blood pressure reading for a person of your age." "Yes, you have hypertension, because your blood pressure is over 140/90." "You need to have a follow-up appointment to recheck your blood pressure."

"You need to have a follow-up appointment to recheck your blood pressure." The diagnosis of hypertension is made based on two or more elevated blood pressure readings. Considering the fact that the patient does not have any medical problems and that this reading is the first elevated blood pressure reading, a follow-up office visit is required. Providing false reassurance to the patient is leading to misinformation. For any person of age 18 and older, BP higher than 140/90 is considered elevated. Diagnosing the patient with a medical diagnosis is not within the nursing scope of practice and cannot be done based on one elevated BP reading.

The patient with hypertension is due for a dose of metoprolol 37.5 mg. Available are 25-mg tablets. How many tablets should the nurse administer?

1.5

African Americans, people middle aged or older, and those with hypertension, diabetes mellitus, chronic kidney disease should restrict sodium to less than or equal to how many mg/day?

1500 mg/day

healthy adults should restrict sodium intake to less than or equal to..?

2300 mg/day

The nurse is checking blood pressure for people at a health fair. Which patient is at higher risk to develop primary hypertension? 65-year-old retired Caucasian with a body mass index (BMI) of 15 60-year-old who has chronic pain caused by cancer 45-year-old blue collar worker who smokes one pack of cigarettes per day 59-year-old African American with a BMI of 35 who has a high stress job

59-year-old African American with a BMI of 35 who has a high stress job The patient has four risk factors for primary hypertension: advanced age, African American race, morbid obesity with a BMI of 35, and a high level of stress.

the presence or absence of diurnal variability can be determined by what?

ABPM

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. b. make an appointment with the dietitian for teaching. c. check the blood pressure (BP) at home at least once a day. d. move slowly when moving from lying to sitting to standing.

ANS: A 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. DIF: Cognitive Level: Apply (application) REF: 691

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 b. Serum potassium of 4.5 mEq/L c. Serum hemoglobin of 14.7 g/dL d. Blood glucose level of 96 mg/dL

ANS: A The elevated serum creatinine indicates renal damage caused by the hypertension. The other laboratory results are normal. DIF: Cognitive Level: Analyze (analysis) REF: 686

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. b. Provide a list of low-sodium foods. c. Help the patient make an appointment with a dietitian. d. Teach the patient about foods that are high in potassium.

ANS: A The initial nursing action should be assessment of the patient's baseline dietary intake through a thorough diet history. The other actions may be appropriate, but assessment of the patient's baseline should occur first. DIF: Cognitive Level: Analyze (analysis) REF: 694

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 b. 52-yr-old with a blood pressure of 198/90 mm Hg who has intermittent claudication c. 50-yr-old with a blood pressure of 190/104 mm Hg who has a creatinine of 1.7 mg/dL d. 43-yr-old with a blood pressure of 172/98 mm Hg whose urine shows microalbuminuria

ANS: A 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. DIF: Cognitive Level: Analyze (analysis) REF: 695

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? a. "The medication may not work well if I take aspirin. " b. "I can expect some swelling around my lips and face." c. "The doctor may order a blood potassium level occasionally." d. "I will call the doctor if I notice that I have a frequent cough."

ANS: B 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. DIF: Cognitive Level: Apply (application) REF: 692

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? a. Tell the patient why a change in drug dosage is needed. b. Ask the patient if the medication is being taken as prescribed. c. Inform the patient that multiple drugs are often needed to treat hypertension. d. Question the patient regarding any lifestyle changes made to help control BP.

ANS: B 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. DIF: Cognitive Level: Analyze (analysis) REF: 695

Which assessment finding for a patient who is receiving IV furosemide (Lasix) to treat stage 2 hypertension is most important to report to the health care provider? a. Blood glucose level of 175 mg/dL b. Serum potassium level of 3.0 mEq/L c. Orthostatic systolic BP decrease of 12 mm Hg d. Most recent blood pressure (BP) reading of 168/94 mm Hg

ANS: B 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. The elevated blood glucose and BP also indicate a need for collaborative interventions but will not require action as urgently as the hypokalemia. An orthostatic drop of 12 mm Hg will require intervention only if the patient is symptomatic. DIF: Cognitive Level: Analyze (analysis) REF: 688

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? a. Instruct the patient about the need to decrease stress levels. b. Teach the patient how to self-monitor and record BPs at home. c. Schedule the patient for regular blood pressure (BP) checks in the clinic. d. Inform the patient and caregiver that major dietary changes will be needed.

ANS: B 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. Regular BP checks in the clinic are likely to be high in a patient with white coat hypertension. There is no evidence that this patient has elevated stress levels or a poor diet, and those factors do not cause white coat hypertension. DIF: Cognitive Level: Apply (application) REF: 687

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? a. "Have you recently taken any antihistamines?" b. "Have you consistently taken your medications?" c. "Did you take any acetaminophen (Tylenol) today?" d. "Have there been recent stressful events in your life?"

ANS: B 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. DIF: Cognitive Level: Apply (application) REF: 691

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? a. 98/56 mm Hg b. 128/76 mm Hg c. 128/92 mm Hg d. 142/78 mm Hg

ANS: B 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. DIF: Cognitive Level: Apply (application) REF: 684

Which action will the nurse in the hypertension clinic take to obtain an accurate baseline blood pressure (BP) for a new patient? a. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second. b. Have the patient sit in a chair with the feet flat on the floor. c. Assist the patient to the supine position for BP measurements. d. Obtain two BP readings in the dominant arm and average the results.

ANS: B 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. DIF: Cognitive Level: Understand (comprehension) REF: 696

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? a. Urine output over 8 hours is 250 mL less than the fluid intake. b. The patient cannot move the left arm and leg when asked to do so. c. Tremors are noted in the fingers when the patient extends the arms. d. The patient complains of a headache with pain at level 7 of 10 (0 to 10 scale).

ANS: B 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. The other clinical manifestations are also likely caused by the hypertension and will require rapid nursing actions, but they do not require action as urgently as the neurologic changes. DIF: Cognitive Level: Analyze (analysis) REF: 699

The nurse obtains the following information from a patient newly diagnosed with prehypertension. Which finding is most important to address with the patient? a. Low dietary fiber intake b. No regular physical exercise c. Drinks a beer with dinner every night d. Weight is 5 pounds above ideal weight

ANS: 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 is within guidelines and will not increase the hypertension risk. DIF: Cognitive Level: Analyze (analysis) REF: 689

what is the primary BP effect of b-adrenergic blocker such as atenolol (tenormin)? a.vasodilation of arterioles by blocking movement of calcium into cells b. decrease Na+ and water reabsorption by blocking the effect of aldosterone c. decrease CO by decreasing rate and strength of the heart and renin secretion by the kidneys d. vasodilation caused by inhibiting sympathetic outflow from the central nervous system (CNS)

ANS: C

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 a. a BP recheck should be scheduled in a few weeks. b. dietary sodium and fat content should be decreased. c. diagnosis, treatment, and ongoing monitoring will be needed. d. there is an immediate danger of a stroke, requiring hospitalization.

ANS: C 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. There is no indication that dietary salt or fat intake have contributed to this sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this BP to an acceptable level. DIF: Cognitive Level: Apply (application) REF: 684

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? a. The patient avoids eating nuts or nut butters. b. The patient restricts intake of chicken and fish. c. The patient drinks low-fat milk with each meal. d. The patient has two cups of coffee in the morning.

ANS: C 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. DIF: Cognitive Level: Apply (application) REF: 687

Which information is most important for the nurse to include when teaching a patient with newly diagnosed hypertension? a. Most people are able to control BP through dietary changes. b. Annual BP checks are needed to monitor treatment effectiveness. c. Hypertension is usually asymptomatic until target organ damage occurs. d. Increasing physical activity alone controls blood pressure (BP) for most people.

ANS: C Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle changes (e.g., 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. DIF: Cognitive Level: Apply (application) REF: 685

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 a. daily alcohol use. b. peptic ulcer disease. c. reactive airway disease. d. myocardial infarction (MI).

ANS: C Nonselective b-blockers block b1- and b2-adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma. b-Blockers will have no effect on the patient's peptic ulcer disease or alcohol use. b-Blocker therapy is recommended after MI. DIF: Cognitive Level: Apply (application) REF: 692

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? a. Include high-potassium foods such as bananas in the diet. b. Increase fluid intake if dryness of the mouth is a problem. c. Change position slowly to help prevent dizziness and falls. d. Check blood pressure (BP) in both arms before taking the drug.

ANS: C 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 the drug, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP should be taken in the nondominant arm by newly diagnosed patients in the morning, before taking the drug, and in the evening. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate. DIF: Cognitive Level: Apply (application) REF: 691

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? a. The patient's pulse has dropped from 68 to 57 beats/min. b. The patient complains that the fingers and toes feel quite cold. c. The patient has developed wheezes throughout the lung fields. d. The patient's blood pressure (BP) reading is now 158/91 mm Hg.

ANS: C 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. The mild decrease in heart rate and complaint of cold fingers and toes are associated with -receptor blockade but do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated. However, this is not as urgently needed as addressing the bronchospasm. DIF: Cognitive Level: Analyze (analysis) REF: 692

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? a. Patient takes a daily multivitamin tablet. b. Patient checks BP daily just after getting up. c. Patient drinks wine three to four times a week. d. Patient uses ibuprofen (Motrin) treat osteoarthritis.

ANS: D Because use of nonsteroidal antiinflammatory drugs (NSAIDs) can prevent adequate BP control, the patient may need to avoid the use of ibuprofen. A multivitamin tablet will help supply vitamin D, which may help lower BP. BP decreases while sleeping, so self-monitoring early in the morning will result in obtaining pressures that are at their lowest. The patient's alcohol intake is not excessive. DIF: Cognitive Level: Apply (application) REF: 691

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

ANS: D 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. The patient will require frequent assessments, so allowing 8 hours of undisturbed sleep is not reasonable. When patients are receiving IV vasodilators, bed rest is maintained to prevent decreased cerebral perfusion and fainting. There is no indication that this patient is nauseated or at risk for aspiration, so an NPO status is unnecessary. DIF: Cognitive Level: Apply (application) REF: 699

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)? a. Evaluate effectiveness of nitroprusside therapy on blood pressure (BP). b. Assess the patient's environment for adverse stimuli that might increase BP. c. Titrate nitroprusside to decrease mean arterial pressure (MAP) to 115 mm Hg. d. Set up the automatic noninvasive BP machine to take readings every 15 minutes.

ANS: D 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. DIF: Cognitive Level: Apply (application) REF: 696

Which action should the nurse take when giving the initial dose of oral labetalol to a patient with hypertension? a. Encourage the use of hard candy to prevent dry mouth. b. Teach the patient that headaches often occur with this drug. c. Instruct the patient to call for help if heart palpitations occur. d. Ask the patient to request assistance before getting out of bed.

ANS: D Labetalol decreases sympathetic nervous system activity by blocking both a- and b-adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension. Heart palpitations, dry mouth, dehydration, and headaches are possible side effects of other antihypertensives. DIF: Cognitive Level: Apply (application) REF: 692

which ethnic group has the highest prevalence of HTN in the world?

African Americans

Despite a high dosage, a male patient who is taking nifedipine for antihypertensive therapy continues to have blood pressures over 140/90 mm Hg. What should the nurse do next?

Assess the patient's adherence to therapy The nurse needs to assess the patient's adherence to therapy. The patient's blood pressure is still elevated and must be addressed.

A patient with hypertension has been prescribed an antihypertensive medication. During a follow-up visit, the patient asks if the medication can be stopped because the blood pressure (BP) is now within the normal range. Which nursing response is appropriate? Stop the medication because the BP is normal. Reduce the dose of the medication because the BP has decreased. Continue the medication until the health care provider advises to discontinue it. Stop taking the medication and manage the BP with lifestyle modifications.

Continue the medication until the health care provider advises to discontinue it. Antihypertensive medications are effective at reducing BP; however, the medications should not be stopped abruptly, because this can cause a severe hypertensive reaction. The medications should be discontinued only after consulting with the primary health care provider. The medication should not be stopped even if the BP measurements show normal readings. Medications should be taken regularly for sustained therapeutic effects. A reduction of the dosage may reduce the efficacy of the drug. Lifestyle modifications are necessary to reduce cardiovascular risks; however, antihypertensive medications should also be used for effective reduction of BP.

The nurse is teaching the patient who was diagnosed recently with primary hypertension. Which instruction has the highest priority? Limit intake of canned fruits Exercise to reduce your weight Walk at least 30 minutes five to seven days a week Decrease intake of food high in salt

Decrease intake of food high in salt Primary hypertension doesn't have an identified cause, but contributing factors include high sodium intake. Therefore, decreasing intake or complete elimination of foods high in sodium will help to reduce blood pressure in the patient diagnosed with primary hypertension. Canned fruits are high in sugar, which does not influence blood pressure. Walking and exercising help to reduce weight and therefore decrease blood pressure, but both interventions will require a longer period of time to achieve results.

For what change in vital signs would the nurse assess a patient experiencing postural hypotension? Increased systolic blood pressure, decreased pulse rate Increased diastolic blood pressure, increased pulse rate Decreased systolic blood pressure, decreased diastolic blood pressure, increased pulse rate Decreased systolic blood pressure, increased diastolic blood pressure, no change in pulse rate

Decreased systolic blood pressure, decreased diastolic blood pressure, increased pulse rate A decrease in both systolic and diastolic blood pressure and an increase in pulse would be seen in a patient with postural hypotension. Blood pressure drops as the volume of circulating blood decreases when a patient abruptly stands from a lying or sitting position. The pulse rate increases as the heart attempts to compensate by increasing the amount of circulating blood by increasing cardiac output. Increased systolic blood pressure and decreased pulse rate; increased diastolic blood pressure and increased pulse rate; and decreased systolic blood pressure, increased diastolic blood pressure, and no change in pulse rate are all incorrect.

A patient is being discharged from the hospital. The primary health care provider prescribes propranolol for hypertension. Which instruction should the nurse include in the patient's discharge teaching plan? Do not stop taking abruptly. Take initial doses at bedtime. Monitor for peripheral edema. Take with orange juice.

Do not stop taking abruptly. Patients should not stop taking this medication abruptly, because this may cause rebound hypertension. The initial dose of alpha-1 adrenergic blockers should be taken at bedtime because of the possible profound orthostatic hypotension with syncope within 90 minutes after the initial dose. Calcium channel blockers may cause peripheral edema. Beta blockers are not potassium wasting, so it is not necessary to take them with orange juice.

The patient has chronic hypertension. Today the patient has gone to the emergency department and the patient's blood pressure has risen to 200/140. What is the priority assessment for the nurse to make? Is the patient pregnant? Does the patient need to urinate? Does the patient have a headache or confusion? Is the patient taking antiseizure medications as prescribed?

Does the patient have a headache or confusion? The nurse's priority assessments include neurologic deficits, retinal damage, heart failure, pulmonary edema, and renal failure. The headache or confusion could be seen with hypertensive encephalopathy, from increased cerebral capillary permeability leading to cerebral edema. Pregnancy can lead to secondary hypertension. Needing to urinate and taking antiseizure medication do not indicate a hypertensive emergency.

what effect do psychosocial risk factors have on the body?

HTN, tachycardia, inflammation, endothelium dysfunction, increased platelet aggregation, insulin resistance, and central obesity

A nurse works in a medical unit. The nurse has assessed the patients and planned care for them. Which activities can be delegated to unlicensed assistive personnel (UAP)? Select all that apply. Report high or low BP readings to the registered nurse. Make appropriate referrals to other health care professionals. Teach patients about lifestyle management and medication use. Check for postural changes in BP. Assess patients for hypertension risk factors and develop risk modification plans.

Report high or low BP readings to the registered nurse. Check for postural changes in BP. Reporting high or low BP readings and checking for postural changes in BP are repetitive activities and do not require nursing judgment. Therefore, these activities can be delegated to unlicensed assistive personnel.

When teaching a patient about dietary management of stage 1 hypertension, which instruction is most appropriate? Restrict all caffeine Restrict sodium intake Increase protein intake Use calcium supplements

Restrict sodium intake The patient should decrease intake of sodium. This will help to control hypertension, which can be aggravated by excessive salt intake, which in turn leads to fluid retention.

A patient reports chest pain and is admitted to the emergency department. The patient is obese, smokes cigarettes, and drinks alcohol in moderate amounts. The patient had taken labetalol for high blood pressure (BP) for one week and then stopped taking the medication the morning of admission. The nurse recognizes that the probable reason for the patient's angina is what? Leading a sedentary lifestyle after a lifetime of obesity Smoking cigarettes Stopping labetalol abruptly after a week of treatment Alcohol consumption

Stopping labetalol abruptly after a week of treatment Labetalol is an alpha- and beta-adrenergic blocker and reduces BP by causing vasodilatation and a decrease in heart rate. The patient should not stop the drug abruptly, because it may precipitate angina and heart failure. Obesity, a sedentary lifestyle, smoking, and alcohol consumption are risk factors for cardiovascular disease but are unlikely to cause angina.

A patient arrives at a medical clinic for a check-up. The patient's blood pressure (BP) is 150/94 mm Hg. All other assessment findings are within normal limits. The nurse reviews the patient's file from previous visits, and there is no history of elevated blood pressure. What could be the reason for a falsely high blood pressure? The blood pressure cuff might have been too small. There may be atherosclerosis in the subclavian artery. The patient may have smoked the day before the BP measurement. The patient may have engaged in strenuous exercises the day before the BP measurement.

The blood pressure cuff might have been too small. BP measurements should be performed using proper technique to get an accurate reading. BP measurements may be falsely high if the BP cuff is too small as it puts undue pressure on the artery. If the subclavian artery has atherosclerosis, the BP measurement would be falsely low. Smoking and engaging in strenuous exercise should be avoided 30 minutes before the BP measurement, because they can alter the measurement. Smoking or engaging in strenuous exercise one day before a BP measurement will not affect the readings.

While measuring a patient's blood pressure (BP), a nurse finds that there is a difference in BP and heart rate when the patient changes position form supine to standing. There is a decrease of 20 mm Hg in systolic BP (SBP), a decrease of 10 mm Hg in diastolic BP (DBP), and an increase in the heart rate of 20 beats/minute. How should the nurse interpret these findings?

The patient is experiencing orthostatic hypotension.

hypertensive crisis occurs more often in patients with?

a history of HTN who have not adhered to their medication regimens or who have been undermedicated

14. 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 b. 52-yr-old with a blood pressure of 198/90 mm Hg who has intermittent claudication c. 50-yr-old with a blood pressure of 190/104 mm Hg who has a creat of 1.7 mg/dL d. 43-yr-old with a blood pressure of 172/98 mm Hg whose urine shows microalbuminuria

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.

22. 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. b. Provide a list of low-sodium foods. c. Help the patient make an appointment with a dietitian. d. Teach the patient about foods that are high in potassium.

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 other actions may be appropriate, but assessment of the patient's baseline should occur first.

15. The nurse is reviewing the laboratory test results for a patient who has recently been diagnosed with hypertension. Which result is mostimportant to communicate to the health care provider? a. Serum creatinine of 2.8 mg/dL b. Serum potassium of 4.5 mEq/L c. Serum hemoglobin of 14.7 g/dL d. Blood glucose level of 96 mg/dL

a. Serum creatinine of 2.8 mg/dL The elevated serum creatinine indicates renal damage caused by the hypertension. The other laboratory results are normal.

20. 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. b. make an appointment with the dietitian for teaching. c. check the blood pressure (BP) at home at least once a day. d. move slowly when moving from lying to sitting to standing.

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 is admitted to the hospital in hypertensive emergency (BP 244/142). Sodium nitroprusside is started to treat the elevated BP. Which management strategies would be appropriate for this patient? (select all that apply) a. measuring hourly urine output b. decreasing the MAP by 50% within the first hour c. continuous BP monitoring with an intraarterial line d. maintaining bed rest and providing tranquilizers to lower the BP e. assessing the patient for signs and symptoms of heart failure and changes in mental status

a. measuring hourly urine output c. continuous BP monitoring with an intraarterial line e. assessing the patient for signs and symptoms of heart failure and changes in mental status

A patient with newly discovered high BP has an average reading of 158/98 mm Hg after 3 months of exercise and diet modifications. Which management strategy will be a priority for this patient? a. medication will be required because the BP is still not at goal b. BP monitoring should continue for another 3 months to confirm diagnosis of hypertension c. lifestyle changes are less important, since they were not effective, and medications will be started d. more vigorous changes in the patient's lifestyle are needed for a longer time before starting medications

a. medication will be required because the BP is still not at goal

Which BP-regulating mechanisms can result in the development of hypertension if defective? (select all that apply a. release of norepinephrine b. secretion of prostaglandins c. stimulation of the SNS d. stimulation of PNS e. activation of the renin-angiotensin-aldosterone system

a. release of norepinephrine c. stimulation of the SNS e. activation of the renin-angiotensin-aldosterone system

What early manifestations is the patient with primary hypertension likely to report? a. no symptoms b. cardiac palpitations c. dyspnea on exertion d. dizziness and vertigo

ans: a

during treatment of a patient with a BP of 222/148 mm Hg and confusion, nausea, and vomiting, the nurse initially titraes the medications to achieve which goal? a. decrease the mean arterial pressure (MAP) to 129 mm Hg b. lower BP to the patient's normal within the second to third hr c. decrease the SBP to 160 mm Hg and the DBP to between 100 and 110 mm Hg as quickly as possible d. reduce the systolic BP (SBP) to 158 mm Hg and the disatolic BP (SBP) to 90 mm Hg within the first 2 hrs

ans: a

what should the nurse emphasize when teaching a patient who is newly prescribed clonidine (catapres)? a. the drug should never be stopped abruptly b. the drug should be taken early in the day to prevent nocturia c. the first dose should be taken when the patient is in bed for he night d. because aspirin will decrease the drug's effectiveness, tylenol should be used instead

ans: a

what are nonmodifiable risk factors for primary hypertension (select all that apply)? a. age b. obesity c. gender d. ethnicity e. genetic link

ans: a, c, d, e,

a 78 yr old patient is admitted with a BP of 180/98 mm Hg. Which age-related physical changes may contribute to this patient's hypertension (select all that apply)? a. decreased renal function b. increased baroreceptor reflexes c. increased peripheral vascular resistance d. increased adrenergic receptor sensitivity e. increased collagen and stiffness of the myocardium f. loss of elasticity in large arteries from arteriosclerosis

ans: a, c, e, f

a patient with stage 2 hypertension who is taking chlorothiazide (diuril) and lisinopril (zestril) has prazosin (minipress) added to the medication regimen. what is most important for the nurse to teach the pateint to do? a. weigh every morning to monitor for fluid retention b. change position slowly and avoid prolonged standing c. use sugarless gum or candy to help relieve dry mouth d. take the pulse daily to note any slowing of the heart rate.

ans: b

most organ damage in hypertention is related to what? a. increased fluid pressure exerted against organ tissue b. atherosclerotic changes in vessels that supply the organs c. erosion and thinning of blood vessels in organs from constant pressure d. increased hydrostatic pressure causing leakage of plasma into organ interstitial spaces

ans: b

the pateint who is being admitted has had a history of uncontrolled hypertension. High SVR is most likely to cause damage to which organ? a. brain b. heart c. retina d. kidney

ans: b

the unit is very busy and short staffed. what could the rn delegate to the unlicensed assistive personnel (UAP)? a. administer antihypertensive medications to stable patients b. obtain orthostatic blood pressure readings for older patients c. check BP readings for the patient receiving IV sodium nitroprusside d. teach about home BP monitoring and use of automatic BP monitoring equipment

ans: b

a 38yr old man is treated for hypertension with triamterene and hydrochlorothiazide and metoprolol (lopressor). Four months after his last clinic visit, his BP returns to pretreatment leves, and he admits he has not been taking his medication regularly. what is the nurse's best response to this patient? a. "try always to take your medication when you carry out another daily routine so that you do not forget to take it" b. "you probably would not need to take medications for hypertension if you would exercise more and stop smoking" c. "the drugs you are taking cause sexual dysfunction in many patients. are you experiencing any problems in this area?" d. "you need to remember that hypertension can be only controlled with medication, not cured, and you must always take your medication"

ans: c

the patient diagnosed with secondary hypertension asks why it is called secondary and not primary. what is the best explanation for the nurse to provide? a. has a more gradual onet then primary hypertension b. does not cause the target organ damage that occurs with primary hypertension c. has specific cause, such as renal disease, that often can be treated by medicne or surgery d. is caused by age-related changes in BP regulatory mechanisms in people over 65yrs of age

ans: c

which manifestation is an indication that a patient is having hypertensive emergency? a. symptoms of a stroke with an elevated BP b. a systolic BP>180 mm Hg and a diastolic BP >110 mm Hg c. a sudden rise in BP accompanied by neurologic impairment d. a severe elevation of BP that occurs over several days or weeks

ans: c

dietary teaching that includes eating dietary sources of potassium is indicted for the hypertensive patient takin which drug? a. enalapril b. labetalol c. spironolactone d. hydrochlorothiazide

ans: d

the patient asks the nurse about valsartan (diovan), the new medication prescribed for blood pressure. what is the best explanation the nurse can use to explain the action of this medication? a. prevents the conversion of angiotensin I to angiotensin II b. acts directly on smooth muscle of arterioles to cause vasodilation c. decreases extracellular fluid volume by increasing Na+ and Cl- excretion with water d. vasodilation, prevents the action of angiotensin II, and promotes increased salt and water excretion

ans: d

what is included in the correct technique for BP measurements? a. always take the BP in both arms b. position the patient supine for all readings c. place the cuff loosely around the upper arm d. take reading at least two times at least 1 min apart

ans: d

which drugs are most commonly used to treat hypertensive crises? a. labetalol and bumetanide (bumex) b. esmolol (brevibloc) and captopril (captopril) c. enalaprilat (vasotec) and minoxidil (minoxidil) d. fenoldopam (corlopam) and sodium nitroprusside (nitropress)

ans: d

what does the nursing responsibility in the management of the patient with hypertensive urgency often include? a. monitoring hourly urine output for drug effectiveness b. titrating IV drug dosages based on BP and HR measurements every 2-3 min c. providing continuous electrocardiographic (ECG) monitoring to detect side effects of the drugs d. instructing the patient to follow up with a health care provider within 24hrs after outpatient treatment

ans:d

what are your primary responsibilities for long-term management of HTN?

assist the patient in reducing BP and adhering to the treatment plan

what is the most common cause of cerebrovascular disease?

atherosclerosis

a lipid profile provides information about additional risk factors related to?

atherosclerosis and CVD

a wide gap between the first korotkoff sounds and the subsequent beats?

auscultatory gap

16. 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? a. "Have you recently taken any antihistamines?" b. "Have you consistently taken your medications?" c. "Did you take any acetaminophen (Tylenol) today?" d. "Have there been recent stressful events in your life?"

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.

9. 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? a. "The medication may not work well if I take aspirin." b. "I can expect some swelling around my lips and face." c. "The doctor may order a blood potassium level occasionally." d. "I will call the doctor if I notice that I have a frequent cough."

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.

12. 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? a. 98/56 mm Hg b. 128/76 mm Hg c. 128/92 mm Hg d. 142/78 mm Hg

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.

18. 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? a. Tell the patient why a change in drug dosage is needed. b. Ask the patient if the medication is being taken as prescribed. c. Inform the patient that multiple drugs are often needed to treat hypertension. d. Question the patient regarding any lifestyle changes made to help control BP.

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.

1. Which action will the nurse in the hypertension clinic take to obtain an accurate baseline blood pressure (BP) for a new patient? a. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second. b. Have the patient sit in a chair with the feet flat on the floor. c. Assist the patient to the supine position for BP measurements. d. Obtain two BP readings in the dominant arm and average the results.

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.

2. The nurse obtains the following information from a patient newly diagnosed with prehypertension. Which finding is most important to address with the patient? a. Low dietary fiber intake b. No regular physical exercise c. Drinks a beer with dinner every night d. Weight is 5 pounds above ideal weight

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.

21. Which assessment finding for a patient who is receiving IV furosemide (Lasix) to treat stage 2 hypertension is most important to report to the health care provider? a. Blood glucose level of 175 mg/dL b. Serum potassium level of 3.0 mEq/L c. Orthostatic systolic BP decrease of 12 mm Hg d. Most recent blood pressure (BP) reading of 168/94 mm Hg

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. The elevated blood glucose and BP also indicate a need for collaborative interventions but will not require action as urgently as the hypokalemia. An orthostatic drop of 12 mm Hg will require intervention only if the patient is symptomatic.

11. An older patient has been diagnosed with possible white coat hypertension. Which planned action by the nurse bestaddresses the suspected cause of the hypertension? a. Instruct the patient about the need to decrease stress levels. b. Teach the patient how to self-monitor and record BPs at home. c. Schedule the patient for regular blood pressure (BP) checks in the clinic. d. Inform the patient and caregiver that major dietary changes will be needed.

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. Regular BP checks in the clinic are likely to be high in a patient with white coat hypertension. There is no evidence that this patient has elevated stress levels or a poor diet, and those factors do not cause white coat hypertension.

17. 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? a. Urine output over 8 hours is 250 mL less than the fluid intake. b. The patient cannot move the left arm and leg when asked to do so. c. Tremors are noted in the fingers when the patient extends the arms. d. The patient complains of a headache with pain at level 7 of 10 (0 to 10 scale).

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. The other clinical manifestations are also likely caused by the hypertension and will require rapid nursing actions, but they do not require action as urgently as the neurologic changes.

While obtaining subjective assessment data from a patient with HTN, the nurse recognizes that a modifiable risk factor for the the development of HTN is? a. a low-calcium diet b. excessive alcohol consumption c. a family history of HTN d. consumption of a high-protein diet

b. excessive alcohol consumption

how do the kidneys contribute to BP regulation?

by controlling sodium excretion and extracellular fluid volume

how do adrenergic inhibiting agents act on the body?

by decreasing the SNS effects that increase BP

how does epinephrine increase CO?

by increasing HR and myocardial contractility

5. 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? a. Include high-potassium foods such as bananas in the diet. b. Increase fluid intake if dryness of the mouth is a problem. c. Change position slowly to help prevent dizziness and falls. d. Check blood pressure (BP) in both arms before taking the 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. Increasing fluid intake may counteract the effect of the drug, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP should be taken in the nondominant arm by newly diagnosed patients in the morning, before taking the drug, and in the evening. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.

13. Which information is *most* important for the nurse to include when teaching a patient with newly diagnosed hypertension? a. Most people are able to control BP through dietary changes. b. Annual BP checks are needed to monitor treatment effectiveness. c. Hypertension is usually asymptomatic until target organ damage occurs. d. Increasing physical activity alone controls blood pressure (BP) for most people.

c. Hypertension is usually asymptomatic until target organ damage occurs. Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle changes (e.g., 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.

4. 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? a. The patient avoids eating nuts or nut butters. b. The patient restricts intake of chicken and fish. c. The patient drinks low-fat milk with each meal. d. The patient has two cups of coffee in the morning.

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.

10. 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? a. The patient's pulse has dropped from 68 to 57 beats/min. b. The patient complains that the fingers and toes feel quite cold. c. The patient has developed wheezes throughout the lung fields. d. The patient's blood pressure (BP) reading is now 158/91 mm Hg.

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 b-blockers) is occurring. The nurse should immediately obtain an O2saturation measurement, apply supplemental O2, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes are associated with b-receptor blockade but do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated. However, this is not as urgently needed as addressing the bronchospasm.

7. 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 a. a BP recheck should be scheduled in a few weeks. b. dietary sodium and fat content should be decreased. c. diagnosis, treatment, and ongoing monitoring will be needed. d. there is an immediate danger of a stroke, requiring hospitalization.

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. There is no indication that dietary salt or fat intake have contributed to this sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this BP to an acceptable level.

6. 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 a. daily alcohol use. b. peptic ulcer disease. c. reactive airway disease. d. myocardial infarction (MI).

c. reactive airway disease. Nonselective b-blockers block b1- and b2-adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma. b-Blockers will have no effect on the patient's peptic ulcer disease or alcohol use. b-Blocker therapy is recommended after MI.

3. Which action should the nurse take when giving the initial dose of oral labetalol to a patient with hypertension? a. Encourage the use of hard candy to prevent dry mouth. b. Teach the patient that headaches often occur with this drug. c. Instruct the patient to call for help if heart palpitations occur. d. Ask the patient to request assistance before getting out of bed.

d. Ask the patient to request assistance before getting out of bed. Labetalol decreases sympathetic nervous system activity by blocking both a- and b-adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension. Heart palpitations, dry mouth, dehydration, and headaches are possible side effects of other antihypertensives.

23. 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? a. Patient takes a daily multivitamin tablet. b. Patient checks BP daily just after getting up. c. Patient drinks wine three to four times a week. d. Patient uses ibuprofen (Motrin) treat osteoarthritis.

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. A multivitamin tablet will help supply vitamin D, which may help lower BP. BP decreases while sleeping, so self-monitoring early in the morning will result in obtaining pressures that are at their lowest. The patient's alcohol intake is not excessive.

19. 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)? a. Evaluate effectiveness of nitroprusside therapy on blood pressure (BP). b. Assess the patient's environment for adverse stimuli that might increase BP. c. Titrate nitroprusside to decrease mean arterial pressure (MAP) to 115 mm Hg. d. Set up the automatic noninvasive BP machine to take readings every 15 minutes.

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.

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

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 IV antihypertensive medications. This can be most easily accomplished with an automated BP machine or arterial line. The patient will require frequent assessments, so allowing 8 hours of undisturbed sleep is not reasonable. When patients are receiving IV vasodilators, bed rest is maintained to prevent decreased cerebral perfusion and fainting. There is no indication that this patient is nauseated or at risk for aspiration, so an NPO status is unnecessary.

In teaching a patient with hypertension about controlling the condition, the nurse recognizes that? a. all patients with elevated BP require medication b. obese persons must achieve a normal weight to lower BP c. it is not necessary to limit salt in the diet if taking a diuretic d. lifestyle modifications are indicated for all persons with elevated BP

d. lifestyle modifications are indicated for all persons with elevated BP

A major consideration in the management of the older adult with HTN is to a. prevent primary HTN from converting to secondary HTN b. recognize that the older adult is less likely to adhere to the drug therapy regimen than the younger adult c. ensure that the patient receives larger initial doses of antihypertensive drugs because of impaired absorption d. use careful technique in assessing the BP of the patient because of the possible presence of an auscultatory gap

d. use careful technique in assessing the BP of the patient because of the possible presence of an auscultatory gap

how do direct vasodilators work on the body?

decrease BP by relaxing smooth muscle and reducing SVR

lowering the BP too quickly or too much may do what?

decrease cerebral, coronary, or renal perfusion precipitating a stroke, MI, or renal failure

what are the two main actions of drugs currently available to treat HTN?

decrease the volume of circulating blood and reduce SVR

the drugs used in the treatment of HTN include?

diuretics, adrenergic (SNS) inhibitors, direct vasodilators, angiotensin and renin inhibitors, and calcium channel blockers

what can hypertensive emergencies cause?

encephalopathy, intracranial or subarachnoid hemorrhage, acute left ventricular failure, MI, renal failure, dissecting aortic aneurysm, and retinopathy

an extremely potent vasoconstrictor that causes adhesion and aggregation of neutrophils and stimulates smooth muscle growth?

endothelin (ET)

stimulation of the SNS results in release of?

epinephrine and norepinephrine from the adrenal medulla

what symptoms might a patient with severe HTN have?

fatigue, dyspnea, dizziness, palpitations, and angina

when the heart's compensatory mechanisms are overwhelmed and no longer pump enough blood to the body, what happens?

heart failure

measurement of serum electrolytes, especially potassium, is important to detect?

hyperaldosteronism

a situation in which a patient's BP is severely elevated (often above 220/140 mm Hg) with clinical evidence of target organ disease

hypertensive emergency

a syndrome in which a sudden rise in BP is associated with severe headache, N/V, seizures, confusion, and coma

hypertensive encephalopathy

hypertensive emergency is often manifested as?

hypertensive encephalopathy

a situation in which a patient's BP is severely elevated (usually above 180/110) but there is no clinical evidence of target organ disease

hypertensive urgency

what does aldosterone do?

increase sodium and water retention

what happens when b1-adrenergic receptors in the heart respond to NE?

increased HR (chronotropic), increased force of contraction (inotropic), and increased speed of conduction (dromotropic)

what is a classic symptom of peripheral vascular disease?

intermittent claudication

what is intermittent claudication?

ischemic leg pain precipitated by activity and relieved with rest

why do you need to wait 1 minute when taking blood pressure on the same arm?

it allows the blood to drain from the arm and prevents inaccurate readings

what happens when a-adrenergic receptors are stimulated by NE?

it causes vasoconstriction

what effect does nicotine in tobacco have on the body, especially in people with HTN?

it causes vasoconstriction and increases BP

why should a patient not discontinue labetalol use abruptly?

it could precipitate angina or heart failure

how does A-II increase BP?

it is a potent vasoconstrictor and increases SVR, and indirectly stimulates the adrenal cortex to secrete aldosterone

sustained high BP increases the cardiac workload and produces?

left ventricular BP

what are the psychosocial risk factors that can contribute to the risk of developing CVD?

low socioeconomic status, social isolation and lack of support, stress at work and in family life, and negative emotions such as depression and hostility

before age 45, is HTN more common in women or men?

men

laboratory indications of renal disease are?

microalbuminuria, proteinuria, microscopic hematuria, and elevated serum creatinine and blood urea nitrogen (BUN)

for adults ages 18-65, walking briskly at a pace that noticeably increases the pulse defines?

moderate-intensity aerobic activity

what is the earliest manifestation of renal disease?

nocturia

what may be given along with IV drugs to help make an earlier transition to long-term therapy?

oral agents

a decrease of 20 mm Hg or more in SBP, or a decrease of 100 mm Hg or more in DBP, or an increase in HR of 20 bpm or more from supine to standing indicates?

orthostatic hypotension

when does a hypertensive urgency develop?

over days to weeks

when does hypertensive emergency develop?

over hours to days

what might a patient with heart failure complain of?

paroxysmal nocturnal dyspnea, fatigue, and shortness of breath upon exertion

how do A-II receptor blockers work?

prevent A-II from binding to its receptors in the blood vessel walls

how do ACE inhibitors work?

prevent the conversion of angiotensin I to A-II and thus reduce A-II mediated vasoconstriction and sodium and water retention

term for elevated BP without an identifiable cause?

primary HTN

treatment of secondary HTN is aimed at?

removing or treating the underlying cause

what helps to reduce BP and muscle sympathetic nerve activity in patients with resistant HTN?

renal denervation

the failure to reach goal BP in patients who are taking full doses of an appropriate 3 drug therapy regimen that includes a diuretic

resistant hypertension

term for elevated BP with a specific cause that often can be identified and corrected

secondary HTN

what are prostaglandins secreted by and what effect do they have on the body?

secreted by the renal medulla and has a vasodilator effect on the systemic circulation

patient with hypertensive crisis might experience what symptoms?

severe headaches, dyspnea, anxiety, and nosebleeds

what is the most effective IV drug to treat hypertensive emergencies?

sodium nitroprusside

side effects of vasodilators and adrenergic inhibitors decrease if taken when?

the evening

what effect do ANP and BNP have on the body?

they antagonize the effects of ADH and aldosterone resulting in excretion of sodium and diuresis resulting in reduce blood volume and BP

how do calcium channel blockers work on the body?

they increase sodium excretion and cause vasodilation by preventing the movement of extracellular calcium into cells

what happens when b2-adrenergic receptors are activated by epinephrine?

vasodilation

IV drugs used for hypertensive emergencies include:

vasodilators, adrenergic inhibitors, nicardipine, labetalol, esmolol, ACE inhibitor enalapril, and calcium channel blocker clevidipine

jogging at a pace that substantially increases the pulse and causes rapid breathing is an example of?

vigorous activity for this age group

sodium retention results in?

water retention, which causes an increased ECF volume

what is "white coat" hypertension

when patients have an elevated BP in a clinical setting and normal BP readings elsewhere

when are the cardiovascular benefits of quitting tobacco seen?

within 1 year for all age groups

after age 64, is HTN more common in women or men?

women