NCLEX Hypertension

25. The critical care nurse is caring for a patient just admitted in a hypertensive emergency. The nurse should anticipate the administration of what medication? A)Warfarin (Coumadin) B)Furosemide (Lasix) C)Sodium nitroprusside (Nitropress) D)Ramipril (Altace)

Ans: C Feedback: The medications of choice in hypertensive emergencies are those that have an immediate effect. IV vasodilators, including sodium nitroprusside (Nitropress), nicardipine hydrochloride (Cardene), clevidipine (Cleviprex), fenoldopam mesylate (Corlopam), enalaprilat, and nitroglycerin, have immediate actions that are short lived (minutes to 4 hours), and they are therefore used for initial treatment. Ramipril is administered orally and would not meet the patient's immediate need for BP management. Diuretics, such as Lasix, are not used as initial treatments and there is no indication for anticoagulants such as Coumadin.

37. A newly diagnosed patient with hypertension is prescribed Diuril, a thiazide diuretic. What patient education should the nurse provide to this patient? A)Eat a banana every day because Diuril causes moderate hyperkalemia. B)Take over-the-counter potassium pills because Diuril causes your kidneys to lose potassium. C)Diuril can cause low blood pressure and dizziness, especially when you get up suddenly. D)Diuril increases sodium levels in your blood, so cut down on your salt.

Ans: C Feedback: Thiazide diuretics can cause postural hypotension, which may be potentiated by alcohol, barbiturates, opioids, or hot weather. Diuril does not cause either moderate hyperkalemia or severe hypokalemia and it does not result in hypernatremia.

3. A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective assessment data from a patient with hypertension, the nurse learns that the patient has a family history of hypertension and she herself has high cholesterol and lipid levels. The patient says she smokes one pack of cigarettes daily and drinks about a pack of beer every day. The nurse notes what nonmodifiable risk factor for hypertension? A)Hyperlipidemia B)Excessive alcohol intake C)A family history of hypertension D)Closer adherence to medical regimen

Ans: C Feedback: Unlike cholesterol levels, alcohol intake and adherence to treatment, family history is not modifiable.

35. A 55-year-old patient comes to the clinic for a routine check-up. The patient's BP is 159/100 mm Hg and the physician diagnoses hypertension after referring to previous readings. The patient asks why it is important to treat hypertension. What would be the nurse's best response? A)Hypertension can cause you to develop dangerous blood clots in your legs that can migrate to your lungs. B)Hypertension puts you at increased risk of type 1 diabetes and cancer in your age group. C)Hypertension is the leading cause of death in people your age. D)Hypertension greatly increases your risk of stroke and heart disease.

Ans: D Feedback: Hypertension, particularly elevated systolic BP, increases the risk of death, stroke, and heart failure in people older than 50 years. Hypertension is not a direct precursor to pulmonary emboli, and it does not put older adults at increased risk of type 1 diabetes or cancer. It is not the leading cause of death in people 55 years of age

4. The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in what way? A)The BP is always higher in a hypertensive emergency. B)Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies. C)Hypertensive urgency is treated with rest and benzodiazepines to lower BP. D)Hypertensive emergencies are associated with evidence of target organ damage

Ans: D Feedback: Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. Blood pressures are extremely elevated in both urgency and emergencies, but there is no evidence of target organ damage in hypertensive urgency. Extremely close hemodynamic monitoring of the patient's BP is required in both situations. The medications of choice in hypertensive emergencies are those with an immediate effect, such as IV vasodilators. Oral doses of fast-acting agents, such as beta-adrenergic blocking agents, angiotensin-converting enzyme inhibitors, or alpha-agonists, are recommended for the treatment of hypertensive urgencies.

26. A patient in hypertensive emergency is being cared for in the ICU. The patient has become hypovolemic secondary to natriuresis. What is the nurse's most appropriate action? A)Add sodium to the patient's IV fluid, as ordered. B)Administer a vasoconstrictor, as ordered. C)Promptly cease antihypertensive therapy. D)Administer normal saline IV, as ordered

Ans: D Feedback: If there is volume depletion secondary to natriuresis caused by the elevated BP, then volume replacement with normal saline can prevent large, sudden drops in BP when antihypertensive medications are administered. Sodium administration, cessation of antihypertensive therapy, and administration of vasoconstrictors are not normally indicated.

21. A patient with newly diagnosed hypertension has come to the clinic for a follow-up visit. The patient asks the nurse why she has to come in so often. What would be the nurse's best response? A)We do this so you don't suffer a stroke. B)We do this to determine how your blood pressure changes throughout the day. C)We do this to see how often you should change your medication dose. D)We do this to make sure your health is stable. We'll then monitor it at routinely scheduled intervals.

Ans: D Feedback: When hypertension is initially detected, nursing assessment involves carefully monitoring the BP at frequent intervals and then at routinely scheduled intervals. The reference to stroke is frightening and does not capture the overall rationale for the monitoring regimen. Changes throughout the day are not a clinical priority for most patients. The patient must not change his or her medication doses unilaterally.

38. A patient in hypertensive urgency is admitted to the hospital. The nurse should be aware of what goal of treatment for a patient in hypertensive urgency? A)Normalizing BP within 2 hours B)Obtaining a BP of less than 110/70 mm Hg within 36 hours C)Obtaining a BP of less than 120/80 mm Hg within 36 hours D)Normalizing BP within 24 to 48 hours

Ans: D Feedback:pg 873 In cases of hypertensive urgency, oral agents can be administered with the goal of normalizing BP within 24 to 48 hours. For patients with this health problem, a BP of £ 120/80 mm Hg may be unrealistic.

Primary or essential hypertension accounts for about 95% of all hypertension diagnoses—with an unknown etiology. Secondary hypertension accompanies specific conditions that create hypertension as a result of tissue damage. Which of the following conditions contribute to secondary hypertension? a) Calcium deficit b) Hepatic function c) Arterial vasoconstriction d) Acid-base imbalance

Arterial vasoconstriction Explanation: p. 862. Secondary hypertension may accompany any primary condition that affects fluid volume or renal function or causes arterial vasoconstriction.

Which of the following conditions contributes to secondary hypertension? a) Acid-based imbalance b) Calcium deficit c) Arterial vasoconstriction d) Hepatic function

Arterial vasoconstriction Correct Explanation: Secondary hypertension may accompany any primary condition that affects fluid volume or renal function or causes arterial vasoconstriction. Calcium deficiency or acid-based imbalance does not contribute to hypertension. (less) Chapter 31: Assessment and Management of Patients With Hypertension - Page 862

The nurse is caring for a patient with an intracranial hemorrhage. The patient is having a hypertensive emergency. Which of the following nursing intervention would take priority in this patient? a) Maintaining the BP at a significantly higher than normal level to prevent orthostatic hypotension. b) Reduction of the BP to 160/100 mm Hg within the half hour of treatment c) Reduction of the mean BP by up to 50% within the first hour of treatment d) Avoid lowering the blood pressure (BP) too quickly

Avoid lowering the blood pressure (BP) too quickly Explanation: It is important not to become over eager and lower the BP too quickly, thus reducing tissue perfusion and causing a myocardial infarction (MI) or cerebrovascular accident. Among the therapeutic goals are a reduction of the mean BP by up to 25% within the first hour of treatment, and a further reduction of a goal pressure to about 160/110 mm Hg over a period of 2 to 6 hours. Maintaining the BP at a significantly higher than normal level can precipitate a stroke or MI. Page 873

A community health nurse teaching a group of adults about preventing and treating hypertension. The nurse should encourage these participants to collaborate with their primary care providers and regularly monitor which of the following? A)Heart rate B)Sodium levels C)Potassium levels D)Blood lipid levels

Blood lipid levels Feedback: Hypertension often accompanies other risk factors for atherosclerotic heart disease, such as dyslipidemia (abnormal blood fat levels), obesity, diabetes, metabolic syndrome, and a sedentary lifestyle. Individuals with hypertension need to monitor their sodium intake, but hypernatremia is not a risk factor for hypertension. In many patients, heart rate does not correlate closely with BP. Potassium levels do not normally relate to BP.

Which of the following client scenarios would be correct for the nurse to identify as a client with secondary hypertension? a) A client of advanced age b) A client with excessive alcohol intake c) A client diagnosed with kidney disease d) A client experiencing depression

C: A client diagnosed with kidney disease Explanation: Secondary hypertension is an elevated blood pressure that results from or is secondary to some other disorder such as kidney disease, a tumor of the adrenal medulla, or atherosclerosis. Depression alone is typically not associated with hypertension. Advanced age and alcohol intake are considered factors for essential hypertension. Page 862

The nurse is caring for a patient prescribed loop diuretic Bumex (bumetanide) for the treatment of stage 2 hypertension. Which of the following indicates the patient is experiencing an adverse effect of the medication? a) Urine output of 90 cc/mL 1 hour after medication administration b) Blood glucose value of 160 mg/dL c) Serum potassium value of 3.0 mEq/L d) Electrocardiogram (EGG) tracing demonstrating peaked T waves

C:Serum potassium value of 3.0 mEq/L Explanation: pg 867 table 31-4 Bumex is a loop diuretic that can cause fluid and electrolyte imbalances. Patients taking these medications may experience a low serum potassium level. ECG changes associated with an elevated serum potassium levels include peaked T waves. Diuresis is a desired effect postadministration of Bumex. The serum glucose level is elevated and requires intervention; however, this elevation is not associated with the administer.

A 77-year-old client has newly diagnosed stage 2 hypertension. The physician has prescribed the client a thiazide and an angio-converting enzyme inhibitor. The nurse is concerned about postural hypotension. Which of the following will the nurse be sure to include in education for this client? a) Change positions (lying or sitting to standing) slowly. b) Check blood pressure every day for signs of rebound hypertension. c) Eat plenty of salty food to prevent hypotension. d) Do not become dependent on canes, walkers, or handrails.

Change positions (lying or sitting to standing) slowly. Explanation: Antihypertensive medications can cause hypotension, especially postural hypotension that may result in injury. The nurse teaches clients to change positions slowly when moving from a lying or sitting position to a standing position. Rebound hypertension occurs when antihypertensive medications are stopped abruptly. The nurse also counsels elderly clients to use supportive devices such as handrails and walkers to prevent falls that could result from dizziness. Eating salty foods could defeat the purpose of taking the antihypertensive medications. Page 872

The nurse is administering medications on a medical surgical unit. A patient is ordered to receive 40 mg of oral Corgard (nadolol) for the treatment of hypertension. Prior to administering the medication, the nurse should complete which of the following? a) Checking the patient's urine output b) Checking the patient's serum K+ level c) Weighing the patient d) Checking the patient's heart rate

Checking the patient's heart rate Corgard is a beta-blocker. A desired effect of this medication is to reduce the pulse rate in patients with tachycardia and an elevated blood pressure (BP). The nurse should check the patient's heart rate (HR) prior to administering Corgard to ensure that the patient's pulse rate is not below 60 (beats per minute (bpm). The other interventions are not indicated prior to administering a beta-blocker medication.

The treatment goal for those with stage 2 hypertension (hypertension with compelling indications or complications) includes lifestyle modifications and multiple drug therapies. Thiazide diuretics are part of this treatment approach for most complications except for: Heart failure Diabetes mellitus Chronic kidney disease Recurrent stroke prevention

Chronic kidney disease Explanation: Since thiazides are diuretics, they would not be the drugs of choice for patients with chronic kidney disease, in whom renal function is already compromised.

A 66-year-old client presents to the emergency room (ER) complaining of a severe headache and mild nausea for the last 6 hours. Upon assessment, the patient's BP is 210/120 mm Hg. The patient has a history of HTN for which he takes 1.0 mg clonidine (Catapres) twice daily for. Which of the following questions is most important for the nurse to ask the patient next? a) "Did you take any medication for your headache?" b) "Do you have a dry mouth or nasal congestion?" c) "Have you taken your prescribed Catapres today?" d) "Are you having chest pain or shortness of breath?"

Correct response: "Have you taken your prescribed Catapres today?" Explanation: The nurse must ask if the patient has taken his prescribed Catapres. Patients need to be informed that rebound hypertension can occur if antihypertensive medications are suddenly stopped. Specifically, a side effect of Catapres is rebound or withdrawal hypertension. Although the other questions may be asked, it is most important to inquire if the patient has taken his prescribed HTN medication given the patient's severely elevated BP. Page 872

The nurse is caring for an elderly client with a diagnosis of hypertension, who is taking several antihypertensive medications. Which saftey precaution is the nurse most likely to reinforce? a) Being sure to keep follow-up appointments b) Walking as far as the client is able every day c) Eating extra potassium due to loss of potassium related to medications d) Changing positions slowly related to possible hypotension

Correct response: Changing positions slowly related to possible hypotension Explanation: Page 872 The elderly have impaired cardiovascular reflexes and thus are more sensitive to the extracellular volume depletion caused by diuretics and to the sympathetic inhibition caused by adrenergic antagonists. The nurse teaches clients to change positions slowly when moving from a lying or sitting position to a standing position. This will help prevent falls. Eating extra potassium is not a good idea if taking a potassium-sparing diuretic. The other choices are good teaching points, but not necessarily safety precautions.

When treating hypertensive emergencies, the nurse identifies the most appropriate route of administration for antihypertensive agents as being which of the following? a) Sublingual b) Continuous IV infusion c) Oral d) Intramuscular

Correct response: Continuous IV infusion Explanation: Page 873 The medications of choice in hypertensive emergencies are best managed through the continuous IV infusion of a short-acting titratable antihypertensive agent. The nurse avoids the sublingual and IM routes as their absorption and dynamics are unpredictable. The oral route would not have as quick an onset as a continuous IV infusion.

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

Correct response: Hypertensive emergency Explanation: Page 862 A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage. Hypertensive urgency is a situation in which blood pressure is severely elevated but there is no evidence of actual or probable target organ damage. Secondary hypertension is high blood pressure from an identified cause, such as renal disease. Primary hypertension denotes high blood pressure from an unidentified source.

An 87-year-old client was just recently diagnosed with prehypertension. She is to meet with a dietitian and return for a follow-up with her cardiologist in 6 months. As her nurse, what would you expect her treatment to include? a) Procedural interventions b) No intervention, just observation c) Nonpharmacological interventions d) Pharmacological interventions

Correct response: Nonpharmacological interventions Explanation: p861 Nonpharmacologic interventions are used for clients with prehypertension

A 35-year-old female patient has been diagnosed with hypertension. The patient is a stock broker, smokes daily, and is also a diabetic. During a follow-up appointment, the patient states that she finds it cumbersome and time consuming to visit the doctor regularly just to check her blood pressure (BP). As the nurse, which of the following aspects of patient teaching would you recommend? a) Purchasing a self-monitoring BP cuff b) Advising a smoking cessation c) Discussing methods for stress reduction d) Administering glycemic control

Correct response: Purchasing a self-monitoring BP cuff Explanation: Page 871 Because this patient finds it time consuming to visit the doctor just for a blood pressure reading, as the nurse, you can suggest the use of an automatic cuff at a local pharmacy, or purchasing a self-monitoring cuff. Discussing methods for stress reduction, advising a smoking cessation, and administering glycemic control would constitute patient education in managing hypertension.

You are doing the final checklist before sending home a 63-year-old female who has been newly diagnosed with hypertension. She is going to be starting her first antihypertensive medicine. What is one of the main things you should tell her and her husband to watch for? a) Tremor b) Persistent cough c) Blurred vision d) Dizziness

Dizziness Explanation: A common adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. Therefore, you should both alert the patient and her husband to this possibility and provide them with some tips for managing dizziness. (less) - Page 872

The home health nurse is caring for a patient who has a comorbidity of hypertension. What assessment question most directly addresses the possibility of worsening hypertension? A)Are you eating less salt in your diet? B)How is your energy level these days? C)Do you ever get chest pain when you exercise? D)

Do you ever see spots in front of your eyes? Feedback: To identify complications or worsening hypertension, the patient is questioned about blurred vision, spots in front of the eyes, and diminished visual acuity. The heart, nervous system, and kidneys are also carefully assessed, but angina pain and decreased energy are not normally suggestive of worsening hypertension. Sodium limitation is a beneficial lifestyle modification, but nonadherence to this is not necessarily a sign of worsening symptoms.

A client with newly diagnosed hypertension asks what she can do to decrease the risk for related cardiovascular problems. Which of the following risk factors is modifiable by the client? a) Impaired renal function b) Dyslipidemia c) Age d) Family history

Dyslipidemia Correct Explanation: Page 862 Age, family history, and impaired renal function are risk factors for cardiovascular disease related to hypertension that the client cannot change. Obesity, inactivity, and disylipidemia are risk factors that the client can improve through diet, exercise, and other healthy lifestyle changes.

Which diagnostic is the recommended method of determining whether left ventricular hypertrophy has occurred? a) ECG b) Blood chemistry c) BUN d) Echocardiogram

Echocardiogram Correct Explanation: An echocardiogram is recommended method of determining whether hypertrophy has occurred. ECG and blood chemistry are part of the routine work up. Renal damage may be suggested by elevations in BUN and creatinine levels. p 864

Which of the following diagnostic tests may reveal an enlarged left ventricle? a) Fluorescein angiography b) Positron emission tomography (PET) scan c) Echocardiography d) Computed tomographic scan

Echocardiography Correct Explanation: Echocardiography reveals an enlarged left ventricle. Fluorescein angiography reveals leaking retinal blood vessels, and a PET scan is used to reveal abnormalities in blood pressure. A CT scan reveals structural abnormalities. Page 864

A nurse is teaching about lifestyle modifications to a group of clients with known hypertension. Which of the following statements would the nurse include in the education session? a) Limit alcohol consumption to no more that 3 drinks per day. b) Maintain a waist circumference of 45 (men) and 40 (women) inches or less. c) Engage in aerobic activity at least 30 minutes/day most days of the week. d) Maintain a body mass index between 30 and 35.

Engage in aerobic activity at least 30 minutes/day most days of the week. Correct Explanation: Page 865 Recommmended lifestye modifications to prevent and manage hypertension include maintaining a normal body mass index (about 24; greater than 25 is considered overweight), maintaining a waist circumference of less than 40 inches for men and 35 inches for women, limiting alcohol intake to no more than 2 drinks for men and 1 drink for women per day, and engaging in aerobic activity at least 30 minutes per day most days of the week.

When teaching a patient about hypertension and lifestyle changes the nurse emphasizes that which of the following should be included in the diet? a) Chloride-containing foods b) Fresh fruits and vegetables c) Whole milk and cheeses d) A glass of red wine

Fresh fruits and vegetables Correct Explanation: The dietary approach to stop hypertension states that a diet high in fruits and vegetables and low in fat and sodium will prevent or control hypertension. There is no need to consume chloride-containing foods. Whole mile milk and cheeses are high in saturated fats and should be avoided. While alcohol is considered acceptable in low quantities, it is not something that must be included in the diet. Page 864

A nurse educator is teaching a small group of clients about hypertension and dietary changes that will assist in lowering blood pressure readings. The nurse is specifically discussing the (Dietary Approaches to Stop Hypertension (DASH) diet and teaches the clients that the food group with the largest number of servings per day is which of the following? a) Low-fat or fat-free dairy foods b) Grains and grain products c) Fruits d) Vegetables

Grains and grain products Explanation: The DASH diet includes (per day) 7 to 8 servings of grains or grain products, 4 to 5 servings of vegetables, 4 to 5 servings of fruits, 2 to 3 servings of low-fat or fat-free dairy products, 2 or fewer servings of meat, fish, and poultry, and 2 to 4 servings of nuts, seeds, and dry beans per week. - Page 894

Which of the following is true regarding the African American population and the development of hypertension? a) Higher incidence of nonfatal stroke b) Decreased rate of stage 2 hypertension c) Later onset of disease d) Greater rate of stage 2 hypertension

Greater rate of stage 2 hypertension Explanation: Page 862 The incidence of hypertension is higher among African Americans, who have an earlier onset, higher prevalence, and a greater rate of stage 2 hypertension leading to higher incidence of nonfatal stroke, death from heart disease, and end-stage renal disease. This increases when the African American individual is male, overweight or obese, physically inactive, and diabetic

A client, newly prescribed a low-sodium diet due to hypertension, is asking for help with meal choices. The client provides four meal choices, which are favorites. Which selection would be best? a) Hot dog with ketchup and relish on whole wheat bun b) Green pepper stuffed with diced tomatoes and chicken c) Creamed chipped beef over toast with mashed potatoes d) Toasted cheese sandwich on whole wheat toast with tomato soup

Green pepper stuffed with diced tomatoes and chicken Correct Explanation: Page 865 Fresh vegetables are low in sodium with diced tomatoes (fresh) and chicken is a good low-sodium, high vegetable and protein selection. Cheese and soup (tomato and creamed) are high in sodium. Processed meats such as a hot dog and condiments such as ketchup are high in sodium.

The nurse is creating a community teaching demonstration focusing on the cause of blood pressure. When completing the visual aid, which body structures represent the mechanism of blood pressure? a) Brain and sympathetic nervous system b) Heart and blood vessels c) Kidneys and autonomic nervous system d) Lung and arteries

Heart and blood vessels Correct Explanation: Blood pressure is the force produced by the volume of the blood in arterial walls. It is represented by the formula: BP= CO (cardiac output)× PR (peripheral resistance). To highlight the mechanism of cardiac output, a heart would be on the visual aid and blood vessels. Page 655

The nurse is performing an assessment on a patient to determine the effects of hypertension on the heart and blood vessels. What specific assessment data will assist in determining this complication? (Select all that apply.)

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

You're seeing a patient in a low-income clinic for the first time and have just checked her BP. You're entering her as prehypertensive because: a) Her diastolic blood pressure is between 80 and 89 mm Hg. b) Her systolic BP is above 180 mm Hg. c) Her diastolic blood pressure is at 100 mm Hg. d) Her systolic BP is between 120 and 130 mm Hg.

Her diastolic blood pressure is between 80 and 89 mm Hg. Explanation: Those numbers indicate a diastolic BP for prehypertension according to the latest definition from the National Heart, Lung, and Blood Institute (2003). That's the latest definition from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2003). Once the systolic BP goes above 120 mm Hg, the patient is considered prehypertensive, according to the National Heart, Lung, and Blood Institute's (2003) latest definition. (less) - Page 862 table 31-1

A community health nurse is planning an educational campaign addressing hypertension. The nurse should anticipate that the incidence and prevalence of hypertension are likely to be highest among members of what ethnic group? A)Pacific Islanders B)African Americans C)Asian-Americans D)Hispanics

Hispanics Feedback: The prevalence of uncontrolled hypertension varies by ethnicity, with Hispanics and African Americans having the highest prevalence at approximately 63% and 57%, respectively.

A client is taking 50 mg of oral spironolactone twice a day to assist with blood pressure control. While the nurse is performing the morning assessment, the client reports nausea, general muscle cramps, and weakness. The telemetry strip shows a peaked, narrow T-wave, which is a change. What electrolye imbalance does the nurse suspect? a) Hyponatremia b) Hypernatremia c) Hyperkalemia d) Hypokalemia

Hyperkalemia Explanation: Potassium-sparing diuretics, such as spironolactone, can cause hyperkalemia, especially if given with an ACE inhibitor. Signs of hyperkalemia are nausea, diarrhea, abdominal cramps, and peaked narrow T-waves. Page 867

Which of the following would be inconsistent as a component of metabolic syndrome? a) Elevated triglyceride levels b) Abdominal obesity c) Hypertension d) Hypotension

Hypotension Explanation: Diabetes, obesity, dyslipidemia, hypertension, and elevated triglycerides are components of metabolic syndrome. Hypotension is not a component of metabolic syndrome. Page 862

The nurse understands that patient education related to antihypertensive medication should include all of the following instructions except which of the following? a) If a dosage of medication is missed, double up on the next one to catch up. b) Avoid over the counter (OTC) cold, weight reduction, and sinus medications. c) Avoid hot baths, exercise, and alcohol within 3 hours of taking vasodilators. d) Do not stop antihypertensive medication abruptly.

If a dosage of medication is missed, double up on the next one to catch up. Explanation: Page 871 Doubling doses could cause serious hypotension (HTN) and is not recommended. Medications should be taken as prescribed. Hot baths, strenuous exercise, and excessive alcohol are all vasodilators and should be avoided. Many OTC preparations can precipitate HTN. Stopping antihypertensives abruptly can precipitate a severe hypertensive reaction and is not recommended

Which of the following nursing diagnosis is the nurse most correct to choose when caring for a client with long-standing hypertension? a) Impaired Gas Exchange b) Ineffective Tissue Perfusion c) Risk for Decreased Cardiac Output d) Activity Intolerance

Ineffective Tissue Perfusion Explanation: The nurse is most correct in choosing ineffective tissue perfusion for the client with long-standing hypertension. In hypertension, the extra work increases the size of the heart muscle. Eventually, the heart cannot meet the body's metabolic needs limiting the perfusion to the tissues. Impaired Gas Exchange, Activity Intolerance, and a Risk for Decreased Cardiac Output may occur due to the ineffective perfusion. p. 872.

Which of the following would be inconsistent with a hypertensive urgency? a) Severe headache b) Epistaxis c) Anxiety d) Intracranial hemorrhage

Intracranial hemorrhage Correct Explanation: Elevated blood pressure in hypertensive urgency is associated with severe headache, epistaxis, and anxiety. An example of a hypertensive emergency is a myocardial infarction, intracranial hemorrhage, or dissecting aortic aneurysm. Page 873

A patient is being seen at the clinic on a monthly basis for assessment of blood pressure. The patient has been checking her blood pressure at home as well and has reported a systolic pressure of 158 and a diastolic pressure of 64. What does the nurse suspect this patient is experiencing?

Isolated systolic hypertension Explanation: As a result of changes that occur with aging, the aorta and large arteries are less able to accommodate the volume of blood pumped out by the heart (stroke volume), and the energy that would have stretched the vessels instead elevates the systolic blood pressure, resulting in an elevated systolic pressure without a change in diastolic pressure. This condition, known as isolated systolic hypertension, is more common in older adults and is associated with significant cardiovascular and cerebrovascular morbidity and mortality

The nurse is assessing a patient new to the clinic. Records brought to the clinic with the patient show the patient has hypertension and that her current BP readings approximate the readings from when she was first diagnosed. What contributing factor should the nurse first explore in an effort to identify the cause of the client's inadequate BP control? A)Progressive target organ damage B)Possibility of medication interactions C)Lack of adherence to prescribed drug therapy D)Possible heavy alcohol use or use of recreational drugs

Lack of adherence to prescribed drug therapy Feedback: Deviation from the therapeutic program is a significant problem for people with hypertension and other chronic conditions requiring lifetime management. An estimated 50% of patients discontinue their medications within 1 year of beginning to take them. Consequently, this is a more likely problem than substance use, organ damage, or adverse drug interactions.

A patient is admitted to the intensive care unit (ICU) with a diagnosis of hypertension emergency/crisis. The patient's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV Nitropress (nitroprusside). Upon assessment, which of the following patient findings requires immediate intervention by the nurse? a) Nausea and severe headache b) Chest pain score of 3/10 (on a scale of 1 to 10) c) Urine output of 40 cc/mL over the last hour d) Left arm numbness and weakness

Left arm numbness and weakness Explanation: Page 873 Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. The finding of left arm numbness and weakness may indicate the patient is experiencing neurological symptoms associated with an ischemic stroke because of the severely elevated BP and requires immediate interventions. A urine output of 40 mL/h is within normal limits. The other findings are likely caused by the hypertension and require intervention, but they do not require action as urgently as the neurologic changes.

A nurse is providing education about lifestyle modifications to a group of clients who have been newly diagnosed with hypertension. The nurse would include all the following statesments except: a) Maintain a waist circumference of 40 (men) and 35 (women) inches or less. b) Engage in aerobic activity at least 30 minutes/day most days of the week. c) Maintain a normal body mass index of about 24. d) Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women.

Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women. Explanation: Page 865 table 31-2 Recommmended lifestye modifications to prevent and manage hypertension include maintaining a normal body mass index (about 24; greater than 25 is considered overweight), maintaining a waist circumference of less than 40 inches for men and 35 inches for women, limiting alcohol intake per day to no more than 2 drinks for men and 1 drink for women, and engaging in aerobic activity at least 30 minutes per day most days of the week.

The nurse is developing a teaching plan for a patient diagnosed with hypertension. It would be important to emphasize which of the following as part of the plan of care? a) Limiting sodium intake in the diet b) Limiting cigarette smoking to 1 pack a week c) Limiting activity to prevent over exertion d) Limiting alcohol to a can of beer to four times a day to thin the blood

Limiting sodium intake in the diet Correct Explanation: Research findings indicate that smoking cessation, weight loss, reduced alcohol and sodium intake, and regular physical activity are effective lifestyle adaptations to reduce blood pressure. Limiting one's daily alcohol to 24 ounces of beer for men is recommended. Table salt should be limited to 1 teaspoon daily. Page 864

The nurse is caring for an 82-year-old male client who has come to the clinic for a yearly physical. When assessing the client, the nurse notes the blood pressure (BP) is 140/93. The nurse knows that in older clients what happens that may elevate the systolic BP? a) Decrease in blood volume b) Loss of arterial elasticity c) Increase in calcium intake d) Decrease in cardiac output

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

The physician is ordering a test for the hypertensive client that will be able to evaluate whether the client has experienced heart damage. Which diagnostic test would the nurse anticipate to determine heart damage? a) Blood chemistry b) Fluorescein angiography c) Chest radiograph d) Multiple gated acquisition scan (MUGA)

Multiple gated acquisition scan (MUGA) Correct Explanation: The nurse realizes that undiagnosed (untreated), long-standing hypertension can cause heart damage. The diagnostic test that best determines heart damage is the multiple gate acquisition scan (MUGA). This test is used to detect how efficiently the heart pumps. A blood chemistry determines electrolyte balance. A chest radiograph (chest x-ray) can provide details of the heart size through shading on the scan. Fluorescein angiography is an ophthalmologic test revealing leaking retinal blood vessels. Page 681

A nurse is teaching an adult female patient about the risk factors for hypertension. What should the nurse explain as risk factors for primary hypertension? A)Obesity and high intake of sodium and saturated fat B)Diabetes and use of oral contraceptives C)Metabolic syndrome and smoking D)Renal disease and coarctation of the aorta

Obesity and high intake of sodium and saturated fat Feedback: Obesity, stress, high intake of sodium or saturated fat, and family history are all risk factors for primary hypertension. Diabetes and oral contraceptives are risk factors for secondary hypertension. Metabolic syndrome, renal disease, and coarctation of the aorta are causes of secondary hypertension.

Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through: a) An MRI b) Laboratory tests c) Ophthalmic examination d) Using a sphygmomanometer

Ophthalmic examination Explanation: Page 863 Papilledema is an edema of the optic nerves, and thus needs an ophthalmic examination for detection.

The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. Which of the following should the nurse integrate into the management of this client's hypertension? A)Ensure that the patient receives a larger initial dose of antihypertensive medication due to impaired absorption. B)Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion. C)Recognize that an older adult is less likely to adhere to his or her medication regimen than a younger patient. D)Carefully assess for weight loss because of impaired kidney function resulting from normal aging.

Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion. Feedback: Elderly people have impaired cardiovascular reflexes and thus are more sensitive to extracellular volume depletion caused by diuretics. The nurse needs to assess hydration status, low BP, and postural hypotension carefully. Older adults may have impaired absorption, but they do not need a higher initial dose of an antihypertensive than a younger person. Adherence to treatment is not necessarily linked to age. Kidney function and absorption decline with age; less, rather than more antihypertensive medication is prescribed. Weight gain is not necessarily indicative of kidney function decline.

The nurse in an oncology clinic notes that the client being treated has hypertension. What tumor is a predisposing condition for secondary hypertension? a) Lymphoma b) Astrocytoma c) Wilms' tumor d) Pheochromocytoma

Pheochromocytoma Explanation: Predisposing conditions include kidney disease, pheochromocytoma (a tumor of the adrenal medulla), hyperaldosteronism (increased secretion of mineralcorticoid by the adrenal cortex), atherosclerosis, use of cocaine or other cardiac stimulants (e.g., weight-control drugs, caffeine), and use of oral contraceptives. Wilms' tumors, astrocytomas, and lymphomas are not predisposing conditions for secondary hypertension. p862

A client diagnosed with hypertension begins drug therapy using an antihypertensive agent. The nurse instructs the client's spouse to remove any objects in the home that can lead to falls. The nurse knows that the teaching has been successful when the client restates which of the following? a) "Insomnia is a common side effect of antihypertensive medications." b) "Constant thirst is a common side effect of antihypertensive therapy." c) "Antihypertensive drugs can lead to falls." d) "Antihypertensives can lead to memory loss."

"Antihypertensive drugs can lead to falls." Explanation: One of the side effects of all antihypertensive drugs is hypotension, which can lead to falls. A major concern regarding side effects of all antihypertensive drugs is hypotension, which can lead to falls.- Page 872

A client with high blood pressure is receiving an antihypertensive drug. The nurse knows that antihypertensive drugs commonly cause fatigue and dizziness, especially on rising. When developing a client teaching plan to minimize orthostatic hypotension, which instruction should the nurse include?

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

A nurse working in the clinic is seeing a client who has just been prescribed a new medication for hypertension. The client asks why hypertension is sometimes called the "silent killer." The nurse's correct response is which of the following? a) "Hypertension often causes no symptoms." b) "Hypertension often causes no pain." c) "Hypertension often kills early in the disease process." d) "Hypertension is difficult to diagnose."

"Hypertension often causes no symptoms." Correct Explanation: Hypertension is sometimes called the "silent killer" because people with it are often symptom free. Physical examination may reveal no abnormalities other than elevated blood pressure. People with hypertension may remain asymptomatic for many years. The usual consequences of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, renal failure, strokes, and impaired vision. Pain is not usually an issue, but that is not why hypertension is called the "silent killer." Hypertension is easily diagnosed by taking a series of blood pressure readings. (less) Chapter 31: Assessment and Management of Patients With Hypertension - Page 862

The nurse is caring for a female client who has had 25 mg of oral hydrochlorothiazide added to her medication regimen for the treatment of hypertension (HTN). Which of the following instructions should the nurse give the patient? a) "You may drink alcohol while taking this medication." b) "Take this medication before going to bed." c) "You may develop dry mouth or nasal congestion while on this medication." d) "Increase the amount of fruits and vegetables you eat."

"Increase the amount of fruits and vegetables you eat." Explanation: Thiazide diuretics cause loss of sodium, potassium, and magnesium. The patient should be encouraged to eat fruits and vegetables which are high in potassium. Diuretics cause increased urination; the patient should not take the medication prior to going to bed. Thiazide diuretics to not cause dry mouth or nasal congestion. Postural hypotension (side effect) may be potentiated by alcohol. Page 867

The nurse in an oncology clinic notes that the client being treated has hypertension. What tumor is a predisposing condition for secondary hypertension? a) Wilms' tumor b) Astrocytoma c) Lymphoma d) Pheochromocytoma

Pheochromocytoma Explanation: Predisposing conditions include kidney disease, pheochromocytoma (a tumor of the adrenal medulla), hyperaldosteronism (increased secretion of mineralcorticoid by the adrenal cortex), atherosclerosis, use of cocaine or other cardiac stimulants (e.g., weight-control drugs, caffeine), and use of oral contraceptives. Wilms' tumors, astrocytomas, and lymphomas are not predisposing conditions for secondary hypertension. Page 862

A nurse is teaching a 38-year-old man with newly diagnosed hypertension who asks if there is any harm in stopping his antihypertensive medication if he decides to discontinue it. The correct reply addresses the consequence of stopping antihypertensive medications abruptly. Which of the following statements from the nurse would be appropriate? a) "Rebound hypotension can occur." b) "Postural hypertension can occur." c) "Rebound hypertension can occur." d) "Postural hypotension can occur."

"Rebound hypertension can occur." Explanation: Clients need to be informed that rebound hypertension can occur if they stop antihypertensive medications suddenly. This can be extremely dangerous and have serious consequences. Hypotension would not be a problem with discontinuation of antihyperstensive medications. Page 872

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

"Sit quietly for 5 minutes prior to taking blood pressure." Explanation: Instructions for the client regarding measuring the blood pressure at home include the following: (1) Avoid smoking cigarettes or drinking caffiene for 30 minutes before measuring blood pressure. (2) Sit quietly for 5 minutes before the measurement. (3) Have the forearm supported at heart level, with both feet on the ground during the measurement of the blood pressure. Page 866

A 55-year-old man newly diagnosed with hypertension returns to his physician's office for a routine follow-up appointment after several months of treatment with Lopressor (metoprolol). During the nurse's initial assessment the patient's blood pressure (BP) is recorded as 180/90 mm Hg. The patient states he does not take his medication as prescribed. The best response by the nurse is which of the following

"The medication you were prescribed may cause sexual dysfunction; are you experiencing this side effect?" The nurse needs to understand why the patient is not taking his medication. Lopressor is a beta-blocker. All patients should be informed that beta-blockers might cause sexual dysfunction and that other medications are available if problems with sexual function occur.

A 77-year-old woman presents to the local community center for a blood pressure screening. The women's blood pressure is recorded as 180/90 mm Hg. The woman has a history of hypertension, but she currently is not taking her medications. Which of the following questions is most appropriate for the nurse to ask the patient first? a) "Are you having trouble paying for your medication?" b) "What medications are you prescribed?" c) "Are you able to get to your pharmacy to pick up your medications?" d) "Why is it that you are not taking your medications?"

"Why is it that you are not taking your medications?" Explanation: It is important for the nurse to first ascertain if the reason why the patient is not taking her medications. Adherence to the therapeutic program may be more difficult for older adults. The medication regimen can be difficult to remember, and the expense can be a challenge. Monotherapy (treatment with a single agent), if appropriate, may simplify the medication regimen and make it less expensive. The other questions are appropriate, but the priority is to determine why the medication regimen is not being followed. Page 864

While in nursing school, you discover the prevalence of high blood pressure in the United States and are amazed at its frequency of occurrence. Which of the following is closest to approximately how many people have high blood pressure?

1 in 4 adults Explanation: Approximately 50 million people, or 1 in 4 adults, in the United States have high blood pressure.

As recommended follow-up for a person diagnosed with prehypertension initially, it's recommended the person gets his or her blood pressure rechecked within which timeframe? a) Confirm within 2 months b) 1 year c) Evaluate within 1 month d) 2 year

1 year Explanation: A patient with an initial BP in the prehypertension range should have his or her BP rechecked in 1 year. A normal BP should be rechecked in 2 years. Stage 1 hypertension should be confirmed and followed up within 2 months. Stage 2 hypertension should be evaluated or referred to a source of care within 1 month. - Page 862

When monitoring a patient who has hypertension and chronic kidney disease, the target pressure for this individual should be less than which blood pressure reading? a) 140/90 mm Hg b) 110/60 mm Hg c) 120/70 mm Hg d) 130/80 mm Hg

130/80 mm Hg Explanation: For individuals with diabetes or chronic kidney disease, JNC 7 specifies a target pressure of less than 130/80 mm Hg. Page 864

Officially, hypertension is diagnosed when the patient demonstrates a systolic blood pressure greater than ______ mm Hg and a diastolic blood pressure greater than _____ mm Hg over a sustained period. a) 120, 70 b) 140, 90 c) 130, 80 d) 110, 60

140, 90 Correct Explanation: Page 862 According to the categories of blood pressure levels established by the JNC VI, stage 1 hypertension is demonstrated by a systolic pressure of 140 to 159, or a diastolic pressure of 90 to 99. Pressure of 130 systolic and 80 diastolic falls within the normal range for an adult. Pressure of 110 systolic and 60 diastolic falls within the normal range for an adult. Pressure of 120 systolic and 70 diastolic falls within the normal range for an adult.

A nurse is discussing with a group of nursing students how to accurately measure blood pressure. The nurse is sure to include all the following information except: a) Routinely calibrate the sphygmomanometer. b) Position the forearm above the level of the heart. c) Initially take the blood pressure in both arms. d) Center the cuff bladder directly over the brachial artery.

Position the forearm above the level of the heart. Explanation: The cuff bladder must be centered over the brachial artery, and the client's forearm must be positioned at heart level. The nurse must routinely calibrate the sphygmomanometer. Initially, the nurse should record the blood pressure results in both arms and take subsequent measurements from the arm with the higher reading. - Page 899

The nurse is instructing a student on the proper technique for measuring blood pressure (BP). Which of the following would indicate a need for further teaching?

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

The nurse is explaining the DASH diet to a patient diagnosed with hypertension. The patients inquires about how many servings of fruit per day can be consumed on the diet. The nurse would be correct in stating which of the following? a) 4 or 5 b) 2 or 3 c) 7 or 8 d) 2 or fewer

4 or 5 Correct Explanation: The patient can consume 4 or 5 servings of fruit per day on the DASH diet. The servings for grains and grain product is 7 or 8. Two or 3 servings of low-fat or fat-free dairy foods can be consumed per day. Meat, fish, and poultry servings are 2 or fewer per day. - Page 866

A 77-year-old client has newly diagnosed stage 2 hypertension. The physician has prescribed a thiazide and an angio-converting enzyme inhibitor. About what is the nurse most concerned? a) Postural hypotension and resulting injury b) Postural hypertension and resulting injury c) Rebound hypertension d) Sexual dysfunction

Postural hypotension and resulting injury Correct Explanation: Antihypertensive medication can cause hypotension, especially postural hypotension that may result in injury. Rebound hypertension occurs when antihypertensive medication is stopped abruptly. Sexual dysfunction may occur, especially with beta blockers, but other medications are available should this problem ensue. This is not immediately a priority concern. Antihypertensive medications do not usually cause postural hypertension. page 872

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

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

A nurse is caring for a client with hypertension. The physician orders furosemide (lasix) 2 mg/kg to be given intravenously. The client weighs 24 kg. The medication comes in a single-use vial that contains 40 mg in 4 mL (10 mg/mL). How much will the nurse draw up for this client's dose? a) 0.24 mL b) 4.8 mL c) 2.4 mL d) 0.48 mL

4.8 mL Correct Explanation: The formula is as follows: 24Kg X 2 mg = 48 mg total dose 48 mg / 10mg/mL = 4.8 mL amount to be drawn up

When measuring the blood pressure in each of the patient's arms, the nurse recognizes that in the healthy adult, which of the following is true? a) Pressures may vary, with the higher pressure found in the left arm. b) Pressures may vary 10 mm Hg or more between arms. c) Pressures must be equal in both arms. d) Pressures should not differ more than 5 mm Hg between arms.

Pressures should not differ more than 5 mm Hg between arms. Explanation: Normally, in the absence of disease of the vasculature, there is a difference of no more than 5 mm Hg between arm pressures. The pressures in each arm do not have to be equal in order to be considered normal. Pressures that vary more than 10 mm Hg between arms indicate an abnormal finding. The left arm pressure is not anticipated to be higher than the right as a normal anatomic variant. Chapter 31: Assessment and Management of Patients With Hypertension - Page 864

Which of the following terms is given to hypertension in which blood pressure that is controlled with therapy becomes uncontrolled (abnormally high) with the discontinuation of therapy? a) Primary b) Rebound c) Essential d) Secondary

Rebound Explanation: Rebound hypertension may precipitate a hypertensive crisis. Essential or primary hypertension denotes high blood pressure from an unidentified source. Secondary hypertension denotes high blood pressure from an identified cause, such as renal disease.- Page 863

A patient is flying overseas for 1 week for business and packed antihypertensive medications in a suitcase. After arriving at the intended destination, the patient found that the luggage had been stolen. If the patient cannot take the medication, what condition becomes a concern? Isolated systolic hypertension Rebound hypertension Angina Left ventricular hypertrophy

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

A 55-year-old black male is found to have a blood pressure of 150/90 mm Hg during a work-site health screening. What should the nurse do? Consider this to be a normal finding for his age and race. Recommend he have his blood pressure rechecked in 1 year. Recommend he have his blood pressure rechecked within 2 weeks. Recommend he see his physician immediately for further evaluation.

Recommend he have his blood pressure rechecked within 2 weeks. Explanation: The nurse should recommend the client have his blood pressure rechecked within 2 weeks because a blood pressure of 150/90 mm Hg isn't considered normal. One year is too long to wait. The client need not see his physician yet.

Decreasing hypertension is the main focus of the medical cardiology practice where you practice nursing. Different goals apply to different age groups for managing and reducing blood pressures. Angie Dodd, a 54-year-old nurse, is beginning medical management of her recently diagnosed hypertension. What is considered the most important strategy in her treatment? a) Reducing her systolic pressure below 140 mmHg b) Reducing her systolic pressure below 130 mmHg c) Reducing her diastolic pressure below 80 mmHg d) Reducing her diastolic pressure below 90 mmHg

Reducing her systolic pressure below 140 mmHg Explanation: Currently, it is believed that in persons older than 50 years of age, reducing the systolic pressure below 140 mm Hg is more important than decreasing the diastolic blood pressure.Page 864

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

Renal disease Explanation: Secondary hypertension occurs when a cause for the high blood pressure can be identified. These causes include renal parenchymal disease, narrowing of the renal arteries, hyperaldosteronism (mineralocorticoid hypertension), pheochromocytoma, certain medications (e.g., prednisone, epoietin alfa [Epogen]), and coarctation of the aorta. High blood pressure can also occur with pregnancy; women who experience high blood pressure during pregnancy are at increased risk of ischemic heart disease, heart attacks, strokes, kidney disease, diabetes, and death from heart attack. Calcium deficiency or acid-based imbalance does not contribute to hypertension. Page 862

Which of the following is the nurse most correct to recognize as a direct effect of client hypertension? a) Hyperglycemia resulting from insulin receptor resistance b) Emphysema related to poor gas exchange c) Renal dysfunction resulting from atherosclerosis d) Anemia resulting from bone marrow suppression

Renal dysfunction resulting from atherosclerosis Correct Explanation: The nurse is most correct to realize high blood pressure damages the arterial vascular system and accelerates atherosclerosis. The effect of the atherosclerosis impairs circulation to the kidney, resulting in renal failure. Neither anemia, hyperglycemia, nor emphysema occurs as a direct effect of hypertension. Chapter 31: Assessment and Management of Patients With Hypertension - Page 862

Which of the following findings indicates that hypertension is progressing to target organ damage? a) Blood urea nitrogen (BUN) level of 12 mg/dL b) Chest x-ray showing pneumonia c) Retinal blood vessel damage d) Urine output of 60 cc/mL over 2 hours

Retinal blood vessel damage Explanation: Symptoms suggesting that hypertension is progressing to the extent that target organ damage is occurring must be detected early so that appropriate treatment can be initiated. All body systems must be assessed to detect any evidence of vascular damage. An eye examination with an ophthalmoscope is important because retinal blood vessel damage indicates similar damage elsewhere in the vascular system. The patient is questioned about blurred vision, spots in front of the eyes, and diminished visual acuity. The heart, nervous system, and kidneys are also carefully assessed. A BUN level and 60 cc/mL over 2 hours are normal findings. The presence of pneumonia does not indicate target organ damage. Page 872

A nurse is discussing with students how to accurately measure blood pressures. Which of the following information is the nurse certain to emphasize? a) Position the client's forearm above the level of the heart. b) Center the cuff bladder directly over the radial artery. c) The size of the cuff does not matter as long as it fits snugly around the arm. d) Routinely calibrate the sphygmomanometer.

Routinely calibrate the sphygmomanometer. Explanation: The nurse must routinely calibrate the sphygmomanometer to ensure accuracy of readings. Using a cuff that is too small will give a false high blood pressure measurement, and using a cuff that is too large results in a false low blood pressure measurement. The cuff bladder must be centered over the brachial artery, and the client's forearm must be positioned at heart level. (less) , page 899

A client, newly admitted to the nursing unit, has a primary diagnosis of renal failure. When assessing the client, the nurse notes a blood pressure (BP) of 180/100. The nurse knows that this is what kind of hypertension? a) Essential b) Primary c) Secondary d) Malignant

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

Hypertension that can be attributed to an underlying cause is termed which of the following? a) Secondary b) Essential c) Primary d) Isolated systolic

Secondary Explanation: Secondary hypertension may be caused by a tumor of the adrenal gland (eg, pheochromocytoma). Primary hypertension has no known underlying cause. Essential hypertension has no known underlying cause. Isolated systolic hypertension is demonstrated by readings in which the systolic pressure exceeds 140 mm Hg and the diastolic measurement is normal or near normal (less than 90 mm Hg).Page 862

A patient with secondary hypertension has come into the clinic for a routine check-up. The nurse is aware that the difference between primary hypertension and secondary hypertension is which of the following? A)Secondary hypertension has a specific cause. B)Secondary hypertension has a more gradual onset than primary hypertension. C)Secondary hypertension does not cause target organ damage. D)Secondary hypertension does not normally respond to antihypertensive drug therapy.

Secondary hypertension has a specific cause Feedback: Secondary hypertension has a specific identified cause. A cause could include narrowing of the renal arteries, renal parenchymal disease, hyperaldosteronism, certain medications, pregnancy, and coarctation of the aorta. Secondary hypertension does respond to antihypertensive drug therapy and can cause target organ damage if left untreated.

A client with severe hypertension states, "I feel fine; I'm not really sick at all." The nurse will teach the client that the system/organs particularly targeted for damage by severe hypertension include which of the following?

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

The nurse is instructing a client who is newly prescribed an antihypertensive medication. Which nursing instruction is emphasized to maintain client safety? a) Do not operate a motor vehicle. b) Use a pillbox to store daily medication. c) Take the medication at the same time daily. d) Sit on the edge of the chair and rise slowly.

Sit on the edge of the chair and rise slowly. Correct Explanation: The nursing instruction emphasized to maintain client safety is to sit on the edge of the chair before rising slowly. By doing so, the client reduces the possibility of falls related to postural hypotension. Using a pillbox to store medications and taking the medication at the same time daily is good medication management instruction. There is no reason when taking antihypertensive medications to restrict driving. Page 868

The nurse is working on a busy cardiac unit caring for four hypertensive clients. Which client description would the nurse assess first because the client is at an increased risk for malignant hypertension?

A client with anorexia and history of no healthcare insurance Explanation: Accelerated and malignant hypertension can occur in individuals who fail to maintain follow-up or comply with medical therapy. Those individuals who have no healthcare insurance often are unable to obtain the medical follow-up or afford the cost of medications to treat the hypertensive state. If the hypertension is untreated, symptoms and complication can rapidly follow. The other choices need further assessment but are not the priority.

A nurse is discussing with a nursing student how to accurately measure blood pressure. Which of the following points does the nurse emphasize? a) The size of the cuff does not matter as long as it fits snugly around the arm. b) A cuff that is too small will give a false low blood pressure. c) A cuff that is too large will give a false high blood pressure. d) A cuff that is too small will give a false high blood pressure.

A cuff that is too small will give a false high blood pressure. Correct Explanation: Page 866 Using a cuff that is too small will give a false high blood pressure measurement, while using a cuff that is too large results in a false low blood pressure measurement.

The nurse is assessing the blood pressure for a patient who has hypertension and the nurse does not hear an auscultatory gap. What outcome may be documented in this circumstance?

A high diastolic or low systolic reading Explanation: An auscultatory gap is when the Korotkoff sounds disappear for a brief period as the cuff is being deflated. Failure to notice an auscultatory gap can result in erroneously high diastolic or low systolic pressure readings

A community health nurse is screening for hypertension. Which of the following clients would the nurse focus on most intensively? a) A 45-year-old Asian woman b) A Hispanic teenager c) A middle-aged African-American man d) A postmenopausal Caucasian woman

A middle-aged African-American man Correct Explanation: African Americans have the highest prevalence of hypertension. The other choices all have a lower incidence of hypertension, so the nurse should pay greatest attention to the middle-aged African-American man. - Page 862

A female client, aged 82 years, visits the clinic for a blood pressure (BP) check. Her hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about her blood pressure medicine? a) Take the medicine on an empty stomach. b) A possible adverse effect of blood pressure medicine is dizziness when you stand. c) There are no adverse effects from blood pressure medicine. d) A severe drop in blood pressure is possible.

A possible adverse effect of blood pressure medicine is dizziness when you stand. Correct Explanation: A possible adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. Teaching should include tips for managing syncope and dizziness. You would not teach the client to take the medicine on an empty stomach. ( Page 868

A 77-year-old client has newly diagnosed stage 2 hypertension for which the physician has prescribed a thiazide and an angio-converting enzyme inhibitor. The nurse is concerned about the client's risk for postural hypotension because of these medications, as well as for what other reason? a) Older adults have impaired cardiovascular reflexes. b) These medications often cause rebound hypertension. c) Older adults have trouble remembering to measure their blood pressure at home. d) Older adults require large doses of these medications to control their blood pressure.

A: Older adults have impaired cardiovascular reflexes. Explanation: Antihypertensive medications can cause hypotension, especially postural hypotension that may result in injury. Older adults have impaired cardiovascular reflexes and thus are more sensitive to the extracellular volume depletion caused by diuretics and to the sympathetic inhibition caused by adrenergic antagonists. Rebound hypertension occurs when antihypertensive medications are stopped abruptly. Older adults are more sensitive to the effects of these medications and so usually require lower doses. Most older clients can remember very well to measure their blood pressure at home. Page 872 quality and safety nursing Alert

The nurse is evaluating the types of medications prescribed for a client's hypertension. Which of the following medication classifications establishes an action on vasoconstrictive hormones in the blood stream? a) Calcium channel blocker b) Loop diuretic c) ACE inhibitor d) Beta-blocker

ACE inhibitor Explanation: The angiotensin-converting enzyme (ACE) inhibitor's primary action is to prevent the conversion of angiotensin I to angiotensin II, a potent vasoconstricting hormone in the blood. A beta-blocker blocks the beta-adrenergic receptors decreasing sympathetic nervous system stimulation. Loop diuretics excrete water from the loop of Henle, reducing circulating blood volume. Calcium channel blockers dilate coronary and peripheral arteries. Page 869

Which ethnic background would the nurse screen for hypertension at an early age? a) Mexican population b) Japanese population c) African American population d) Asian population

African American population Correct Explanation: Page 862 The African American population is at the highest risk for development of hypertension. The other ethnic backgrounds have a lower risk.

Hypertension is defined as "sustained elevations in systolic or diastolic blood pressures that exceed prehypertension levels." What are some of the consequences of hypertension that make it such a health menace in the United States? a) Cerebrovascular accident b) Cardiac failure c) Renal disease d) All options are correct.

All options are correct. Correct Explanation: Page 862 Healthcare professionals have revised guidelines for identifying hypertension because hypertension places people at risk for heart disease, heart failure, stroke, and kidney disease.

1. An older adult is newly diagnosed with primary hypertension and has just been started on a beta-blocker. The nurse's health education should include which of the following? A)Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the beta-blocker B)Maintaining a diet high in dairy to increase protein necessary to prevent organ damage C)Use of strategies to prevent falls stemming from postural hypotension D)Limiting exercise to avoid injury that can be caused by increased intracranial pressure

Ans: C Feedback: Elderly people have impaired cardiovascular reflexes and are more sensitive to postural hypotension. The nurse teaches patients to change positions slowly when moving from lying or sitting positions to a standing position, and counsels elderly patients to use supportive devices as necessary to prevent falls that could result from dizziness. Lifestyle changes, such as regular physical activity/exercise, and a diet rich in fruits, vegetables, and low-fat dairy products, is strongly recommended. Increasing fluids in elderly patients may be contraindicated due to cardiovascular disease. Increased intracranial pressure is not a risk and activity should not normally be limited.

2. A patient with primary hypertension comes to the clinic complaining of a gradual onset of blurry vision and decreased visual acuity over the past several weeks. The nurse is aware that these symptoms could be indicative of what? A)Retinal blood vessel damage B)Glaucoma C)Cranial nerve damage D)Hypertensive emergency

Ans: A Feedback: Blurred vision, spots in front of the eyes, and diminished visual acuity can mean retinal blood vessel damage indicative of damage elsewhere in the vascular system as a result of hypertension. Glaucoma and cranial nerve damage do not normally cause these symptoms. A hypertensive emergency would have a more rapid onset.

20. The nurse is developing a nursing care plan for a patient who is being treated for hypertension. What is a measurable patient outcome that the nurse should include? A)Patient will reduce Na+ intake to no more than 2.4 g daily. B)Patient will have a stable BUN and serum creatinine levels. C)Patient will abstain from fat intake and reduce calorie intake. D)Patient will maintain a normal body weight.

Ans: A Feedback: Dietary sodium intake of no more than 2.4 g sodium is recommended as a dietary lifestyle modification to prevent and manage hypertension. Giving a specific amount of allowable sodium intake makes this a measurable goal. None of the other listed goals is quantifiable and measurable.

18. A patient has come to the clinic for a follow-up assessment that will include a BP reading. To ensure an accurate reading, the nurse should confirm that the patient has done which of the following? A)Tried to rest quietly for 5 minutes before the reading is taken B)Refrained from smoking for at least 8 hours C)Drunk adequate fluids during the day prior D)Avoided drinking coffee for 12 hours before the visit

Ans: A Feedback: Prior to the nurse assessing the patient's BP, the patient should try to rest quietly for 5 minutes. The forearm should be positioned at heart level. Caffeine products and cigarette smoking should be avoided for at least 30 minutes prior to the visit. Recent fluid intake is not normally relevant.

7. A patient has been prescribed antihypertensives. After assessment and analysis, the nurse has identified a nursing diagnosis of risk for ineffective health maintenance related to nonadherence to therapeutic regimen. When planning this patient's care, what desired outcome should the nurse identify? A)Patient takes medication as prescribed and reports any adverse effects. B)Patient's BP remains consistently below 140/90 mm Hg. C)Patient denies signs and symptoms of hypertensive urgency. D)Patient is able to describe modifiable risk factors for hypertension.

Ans: A Feedback: The most appropriate expected outcome for a patient who is given the nursing diagnosis of risk for ineffective health maintenance is that he or she takes the medication as prescribed. The other listed goals are valid aspects of care, but none directly relates to the patient's role in his or her treatment regimen.

8. The nurse is providing care for a patient with a new diagnosis of hypertension. How can the nurse best promote the patient's adherence to the prescribed therapeutic regimen? A)Screen the patient for visual disturbances regularly. B)Have the patient participate in monitoring his or her own BP. C)Emphasize the dire health outcomes associated with inadequate BP control. D)Encourage the patient to lose weight and exercise regularly.

Ans: B Feedback: Adherence to the therapeutic regimen increases when patients actively participate in self-care, including self-monitoring of BP and diet. Dire warnings may motivate some patients, but for many patients this is not an appropriate or effective strategy. Screening for vision changes and promoting healthy lifestyle are appropriate nursing actions, but do not necessarily promote adherence to a therapeutic regimen.

13. The nursing lab instructor is teaching student nurses how to take blood pressure. To ensure accurate measurement, the lab instructor would teach the students to avoid which of the following actions? A)Measuring the BP after the patient has been seated quietly for more than 5 minutes B)Taking the BP at least 10 minutes after nicotine or coffee ingestion C)Using a cuff with a bladder that encircles at least 80% of the limb D)Using a bare forearm supported at heart level on a firm surface

Ans: B Feedback: Blood pressures should be taken with the patient seated with arm bare, supported, and at heart level. The patient should not have smoked tobacco or taken caffeine in the 30 minutes preceding the measurement. The patient should rest quietly for 5 minutes before the reading is taken. The cuff bladder should encircle at least 80% of the limb being measured and have a width of at least 40% of limb circumference. Using a cuff that is too large results in a lower BP and a cuff that is too small will give a higher BP measurement.

22. The hospital nurse cares for many patients who have hypertension. What nursing diagnosis is most common among patients who are being treated for this health problem? A)Deficient knowledge regarding the lifestyle modifications for management of hypertension B)Noncompliance with therapeutic regimen related to adverse effects of prescribed therapy C)Deficient knowledge regarding BP monitoring D)Noncompliance with treatment regimen related to medication costs

Ans: B Feedback: Deviation from the therapeutic program is a significant problem for people with hypertension and other chronic conditions requiring lifetime management. For many patients, this is related to adverse effects of medications. Medication cost is relevant for many patients, but adverse effects are thought to be a more significant barrier. Many patients are aware of necessary lifestyle modification, but do not adhere to them. Most patients are aware of the need to monitor their BP.

39. A patient's medication regimen for the treatment of hypertension includes hydrochlorothiazide. Following administration of this medication, the nurse should anticipate what effect? A)Drowsiness or lethargy B)Increased urine output C)Decreased heart rate D)Mild agitation

Ans: B Feedback: Thiazide diuretics lower BP by reducing circulating blood volume; this results in a short-term increase in urine output. These drugs do not cause bradycardia, agitation, or drowsiness.

36. The nurse is reviewing the medication administration record of a patient who takes a variety of medications for the treatment of hypertension. What potential therapeutic benefits of antihypertensives should the nurse identify? Select all that apply. A)Increased venous return B)Decreased peripheral resistance C)Decreased blood volume d)Decreased strength and rate of myocardial contractions E)Decreased blood viscosity

Ans: B, C, D Feedback: The medications used for treating hypertension decrease peripheral resistance, blood volume, or the strength and rate of myocardial contraction. Antihypertensive medications do not increase venous return or decrease blood viscosity.

19. The nurse is providing care for a patient with a diagnosis of hypertension. The nurse should consequently assess the patient for signs and symptoms of which other health problem? A)Migraines B)Atrial-septal defect C) Atherosclerosis D) Thrombocytopenia

Ans: C Feedback: Hypertension is both a sign and a risk factor for atherosclerotic heart disease. It is not associated with structural cardiac defects, low platelet levels, or migraines.

5. A group of student nurses are practicing taking blood pressure. A 56-year-old male student has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, he exclaims, "My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it?" Which of the following responses by the nursing instructor would be best? A)"Yes. Hypertension is prevalent among men; it is fortunate we caught this during your routine examination." B)"We will need to reevaluate your blood pressure because your age places you at high risk for hypertension." C)"A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made." D) "You have no need to worry. Your pressure is probably elevated because you are being tested."

Ans: C Feedback: Hypertension is confirmed by two or more readings with systolic pressure of at least 140 mm Hg and diastolic pressure of at least 90 mm Hg. An age of 56 does not constitute a risk factor in and of itself. The nurse should not tell the student that there is no need to worry.

12. A patient in a hypertensive emergency is admitted to the ICU. The nurse anticipates that the patient will be treated with IV vasodilators, and that the primary goal of treatment is what? A)Lower the BP to reduce onset of neurologic symptoms, such as headache and vision changes. B)Decrease the BP to a normal level based on the patient's age. C)Decrease the mean arterial pressure between 20% and 25% in the first hour of treatment. D)Reduce the BP to £ 120/75 mm Hg as quickly as possible.

Ans: C Feedback: Initially, the treatment goal in hypertensive emergencies is to reduce the mean arterial pressure by 25% in the first hour of treatment, with further reduction over the next 24 hours. Lowering the BP too fast may cause hypotension in a patient whose body has adjusted to hypertension and could cause a stroke, MI, or visual changes. Neurologic symptoms should be addressed, but this is not the primary focus of treatment planning.

24. The nurse is collaborating with the dietitian and a patient with hypertension to plan dietary modifications. These modifications should include which of the following? A)Reduced intake of protein and carbohydrates BIncreased intake of calcium and vitamin D C)Reduced intake of fat and sodium D)Increased intake of potassium, vitamin B12 and vitamin D

Ans: C Feedback: Lifestyle modifications usually include restricting sodium and fat intake, increasing intake of fruits and vegetables, and implementing regular physical activity. There is no need to increase calcium, potassium, and vitamin intake. Calorie restriction may be required for some patients, but a specific reduction in protein and carbohydrates is not normally indicated.

Of the following diuretic medications, which conserves potassium? a) Chlorthalidone (Hygroton) b) Chlorothiazide (Diuril) c) Spironolactone (Aldactone) d) Furosemide (Lasix)

Spironolactone (Aldactone) Correct Explanation: Aldactone is known as a potassium-sparing diuretic. Lasix causes loss of potassium from the body. Diuril causes mild hypokalemia. Hygroton causes mild hypokalemia. Page 867

A nursing class is practicing measurement of blood pressure. One otherwise healthy participant, 46 years old, is 138/90. This man requires follow-up. In which classification of hypertension is he according to the JNC 7 (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood pressure) recommendation? a) Stage 2 with compelling indications b) Stage 1 c) Stage 1 with compelling indications d) Stage 2

Stage 1 Correct Explanation: Stage 1 hypertension is a blood pressure of 140 to 159 systolic or 90 to 99 diastolic. Stage 2 hypertension is a blood pressure greater than 160 systolic or greater than 100 diastolic. Compelling indications include heart failure, post-myocardial infarction, high cardiovascular disease risk, diabetes, chronic kidney disease, and previous stroke. Page 865

The nurse is employed in a physician's office and is caring for a client present for an annual exam. A blood pressure of 124/84 mm Hg is documented. Following revised guidelines for identifying hypertension, which educational pamphlet is help? a) Use of beta-blockers for treatment of hypertension b) Diagnostic testing for determining cardiac functioning c) Stress reduction to lower prehypertensive state d) Increasing fluids for low blood pressure

Stress reduction to lower prehypertensive state Correct Explanation: A blood pressure of 124/84 mm Hg is now considered to be in the lower range of prehypertension. Knowledge of stress reduction may be helpful in lowering the blood pressure without medication therapy. A blood pressure of 124/84 mm Hg is not considered a low blood pressure or in need of medication therapy due to hypertension. Diagnostic testing for cardiac functioning is not typical for a client with prehypertension. (less) Chapter 31: Assessment and Management of Patients With Hypertension - Page 871

You are part of a group of nursing students who are making a presentation on chronic hypertension. What is one subject you would need to include in your presentation as a possible consequence of untreated chronic hypertension? a) Right-sided heart failure b) Stroke c) Pulmonary insufficiency d) Peripheral edema

Stroke Correct Explanation: Page 861 A stroke occurs if vessels in the brain rupture and bleed. If an aneurysm has developed in the aorta from chronic hypertension, it may burst and cause hemorrhage and shock. Options A, B, and D are not usually consequences of untreated chronic hypertension.

A student nurse is taking care of an elderly patient with hypertension during a clinical experience. The instructor asks the student about the relationships between BP and age. What would be the best answer by the student? A)Because of reduced smooth muscle tone in blood vessels, blood pressure tends to go down with age, not up. B)Decreases in the strength of arteries and the presence of venous insufficiency cause hypertension in the elderly. C)Structural and functional changes in the cardiovascular system that occur with age contribute to increases in blood pressure. D)The neurologic system of older adults is less efficient at monitoring and regulating blood pressure.

Structural and functional changes in the cardiovascular system that occur with age contribute to increases in blood pressure. Feedback: Structural and functional changes in the heart and blood vessels contribute to increases in BP that occur with aging. Venous insufficiency does not cause hypertension, however. Increased BP is not primarily a result of neurologic changes.

The nurse is caring for a client with hypertension. The nurse is correct to realize that a 24-hour urine is ordered to determine if the cause of hypertension is related to the dysfunction of which of the following? a) The adrenal gland b) The thymus c) The thyroid gland d) The pituitary gland

The adrenal gland Correct Explanation: The 24-hour urine collection specimen is ordered to determine dysfunction of the adrenal gland. The 24-hour urine detects elevated catecholamines. The other options are not evaluated by a 24-hour urine. Page 864

A patient's recently elevated BP has prompted the primary care provider to prescribe furosemide (Lasix). The nurse should closely monitor which of the following? A)The client's oxygen saturation level B)The patient's red blood cells, hematocrit, and hemoglobin C)The patient's level of consciousness D)The patient's potassium level

The patient's potassium level Feedback: Loop diuretics can cause potassium depletion. They do not normally affect level of consciousness, erythrocytes, or oxygen saturation.

Why is it important for the nurse to implement measures to relieve emotional stress for patients with hypertension? a) The reduction of stress decreases the production of neurotransmitters that constrict peripheral arterioles. b) The reduction of stress increases the blood volume and improves the potential for greater cardiac output. c) The reduction of stress increases the resistance that the heart must overcome to eject blood. d) The reduction of stress increases the production of neurotransmitters that constrict peripheral arterioles.

The reduction of stress decreases the production of neurotransmitters that constrict peripheral arterioles. Correct Explanation: Reduced stress decreases the production of neurotransmitters that constrict peripheral arterioles. Reduced stress may assist in reducing blood volume and resistance to the heart. Page 871

The nurse observes a certified nursing assistant (CNA) obtaining a blood pressure reading with a cuff that is too small for the patient. The nurse informs the CNA that using a cuff that is too small can affect the reading results in what way?

The results will be falsely elevated. Explanation: Select the size of the cuff based on the size of the patient. (The cuff size should have a bladder width of at least 40% of limb circumference and length at least 80% of limb circumference.) The average adult cuff is 12 to 14 cm wide and 30 cm long. Using a cuff that is too small will give a higher BP measurement, and using a cuff that is too large results in a lower BP measurement compared to one taken with a properly sized cuff.

The nurse understands that an overall goal of hypertension management includes which of the following? a) The patient maintains a normal blood pressure reading. b) There are no complaints of sexual dysfunction. c) There is no indication of target organ damage. d) There is no complaint of postural hypotension.

There is no indication of target organ damage. Explanation: Prolonged blood pressure elevation gradually damages blood vessels throughout the body, particularly in target organs such as the heart, kidneys, brain, and eyes. The overall goal of management is that the patient does not experience target organ damage. The desired effects of antihypertensives are to maintain a normal BP. Postural hypotension and sexual dysfunction are side effects of certain antihypertension medications. Page 862

The nurse is obtaining a healthy history from a client with blood pressure of 146/88 mm Hg. The client states that lifestyle changes have not been effective in lowering the blood pressure. Which medication classification does the nurse anticipate first? a) Beta-blocker b) ACE inhibitors c) Thiazide diuretic d) Calcium channel blocker

Thiazide diuretic Explanation: Clients with hypertension, unable to be lowered by lifestyle changes, usually are placed on a thiazide diuretic initially. However, most people with hypertension will need two or more antihypertensive medications to reduce their blood pressure. - Page 867

A client comes to the emergency department complaining of visual changes and a severe headache. The nurse measures the client's blood pressure at 210/120 mm Hg. However, the client denies having hypertension or any other disorder. After diagnosing malignant hypertension (hypertensive emergency), a life-threatening disorder, the physician initiates emergency intervention. What is the most common cause of malignant hypertension (hypertensive emergency)?

Untreated hypertension Explanation: Untreated hypertension is the most common cause of malignant hypertension (hypertensive emergency). Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as those that occur with monoamine oxidase inhibitors and aged cheeses).

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

Up to 25% Explanation: Page 873 The therapeutic goals are reduction of the mean BP by up to 25% within the first hour of treatment, a further reduction to a goal pressure of about 160/100 mm Hg over a period of 2 to 6 hours, and then a more gradual reduction in pressure to the target goal over a period of days.

A nurse is educating about lifestyle modifications for a group of clients with newly diagnosed hypertension. While discussing dietary changes, which of the following points would the nurse emphasize? a) It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. b) The taste buds never adapt to decreased salt intake. c) A person with hypertension should never consume alcohol. d) There is usually no need to change alcohol consumption for clients with hypertension.

a: It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. Correct Explanation: It takes 2 to 3 months for the taste buds to adapt to changes in salt intake. Knowing this may help the client adjust to reduced salt intake. The client should be advised to limit alcohol intake. Page 871

The nurse is caring for a client with essential hypertension. The nurse reviews labwork and assesses kidney function. Which action of the kidney would the nurse evaluate as the body's attempt to regulate high blood pressure? a) The kidney excretes sodium and water. b) The kidney retains sodium and excretes water. c) The kidney retains sodium and water. d) The kidney retains water and excretes sodium.

a: The kidney excretes sodium and water. Explanation: Hypernatremia (elevated serum sodium level) increases blood volume, which raises blood pressure. The kidney's response to the elevation in blood pressure is to excrete sodium and excess water. Any retention of sodium and water would increase blood volume and, thus, blood pressure. Sodium and water move together. Page 863

A systolic blood pressure of 135 mm Hg would be classified as which of the following? a) Stage 2 hypertension b) Stage 1 hypertension c) Prehypertension d) Normal

c) Prehypertension pg 862 table 31-1

A client in a clinic setting has just been diagnosed with hypertension. She asks what the end goal is for treatment. The correct reply from the nurse is which of the following? a) To lose weight, achieve a body mass index of 24 or less, and to eat a diet rich in fruits and vegetables b) To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less c) To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less d) To stop smoking and increase physical activity to 30 minutes/day most days of the week

c:To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less Explanation: Page 864 The end goal of hypertension treatment is to prevent complications and death by achieving and maintaining arterial blood pressure at 140/90 or lower for most people. To achieve this end goal, the client is taught to make the following lifestyle changes (these are not end goals; they are ways to reach the end goal listed above): (1) maintaining a normal body mass index (about 24; greater than 25 is considered overweight); maintaining a waist circumference of less than 40 inches for men and 35 inches for women; limiting alcohol intake to no more than 2 drinks for men and 1 drink for women per day; engaging in aerobic activity at least 30 minuetes per day most days of the week.

Choice Multiple question - Select all answer choices that apply. Choose the statements that correctly match the hypertensive medication with its side effect. Select all that apply. a) Beta-blockers may cause sedation. b) With thiazide diuretics, monitor serum potassium levels. c) Direct vasodilators may cause headache and tachycardia. d) With ACE inhibitors, assess for bradycardia. e) With adrenergic inhibitors, cough is a common side effect.

c• Direct vasodilators may cause headache and tachycardia. b• With thiazide diuretics, monitor serum potassium levels. Explanation: Thiazide diuretics may deplete potassium; many clients will need potassium supplementation. Angiotensin-converting enzyme (ACE) inhibitors can induce a mild to severe dry cough. Beta-blockers may induce decreased heart rate; pulse rate should be assessed before administration. Direct vasodilators may cause headache and increased heart rate. Adrenergic inhibitors can cause sedation and fatigue. - Page 867

It is important for the nurse to encourage the patient to rise slowly from a sitting or lying position because: a) Gradual changes in position provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain. b) Gradual changes in position help reduce the blood pressure to resupply oxygen to the brain. c) Gradual changes in position help reduce the heart's work to resupply oxygen to the brain. d) Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain.

d : Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. Explanation: It is important for the nurse to encourage the patient to rise slowly from a sitting or lying position because gradual changes in position provide time for the heart to increase its rate of contraction to resupply oxygen to the brain and not blood pressure or heart rate. Page 872

The nurse is teaching a patient diagnosed with hypertension about the DASH diet. How many servings of meat, fish, and poultry should a patient consume per day? a) 2 or fewer b) 7 or 8 c) 4 or 5 d) 2 or 3

d:2 or fewer Explanation: Two or fewer servings of meat, fish, and poultry are recommended in the DASH diet. Page 866 Table 31-3

It is appropriate for the nurse to recommend smoking cessation for patients with hypertension because nicotine a) decreases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. b) decreases circulating blood volume. c) increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. d) increases the heart rate, constricts arterioles, and increases the heart's ability to eject blood.

increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. Correct Explanation: The nurse recommends smoking cessation for patients with hypertension because nicotine raises the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. Reduced oral fluids decrease the circulating blood volume. - Page 871

Choice Multiple question - Select all answer choices that apply. A nurse providing education about hypertension to a community group is reviewing consequences of the disease. Which of the following would the nurse identify as target organs for hypertensive damage? Choose all that apply. a) Stomach b) Kidneys c) Brain d) Eyes e) Heart

• Eyes • Kidneys • Brain • Heart Correct Explanation: Prolonged hypertension eventually damages blood vessels throughout the body, particularly in target organs such as the heart, kidneys, brain, and eyes. - Page 862

Choice Multiple question - Select all answer choices that apply. Target organ damage from untreated/undertreated hypertension includes which of the following? Select all that apply. a) Hyperlipidemia b) Stroke c) Diabetes d) Retinal damage e) Heart failure

• Heart failure • Retinal damage • Stroke Explanation: Page 862 Target organ systems include cardiac, cerebrovascular, peripheral vascular, renal, and the eye. Hyperlipidemia and diabetes are risk factors for development of hypertension.

Choice Multiple question - Select all answer choices that apply. A 59-year-old client has just received a diagnosis of hypertension from his cardiologist after the completion of diagnostics. After discussing the diagnosis and its consequences with the physician, the client asks you questions regarding his condition. What can the client do to decrease the consequences of his hypertension? Select all that apply. a) Manage stress effectively. b) Use smokeless tobacco. c) Lose weight. d) Get plenty of rest.

• Lose weight. • Manage stress effectively. Explanation: Obesity, inactivity, smoking, excessive alcohol intake, and ineffective stress management are risk factors for hypertension. - Page 871

Choice Multiple question - Select all answer choices that apply. The nurse is conducting a service project for a local elderly community group on the topic of hypertension. The nurse will relay that risk factors and cardiovascular problems related to hypertension include which of the following? Select all that apply. a) Decreased low-density lipoprotein (LDL) levels. b) Obesity (BMI ≥ 30 kg/m2) c) Smoking d) Age ≥55 in men e) Elevated high-density lipoprotein (HDL) cholesterol

• Obesity (BMI ≥ 30 kg/m2) • Age ≥55 in men • Smoking Correct Explanation: Major risk factors (in addition to hypotension) include smoking, dyslipidemia (high LDL, low HDL cholesterol), diabetes mellitus, impaired renal function, obesity, physical inactivity, age (older than 55 years for men, 65 years for women), and family history of cardiovascular disease. Page 864

Choice Multiple question - Select all answer choices that apply. A nurse is providing education about hypertension to a community group. One client reports that his doctor has diagnosed him with hypertension, but that he feels just fine. He asks, "What would happen if I did not treat my hypertension?" Which of the following are possible consequences of untreated hypertension? Choose all that apply. a) Pancreatitis b) Stroke c) Myocardial infarction d) Coronary artery disease e) Tension pneumothorax

• Stroke • Myocardial infarction • Coronary artery disease Correct Explanation: People with hypertension may remain asymptomatic for many years. When specific signs and symptoms appear, however, they usually indicate vascular damage. Coronary artery disease with angina and myocardial infarction are common consequences of hypertension. Cerebrovascular involvement may lead to a stroke. Tension pneumothorax and pancreatitis are not directly related to hypertension. Page 863

Choice Multiple question - Select all answer choices that apply. Which of the following statements are true when the nurse is measuring blood pressure (BP)? Select all that apply. a) Using a BP cuff that is too large will give a higher BP measurement. b) The patient's arm should be positioned at the level of the heart. c) The patient's BP should be taken 1 hour after the consumption of alcohol. d) Using a BP cuff that is too small will give a higher BP measurement. e) Ask the patient to sit quietly while the BP is being measured.

• Using a BP cuff that is too small will give a higher BP measurement. • The patient's arm should be positioned at the level of the heart. • Ask the patient to sit quietly while the BP is being measured. Explanation: These statements are all true when measuring a BP. When using a BP cuff that is too large the reading will be lower than the actual BP. The patient should avoid smoking cigarettes or drinking caffeine for 30 minutes before BP is measured. Page 866