PrepU Chapter 27

The nurse is caring for a client who has had 25 mg of oral hydrochlorothiazide added to the medication regimen for the treatment of hypertension. Which instruction should the nurse give the client?

"Increase the amount of fruits and vegetables you eat."

Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension?

"Limiting my salt intake to 2 grams per day will improve my blood pressure."

Hypertension is diagnosed when the client demonstrates a systolic blood pressure greater than ______ mm Hg or a diastolic blood pressure greater than _____ mm Hg over a sustained period.

130, 80

A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. What will the nurse specify about this client's target blood pressure?

130/80 or lower

According to the DASH diet, how many servings of vegetables should a person consume each day?

4 or 5

Which of the following client scenarios would be correct for the nurse to identify as a client with secondary hypertension?

A client diagnosed with kidney disease

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

A patient has been diagnosed with prehypertension and has been encouraged to exercise regularly and begin a weight loss program. What other healthcare professional may be helpful for the client to see?

Dietician

A client with newly diagnosed hypertension asks how to decrease the risk for related cardiovascular problems. What risk factor is modifiable by the client?

Dyslipidemia

A client with hypertension has been able to maintain a blood pressure of 130/70 mm Hg for 1 year while reducing dietary sodium and taking hydrochlorothiazide (HCTZ) and atenolol. What treatment plan will the nurse educate the client about?

Gradual reducing the HCTZ and the atenolol and continuing to reduce sodium intake

A client experiences orthostatic hypotension while receiving furosemide to treat hypertension. How will the nurse intervene?

Instruct the client to sit for several minutes before standing.

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

Isolated systolic hypertension

A nurse is educating about lifestyle modifications for a group of clients with newly diagnosed hypertension. While discussing dietary changes, which point would the nurse emphasize?

It takes 2 to 3 months for the taste buds to adapt to decreased salt intake.

The nurse is discussing aging and the incidence of hypertension with an older adult. What lifestyle change will lower blood pressure for the older adult?

Keep weight stable.

The nurse is assessing a patient with severe hypertension. When performing a focused assessment of the eyes, what does the nurse understand may be observed related to the hypertension?

Papilledema

The nurse is instructing a student on the proper technique for measuring blood pressure (BP). Which student action indicates a need for further teaching?

Positions the arm at waist level

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

Potassium level

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?

Rebound hypertension

A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. What are risk factors for cardiovascular problems in clients with hypertension? Select all that apply.

Smoking Diabetes mellitus Physical inactivity

During the physical assessment of a client with hypertension, what would the nurse expect to be the most obvious finding?

Sustained increase of either one or both systolic or diastolic measurements.

Which statements are true when the nurse is measuring blood pressure (BP)? Select all that apply.

Using a BP cuff that is too small will give a higher BP measurement. The client's arm should be positioned at the level of the heart. The client should sit quietly while BP is being measured.

A client with a history of hypertension is receiving client education about structures that regulate arterial pressure. Which structure is a component of that process?

kidneys

The nurse is caring for an older adult client who has come to the clinic for a yearly physical. When assessing the client, the nurse notes the blood pressure (BP) is 140/93. The nurse knows that in older clients what happens that may elevate the systolic BP?

Loss of arterial elasticity

The nurse is caring for a client with essential hypertension. The nurse reviews lab work and assesses kidney function. Which action of the kidney would the nurse evaluate as the body's attempt to regulate high blood pressure?

The kidney excretes sodium and water.

Primary or essential hypertension accounts for about 95% of all hypertension diagnoses with an unknown etiology. Secondary hypertension accompanies specific conditions that create hypertension as a result of tissue damage. Which condition contributes to secondary hypertension?

arterial vasoconstriction

The nurse is administering medications on a medical-surgical unit. A client is ordered to receive 40 mg oral nadolol for the treatment of hypertension. Before administering the medication, the nurse should

check the client's heart rate.

Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress

decreases the production of neurotransmitters that constrict peripheral arterioles.

A client who was recently diagnosed with prehypertension is to meet with a dietitian and return for a follow-up with the cardiologist in 6 months. What would this client's treatment likely include?

nonpharmacological interventions

Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through:

ophthalmic examination.

The nurse is teaching a client about chronic untreated hypertension. What complication will the nurse explain to the client?

stroke

A nurse is caring for a client who has hypertension and diabetes mellitus. The client's blood pressure this morning was 150/92 mm Hg. When the client asks the nurse what his or her blood pressure should be, what is the nurse's most appropriate response?

"Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg."

It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position

provide time for the heart to increase the rate of contraction to resupply oxygen to the brain.

The nurse encourages the client diagnosed with hypertension to rise slowly from a sitting or lying position because gradual changes in position

provide time for the heart to increase the rate of contraction to resupply oxygen to the brain.

Hypertension that can be attributed to an underlying cause is termed

secondary hypertension.

A 35-year-old client has been diagnosed with hypertension. The client is a stock broker, smokes daily, and has diabetes. During a follow-up appointment, the client states that regular visits to the doctor just to check blood pressure (BP) are cumbersome and time consuming. As the nurse, which aspect of client teaching would you recommend?

Purchasing a self-monitoring BP cuff

A client is brought to the emergency department with reports of a bad headache and an increase in blood pressure. The blood pressure reading obtained by the nurse is 260/180 mm Hg. What is the therapeutic goal for reduction of the mean blood pressure?

Reduce the blood pressure by 20% to 25% within the first hour of treatment.

A client has been prescribed three medications for hypertension and the nurse measured a blood pressure of 180/80. Which question will the nurse ask the client first?

"Are you still taking the medication?"

A 77-year-old client presents to the local community center for a blood pressure (BP) screening; BP is recorded as 180/90 mm Hg. The client has a history of hypertension but currently is not taking the prescribed medications. Which question is most appropriate for the nurse to ask the client first?

"Can you tell me the reasons you aren't taking your medications?"

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?

Blood lipid levels

A client is placed on a low-sodium (500 mg/day) diet. Which client statement indicates that the nurse's nutrition teaching plan has been effective?

"I chose broiled chicken with a baked potato for dinner."

A nurse is educating a client about monitoring blood pressure readings at home. What will the nurse be sure to emphasize?

"Sit quietly for 5 minutes prior to taking blood pressure."

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?

ACE inhibitor

A client with newly diagnosed hypertension asks what to do to decrease the risk for related cardiovascular problems. Which risk factor is not modifiable by the client?

Age

A nurse is providing education to a client about monitoring blood pressure readings at home. What reminders will the nurse review with the client? Select all that apply.

Avoid talking during the measurement. Sit with both feet on the ground during the measurement. Ensure at least 5 minutes of quiet rest before measurements. Be sure the forearm is well supported at heart level while taking blood pressure

When administering benazepril with spironolactone, the nurse should be aware that which electrolyte imbalance may occur?

Hyperkalemia

A client is being seen at the clinic for a routine physical when the nurse notes the client's blood pressure is 150/97. The client is considered to be a healthy, well-nourished young adult. What type of hypertension does this client have?

Essential (primary)

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?

Heart and blood vessels

Which condition(s) indicates target organ damage from untreated/undertreated hypertension? Select all that apply.

Heart failure Retinal damage Stroke

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

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

Hyperkalemia

A client informs the nurse, "I can't adhere to the dietary sodium decrease that is required for the treatment of my hypertension." What can the nurse educate the client about regarding this statement?

It takes 2 to 3 months for the taste buds to adapt to changes in salt intake.

The nurse is planning the care of a patient admitted to the hospital with hypertension. What objective will help to meet the needs of this patient?

Lowering and controlling the blood pressure without adverse effects and without undue cost

Which adrenergic inhibitor acts directly on the blood vessels, producing vasodilation?

Prazosin

When measuring the blood pressure in each arm of a healthy adult client, the nurse recognizes that which statement is true?

Pressures should not differ more than 5 mm Hg between arms.

The nurse is caring for a client newly diagnosed with secondary hypertension. Which condition contributes to the development of secondary hypertension?

Renal disease

The nurse is caring for a client prescribed bumetanide for the treatment of stage 2 hypertension. Which finding indicates the client is experiencing an adverse effect of the medication?

Serum potassium value of 3.0 mEq/L

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

dizziness

What risk factors would cause the nurse to become concerned that the client may have atherosclerotic heart disease? Select all that apply.

hypertension diabetes obesity family history of early cardiovascular events