Ch 27 Assessment and Management of Patients with Hypertension

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. Which client statement confirms that the teaching has been successful?

"Antihypertensive drugs can lead to falls."

A client with high blood pressure is receiving an antihypertensive drug. When developing a client teaching plan to minimize orthostatic hypotension, which instruction should the nurse include?

"Flex your calf muscles, avoid alcohol, and change positions slowly."

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." What is the best response by the nurse?

"Hypertension often causes no symptoms."

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."

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."

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

25%

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

4 or 5

A nurse is discussing with a nursing student how to accurately measure blood pressure. What statement by the student indicates an understanding of the education?

A cuff that is too small will give a false high blood pressure.

Which of the following nursing diagnoses is the nurse most correct to choose when caring for a client with long-standing hypertension?

Altered Tissue Perfusion

A client has just been diagnosed with prehypertension. What would the nurse instruct this client to do to restore his blood pressure below hypertensive levels?

Decrease sodium intake.

A diabetic client visits a walk-in clinic and asks the nurse to take a blood pressure (BP) reading. The measurements are 150/90 mm Hg. Which of the following would the nurse expect as the treatment to normalize the client's BP?

Drug therapy

A nurse is teaching about lifestyle modifications to a group of clients with known hypertension. Which statement would the nurse include in the education session?

Engage in aerobic activity at least 30 minutes/day most days of the week.

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 caring for a client with accelerated hypertension. Which body system would the nurse assess to identify early signs of blood pressure progression?

Eyes

A client, newly prescribed a low-sodium diet due to hypertension, is asking for help with meal choices. The client names four favorite meals. Which selection would be best?

Green pepper stuffed with diced tomatoes and chicken

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

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

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 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

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

A nurse is assessing a client and notes a blood pressure (BP) of 205/115. The client has had BP's within normal limits up until this time. The client reports a sudden onset severe headache. The nurse recognizes this as probable malignant hypertension. What would be the nurse's first action?

Notify the health care provider.

A client is admitted to the intensive care unit (ICU) with a diagnosis of hypertension emergency/crisis. The client's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV nitroprusside. Upon assessment, which finding requires immediate intervention by the nurse?

Numbness and weakness in the left arm

An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for?

Postural hypotension and resulting injury

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

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.

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 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.

Which of the following is the nurse most correct to recognize as a direct effect of client hypertension?

Renal dysfunction resulting from atherosclerosis

Which term describes high blood pressure from an identified cause, such as renal disease?

Secondary hypertension

The nurse is instructing a client who is newly prescribed an antihypertensive medication. Which nursing instruction is emphasized to maintain client safety?

Sit on the edge of the chair and rise slowly.

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

Which diuretic medication conserves potassium?

Spironolactone

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 helpful?

Stress reduction to lower prehypertensive state

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.

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.

The nurse is caring for a client with a blood pressure of 210/100 mm Hg in the emergency room. What is the most appropriate route of administration for antihypertensive agents?

continuous IV infusion

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 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

The nurse is teaching a client about hypertension and the effects on the left ventricle. What diagnostic test will the nurse describe?

echocardiography

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

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

Hypertension that can be attributed to an underlying cause is termed

secondary hypertension.

The nurse is seeing a client for the first time and has just checked the client's blood pressure. The nurse would consider the client prehypertensive if:

systolic BP is between 120 and 139 mm Hg.

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 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."

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."

It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine

increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood.