CH 31 hypertension mangement
The nursing student is part of a group of nursing students who are making a presentation on chronic hypertension. What is one subject the nursing student would need to include in the presentation as a possible consequence of untreated chronic hypertension? Stroke Peripheral edema Right-sided heart failure Pulmonary insufficiency
Stroke Explanation: *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. The other options are not usually consequences of untreated chronic hypertension.
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? -Instructing the patient to enter a weight loss program and begin an exercise regimen -Scheduling the patient for all follow-up visits and making phone calls to the home to ensure adherence --Lowering and controlling the blood pressure without adverse effects and without undue cost -Making sure that the patient adheres to the therapeutic medication regimen
Lowering and controlling the blood pressure without adverse effects and without undue cost Explanation: The objective of nursing care for patients with hypertension focuses on lowering and controlling the blood pressure without adverse effects and without undue cost.
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? Administering glycemic control Purchasing a self-monitoring BP cuff Discussing methods for stress reduction Advising smoking cessation
Purchasing a self-monitoring BP cuff Explanation: Because this client finds visiting the doctor time-consuming just for a BP 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 to reduce stress, advising smoking cessation, and achieving glycemic control would constitute client education in managing hypertension.
A client with hypertension has been started on losartan, an angiotensin II receptor blocker (ARB). After 6 weeks of therapy, the health care provider concludes that losartan alone is not controlling the hypertension. What would the health care provider likely add to the regimen to better control the client's hypertension? An ACE inhibitor A vasopressor Another ARB A diuretic
A diuretic Explanation: When losartan therapy is started, maximal effects on blood pressure usually occur within 3 to 6 weeks. If losartan alone does not control blood pressure, a low dose of a diuretic may be added. A combination product of losartan and hydrochlorothiazide is available. The addition of an ACE inhibitor, a vasopressor or another ARB is not appropriate.
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.) Lung sounds Respiratory rate Heart rhythm Character of apical and peripheral pulses Heart rate
Heart rate Heart rhythm Character of apical and peripheral pulses X NOT Respiratory rate
Which of the following would be inconsistent with a hypertensive urgency? Epistaxis Anxiety Intracranial hemorrhage Severe headache
Intracranial hemorrhage Epistaxis = bleeding of nose or nasoparynx from hemorhhage 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.
You are precepting a new graduate nurse on your unit. The two of you are caring for a client with malignant hypertension. The new nurse asks what malignant hypertension can cause. What would be your best answer? Right ventricular failure Peripheral edema Pulmonary hypertension Left ventricular failure
Left ventricular failure malignant hypertension = extremely high blood pressure that develops rapidly and causes some type of organ damage. above 180/110 Explanation: Cardiac effects include left ventricular failure with pulmonary edema or MI. Malignant hypertension does not have consequences of right ventricular failure, pulmonary hypertension, or peripheral edema.
The nurse is instructing a student on the proper technique for measuring blood pressure (BP). Which student action indicates a need for further teaching? -Wraps the blood pressure cuff firmly around the arm --Palpates the systolic pressure before auscultating blood pressure -Centers the blood pressure cuff bladder directly over the brachial artery -Positions the arm at waist level
Positions the arm at waist level Explanation: ARM LEVEL MUST BE AT SAME LEVEL AS HEART 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 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? Thiazide diuretic Beta-blocker Calcium channel blocker ACE inhibitors
Thiazide diuretic Thiazide diuretic = used to treat hypertension and edema by inhibiting reabsorption of sodium (Na+) and chloride (Cl−) ions Beta-blocker = blocks hormone epinephrine/ adrenaline so heart beats slower, then lower BP Calcium channel blocker = relax blood vessels and increase the supply of blood and oxygen to the heart to offload heart more ACE inhibitors = (angiotensin-converting-enzyme) relax blood vessels via inhibiting enzye for angiotensin that vasoconstricts blood vessels 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.
The nurse and a dietitian are instructing the client on a low-sodium diet needed to lower the blood pressure. Which question, asked by the nurse, is most important? "Do you eat three meals per day?" "How do you prepare your food?" "Do you snack in the evening?" "Who eats meals with you?"
"How do you prepare your food?" Explanation: Asking the client how food is prepared, gives the nurse and dietitian the ability to judge the sodium content. If the client opens cans of food, typically, there will be elevated sodium content. If the client uses prepared foods or eats out regularly, there is sodium in the content. If the client uses fresh ingredients, sodium content is minimal. Asking about who eats with the client and their eating patterns are not as helpful in determining sodium content.
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? "Are you having trouble paying for your medications?" "Are you able to get to your pharmacy to pick up your medications?" " Why are you not taking your medications?" " What medications are you prescribed?"
"Why are you not taking your medications?" Explanation: It is important for the nurse to first ascertain why the client is not taking prescribed 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.
A client has severe coronary artery disease (CAD) and hypertension. Which medication order should the nurse consult with the health care provider about that is contraindicated for a client with severe CAD? Bumetanide Methyldopa Clonidine Amiloride
Clonidine Explanation: Clonidine (Catapres) is contraindicated for clients with severe coronary artery disease.
A client with newly diagnosed hypertension asks how to decrease the risk for related cardiovascular problems. What risk factor is modifiable by the client? Impaired renal function Dyslipidemia Age Family history
Dyslipidemia Explanation: 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.
It is important for the nurse to encourage the patient to rise slowly from a sitting or lying position because: -Gradual changes in position help reduce the heart's work to resupply oxygen to the brain. -Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. -Gradual changes in position provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain. -Gradual changes in position help reduce the blood pressure to resupply oxygen to the brain.
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.
Why is it important for a nurse to encourage the client to control the blood pressure? (Select all that apply.) Hypertension increases the buildup of atherosclerotic plaque. Hypertension increases risk of stroke. Hypertension increases risk of colorectal carcinoma. Hypertension increases risk of liver disease Hypertension increases the workload of the heart.
Hypertension increases the buildup of atherosclerotic plaque. Hypertension increases risk of stroke. Hypertension increases the workload of the heart. Explanation: Plaque, stroke, and increased workload are consequences of hypertension. Increased risk of kidney disease, heart failure, and blindness are also consequences of hypertension.
A patient arrives at the clinic for a follow-up visit for treatment of hypertension. The nurse obtains a blood pressure reading of 180/110 but finds no evidence of impending or progressive organ damage when performing the assessment on the patient. What situation does the nurse understand this patient is experiencing? Hypertensive emergency Secondary hypertension Hypertensive urgency Primary hypertension
Hypertensive urgency Hypertensive urgency = high rate 180/110, may have nose bleeds, headache, or anxiety Hypertensive emergency = high BP, 180/110. Organ failure. Explanation: Hypertensive urgency describes a situation in which blood pressure is very elevated but there is no evidence of impending or progressive target organ damage (Chobanian et al., 2003). Elevated blood pressures associated with severe headaches, nosebleeds, or anxiety are classified as urgencies. In these situations, oral agents can be administered with the goal of normalizing blood pressure within 24 to 48 hours
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? Primary hypertension Secondary hypertension Isolated systolic hypertension Hypertensive urgency
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 teaches the client which guidelines regarding lifestyle modifications for hypertension? Reduce smoking to no more than four cigarettes per day Maintain adequate dietary intake of fruits and vegetables Stop alcohol intake Limit aerobic physical activity to 15 minutes, three times per week
Maintain adequate dietary intake of fruits and vegetables Explanation: Guidelines include adopting the Dietary Approaches to Stop Hypertension (DASH) eating plan: consume a diet rich in fruits, vegetables, and low-fat dairy products and reduced amounts of saturated and total fat; reduce dietary sodium intake to no more than 100 mmol/day (2.4 g sodium or 6 g sodium chloride); engage in regular aerobic physical activity such as brisk walking (at least 30 min/day, most days of the week); moderate alcohol consumption, limiting consumption to no more than two drinks (eg, 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and to no more than one drink per day in women and lighter-weight people. *Tobacco should be avoided* because anyone with high blood pressure is already at increased risk for heart disease, and smoking amplifies this risk.
The ICU nurse is caring for a patient in shock. What is one of the most important functions of the nursing role in caring for this patient? Reporting adverse effects of treatment Documenting the administration of medications Monitoring for complications and side effects of treatment Safely administering prescribed fluids
Monitoring for complications and side effects of treatment Explanation: General nursing measures include ensuring safe administration of prescribed fluids and medications and documenting their administration and effects. An important function of the nursing role is monitoring for complications and side effects of treatment and reporting them promptly. The other options are correct but not more important functions of nursing care than monitoring for complications and side effects of treatment.
Losartan is frequently prescribed for hypertension management. For which client would the health care provider write a smaller starting dose of the medication, based on medical history and age? Luke, age 28, who is suffering from hypertension Nick, age 35, who is suffering from hepatic impairment Judy, age 36, who is pregnant Cole, age 88, who is suffering from hypertension
Nick, age 35, who is suffering from hepatic impairment Explanation: Clients who have impaired liver function have increased bioavailability of losartan because metabolism is impaired. They should be given a lower starting dose of the drug and be monitored for therapeutic and adverse effects. No dosage adjustments seem to be necessary for older adults because losartan is just as safe and effective in this group as it is in younger adults. Because losartan has essentially no contraindications, older adults with hypertension and other comorbidities can still be prescribed losartan. The drug should not be used during pregnancy because of adverse effects on the fetus.
A diastolic blood pressure of 90 mm Hg is classified as normal. prehypertension. stage 1 hypertension. stage 2 hypertension.
Prehypertension 140/90 is high blood pressure stage TWO 130/80 to 139/89 is high blood pressure stage ONE if above or at 180/120 is medical crisis Explanation: A systolic BP of 128 mm Hg is classified as prehypertension. A systolic BP of less than 120 mm Hg is normal. A systolic BP of 140 to 159 mm Hg is Stage I hypertension. A systolic BP of greater than or equal to 160 is classified as Stage 2 hypertension.
A nurse is caring for a client who is diabetic and has been diagnosed with hypertension. An angiotensin-converting enzyme inhibitor, captopril, has been prescribed. Which should the nurse assess before beginning drug therapy? Blood glucose levels Serum potassium levels Serum magnesium levels Serum calcium levels
Serum potassium levels Explanation: Captopril inhibits the angiotensin-converting enzyme that is needed to change the inactive angiotensin I to the active form, angiotensin II. This reduction of angiotensin II decreases the secretion of aldosterone, preventing sodium and water retention. This action decreases peripheral vascular resistance and lowers blood pressure. Serum potassium may increase as a result of decreased aldosterone levels. It would be helpful to have a baseline level at the beginning of the drug therapy to monitor the possible effect of hyperkalemia. There is no need to monitor calcium and magnesium levels. While it is important to always know a diabetic's blood glucose level, captopril does not alter the level during therapy.
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 Electrocardiogram (EGG) tracing demonstrating peaked T waves Urine output of 90 mL 1 hour after medication administration Blood glucose value of 160 mg/dL
Serum potassium value of 3.0 mEq/L Explanation: Bumetanide is a loop diuretic that can cause fluid and electrolyte imbalances. Clients taking these medications may experience a low serum potassium concentration. ECG changes associated with an elevated serum potassium concentration include peaked T waves. Diuresis is a desired effect postadministration of bumetanide. The serum glucose concentration is elevated and requires intervention; however, this elevation is not associated with the administration of bumetanide.
The nurse is conducting a service project for a local elderly community group on the topic of hypertension. The nurse will relay that which risk factors and cardiovascular problems are related to hypertension? (Select all that apply.) Decreased low-density lipoprotein (LDL) levels Smoking Elevated high-density lipoprotein (HDL) cholesterol Overweight/obesity Age ≥65 in women
Smoking Overweight/obesity Age ≥65 in women Explanation: Major risk factors (in addition to hypertension) include smoking, dyslipidemia (high LDL, low high-density lipoprotein cholesterol), diabetes mellitus, impaired renal function, obesity, physical inactivity, age (younger than 45 years for men, 65 years and older for women), and family history of cardiovascular disease. Reference:
A client in a clinic setting has just been diagnosed with hypertension. When the client asks what the end goal is for treatment, what is the nurse's best response? -To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less -To lose weight, achieve a body mass index of 24 or less, and to eat a diet rich in fruits and vegetables -To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less -To stop smoking and increase physical activity to 30 minutes/day most days of the week
To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less Explanation: 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.
