Hypertension PrepU
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." The client's choice of a baked potato with broiled chicken indicates effective nutrition teaching because potatoes and chicken are relatively low in sodium. Ham, sardines, and bouillon are extremely high in sodium and shouldn't be included in a low-sodium diet.
The nurse is providing education for a client diagnosed with essential hypertension. The nurse will state that the cause of this disorder is:
Unknown Essential or primary hypertension has no identifiable cause, although there are many risk factors. The other options are causes of secondary hypertension, for which a cause can be identified and often treated.
A nurse is providing teaching for a client who has a new diagnosis of hypertension and a new prescription for spironolactone 25 mg/day. Which of the following statements by the client indicates an understanding of the teaching?
"I will report any changes in heart rate to my provider." The nurse should teach the patient to monitor her HR and report any changes to her provider.
A nurse is teaching a client with newly diagnosed hypertension who asks if there is any harm in stopping antihypertensive medication. What is the nurse's best response?
"Rebound hypertension can occur." 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.
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% 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.
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 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.
An older adult client visits the clinic for a blood pressure check. The client's hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about blood pressure medicine?
A possible adverse effect of blood pressure medicine is dizziness when you stand. 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. The nurse would not teach the client to take the medicine on an empty stomach.
A client who is taking a diuretic asks the nurse to explain how a drug that makes her urinate more frequently can help her hypertension. The nurse will explain that diuretics exert their antihypertensive action in which ways? Select all that apply.
By decreasing vascular volume through the process of increasing sodium & water excretion By reducing peripheral vascular resistance Diuretics lower blood pressure initially by decreasing vascular volume (by suppressing renal reabsorption of sodium and increasing sodium and water excretion) and cardiac output. Long-term diuretic administration results in a decrease in peripheral vascular resistance.
A 46-year-old client with a high body-mass index and a sedentary lifestyle has been diagnosed with hypertension after serial blood pressure readings. The clinician has opted to begin the client on captopril (Capoten). The nurse should recognize that the therapeutic effect of this drug is achieved in what way?
By inhibiting the transformation of angiotensin I to angiotensin II Captopril inhibits the ACE needed to change the inactive angiotensin I to the active form, angiotensin II. This reduction of angiotensin II decreases the secretion of aldosterone, thus preventing sodium and water retention.
A nurse is screening a male client for hypertension. The nurse should identify that which of the following actions by the client increase his risk for hypertension? Select all that apply.
Eating popcorn at the movie theater Consuming 36 oz beet daily Popcorn at a movie theater contains a large quantity of sodium and fat, which increases the risk for hypertension. Consuming more than 24 oz beer daily for a male client increases the risk.
A patient with long-standing hypertension is admitted to the hospital with hypertensive urgency. The physician orders a chest x-ray, which reveals an enlarged heart. What diagnostic test does the nurse anticipate preparing the patient for to determine left ventricular enlargement?
Echocardiography Left ventricular hypertrophy can be assessed by echocardiography.
A teenager is diagnosed with hypertension. The nurse knows that risk factors for hypertension in children and adolescents include which of these? Select all that apply.
High salt consumption Inactive lifestyle Obesity The prevalence of hypertension in children and adolescents is increasing due to increases in obesity, and lifestyle factors such as lack of exercise and consumption of high-calorie, high-salt foods. Gender is not a factor nor is academic performance.
A blood pressure (BP) of 140/90 mm Hg is considered to be
Hypertension A BP of 140/90 mm Hg or higher is hypertension. A blood pressure less than 120/80 mm Hg is considered normal. A BP of 120 to 139/80 to 89 mm Hg is prehypertension. Hypertensive emergency is a situation in which BP is severely elevated and there is evidence of actual or probable target organ damage.
The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be:
Hypertension The major risk factors that can be modified by a change in health care behaviors include cigarette smoking, obesity, hypertension, hyperlipidemia and elevated LDL cholesterol, and diabetes mellitus, all of which are traditional cardiovascular risk factors.
The nurse has admitted a client with type 1 diabetes mellitus who has been prescribed captopril for treatment of hypertension. The nurse knows this medication is used in clients with diabetes for what reason?
It reduces proteinuria. Captopril is an ACE inhibitor, and it is used to treat hypertension in clients with type 1 diabetes mellitus because it reduces proteinuria and slows progression of renal impairment.
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. 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.
A nurse is providing discharge teaching for a client who has a prescription for furosemide 40 mg PO daily. The nurse should instruct the client to take this medication at which of the following times of daily?
Morning The client should take furosemide, a diuretic, in the morning so that the peak action and duration of medication occurs during waking ours.
After receiving the results of an echocardiogram, a client has many questions regarding the results and their impact on the client's lifestyle. The client is a 57-year-old Hispanic man with a 10-year history of hypertension. The client would like to know what effect hypertension has on the heart. What is the nurse's best reply?
Myocardium hypertrophy As a result of increased cardiac workload from cardiac wall sclerosis, the myocardium hypertrophies as a compensatory mechanism and heart failure eventually occurs.
A nurse is caring for a client who is admitted to the emergency department with a BP of 266/147. The client reports a headache and double vision. She ran out of her diltiazem 3 days ago, and is unable to purchase more. Which of the following actions should the nurse take first?
Obtain IV access and prepare the administer of an IV antihypertensive. The greatest risk to the client is injury due to a BP of 266/147, which can be life-threatening and should be lowered as soon as possible. IV access will permit administration of an IV hypertensive, which will act more rapidly.
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 Antihypertensive medication can cause hypotension, especially postural hypotension that may result in injury. Antihypertensive medications do not usually cause postural hypertension.
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 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 (Zestril) or angiotensin receptor blocker.
A nurse is planning a community education program on lifestyle modification to manage hypertension. Which topic should be included in the teaching plan? Select all that apply.
Reduce dietary sodium intake. Consume a diet rich in fruits, vegetables, and low- fat dairy products. Limit alcohol consumption. Stop smoking. Hypertension lifestyle modification includes the maintenance of normal body weight (BMI, 18.5-24.9 kg/m2). Adoption of the Dietary Approaches to Stop Hypertension (DASH) eating plan includes consuming a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat 8-14 mm Hg. Dietary sodium should be reduced 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 minutes per day). Alcohol consumption should be moderate, with consumption of no more than 2 drinks (1 oz [30 mL] ethanol; e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and 1 drink per day in women and persons of lighter weight.
The nurse is caring for a client who is prescribed medication for the treatment of hypertension. The nurse recognizes that which medication conserves potassium?
Spironolactone Spironolactone is known as a potassium-sparing diuretic. Furosemide causes loss of potassium from the body. Chlorothiazide and chlorthalidone cause mild hypokalemia.
A nurse in an urgent care clinic is obtaining a history from a client who has type 2 diabetes mellitus and a recent diagnosis of hypertension. This is the second time in 2 weeks that the client experienced hypoglycemia. Which of the following client data should the nurse report to the provider?
Takes metoprolol after meals Metoprolol can mask the effects of hypoglycemia in clients who have DM.
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?
The adrenal gland The 24-hour urine collection specimen is ordered to determine dysfunction of the adrenal gland. The 24-hour urine detects elevated catecholamines.
