Hypertension Review
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
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.
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.
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.
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.
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
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.
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.
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
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.
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.
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.
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 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.
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 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. 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
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?
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.
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