MCA-II Hypertension
A patient with hypertension has been prescribed an antihypertensive medication. During a follow-up visit, the patient asks if the medication can be stopped because the BP is now within the normal range. Which response would the nurse provide?
"Continue the medication unless your health care provider advises discontinuing it." Antihypertensive medications are effective at reducing BP; however, the medications should not be stopped abruptly because this can cause a severe hypertensive reaction. The medications should be discontinued only after consulting with the health care provider. The medication should not be stopped even if the BP measurements show normal readings. Medications should be taken regularly for sustained therapeutic effects. A reduction of the dosage may reduce the efficacy of the drug. Lifestyle modifications are necessary to reduce cardiovascular risks; however, antihypertensive medications should also be used for effective reduction of BP.
A patient is diagnosed with primary hypertension and asks the nurse what caused the condition. Which response would the nurse give?
"There is no identified cause." There is not one exact cause of primary hypertension; there are several contributing factors. Renal or kidney disease is a cause of secondary hypertension. An increase, not a decrease, in plasma renin levels is a contributing factor in the development of primary hypertension. Hypertension speeds up the process of atherosclerosis in the peripheral blood vessels.
Which systolic BP (SBP) measurement correlates with stage 1 hypertension?
132 mm Hg Stage 1 hypertension is defined as an SBP of 130 to 139 or a diastolic BP (DBP) of 80 to 89 mm Hg. Normal BP is defined as an SBP of less than 120 mm Hg and a DBP of less than 80 mm Hg. Elevated BP is defined as an SBP between 120 and 129 mm Hg and a DBP of less than 80 mm Hg. Hypertension (stage 1) is defined as an SBP between 130 and 139 mm Hg and a DBP between 80 and 89 mm Hg. Hypertension (stage 2) is defined as an SBP of greater than 140 mm Hg and a DBP of greater than 90 mm Hg. If either the SBP or DBP is outside of a range, the higher measurement determines the classification.
Which changes in vital signs indicate that a patient who has just stood up is experiencing postural hypotension?
Decreased systolic BP, decreased diastolic BP, and/or increased HR A decrease in both systolic and diastolic BP and an increase in HR would be seen in a patient with postural hypotension. BP drops as the volume of circulating blood decreases when a patient abruptly stands from a lying or sitting position. The HR increases as the heart attempts to compensate by increasing the amount of circulating blood by increasing cardiac output. Increased systolic BP and decreased HR; increased diastolic BP and increased HR; and decreased systolic BP, increased diastolic BP, and no change in HR are all incorrect.
A patient's BP reading is 142/91 mm Hg. How should the nurse classify the BP?
Hypertension, stage 2 Normal BP is defined as a systolic BP (SBP) of less than 120 mm Hg and a diastolic BP (DBP) of less than 80 mm Hg. Elevated BP is defined as an SBP between 120 and 129 mm Hg and a DBP of less than 80 mm Hg. Hypertension (stage 1) is defined as an SBP between 130 and 139 mm Hg and a DBP between 80 and 89 mm Hg. Hypertension (stage 2) is defined as an SBP of greater than 140 mm Hg and a DBP of greater than 90 mm Hg. If either the SBP or DBP is outside of a range, the higher measurement determines the classification.
A patient has not reached goal BP despite taking full doses of an appropriate three-drug therapy regimen, including a diuretic. Which finding in the patient history is the likely cause of resistant hypertension?
Increasing obesity An increase in obesity is one of the causes of resistant hypertension. Licorice (rather than peppermint), excess salt (rather than pepper) intake, and oral contraceptives (rather than ED medications) are also possible causes of resistant hypertension.
A patient with hypertension receives a prescription for lisinopril. Which mechanism of action would the nurse expect from this medication?
Inhibits conversion of angiotensin I to angiotensin II Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that inhibits the conversion of angiotensin I to angiotensin II, which reduces angiotensin II-mediated vasoconstriction and sodium and water retention. β-adrenergic receptor blockers (β-blockers) result in vasodilation and a decreased heart rate. Direct vasodilators relax arterial and venous smooth muscle. Central-acting α-adrenergic antagonists reduce sympathetic outflow from the CNS to produce vasodilation and decreased systemic vascular resistance (SVR) and BP.
The nurse provides discharge teaching to a female patient who was newly diagnosed with primary hypertension. Which instruction would be included?
Limit the intake of alcohol to no more than one drink per day. Excessive alcohol intake is strongly associated with hypertension. Women and lighter-weight men should limit their intake to no more than one drink per day. Calcium supplements are not recommended to lower BP. Increased levels of dietary omega-3 fatty acids are associated with lower BP. People with hypertension should restrict sodium to less than or equal to 1500 mg/day.
Which medication should be used with caution in patients with diabetes because the drug may depress the tachycardia associated with hypoglycemia?
Metoprolol Metoprolol, a β-adrenergic receptor blocker (β-blocker), slows the heart rate. Tachycardia is a classic symptom of hypoglycemia; therefore patients must be made aware of the failure of the heart rate to respond to decreasing glucose levels and should be instructed to look for other signs of hypoglycemia. Diltiazem and hydromorphone will not affect blood sugars or signs/symptoms of hypoglycemia. Prednisone will increase, not decrease, blood sugar levels.
The nurse is assessing a patient for orthostatic hypotension. First, the nurse measured the BP and heart rate (HR) with the patient in the supine position. Which action would the nurse take next?
Move the patient to a sitting position and measure the BP and HR within two minutes. When assessing for orthostatic changes, after measuring the BP and HR in the supine position, the patient then is placed in a sitting position, and the BP and HR are measured within one to two minutes. The patient is then repositioned to the standing position, and BP and HR are measured again within one to two minutes. The results then are recorded, with a decrease of 20 mm Hg or more in systolic BP (SBP), a decrease of 10 mm Hg or more in diastolic BP (DBP), or an increase in the pulse of greater than or equal to 20 beats/minute from supine to standing indicating orthostatic hypotension.
Which mechanism of hypertension causes target organ damage?
Promotion of atherosclerosis and damage to the walls of the arteries Hypertension is a major risk factor for the development of atherosclerosis by mechanisms not yet fully known. However, once atherosclerosis develops, it damages the walls of arteries and reduces circulation to target organs and tissues. Hypertension does not thicken capillary membranes, cause direct pressure on organs, or increase blood viscosity.
The nurse is preparing to measure the BP of a patient who is lying down on a bed. Which technique should the nurse use?
Rest the patient's arm on a pillow during the BP measurement. For measurements taken in a supine position, raise and support (e.g., with a small pillow) the arm at the heart level. If the arm is resting on the bed, it will be below the heart level. This allows the blood to drain from the arm and prevents inaccurate readings. If the patient is in a lying-down position, the arm should be placed on a pillow so that it is at the heart level. The upper arm, not the forearm, is the preferred site of BP cuff placement because of its accuracy of recordings. Atherosclerosis in the subclavian artery may result in a falsely low BP in the affected side; therefore the arm that has the highest recording of the BP should be used for further measurements. BP measurements should be taken at least one minute apart.
Which instruction is important for the nurse to provide to a patient about the management of stage 1 hypertension?
Restrict sodium intake. The patient should decrease the intake of sodium. This will help to control hypertension, which can be aggravated by excessive salt intake, which in turn leads to fluid retention. Caffeine and protein intake do not affect hypertension. Calcium supplements are not recommended to lower BP.
Which laboratory test result indicates the presence of target organ damage in a patient with hypertension?
Serum creatinine of 2.6 mg/dL The normal serum creatinine level is 0.6 to 1.3 mg/dL. This elevated level of 2.6 mg/dL indicates target organ damage to the kidneys. BUN of 15 mg/dL, serum uric acid of 3.8 mg/dL, and serum potassium of 3.5 mEq/L are within normal limits.
