Med Surg Ch. 31 HTN

A 66-year-old client presents to the emergency department reporting severe headache and mild nausea for the past 6 hours. Upon assessment, the client's BP is 210/120 mm Hg. The client has a history of hypertension and takes 1.0 mg clonidine twice daily. Which question is most important for the nurse to ask the client next?

"Have you taken your prescribed clonidine today?" The nurse must ask whether the client has taken his prescribed clonidine. Clients need to be informed that rebound hypertension can occur if antihypertensive medications are suddenly stopped. Specifically, a side effect of clonidine is rebound or withdrawal hypertension. Although the other questions may be asked, it is most important to inquire whether the client has taken the prescribed hypertension medication given the client's severely elevated BP.

While in nursing school, you discover the prevalence of high blood pressure in the United States and are amazed at its frequency of occurrence. Which of the following is closest to approximately how many people have high blood pressure?

1 in 4 adults Approximately 50 million people, or 1 in 4 adults, in the United States have high blood pressure.

Which ethnic background would the nurse screen for hypertension at an early age?

African population The population of African descent is at the highest risk for development of hypertension. The other ethnic backgrounds have a lower risk.

Which condition contributes to secondary hypertension?

Arterial vasoconstriction Secondary hypertension may accompany any primary condition that affects fluid volume or renal function or causes arterial vasoconstriction. Calcium deficiency or acid-based imbalance does not contribute to hypertension.

When administering an angiotensin-converting enzyme (ACE) inhibitor with spironolactone, the nurse should be aware that which electrolyte imbalance may occur?

Hyperkalemia ACE inhibitors and angiotensin receptor blocker (ARBs) block aldosterone and may cause hyperkalemia when used with a potassium sparing diuretic such as spironolactone. Hypercalcemia and hypocalcemia would not occur as an imbalance.

Which finding indicates that hypertension is progressing to target organ damage?

Retinal blood vessel damage 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 client 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 concentration of 12 mg/dL and urine output of 60 mL over 2 hours are normal findings. The presence of pneumonia does not indicate target organ damage.

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 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.

A client with a history of hypertension is receiving client education about structures that regulate arterial pressure. Which structure is a component of that process?

kidneys The autonomic nervous system, the kidneys, and various endocrine glands regulate arterial pressure.

A diastolic blood pressure of 90 mm Hg is classified as

stage 1 hypertension. A diastolic BP of 80 to 80 mm Hg is classified as prehypertension. A diastolic BP less than 80 mm Hg is normal. A diastolic BP of 90 to 99 mm Hg is stage I hypertension. A diastolic BP of 100 mm Hg or above is classified as stage 2 hypertension.

A patient with hypertension is waking up several times a night to urinate. The nurse knows that what laboratory studies may indicate pathologic changes in the kidneys due to the hypertension? (Select all that apply.)

-Creatinine -Blood urea nitrogen (BUN) Pathologic changes in the kidneys (indicated by increased blood urea nitrogen [BUN] and serum creatinine levels) may manifest as nocturia (getting up during the night to urinate).

Which condition(s) indicates target organ damage from untreated/undertreated hypertension? Select all that apply.

-Heart failure -Retinal damage -Stroke Target organs include the heart, kidney, brain, and eyes. Hyperlipidemia and diabetes are risk factors for development of hypertension.

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.

-Smoking -Overweight/obesity -Age ≥65 in women 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.

A patient with hypertension has been able to maintain a blood pressure of 130/70 mm Hg for 1 year while reducing dietary sodium and taking hydrochlorothiazide (HCTZ) and atenolol (Tenormin). What treatment plan will the nurse educate the patient about?

Gradual reducing the HCTZ and the atenolol and continuing to reduce sodium intake When the blood pressure is less than 140/90 mm Hg for at least 1 year, gradual reduction of the types and doses of medication is indicated. Continuing to reduce sodium intake is a healthy lifestyle measure than anyone with hypertension should make.

A client in a clinic setting has just been diagnosed with hypertension. She asks what the end goal is for treatment. The correct reply from the nurse is which of the following?

To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less 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.

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 evaluating the types of medications prescribed for a client's hypertension. Which of the following medication classifications establishes an action on vasoconstrictive hormones in the blood stream?

ACE inhibitor The angiotensin-converting enzyme (ACE) inhibitor's primary action is to prevent the conversion of angiotensin I to angiotensin II, a potent vasoconstricting hormone in the blood. A beta-blocker blocks the beta-adrenergic receptors decreasing sympathetic nervous system stimulation. Loop diuretics excrete water from the loop of Henle, reducing circulating blood volume. Calcium channel blockers dilate coronary and peripheral arteries.

A client is taking 50 mg of oral spironolactone twice a day to assist with blood pressure control. While the nurse is performing the morning assessment, the client reports nausea, general muscle cramps, and weakness. The ECG strip shows a peaked, narrow T-wave, which is a change. What electrolyte imbalance does the nurse suspect?

Hyperkalemia Potassium-sparing diuretics, such as spironolactone, can cause hyperkalemia, especially if given with an ACE inhibitor. Signs of hyperkalemia are nausea, diarrhea, abdominal cramps, and peaked narrow T-waves.

A client comes to the emergency department complaining of visual changes and a severe headache. The nurse measures the client's blood pressure at 210/120 mm Hg. However, the client denies having hypertension or any other disorder. After diagnosing malignant hypertension (hypertensive emergency), a life-threatening disorder, the physician initiates emergency intervention. What is the most common cause of malignant hypertension (hypertensive emergency)?

Untreated hypertension Untreated hypertension is the most common cause of malignant hypertension (hypertensive emergency). Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as those that occur with monoamine oxidase inhibitors and aged cheeses).