NURB 3130 - Chapter 27: Hypertension REVIEW QUESTIONS

A client newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a client with prolonged, uncontrolled hypertension is at risk for developing which health problem? A. Chronic kidney disease B. Right ventricular hypertrophy C. Glaucoma D. Anemia

A. Chronic kidney disease Rationale: When uncontrolled hypertension is prolonged, it can result in chronic kidney disease, myocardial infarction, stroke, impaired vision, left ventricular hypertrophy, and cardiac failure. Glaucoma and anemia are not directly associated with hypertension.

The nurse identifies a nursing diagnosis of Ineffective Health Maintenance related to nonadherence to therapeutic regimen in a client with hypertension who has not been taking their medication as prescribed. When planning this client's care, which outcome would be appropriate? A. Client takes medication as prescribed and reports any adverse effects. B. Client's BP remains consistently below 140/90 mm Hg. C. Client denies signs and symptoms of hypertensive urgency. D. Client is able to describe modifiable risk factors for hypertension.

A. Client takes medication as prescribed and reports any adverse effects. Rationale: The most appropriate expected outcome for a client who is given the nursing diagnosis of risk for ineffective health maintenance is that the client takes the medication as prescribed. The other listed goals are valid aspects of care, but none directly relates to the client's role in the treatment regimen.

The nurse is developing a nursing care plan for a client who is being treated for hypertension. Which outcome is most appropriate for the nurse to include? A. Client will reduce Na+ intake to less than 2 g daily. B. Client will have a stable BUN and serum creatinine levels. C. Client will abstain from fat intake and reduce calorie intake. D. Client will maintain a normal body weight.

A. Client will reduce Na+ intake to less than 2 g daily. Rationale: Dietary sodium intake of less than 2 g daily is recommended as a dietary lifestyle modification to prevent and manage hypertension. Also, giving a specific amount of allowable sodium intake makes this a measurable goal and therefore more appropriate than the other goals, which are not quantifiable or measurable.

The nurse is monitoring blood pressure for a client with unstable readings. How often should the nurse check the client's blood pressure? A. Every 5 minutes B. Every 30 minutes C. Every 30 minutes until stable D. Every 2 minutes

A. Every 5 minutes

A nurse is teaching an client about the risk factors for hypertension. Which factors should the nurse explain as risk factors for primary hypertension A. Obesity and high intake of sodium and saturated fat B. Diabetes and use of oral contraceptives C. Metabolic syndrome and smoking D. Renal disease and coarctation of the aorta

A. Obesity and high intake of sodium and saturated fat Rationale: Obesity, stress, high intake of sodium or saturated fat, and family history are all risk factors for primary hypertension. Diabetes and oral contraceptives are risk factors for secondary hypertension. Metabolic syndrome, smoking, renal disease, and coarctation of the aorta are causes of secondary hypertension.

A client with primary hypertension comes to the clinic reporting a gradual onset of blurry vision and decreased visual acuity over the past several weeks. The nurse is aware that these symptoms could be indicative of which condition? A. Retinal blood vessel damage B. Glaucoma C. Cranial nerve damage D. Hypertensive emergency

A. Retinal blood vessel damage Rationale: Blurred vision, spots in front of the eyes, and diminished visual acuity can mean retinal blood vessel damage indicative of damage elsewhere in the vascular system as a result of hypertension. Glaucoma and cranial nerve damage do not normally cause these symptoms. A hypertensive emergency would have a more rapid onset.

A client with primary hypertension reports dizziness with ambulation when taking the prescribed alpha-adrenergic blocker. When teaching this client, what should the nurse emphasize? A. Rising slowly from a lying or sitting position B. Increasing fluids to maintain BP C. Stopping medication if dizziness persists D. Taking medication first thing in the morning

A. Rising slowly from a lying or sitting position

The nurse is teaching a client about some of the health consequences of uncontrolled hypertension. What health problems should the nurse describe? Select all that apply. A. Transient ischemic attacks (TIAs) B. Cerebrovascular disease C. Retinal hemorrhage D. Venous insufficiency E. Right ventricular hypertrophy

A. Transient ischemic attacks (TIAs) B. Cerebrovascular disease C. Retinal hemorrhage Rationale: Potential complications of hypertension include the following: left ventricular hypertrophy; MI; heart failure; transient ischemic attacks; cerebrovascular disease; renal insufficiency and failure; and retinal hemorrhage. Venous insufficiency and right ventricular hypertrophy are not potential complications of uncontrolled hypertension.

A client with secondary hypertension has come into the clinic for a routine check-up. When comparing this client's diagnosis to primary hypertension, the nurse recognizes that secondary hypertension: A. has a specific cause. B. has a more gradual onset than primary hypertension. C. does not normally cause target organ damage. D. does not normally respond to antihypertensive drug therapy.

A. has a specific cause. Rationale: Secondary hypertension has a specific identified cause. A cause could include narrowing of the renal arteries, renal parenchymal disease, hyperaldosteronism, certain medications, pregnancy, and coarctation of the aorta. Secondary hypertension does respond to antihypertensive drug therapy and can cause target organ damage if left untreated.

A community health nurse is planning an educational campaign addressing hypertension. The nurse should anticipate that the incidence and prevalence of hypertension are likely to be highest among members of what ethnic group? A. Pacific Islanders B. African-Americans C. Asians D. Hispanics

B. African-Americans Rationale: The prevalence of hypertension varies by ethnicity and gender, and is estimated at approximately 32.9% among Caucasian men, 30.1% among Caucasian women, 44.9% among black men, 46.1% among black women, 29.6% among Hispanic men, and 29.9% among Hispanic women. The prevalence of hypertension among blacks is among the highest in the world

The nurse is providing education to a client newly diagnosed with hypertension. Which outcome would be most appropriate for this client? A. Client will have no visual disturbances. B. Client will return demonstrate measuring a blood pressure. C. Client will state two side effects of not taking antihypertensives. D. Client will lose two pounds within two weeks.

B. Client will return demonstrate measuring a blood pressure. Rationale: The primary outcome for this client is making sure that blood pressure remains under control. This is best done by measurement of blood pressure (BP) reading. Visual disturbances can happen with uncontrolled hypertension, but it is not the primary client outcome. Stating two detrimental effects of hypertension is important but not as important as measurement of BP. Losing weight is also important in controlling BP, but the question is not addressing obesity.

The nurse is reviewing the medication administration record of a client 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

B. Decreased peripheral resistance C. Decreased blood volume D. Decreased strength and rate of myocardial contractions Rationale: 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.

During an adult client's last two office visits, the nurse obtained BP readings of 122/76 mm Hg and 128/78 mm Hg, respectively. How would this client's BP be categorized? A. Normal B. Elevated C. Stage 1 hypertension D. Stage 2 hypertension

B. Elevated

A client has been diagnosed as being prehypertensive. What should the nurse encourage this client to do to aid in preventing a progression to a hypertensive state? A. Avoid excessive potassium intake. B. Exercise on a regular basis. C. Eat less protein and more vegetables. D. Limit morning activity.

B. Exercise on a regular basis. Rationale: To prevent or delay progression to hypertension and reduce risk, JNC 7 urged health care providers to encourage people with blood pressures in the prehypertension category to begin lifestyle modifications, such as nutritional changes and exercise. There is no need for clients to limit their activity in the morning or to avoid potassium and protein intake.

A client'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

B. Increased urine output Rationale: 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.

The nurse is screening a number of adults for hypertension. Which range of blood pressure is considered normal? A. Less than 110/80 mm Hg B. Less than 120/80 mm Hg C. Less than 130/90 mm Hg D. Less than 140/90 mm Hg

B. Less than 120/80 mm Hg Rationale: JNC 7 defines a blood pressure of less than 120/80 mm Hg as normal, 120 to 129/80 to 89 mm Hg as prehypertension, and 140/90 mm Hg or higher as hypertension.

The community health nurse cares for many clients who have hypertension. What nursing diagnosis is most common among clients who are being treated for this health problem? A. Deficient knowledge regarding the lifestyle modifications for management of hypertension B. Noncompliance with therapeutic regimen related to adverse effects of prescribed therapy C. Deficient knowledge regarding BP monitoring D. Noncompliance with treatment regimen related to medication costs

B. Noncompliance with therapeutic regimen related to adverse effects of prescribed therapy Rationale: Deviation from the therapeutic program is a significant problem for people with hypertension and other chronic conditions requiring lifetime management. For many clients, this is related to adverse effects of medications. Medication cost is relevant for many clients, but adverse effects are thought to be a more significant barrier. Many clients are aware of necessary lifestyle modification, but do not adhere to them. Most clients are aware of the need to monitor their BP.

The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. Which item should the nurse integrate into the management of this client's hypertension? A. Ensure that the client 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 the medication regimen than a younger client. D. Carefully assess for weight loss because of impaired kidney function resulting from normal aging.

B. Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion. Rationale: Older adults 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.

The nursing lab instructor is teaching student nurses how to take blood pressure. To ensure accurate measurement, the lab instructor would teach the students to avoid which action? A. Measuring the BP after the client has been seated quietly for more than 5 minutes B. Taking the BP 10 minutes after nicotine or coffee ingestion C. Using a cuff with a bladder that encircles at least 80% of the limb D. Using a bare forearm supported at heart level on a firm surface

B. Taking the BP 10 minutes after nicotine or coffee ingestion Rationale: Blood pressures should be taken with the client seated with arm bare, supported, and at heart level. The client should not have smoked tobacco or taken caffeine in the 30 minutes preceding the measurement. The client should rest quietly for 5 minutes before the reading is taken. The cuff bladder should encircle at least 80% of the limb being measured and have a width of at least 40% of limb circumference. Using a cuff that is too large results in a lower BP and a cuff that is too small will give a higher BP measurement

A client newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the client and advises that the client should avoid tobacco use. What is the primary rationale behind that advice to the client? A. Quitting smoking will cause the client's hypertension to resolve. B. Tobacco use increases the client's concurrent risk of heart disease. C. Tobacco use is associated with a sedentary lifestyle. D. Tobacco use causes ventricular hypertrophy.

B. Tobacco use increases the client's concurrent risk of heart disease. Rationale: Smoking increases the risk for heart disease, for which a client with hypertension is already at an increased risk. Quitting will not necessarily cause hypertension to resolve and smoking does not directly cause ventricular hypertrophy. The association with a sedentary lifestyle is true, but this is not the main rationale for the nurse's advice; the association with heart disease is more salient.

A 56-year-old client at a screening event has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, the client states, "My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it?" What is the nurse's best response? A. "Yes. It is fortunate we caught this during your routine examination." B. "We will need to reevaluate your blood pressure because your age places you at high risk for hypertension." C. "A single elevated blood pressure does not confirm hypertension. Diagnosis requires multiple elevated readings." D. "You have no need to worry. Your pressure is probably elevated because you are being tested."

C. "A single elevated blood pressure does not confirm hypertension. Diagnosis requires multiple elevated readings." Rationale: Hypertension is confirmed by two or more readings with systolic pressure of at least 140 mm Hg and diastolic pressure of at least 90 mm Hg. An age of 56 does not constitute a risk factor in and of itself. The nurse should not tell the client that there is no need to worry.

The nurse is providing health education to an older adult client. What should the nurse teach the client about the relationship between hypertension and age? A. "Because of reduced smooth muscle tone in blood vessels, blood pressure tends to go down with age, not up." B. "Decreases in the strength of arteries and the presence of venous insufficiency cause hypertension in older adults." C. "Structural and functional changes in the cardiovascular system that occur with age contribute to an increase in blood pressure." D. "The neurologic system of older adults is less efficient at monitoring and regulating blood pressure."

C. "Structural and functional changes in the cardiovascular system that occur with age contribute to an increase in blood pressure." Rationale: Structural and functional changes in the heart and blood vessels contribute to an increase in BP that occurs with aging. Venous insufficiency does not cause hypertension, however. Increased BP is not primarily a result of neurologic changes.

A newly diagnosed client with hypertension is prescribed a thiazide diuretic. What client education should the nurse provide to this client? A. "Eat a banana every day because this medication causes moderate hyperkalemia." B. "Take over-the-counter potassium pills because this medication causes your kidneys to lose potassium." C. "This medication can cause low blood pressure and dizziness, especially when you get up suddenly." D. "This medication increases sodium levels in your blood, so cut down on your salt."

C. "This medication can cause low blood pressure and dizziness, especially when you get up suddenly." Rationale: Thiazide diuretics can cause postural hypotension, which may be potentiated by alcohol, barbiturates, opioids, or hot weather. Thiazide diuretics do not cause either moderate hyperkalemia or severe hypokalemia and they do not result in hypernatremia.

At a blood pressure screening, the nurse learns that a client has a family history of hypertension, high cholesterol, and elevated lipid levels. The client says reports smoking one pack of cigarettes daily and drinking "about a pack of beer" every day. The nurse notes which nonmodifiable risk factor for hypertension? A. Hyperlipidemia B. Excessive alcohol intake C. A family history of hypertension D. Closer adherence to medical regimen

C. A family history of hypertension Rationale: Unlike cholesterol levels, alcohol intake, and adherence to treatment, family history is not modifiable

The nurse is providing care for a client with a diagnosis of hypertension. The nurse should consequently assess the client for signs and symptoms of which other health problem? A. Migraines B. Atrial-septal defect C. Atherosclerosis D. Thrombocytopenia

C. Atherosclerosis Rationale: Hypertension is both a sign and a risk factor for atherosclerotic heart disease. It is not associated with structural cardiac defects, low platelet levels, or migraines.

The nurse is caring for a client in the emergency department who was admitted for a hypertensive emergency. The nurse knows the goal of intravenous vasodilator therapy for a hypertensive emergency would be which outcome? A. Lower the blood pressure to reduce the onset of neurological changes B. Decrease the blood pressure to a normal level based on the client's age C. Decrease the systolic blood pressure by no more than 25% within the first hour D. Decrease the blood pressure to less than or equal to 120/80 as quickly as possible

C. Decrease the systolic blood pressure by no more than 25% within the first hour Rationale: The initial treatment for hypertensive crisis is to decrease the systolic blood pressure by no more than 25% within the first hour of treatment. Lowering the blood pressure too fast may cause hypotension in a client whose body has adjusted to hypertension and could cause a stroke, myocardial infarction, or visual changes.Neurologic symptoms should be addressed, but this is not the primary focus of treatment planning

The nurse is assessing a client new to the clinic. Records brought to the clinic show that the client's hypertension has not improved. What contributing factor should the nurse first explore in an effort to identify the cause of the client's inadequate BP control? A. Progressive target organ damage B. Possibility of medication interactions C. Lack of adherence to prescribed drug therapy D. Possible heavy alcohol use or use of recreational drugs

C. Lack of adherence to prescribed drug therapy Rationale: Deviation from the therapeutic program is a significant problem for people with hypertension and other chronic conditions requiring lifetime management. An estimated 50% of clients discontinue their medications within 1 year of beginning to take them. Consequently, this is a more likely problem than substance use, organ damage, or adverse drug interactions.

The nurse is collaborating with the dietitian and a client with hypertension to plan dietary modifications. Which modifications should be the priority? A. Reduced intake of protein and carbohydrates B. Increased intake of calcium and vitamin D C. Reduced intake of fat and sodium D. Increased intake of potassium, vitamin B12 and vitamin D

C. Reduced intake of fat and sodium Rationale: Lifestyle modifications usually include restricting sodium and fat intake, increasing intake of fruits and vegetables, and implementing regular physical activity. There is no need to increase calcium, potassium, and vitamin intake. Calorie restriction may be required for some clients, but a specific reduction in protein and carbohydrates is not normally indicated.

The critical care nurse is caring for a client just admitted in a hypertensive emergency. The nurse should anticipate the administration of what medication? A. Warfarin B. Furosemide C. Sodium nitroprusside D. Ramipril

C. Sodium nitroprusside Rationale: The medications of choice in hypertensive emergencies are those that have an immediate effect. IV vasodilators, including sodium nitroprusside, nicardipine hydrochloride, clevidipine, fenoldopam mesylate, enalaprilat, and nitroglycerin, have immediate actions that are short lived (minutes to 4 hours), and they are therefore used for initial treatment. Ramipril is given orally and would not meet the client's immediate need for BP management. Diuretics, such as furosemide, are not used as initial treatments and there is no indication for anticoagulants such as warfarin.

An older adult is newly diagnosed with primary hypertension and has just been started on a beta-blocker. Which topic should the nurse include in health education? 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 orthostatic hypotension D. Limiting exercise to avoid injury that can be caused by increased intracranial pressure

C. Use of strategies to prevent falls stemming from orthostatic hypotension Rationale: Older adults have impaired cardiovascular reflexes and are more sensitive to orthostatic hypotension. The nurse teaches clients to change positions slowly when moving from lying or sitting positions to a standing position and counsels older clients 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, are strongly recommended. Increasing fluids in older clients may be contraindicated due to cardiovascular disease. Increased intracranial pressure is not a risk, and activity should not normally be limited.

The home health nurse is caring for a client who has a diagnosis 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?"

D. "Do you ever see spots in front of your eyes?"

A 55-year-old client comes to the clinic for a routine check-up. The client's BP is 159/100 mm Hg and the health care provider diagnoses hypertension after referring to previous readings. The client asks why it is important to treat hypertension, since the client denies any discomfort. What would be the nurse's best response? A. "Hypertension can cause you to develop dangerous blood clots in your legs that can migrate to your lungs." B. "Hypertension puts you at increased risk of type 1 diabetes and cancer in your age group." C. "Hypertension is the leading cause of death in people your age." D. "Hypertension greatly increases your risk of stroke and heart disease."

D. "Hypertension greatly increases your risk of stroke and heart disease." Rationale: Hypertension, particularly elevated systolic BP, increases the risk of death, stroke, and heart failure in people older than 50 years. Hypertension is not a direct precursor to pulmonary emboli, and it does not put older adults at increased risk of type 1 diabetes or cancer. It is not the leading cause of death in people 55 years of age.

A client with newly diagnosed hypertension has come to the clinic for a follow-up visit. The client asks the nurse why the client has to come in so often. Which response by the nurse would be best? A. "To identify any of the early symptoms of a stroke" B. "To determine how your blood pressure changes throughout the day" C. "To see how often you should change your medication dose" D. "To make sure your health is stable"

D. "To make sure your health is stable"

The nurse is planning the care of a client who has been diagnosed with hypertension, but who otherwise enjoys good health. When assessing the response to an antihypertensive drug regimen, which blood pressure would be the goal of treatment? A. 160/90 mm Hg or lower B. 100/80 mm Hg or lower C. Average of two BP readings of 150/80 mm Hg D. 130/80 mm Hg or lower

D. 130/80 mm Hg or lower Rationale: A pressure of 130/80 mm Hg or less is the goal for clients. All other readings are out of range or not appropriate.

A client with a hypertensive emergency is being treated in the intensive care unit. The nurse knows that which client is at risk for developing this type of emergency? A. A client who stops their antihypertensive medication abruptly B. A client with a diagnosis of primary hypertension C. A client with well-controlled hypertension D. A client with hypertension that was diagnosed 2 years ago

D. A client with hypertension that was diagnosed 2 years ago Rationale: Clients who abruptly stop their antihypertensive medications are at risk for developing hypertensive emergencies. Clients with secondary, not primary, hypertension are also at risk. A client who is undiagnosed is at risk, not one who was diagnosed 2 years ago. A client who has good control of their hypertension is less likely to be at risk.

The staff educator is teaching emergency department nurses about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in which way? A. The blood pressure (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.

D. Hypertensive emergencies are associated with evidence of target organ damage. Rationale: 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 they cause. 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 client's BP is required in both situations. The medications of choice in hypertensive emergencies are those with an immediate effect, such as intravenous 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.

A client in hypertensive urgency is admitted to the hospital. The nurse should be aware of which goal of treatment for a client in hypertensive urgency? A. Normalizing blood pressure (BP) within 2 hours B. Obtaining a BP of less than 110/70 mm Hg within 36 hours C. Obtaining a BP of less than 120/80 mm Hg within 36 hours D. Normalizing BP within 24 to 48 hours

D. Normalizing BP within 24 to 48 hours Rationale: In cases of hypertensive urgency, oral agents can be given with the goal of normalizing BP within 24 to 48 hours. For clients with this health problem, a BP of <120/80 mm Hg may be unrealistic. Normalizing BP within only 2 hours is not realistic.

The nurse takes the client's blood pressure, and the reading is 161/101 mm Hg. The nurse knows this blood pressure would be classified as which type? A. Elevated B. Normal C. Stage 1 hypertensive D. Stage 2 hypertensive

D. Stage 2 hypertensive Rationale: The latest guidelines (November 2017) released by the American College of Cardiology and the American Heart Association are: Normal blood pressure: Systolic less than 120 mm Hg and diastolic less than 80 mm Hg. Elevated blood pressure: Systolic between 120 and 129 mm Hg and diastolic less than 80 mm Hg. Stage 1 hypertension: Systolic between 130 and 139 mm Hg or diastolic between 80 and 89 mm Hg. Stage 2 hypertension: Systolic of 140 or greater mm Hg or diastolic of 90 or greater mm Hg

A client's recently elevated BP has prompted the primary care provider to prescribe furosemide. The nurse should closely monitor which of the following levels? A. The client's oxygen saturation level B. The client's red blood cells, hematocrit, and hemoglobin C. The client's level of consciousness D. The client's potassium level

D. The client's potassium level Rationale: Loop diuretics can cause potassium depletion. They do not normally affect level of consciousness, erythrocytes, or oxygen saturation.