Ch 31 Assessment and Management of Patients With Hypertension

The desired goal for the systolic blood pressure for a person with diabetes or chronic kidney disease is:

130 mm Hg

Approximately what percent of adults have hypertension?

30%

An estimated ____________% of patients discontinue their medications within 1 year of beginning to take them

50%

a patient is instructed to adhere to a DASH diet. What does the diet recommend?

A diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated fats and total fats

CASE STUDY: What health promotion strategies can the nurse suggest to Georgia to reduce complications and improve disease outcomes?

Adhere to dietary regimens, become involved with a regular exercise program, and take her medication as prescribed

CASE STUDY: The nurse informs Georgia that she should make an appointment to see her ophthalmologist. Why is it important that Georgia adhere to follow-up with an ophthalmologist?

An eye examination with an ophthalmoscope is particularly 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

CASE STUDY: Georgia is prescribed furosemide 20 mg once every day. What should the nurse educate Georgia about regarding the action of furosemide?

Blocks reabsorption of sodium, chloride, and water in the kidneys

Blood pressure is the product of: ______________ multiplied by _______________

Cardiac output; peripheral resistance

What is the correlation between cigarette smoking and high blood pressure?

Cigarette smoking does not cause high blood pressure; HOWEVER, if a person with hypertension smokes, that person's risk of dying from heart disease of related disorders increases significantly

Stimulates dopamine and alpha2-adrenergic receptors: (associated action)

Fenoldopam (Hypertension medication)

Blocks reabsorption of sodium and water in kidneys: (associated action)

Furosemide (Hypertension medication)

Stimulates alpha2-adrenergic receptors: (associated action)

Guanfacine (Hypertension medication)

What conditions may trigger a hypertensive emergency or urgency?

Hypertension that has been poorly controlled, undiagnosed hypertension, and patients who have abruptly discontinued their medications

What are the two classes of hypertensive crisis that require immediate intervention?

Hypertensive emergency, hypertensive urgency

Displaces norepinephrine from storage site: (associated action)

Methyldopa (Hypertension medication)

What is a major concern for medical and nursing management of hypertension?

Noncompliance with recommended therapeutic regimen

Blocks beta-adrenergic receptors: (associated action)

Propranolol (Hypertension medication)

CASE STUDY: Georgia, a 30 y/o woman, is diagnosed as having secondary hypertension when serial blood pressure recordings show her average reading to be 170/100 mm Hg. Her hypertension is the result of renal dysfunction. How will Georgia's kidney help maintain her hypertensive state?

Releasing renin in response to decreased renal perfusion

Inhibits aldosterone: (associated action)

Spironolactone (Hypertension medication)

For a patient diagnosed with hypertension, what lifestyle modifications will assist with the management of the disease process?

Weight reduction, DASH diet, dietary sodium restriction, increasing physical activity, and moderation of alcohol consumption

isolated systolic hypertension

a condition most commonly seen in the older adult in which the systolic pressure is greater than 140 mm Hg and the diastolic pressure is less than 80 mm Hg

hypertensive emergency

a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage

hypertensive urgency

a situation in which blood pressure is severely elevated but there is no evidence of impending or progressive target organ damage

A patient has severe coronary artery disease (CAD) and hypertension. Which medication prescription should the nurse consult with the healthcare provider about that is contraindicated for a patient with severe CAD? a. Clonidine b. Amiloride c. Bumetanide d. Methyldopa

a. Clonidine

A patient with hypertension is waking up several times a night to urinate. What lab studies should the nurse assess that may indicate pathologic changes in the kidneys due to the hypertension? (Select all that apply) a. Creatinine b. Blood urea nitrogen (BUN) c. Urine for culture and sensitivity d. AST and ALT

a. Creatinine b. Blood urea nitrogen (BUN)

The nurse is performing an assessment on a patient to determine the effects of hypertension on the heart and blood vessels. What specific assessment data will assist in determining this complication? (Select all that apply) a. Heart rate b. Respiratory rate c. Heart rhythm d. Character of apical and peripheral pulses e. Lung sounds

a. Heart rate c. Heart rhythm d. Character of apical and peripheral pulses

A patient is being seen at the clinic on a monthly basis for assessment of blood pressure. The patient has been checking blood pressure at home as well and has reported a systolic pressure of 158 and a diastolic pressure of 64. What does the nurse suspect this patient is experiencing? a. Isolated systolic hypertension b. Secondary hypertension c. Primary hypertension d. Hypertensive urgency

a. Isolated systolic hypertension

The nurse is planning the care of a patient admitted to the hospital with hypertension. What objective will help to meet the needs of this patient? a. Lowering and controlling the blood pressure without adverse effects and without undue cost b. Making sure that the patient adheres to the therapeutic medication regimen c. Instructing the patient to enter a weight loss program and begin an exercise regimen d. Scheduling the patient for all follow up visits and making phone calls to the home to ensure adherence

a. Lowering and controlling the blood pressure without adverse effects and without undue cost

A patient is brought to the emergency department reporting a bad headache and an increase in blood pressure. The blood pressure reading obtained by the nurse is 260/180 mm Hg. What is the therapeutic goal for reduction of the mean blood pressure? a. Reduce the blood pressure by 20% to 25% within the first hour of treatment b. Reduce the blood pressure to about 140/80 mm Hg c. Rapidly reduce the blood pressure so the patient will not suffer a stroke d. Reduce the blood pressure by 50% within the first hour of treatment

a. Reduce the blood pressure by 20% to 25% within the first hour of treatment

dyslipidemia

abnormal blood lipid levels, including high total, low-density lipoprotein, and triglyceride levels as well as low high-density lipoprotein levels

A patient with long-standing hypertension is admitted to the hospital with hypertensive urgency. The healthcare provider 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? a. Cardiac catheterization b. Echocardiography c. Stress test d. Tilt-table test

b. Echocardiography

A patient is taking amiloride and lisinopril for the treatment of hypertension. What lab studies should the nurse monitor while the patient is taking these medications together? a. Magnesium levels b. Potassium levels c. Calcium levels d. Sodium levels

b. Potassium levels

A patient if flying overseas for 1 weeks for business and packed antihypertensive medications in a suitcase. After arriving at the intended destination, the patient found that the luggage had been stolen. If the patient cannot take the medication, what condition becomes a concern? a. Isolated systolic hypertension b. Rebound hypertension c. Angina d. Left ventricular hypertrophy

b. Rebound hypertension

rebound hypertension

blood pressure that is controlled with medication and becomes uncontrolled (abnormally high) with the abrupt discontinuation of medication

A patient has been diagnosed with prehypertension and has been encouraged to exercise regularly and begin a weight loss program. After what period of time does the nurse inform the patient to return for a follow-up visit? a. 2 months b. 6 months c. 1 year d. 2 years

c. 1 year

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 hydrochlorothizide and atenolol. What treatment will the nurse educate the patient about? a. Continuing the medication and reducing dietary sodium b. Discontinuing the hydrochlorothiazide and atenolol and continuing to reduce sodium intake c. Gradually reducing the hydrochlorothiazide and the atenolol and continuing to reduce sodium intake d. Gradually reducing the atenolol and continuing the hydrochlorothiazide

c. Gradually reducing the hydrochlorothiazide and the atenolol and continuing to reduce sodium intake

A patient informs the nurse, "I can't adhere to the dietary sodium decrease that is required for the treatment of my hypertension." What can the nurse educate the client about regarding this statement? a. If dietary sodium isn't restricted, the patient will be unable to control the blood pressure and will be at risk for stroke b. The patient can speak to the healthcare provider about increasing the dosage of medication instead of reducing the added salt c. It takes 2 to 3 months for the taste buds to adapt to changes in salt intake d. The patient should use other methods of flavoring foods

c. It takes 2 to 3 months for the taste buds to adapt to changes in salt intake

A risk factor assessment, as advocated by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), is needed to classify and guide the treatment of hypertensive people at risk for: ______________

cardiovascular damage

The nurse is assessing the blood pressure for a patient who has hypertension and the nurse does not hear an auscultatory gap. What outcomes may be documented in this circumstances? a. A low diastolic reading b. A high systolic pressure reading c. A normal reading d. A high diastolic or low systolic reading

d. A high diastolic or low systolic reading

A patient arrives at the clinic for a follow-up visit for treatment of hypertension. The nurse obtains a blood pressure reading of 180/110 mm Hg but finds no evidence of impending or progressive organ damage when performing the assessment on the patient. What situation does the nurse determine this patient is experiencing? a. Hypertensive emergency b. Primary hypertension c. Secondary hypertension d. Hypertensive urgency

d. Hypertensive urgency

The nurse is assessing a patient with severe hypertension. When performing a focused assessment of the eyes, what may be observed r/t hypertension? a. Cataracts b. Glaucoma c. Retinal detachment d. Papilledema

d. Papilledema

primary hypertension

denotes high blood pressure from an unidentified cause; also called essential hypertension

Cardiac Output is the product of: ______________ multiplied by _______________

heart rate; stroke volume

secondary hypertension

high blood pressure from an identified cause, such as kidney disease

monotherapy

medication therapy with a single agent

Patients may experience _______________ if antihypertensive medication is suddenly stopped

rebound hypertension