Chapter 27: Assessment and management of patients with Hypertension

A nurse is caring for a client who has hypertension and diabetes mellitus. The client's blood pressure this morning was 150/92 mm Hg. When the client asks the nurse what his or her blood pressure should be, what is the nurse's most appropriate response? "Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg." "Your blood pressure is fine. Just keep doing what you're doing." "The lower the better. Blood pressure of 130/80 mm Hg is best for everyone." "The current recommendation is for everyone to have blood pressure of 140/90 mm Hg or lower."

"Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg." Explanation: An individual with diabetes mellitus should strive for blood pressure of 120/80 mm Hg or less. An individual without diabetes should strive for blood pressure of 140/90 mm Hg or less.

A nurse is caring for a client who has hypertension and diabetes mellitus. The client's blood pressure this morning was 150/92 mm Hg. When the client asks the nurse what his or her blood pressure should be, what is the nurse's most appropriate response? "Your blood pressure is fine. Just keep doing what you're doing." "The current recommendation is for everyone to have blood pressure of 140/90 mm Hg or lower." "Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg." "The lower the better. Blood pressure of 130/80 mm Hg is best for everyone."

"Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg." Explanation: An individual with diabetes mellitus should strive for blood pressure of 120/80 mm Hg or less. An individual without diabetes should strive for blood pressure of 140/90 mm Hg or less.

A client with high blood pressure is receiving an antihypertensive drug. When developing a client teaching plan to minimize orthostatic hypotension, which instruction should the nurse include? "Rest between demanding activities, eat plenty of fruits and vegetables, and drink 6 to 8 cups of fluid daily." "Flex your calf muscles, avoid alcohol, and change positions slowly." "Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising." "Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night."

"Flex your calf muscles, avoid alcohol, and change positions slowly." Explanation: Measures that minimize orthostatic hypotension include flexing the calf muscles to boost blood return to the heart, avoiding alcohol and straining at stool, changing positions slowly, eating a high-protein snack at night, wearing elastic stockings, and holding onto a stationary object when rising. Although the client should rest between demanding activities and consume plenty of fluids and fiber (contained in fruits and vegetables) to maintain a balanced diet, these measures don't directly relieve orthostatic hypotension.

A nurse working in the clinic is seeing a client who has just been prescribed a new medication for hypertension. The client asks why hypertension is sometimes called the "silent killer." What is the best response by the nurse? "Hypertension is difficult to diagnose." "Hypertension often kills early in the disease process." "Hypertension often causes no pain." "Hypertension often causes no symptoms."

"Hypertension often causes no symptoms." Explanation: Hypertension is sometimes called the "silent killer" because people with it are often symptom free. Physical examination may reveal no abnormalities other than elevated blood pressure. People with hypertension may remain asymptomatic for many years. The usual consequences of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, renal failure, strokes, and impaired vision. Pain is not usually an issue, but that is not why hypertension is called the "silent killer." Hypertension is easily diagnosed by taking a series of blood pressure readings.

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 can still eat a ham-and-cheese sandwich with potato chips for lunch." "I chose broiled chicken with a baked potato for dinner." "I'm glad I can still have chicken bouillon." "I chose a tossed salad with sardines and oil and vinegar dressing for lunch."

"I chose broiled chicken with a baked potato for dinner." Explanation: 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 caring for a client who has had 25 mg of oral hydrochlorothiazide added to the medication regimen for the treatment of hypertension. Which instruction should the nurse give the client? "Increase the amount of fruits and vegetables you eat." "Take this medication before going to bed." "You may drink alcohol while taking this medication." "You may develop nasal congestion or depression while taking this medication."

"Increase the amount of fruits and vegetables you eat." Explanation: Thiazide diuretics cause loss of sodium, potassium, and magnesium, so the client should be encouraged to eat fruits and vegetables that are high in potassium. Diuretics cause increased urination; the client should not take the medication before going to bed. Thiazide diuretics do not cause dry mouth or nasal congestion; both side effects are associated with alpha2-agonists. Postural hypotension may be potentiated by alcohol.

The nurse is caring for a client who has had 25 mg of oral hydrochlorothiazide added to the medication regimen for the treatment of hypertension. Which instruction should the nurse give the client? "Increase the amount of fruits and vegetables you eat." "You may develop nasal congestion or depression while taking this medication." "You may drink alcohol while taking this medication." "Take this medication before going to bed."

"Increase the amount of fruits and vegetables you eat." Explanation: Thiazide diuretics cause loss of sodium, potassium, and magnesium, so the client should be encouraged to eat fruits and vegetables that are high in potassium. Diuretics cause increased urination; the client should not take the medication before going to bed. Thiazide diuretics do not cause dry mouth or nasal congestion; both side effects are associated with alpha2-agonists. Postural hypotension may be potentiated by alcohol.

A nurse is teaching a client with newly diagnosed hypertension who asks if there is any harm in stopping antihypertensive medication. What is the nurse's best response? "Postural hypotension can occur." "Rebound hypotension can occur." "Postural hypertension can occur." "Rebound hypertension 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 antihypertensive medications.

A 55-year-old male client newly diagnosed with hypertension returns to the physician's office for a routine follow-up appointment after several months of treatment with metoprolol. During the initial assessment, the nurse records the client's blood pressure (BP) as 180/90 mm Hg. The client states that the medication is not taken as prescribed. Which is the best response by the nurse? "It is very important for you to take your medication as prescribed, or you could experience a stroke." "Be certain to discuss your noncompliance with your medication regimen with the physician." "Your hypertension must be treated with medications; you need to take your metoprolol every day." "The medication you were prescribed may cause sexual dysfunction; are you experiencing this side effect?"

"The medication you were prescribed may cause sexual dysfunction; are you experiencing this side effect?" The nurse needs to understand why the patient is not taking his medication. Lopressor is a beta-blocker. All patients should be informed that beta-blockers might cause sexual dysfunction and that other medications are available if problems with sexual function occur. The other statements, although true, are nontherapeutic and would not elicit why the patient was not taking his medications as prescribed.

Which condition(s) indicates target organ damage from untreated/undertreated hypertension? Select all that apply. Heart failure Retinal damage Stroke Hyperlipidemia Diabetes

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

A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. What will the nurse specify about this client's target blood pressure? 145/95 or lower 150/95 or lower 130/80 or lower 125/85 or lower

130/80 or lower Explanation: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) specifies a lower goal pressure of 130/80 for people with diabetes mellitus.

The nurse is teaching a client diagnosed with hypertension about the DASH diet. How many servings of meat, fish, and poultry should the client consume per day? 2 or fewer 2 or 3 4 or 5 7 or 8

2 or fewer Explanation: Two or fewer servings of lean meat, fish, and poultry are recommended in the DASH diet. The diet also recommends two or three servings of low-fat or fat-free dairy foods, four or five servings of fruits and vegetables, and seven or eight servings of grains and grain products.

A patient is being treated for hypertensive emergency. When treating this patient, the priority goal is to lower the mean blood pressure (BP) by up to which percentage in the first hour? 25% 45% 35% 40%

25%

The nurse is explaining the DASH diet to a client diagnosed with hypertension. The client inquires about how many servings of fruit per day can be consumed on the diet. What is the nurse's best response? 2 or 3 servings per day 4 or 5 servings per day 2 or fewer servings per day 7 or 8 servings per day

4 or 5 servings per day Explanation: The client can consume 4 or 5 servings of fruit per day on the DASH diet. The servings for grains and grain product is 7 or 8. Two or 3 servings of low-fat or fat-free dairy foods can be consumed per day. Meat, fish, and poultry servings are 2 or fewer per day.

An older adult client visits the clinic for a blood pressure check. The client's hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about blood pressure medicine? A severe drop in blood pressure is possible. A possible adverse effect of blood pressure medicine is dizziness when you stand. Take the medicine on an empty stomach. There are no adverse effects from blood pressure medicine.

A possible adverse effect of blood pressure medicine is dizziness when you stand.

An older adult client visits the clinic for a blood pressure check. The client's hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about blood pressure medicine? A possible adverse effect of blood pressure medicine is dizziness when you stand. There are no adverse effects from blood pressure medicine. A severe drop in blood pressure is possible. Take the medicine on an empty stomach.

A possible adverse effect of blood pressure medicine is dizziness when you stand. Explanation: A possible adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. Teaching should include tips for managing syncope and dizziness. The nurse would not teach the client to take the medicine on an empty stomach.

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? Calcium channel blocker ACE inhibitor Beta-blocker Loop diuretic

ACE inhibitor Explanation: 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.

The nurse is administering metoprolol to a client. What type of medication should the nurse educate the client about? Diuretic Beta blocker Angiotensin-converting enzyme (ACE) inhibitor Vasodilator

Beta blocker

A community health nurse teaching a group of adults about preventing and treating hypertension. The nurse should encourage these participants to collaborate with their primary care providers and regularly monitor which of the following? Sodium levels Heart rate Blood lipid levels Potassium levels

Blood lipid levels Explanation: Hypertension often accompanies other risk factors for atherosclerotic heart disease, such as dyslipidemia (abnormal blood fat levels), obesity, diabetes, metabolic syndrome, and a sedentary lifestyle. Individuals with hypertension need to monitor their sodium intake, but hypernatremia is not a risk factor for hypertension. In many clients, heart rate does not correlate closely with BP. Potassium levels do not normally relate to BP.

A client has severe coronary artery disease (CAD) and hypertension. Which medication order should the nurse consult with the health care provider about that is contraindicated for a client with severe CAD? Bumetanide Methyldopa Amiloride Clonidine

Clonidine

A client has just been diagnosed with prehypertension. What would the nurse instruct this client to do to restore his blood pressure below hypertensive levels? Decrease sodium intake. Increase iodine intake. Avoid over-the-counter decongestants. Increase fluid intake.

Decrease sodium intake.

A client comes to the emergency department complaining of visual changes and severe headache and denies past medical history. The nurse measures the client's blood pressure at 210/120 mm Hg. What question will the nurse ask to explore the hypertension situation? Do you have hypertension in your family?" "Did you try an over-the-counter medication?" "Do you smoke cigarettes?" "What have you eaten in the last 24 hours?"

Do you have hypertension in your family?" Explanation: Asking the client about family history is a pertinent question to help relate the hypertension. Untreated hypertension is the most common cause of malignant hypertension (hypertensive emergency). 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).

Which diagnostic method is recommended to determine whether left ventricular hypertrophy has occurred? Blood chemistry Blood urea nitrogen Echocardiography Electrocardiography

Echocardiography

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 Hypokalemia Hyponatremia Hypernatremia

Hyperkalemia Explanation: 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 with high blood pressure is receiving an antihypertensive drug. When developing a client teaching plan to minimize orthostatic hypotension, which instruction should the nurse include? "Rest between demanding activities, eat plenty of fruits and vegetables, and drink 6 to 8 cups of fluid daily." "Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night." "Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising." "Flex your calf muscles, avoid alcohol, and change positions slowly."

Flex your calf muscles, avoid alcohol, and change positions slowly." Explanation: Measures that minimize orthostatic hypotension include flexing the calf muscles to boost blood return to the heart, avoiding alcohol and straining at stool, changing positions slowly, eating a high-protein snack at night, wearing elastic stockings, and holding onto a stationary object when rising. Although the client should rest between demanding activities and consume plenty of fluids and fiber (contained in fruits and vegetables) to maintain a balanced diet, these measures don't directly relieve orthostatic hypotension.

The nurse is creating a community teaching demonstration focusing on the cause of blood pressure. When completing the visual aid, which body structures represent the mechanism of blood pressure? Heart and blood vessels Kidneys and autonomic nervous system Lung and arteries Brain and sympathetic nervous system

Heart and blood vessels Explanation: Blood pressure is the force produced by the volume of the blood in arterial walls. It is represented by the formula: BP = CO (cardiac output) * PR (peripheral resistance). To highlight the mechanism of cardiac output, a heart would be on the visual aid and blood vessels.

Which of the following would be inconsistent with a hypertensive urgency? Anxiety Intracranial hemorrhage Severe headache Epistaxis

Intracranial hemorrhage Explanation: Elevated blood pressure in hypertensive urgency is associated with severe headache, epistaxis, and anxiety. An example of a hypertensive emergency is a myocardial infarction, intracranial hemorrhage, or dissecting aortic aneurysm.

A client is being seen at the clinic on a monthly basis for assessment of blood pressure. The client 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 client is experiencing? Isolated systolic hypertension Primary hypertension Secondary hypertension Hypertensive urgency

Isolated systolic hypertension Explanation: As a result of changes that occur with aging, the aorta and large arteries are less able to accommodate the volume of blood pumped out by the heart (stroke volume), and the energy that would have stretched the vessels instead elevates the systolic blood pressure, resulting in an elevated systolic pressure without a change in diastolic pressure. This condition, known as isolated systolic hypertension, is more common in older adults and is associated with significant cardiovascular and cerebrovascular morbidity and mortality (Chobanian et al., 2003).

A client 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? The client should use other methods of flavoring foods . It takes 2 to 3 months for the taste buds to adapt to changes in salt intake. The client can speak to the health care provider about increasing the dosage of medication instead of reducing the added salt. If dietary sodium isn't restricted, the client will be unable to control the blood pressure and will be at risk for stroke.

It takes 2 to 3 months for the taste buds to adapt to changes in salt intake. Explanation: The program usually consists of restricting sodium and fat intake, increasing intake of fruits and vegetables, and implementing regular physical activity. Explaining that it takes 2 to 3 months for the taste buds to adapt to changes in salt intake may help the client adjust to reduced salt intake. Reference:

The nurse is discussing aging and the incidence of hypertension with an older adult. What lifestyle change will lower blood pressure for the older adult? Sleep four hours each night. Exercise once a week. Keep weight stable. Add salt to foods for taste.

Keep weight stable. Explanation: Obesity can contribute to hypertension, so keeping weight stable is healthy. Salt can add to hypertension. The American Heart Association recommends exercising more than once a week for the older adult. Sleeping for four hours is not enough for rest.

The nurse is caring for an older adult client who has come to the clinic for a yearly physical. When assessing the client, the nurse notes the blood pressure (BP) is 140/93. The nurse knows that in older clients what happens that may elevate the systolic BP? Loss of arterial elasticity Decrease in blood volume Increase in calcium intake Decrease in cardiac output

Loss of arterial elasticity Explanation: In older clients, systolic BP may be elevated because of loss of arterial elasticity (arteriosclerosis). Systolic BP would not become elevated by a decrease in blood volume, an increase in calcium intake, or a decrease in cardiac output.

The nurse teaches the client which guidelines regarding lifestyle modifications for hypertension? Stop alcohol intake Maintain adequate dietary intake of fruits and vegetables Reduce smoking to no more than four cigarettes per day Limit aerobic physical activity to 15 minutes, three times per week

Maintain adequate dietary intake of fruits and vegetables Explanation: Guidelines include adopting the Dietary Approaches to Stop Hypertension (DASH) eating plan: consume a diet rich in fruits, vegetables, and low-fat dairy products and reduced amounts of saturated and total fat; reduce dietary sodium intake to no more than 100 mmol/day (2.4 g sodium or 6 g sodium chloride); engage in regular aerobic physical activity such as brisk walking (at least 30 min/day, most days of the week); moderate alcohol consumption, limiting consumption to no more than two drinks (e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and to no more than one drink per day in women and lighter-weight people. Tobacco should be avoided because anyone with high blood pressure is already at increased risk for heart disease, and smoking amplifies this risk.

A client is admitted to the intensive care unit (ICU) with a diagnosis of hypertension emergency/crisis. The client's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV nitroprusside. Upon assessment, which finding requires immediate intervention by the nurse? Numbness and weakness in the left arm Chest pain score of 3 (on a scale of 1 to 10) Nausea and severe headache Urine output of 40 mL over the past hour

Numbness and weakness in the left arm

A client is admitted to the intensive care unit (ICU) with a diagnosis of hypertension emergency/crisis. The client's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV nitroprusside. Upon assessment, which finding requires immediate intervention by the nurse? Nausea and severe headache Numbness and weakness in the left arm Urine output of 40 mL over the past hour Chest pain score of 3 (on a scale of 1 to 10)

Numbness and weakness in the left arm Explanation: 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 numbness and weakness in left arm may indicate the client is experiencing neurological symptoms associated with an ischemic stroke because of the severely elevated BP; immediate intervention is required. 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 instructing a student on the proper technique for measuring blood pressure (BP). Which student action indicates a need for further teaching? Positions the arm at waist level Wraps the blood pressure cuff firmly around the arm Centers the blood pressure cuff bladder directly over the brachial artery Palpates the systolic pressure before auscultating blood pressure

Positions the arm at waist level

The nurse is instructing a student on the proper technique for measuring blood pressure (BP). Which student action indicates a need for further teaching? Palpates the systolic pressure before auscultating blood pressure Wraps the blood pressure cuff firmly around the arm Centers the blood pressure cuff bladder directly over the brachial artery Positions the arm at waist level

Positions the arm at waist level Explanation:ARM LEVEL MUST BE AT SAME LEVEL AS HEARTPositioning the arm above the heart level will give a falsely low reading. Placing the arm below the heart will falsely elevate the reading. All other options are correct steps in achieving an accurate blood pressure.

An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for? Postural hypertension and resulting injury Sexual dysfunction Rebound hypertension Postural hypotension and resulting injury

Postural hypotension and resulting injury

older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for? Postural hypertension and resulting injury Postural hypotension and resulting injury Rebound hypertension Sexual dysfunction

Postural hypotension and resulting injury Explanation: Antihypertensive medication can cause hypotension, especially postural hypotension that may result in injury. Rebound hypertension occurs when antihypertensive medication is stopped abruptly. Sexual dysfunction may occur, especially with beta blockers, but other medications are available should this problem ensue. This is not immediately a priority concern. Antihypertensive medications do not usually cause postural hypertension.

A 35-year-old client has been diagnosed with hypertension. The client is a stock broker, smokes daily, and has diabetes. During a follow-up appointment, the client states that regular visits to the doctor just to check blood pressure (BP) are cumbersome and time consuming. As the nurse, which aspect of client teaching would you recommend? Administering glycemic control Purchasing a self-monitoring BP cuff Advising smoking cessation Discussing methods for stress reduction

Purchasing a self-monitoring BP cuff Explanation: Because this client finds visiting the doctor time-consuming just for a BP reading, as the nurse, you can suggest the use of an automatic cuff at a local pharmacy, or purchasing a self-monitoring cuff. Discussing methods to reduce stress, advising smoking cessation, and achieving glycemic control would constitute client education in managing hypertension

Which of the following is the nurse most correct to recognize as a direct effect of client hypertension? Anemia resulting from bone marrow suppression Emphysema related to poor gas exchange Renal dysfunction resulting from atherosclerosis Hyperglycemia resulting from insulin receptor resistance

Renal dysfunction resulting from atherosclerosis 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.

Which finding indicates that hypertension is progressing to target organ damage? Blood urea nitrogen concentration of 12 mg/dL Retinal blood vessel damage Chest x-ray showing pneumonia Urine output of 60 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 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.

A client, newly admitted to the nursing unit, has a primary diagnosis of renal failure. When assessing the client, the nurse notes a blood pressure (BP) of 180/100. The nurse knows that this is what kind of hypertension? Primary Essential Malignant Secondary

SecondaryExplanation:Secondary hypertension is elevated BP that results from or is secondary to some other disorder. This type of hypertension is not primary, essential, or malignant.

A nurse is educating a client about monitoring blood pressure readings at home. What will the nurse be sure to emphasize? "Sit with legs crossed when taking your blood pressure." "Be sure the forearm is well supported above heart level while taking blood pressure." "Sit quietly for 5 minutes prior to taking blood pressure." "Avoid smoking cigarettes for 8 hours prior to taking blood pressure."

Sit quietly for 5 minutes prior to taking blood pressure."

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 Decreased low-density lipoprotein (LDL) levels Elevated high-density lipoprotein (HDL) cholesterol Age ≥65 in women

SmokingOverweight/obesityAge ≥65 in womenExplanation: 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.

During the physical assessment of a client with hypertension, what would the nurse expect to be the most obvious finding? Hypotension in either one or both systolic or diastolic measurements. Sustained increase of either one or both systolic or diastolic measurements. Client is underweight. Client is anemic.

Sustained increase of either one or both systolic or diastolic measurements. Explanation: The most obvious finding during a physical assessment is a sustained elevation of one or both blood pressure measurements. A client being overweight might depict having hypertension. An anemic client does not display any traits of having hypertension.

The nurse is obtaining a health history from a client with a blood pressure of 146/88 mm Hg. The client states that lifestyle changes have not been effective in lowering blood pressure. Which medication classification does the nurse anticipate first? Beta-blocker Thiazide diuretic Calcium channel blocker ACE inhibitors

Thiazide diuretic Explanation: 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 in a clinic setting has just been diagnosed with hypertension. When the client asks what the end goal is for treatment, what is the nurse's best response? To lose weight, achieve a body mass index of 24 or less, and to eat a diet rich in fruits and vegetables To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less To stop smoking and increase physical activity to 30 minutes/day most days of the week

To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less Explanation: 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 minutes per day most days of the week

Which statements are true when the nurse is measuring blood pressure (BP)? Select all that apply. The client's BP should be measured 1 hour before consuming alcohol. The client's arm should be positioned at the level of the heart. Using a BP cuff that is too small will give a higher BP measurement. Using a BP cuff that is too large will give a higher BP measurement. The client should sit quietly while BP is being measured.

Using a BP cuff that is too small will give a higher BP measurement.T he client's arm should be positioned at the level of the heart. The client should sit quietly while BP is being measured. Explanation:These statements are all true when measuring a BP. When using a BP cuff that is too large, the reading will be lower than the actual BP. The client should avoid smoking cigarettes or drinking caffeine for 30 minutes before BP is measured.

A 77-year-old client presents to the local community center for a blood pressure (BP) screening; BP is recorded as 180/90 mm Hg. The client has a history of hypertension but currently is not taking the prescribed medications. Which question is most appropriate for the nurse to ask the client first? "Are you having trouble paying for your medications?" "What medications are you prescribed?" "Are you able to get to your pharmacy to pick up your medications?" "Can you tell me the reasons you aren't taking your medications?"

Why are you not taking your medications? "Explanation:It is important for the nurse to first ascertain why the client is not taking prescribed medications. Adherence to the therapeutic program may be more difficult for older adults. The medication regimen can be difficult to remember, and the expense can be a challenge. Monotherapy (treatment with a single agent), if appropriate, may simplify the medication regimen and make it less expensive. The other questions are appropriate, but the priority is to determine why the medication regimen is not being followed

Primary or essential hypertension accounts for about 95% of all hypertension diagnoses with an unknown etiology. Secondary hypertension accompanies specific conditions that create hypertension as a result of tissue damage. Which condition contributes to secondary hypertension? acid-base imbalance calcium deficit hepatic function arterial vasoconstriction

arterial vasoconstriction Explanation: Secondary hypertension may accompany any primary condition that affects fluid volume or renal function, or causes arterial vasoconstriction.

The nurse is administering medications on a medical-surgical unit. A client is ordered to receive 40 mg oral nadolol for the treatment of hypertension. Before administering the medication, the nurse should check the client's heart rate. check the client's serum K+ level. check the client's urine output. weigh the client.

check the client's heart rate. Explanation: Nadolol is a beta-blocker. A desired effect of this medication is to reduce the pulse rate in clients with tachycardia and elevated blood pressure (BP). The nurse should check the client's heart rate (HR) before administering nadolol to ensure that the pulse is not less than 60 beats per minute. The other interventions are not indicated before administering a beta-blocker medication.

The nurse is caring for a client with a blood pressure of 210/100 mm Hg in the emergency room. What is the most appropriate route of administration for antihypertensive agents? intramuscular continuous IV infusion oral sublingual

continuous IV infusion Explanation: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.

Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress decreases the production of neurotransmitters that constrict peripheral arterioles. increases blood volume and improves the potential for greater cardiac output. increases the resistance that the heart must overcome to eject blood. increases the production of neurotransmitters that constrict peripheral arterioles.

decreases the production of neurotransmitters that constrict peripheral arterioles. Explanation: Reduced stress decreases the production of neurotransmitters that constrict peripheral arterioles. Reduced stress may assist in reducing blood volume and resistance to the heart.

Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress increases blood volume and improves the potential for greater cardiac output. decreases the production of neurotransmitters that constrict peripheral arterioles. increases the production of neurotransmitters that constrict peripheral arterioles. increases the resistance that the heart must overcome to eject blood.

decreases the production of neurotransmitters that constrict peripheral arterioles. Explanation: Reduced stress decreases the production of neurotransmitters that constrict peripheral arterioles. Reduced stress may assist in reducing blood volume and resistance to the heart.

When measuring blood pressure in each arm of a healthy adult, the nurse recognizes that the pressures differ no more than 5 mm Hg between arms. may vary 10 mm Hg or more between arms. may vary, with the higher pressure found in the left arm. must be equal in both arms.

differ no more than 5 mm Hg between arms.

A client who is newly diagnosed with hypertension is going to be starting antihypertensive medicine. What is one of the main things the client and the client's spouse should watch for? blurred vision persistent cough tremor dizziness

dizziness Explanation: A common adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. The client and the client's spouse should be alerted to this possibility and provided with some tips for managing dizziness.

Which term describes a situation in which blood pressure is very elevated but there is no evidence of impending or progressive target organ damage? Hypertensive emergency Secondary hypertension Hypertensive urgency Primary hypertension

hypertensive urgency Explanation: Hypertensive urgency is a situation in which blood pressure is severely elevated but there is no evidence of actual or probable target organ damage. A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage. Primary hypertension denotes high blood pressure from an unidentified source. Secondary hypertension is high blood pressure from an identified cause, such as renal disease.

A client who was recently diagnosed with prehypertension is to meet with a dietitian and return for a follow-up with the cardiologist in 6 months. What would this client's treatment likely include? procedural interventions nonpharmacological interventions observation only pharmacological interventions

nonpharmacological interventions

Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through: laboratory tests. an MRI. using a sphygmomanometer. ophthalmic examination.

ophthalmic examination. Explanation: Papilledema is an edema of the optic nerves, and thus needs an ophthalmic examination for detection.

It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position help reduce the blood pressure to resupply oxygen to the brain. provide time for the heart to increase the rate of contraction to resupply oxygen to the brain. help reduce the work required by the heart to resupply oxygen to the brain. provide time for the heart to reduce the rate of contraction to resupply oxygen to the brain.

provide time for the heart to increase rate of contraction to resupply oxygen to the brain.Explanation:It is important for the nurse to encourage the patient to rise slowly from a sitting or lying position because gradual changes in position provide time for the heart to increase its rate of contraction to resupply oxygen to the brain and not blood pressure or heart rate.

It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position provide time for the heart to reduce the rate of contraction to resupply oxygen to the brain. help reduce the work required by the heart to resupply oxygen to the brain. provide time for the heart to increase the rate of contraction to resupply oxygen to the brain. help reduce the blood pressure to resupply oxygen to the brain.

provide time for the heart to increase the rate of contraction to resupply oxygen to the brain. Explanation: It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position provide time for the heart to increase its rate of contraction to resupply oxygen to the brain, not blood pressure or heart rate.

A nurse is teaching a client with severe hypertension about the damage this condition can cause to the body. What system/organs will the nurse note are particularly targeted for damage due to severe hypertension? Gastrointestinal Sensory Musculoskeletal Integumentary

sensory Explanation: Prolonged elevated blood pressure eventually damages blood vessels throughout the body, particularly in target organs such as the heart, kidneys, brain, and eyes. The usual consequences of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, renal failure, strokes, and impaired vision.

The nurse is teaching a client about chronic untreated hypertension. What complication will the nurse explain to the client? stroke right-sided heart failure pulmonary insufficiency peripheral edema

stroke Explanation:A stroke occurs if vessels in the brain rupture and bleed. If an aneurysm has developed in the aorta from chronic hypertension, it may burst and cause hemorrhage and shock. Perpheral edema, right-sided heart failure, and pulmonary insufficiency are not usually consequences of untreated chronic hypertension.