Chapter 27: Caring for Clients with 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? Purchasing a self-monitoring BP cuff Discussing methods for stress reduction Advising smoking cessation Administering glycemic control

Purchasing a self-monitoring BP cuff

A client with newly diagnosed hypertension has come to the clinic for a follow-up visit. The client asks the nurse why she has to come in so often. What would be the nurse's best response? "We do this so we can identify any of the early symptoms of a stroke." "We do this to determine how your blood pressure changes throughout the day." "We do this to see how often you should change your medication dose." "We do this to make sure your health is stable. We'll then monitor it at routinely scheduled intervals."

"We do this to make sure your health is stable. We'll then monitor it at routinely scheduled intervals."

A client has been diagnosed as experiencing "white-coat hypertension." This refers to: anxiety insomnia depression loss of consciousness

Anxiety

The nurse is caring for a client who is prescribed medication for the treatment of hypertension. The nurse recognizes that which medication conserves potassium? Furosemide Spironolactone Chlorothiazide Chlorthalidone

Spironolactone

A blood pressure (BP) of 140/90 mm Hg is considered to be normal. prehypertension. hypertension. a hypertensive emergency.

hypertension

High blood pressure is highly prevalent in the United States. Approximately how many people have high blood pressure in the United States? 1 in 3 adults 1 in 6 adults 1 in 7 adults 1 in 10 adults

1 in 3 adults

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? Migraines Atrial-septal defect Atherosclerosis Thrombocytopenia

Atherosclerosis

Choose the statements that correctly match the hypertensive medication with its side effect. Select all that apply. With ACE inhibitors, assess for bradycardia. Beta-blockers may cause sedation. Direct vasodilators may cause headache and tachycardia. Cough is a common side effect of adrenergic inhibitors. With thiazide diuretics, monitor serum potassium concentration.

Direct vasodilators may cause headache and tachycardia. With thiazide diuretics, monitor serum potassium concentration.

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? Avoid excessive potassium intake. Exercise on a regular basis. Eat less protein and more vegetables. Limit morning activity.

Exercise on a regular basis.

The nurse is teaching a client who is experiencing dizziness to rise slowly from a sitting or lying position. What is the rationale for the teaching? Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. Gradual changes in position help reduce the blood pressure to resupply oxygen to the brain. Gradual changes in position help reduce the heart's work to resupply oxygen to the brain. Gradual changes in position provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain.

Gradual changes in position provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain.

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: has a specific cause. has a more gradual onset than primary hypertension. does not normally cause target organ damage. does not normally respond to antihypertensive drug therapy. TAKE ANOTHER QUIZ

Has a specific cause

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.) Heart rate Respiratory rate Heart rhythm Character of apical and peripheral pulses Lung sounds

Heart rate Heart rhythm Character of apical and peripheral pulses

The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in what way? The BP is always higher in a hypertensive emergency. Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies. Hypertensive urgency is treated with rest and benzodiazepines to lower BP. Hypertensive emergencies are associated with evidence of target organ damage.

Hypertensive emergencies are associated with evidence of target organ damage

Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage? Hypertensive emergency Hypertensive urgency Primary hypertension Secondary hypertension

Hypertensive emergency

It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. decreases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. increases the heart rate, constricts arterioles, and increases the heart's ability to eject blood. decreases circulating blood volume.

Increases the heart rate, constricts arterioles, and reduces the heart's ability t eject blood.

A client experiences orthostatic hypotension while receiving furosemide to treat hypertension. How will the nurse intervene? Administer I.V. fluids as ordered. Administer an isosorbide as ordered. Insert an indwelling urinary catheter as ordered. Instruct the client to sit for several minutes before standing.

Instruct the client to sit for several minutes before standing.

The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. What should the nurse integrate into the management of this client's hypertension? Ensure that the client receives a larger initial dose of antihypertensive medication due to impaired absorption. Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion. Recognize that an older adult is less likely to adhere to the medication regimen than a younger client. Carefully assess for weight loss because of impaired kidney function resulting from normal aging.

Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion.

Which term describes high blood pressure from an identified cause, such as renal disease? Primary hypertension Secondary hypertension Rebound hypertension Hypertensive emergency

Secondary hypertension

A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. What are risk factors for cardiovascular problems in clients with hypertension? Select all that apply. Gallbladder disease Smoking Diabetes mellitus Physical inactivity Frequent upper respiratory infections

Smoking Diabetes mellitus Physical inactivity

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 130/80 or lower 150/95 or lower 125/85 or lower

130/80 or lower

According to the DASH diet, how many servings of vegetables should a person consume each day? 2 or fewer 2 or 3 4 or 5 7 or 8

4 or 5

A client with newly diagnosed hypertension asks what to do to decrease the risk for related cardiovascular problems. Which risk factor is not modifiable by the client? Age Obesity Inactivity Dyslipidemia

Age

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 Rebound hypertension Sexual dysfunction Postural hypotension and resulting injury

Postural hypertension and resulting injury

A client is taking amiloride and lisinopril for the treatment of hypertension. What laboratory studies should the nurse monitor while the client is taking these two medications together? Magnesium level Potassium level Calcium level Sodium level

Potassium level

A patient comes to the walk-in clinic. While assessing the patient's vital signs, the nurse assesses the patient's blood pressure at 128/89 mm Hg. According to JNC7, how would this patient's blood pressure be classified? Hypertensive Normal Slightly hypertensive Prehypertensive

Prehypertensive

A 56-year-old male 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? "Yes. Hypertension is prevalent among men; it is fortunate we caught this during your routine examination." "We will need to reevaluate your blood pressure because your age places you at high risk for hypertension." "A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made." "You have no need to worry. Your pressure is probably elevated because you are being tested."

"A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made."

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." "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."

"Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg."

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 often causes no symptoms." "Hypertension often kills early in the disease process." "Hypertension often causes no pain." "Hypertension is difficult to diagnose."

"Hypertension often causes no symptoms."

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? "Take this medication before going to bed." "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."

"Increase the amount of fruits and vegetables you eat."

Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension? "A glass of red wine each day will lower my blood pressure." "I should eliminate caffeine from my diet to lower my blood pressure." "If I include less fat in my diet, I'll lower my blood pressure." "Limiting my salt intake to 2 grams per day will improve my blood pressure."

"Limiting my salt intake to 2 grams per day will improve my blood pressure."

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

"This medication can cause low blood pressure and dizziness, especially when you get up suddenly."

A nurse is assisting with checking blood pressures at a local health care fair. To which client would the nurse pay particular attention? A 16-year-old girl A 40-year-old African-American man A 50-year-old Caucasian woman An Asian adult man

A 40-year-old African-American man

A nurse is discussing with a nursing student how to accurately measure blood pressure. What statement by the student indicates an understanding of the education? A cuff that is too small will give a false high blood pressure. A cuff that is too small will give a false low blood pressure. A cuff that is too large will give a false high blood pressure. The size of the cuff does not matter as long as it fits snugly around the arm.

A cuff that is too small will give a false high blood pressure.

A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective assessment data from a client with hypertension, the nurse learns that the client has a family history of hypertension and she herself has high cholesterol and lipid levels. The client says she smokes one pack of cigarettes daily and drinks "about a pack of beer" every day. The nurse notes what nonmodifiable risk factor for hypertension? Hyperlipidemia Excessive alcohol intake A family history of hypertension Closer adherence to medical regimen

A family history of hypertension

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 what health problem? Acute kidney injury Right ventricular hypertrophy Glaucoma Anemia

Acute kidney injury

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? Pacific Islanders African-Americans Asians Hispanics

African-Americans

An adult patient's blood pressure readings have ranged from 138/92 to 154/100 during the past several weeks. As a result, the patient's nurse practitioner has ordered diagnostic follow-up. Which of the following diagnostic tests should the nurse prioritize when assessing the patient for target organ damage? C-reactive protein (CRP) levels Sodium, chloride, and potassium levels Arterial blood gas (ABG) results Blood urea nitrogen (BUN) and creatinine levels

Blood urea nitrogen (BUN) and creatinine levels

A patient has been prescribed antihypertensives. After assessment and analysis, the nurse has identified a nursing diagnosis of risk for ineffective health maintenance related to nonadherence to therapeutic regimen. When planning this client's care, what desired outcome should the nurse identify? Client takes medication as prescribed and reports any adverse effects. Client's BP remains consistently below 140/90 mm Hg. Client denies signs and symptoms of hypertensive urgency. Client is able to describe modifiable risk factors for hypertension.

Client takes medication as prescribed and reports any adverse effects.

The nurse is developing a nursing care plan for a client who is being treated for hypertension. What is a measurable client outcome that the nurse should include? Client will reduce Na+ intake to no more than 2.4 g daily. Client will have a stable BUN and serum creatinine levels. Client will abstain from fat intake and reduce calorie intake. Client will maintain a normal body weight.

Client will reduce Na+ intake to no more than 2.4 g daily.

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

Decreases the production of neurotransmitters that constrict peripheral arterioles.

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? dizziness persistent cough blurred vision tremor

Dizziness

The nurse is providing care for a client with a new diagnosis of hypertension. How can the nurse best promote the client's adherence to the prescribed therapeutic regimen? Screen the client for visual disturbances regularly. Have the client participate in monitoring his or her own BP. Emphasize the dire health outcomes associated with inadequate BP control. Encourage the client to lose weight and exercise regularly.

Have the client participate in monitoring her or her own BP.

A client's medication regimen for the treatment of hypertension includes hydrochlorothiazide. Following administration of this medication, the nurse should anticipate what effect? Drowsiness or lethargy Increased urine output Decreased heart rate Mild agitation

Increased urine output

A client diagnosed with hypertension informs the nurse that they are not taking prescribed antihypertensive medications due to an absence of symptoms. What is the most appropriate response by the nurse? Inform the client that this is why hypertension is known as "the silent killer." Inform the client that remaining unmedicated is all right in conjunction with routine follow-up. Suggest that the client try an herbal supplement instead. Inform the client there should be no problems as long as she a low sodium diet is maintained.

Inform the client that this is why hypertension is known as "the silent killer."

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? Progressive target organ damage Possibility of medication interactions Lack of adherence to prescribed drug therapy Possible heavy alcohol use or use of recreational drugs

Lack of adherence to prescribed drug therapy

The nurse is screening a number of adults for hypertension. What range of blood pressure is considered normal? Less than 140/90 mm Hg Less than 130/90 mm Hg Less than 129/89 mm Hg Less than 120/80 mm Hg

Less than 120/80 mm Hg

The nurse is developing a teaching plan for a client diagnosed with hypertension. What would be important for the nurse to emphasize as part of the plan of care? Limiting sodium intake in the diet Limiting cigarette smoking to 1 pack a week Limiting alcohol to a can of beer to four times a day to thin the blood Limiting activity to prevent over exertion

Limiting sodium intake in the diet

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? Lowering and controlling the blood pressure without adverse effects and without undue cost Making sure that the patient adheres to the therapeutic medication regimen Instructing the patient to enter a weight loss program and begin an exercise regimen Scheduling the patient for all follow-up visits and making phone calls to the home to ensure adherence

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

A client is brought to the emergency department with reports of 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? Reduce the blood pressure by 20% to 25% within the first hour of treatment. Reduce the blood pressure to about 140/80 mm Hg. Rapidly reduce the blood pressure so the client will not suffer a stroke. Reduce the blood pressure by 50% within the first hour of treatment.

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

A patient newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a patient with prolonged uncontrolled hypertension is at risk for developing what health problem? Renal failure Right ventricular hypertrophy Glaucoma Anemia

Renal failure

Which finding indicates that hypertension is progressing to target organ damage? Retinal blood vessel damage Urine output of 60 mL over 2 hours Blood urea nitrogen concentration of 12 mg/dL Chest x-ray showing pneumonia

Retinal blood vessel damage

A patient with secondary hypertension has come into the clinic for a routine check-up. The nurse is aware that the difference between primary and secondary hypertension is what? Secondary hypertension has a specific cause. Secondary hypertension has a more gradual onset than primary hypertension. Secondary hypertension does not cause target organ damage. Secondary hypertension does not respond to antihypertensive drug therapy.

Secondary hypertension has a specific cause.

A client comes to the walk-in clinic complaining of frequent headaches. While assessing the client's vital signs, the nurse notes the BP is 161/101 mm Hg. How would this client's BP be defined? Elevated Normal Stage 1 hypertensive Stage 2 hypertensive

Stage 2 hypertensive

Mr. Faulkner is a 69-year-old man who has enjoyed generally good health for his entire adult life. As a result, he has been surprised to receive a new diagnosis of hypertension after a series of visits to his primary care provider. The nurse who is working with Mr. Faulkner should recognize which of the following aspects of aging and hypertension? The diagnostic criteria for hypertension in adults over 65 differ from those for younger adults. The incidence and prevalence of hypertension increase with age. Blood pressure remains stable throughout adulthood but tends to be assessed more often by health care providers of older adults. Older adults are less vulnerable to the pathophysiological effects of hypertension than are younger adults.

The incidence and prevalence of hypertension increase with age.

The nurse observes a certified nursing assistant (CNA) obtaining a blood pressure reading with a cuff that is too small for the patient. The nurse informs the CNA that using a cuff that is too small can affect the reading results in what way? The results will be falsely decreased. The results will be falsely elevated. It will give an accurate reading. It will be significantly different with each reading.

The results will be falsely elevated.

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 prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less To stop smoking and increase physical activity to 30 minutes/day most days of the week 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 140/90 or less

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? Quitting smoking will cause the client's hypertension to resolve. Tobacco use increases the client's concurrent risk of heart disease. Tobacco use is associated with a sedentary lifestyle. Tobacco use causes ventricular hypertrophy.

Tobacco use increases the client's concurrent risk of heart disease.

A client has come to the clinic for a follow-up assessment that will include a BP reading. To ensure an accurate reading, the nurse should confirm that the client has done which of the following? Tried to rest quietly for 5 minutes before the reading is taken Refrained from smoking for at least 8 hours Drank adequate fluids during the day prior Avoided drinking coffee for 12 hours before the visit

Tried o rest quietly for 5 minutes before the reading is taken

A patient has come to the clinic for a follow-up assessment. Before taking the blood pressure, the nurse should determine if the patient has: Tried to rest quietly for 5 minutes before the reading is taken Refrained from smoking for at least 8 hours Been NPO for at least 2 hours Avoided drinking coffee for 12 hours before the visit

Tried to rest quietly for 5 minutes before the reading is taken

An older adult is newly diagnosed with primary hypertension and has just been started on a beta-blocker. What should the nurse include in health education? Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the beta-blocker Maintaining a diet high in dairy to increase protein necessary to prevent organ damage Use of strategies to prevent falls stemming from postural hypotension Limiting exercise to avoid injury that can be caused by increased intracranial pressure

Use of strategies to prevent falls stemming from postural hypotension

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

decreases the production of neurotransmitters that constrict peripheral arterioles.

What risk factors would cause the nurse to become concerned that the client may have atherosclerotic heart disease? Select all that apply. hypertension diabetes obesity lowered triglyceride levels active lifestyle family history of early cardiovascular events

hypertension diabetes obesity family history of early cardiovascular events

The nurse is reviewing the diet of a client who has been diagnosed with hypertension. The nurse recommends reducing or avoiding caffeine because caffeine: increases the heart rate and causes vasoconstriction. reduces the heart rate and leads to a coronary artery disease. reduces the heart rate and causes low blood pressure. increases the heart rate and causes angina.

increases the heart rate and causes vasoconstriction.