Chapter 31: Assessment and Management of Patients With Hypertension

. The home health nurse is caring for a patient who has a comorbidity of hypertension. What assessment question most directly addresses the possibility of worsening hypertension?

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

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 dose the nurse inform the patient to return for a follow-up visit?

1 Yr

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

130

The nurse is planning the care of a patient who has been diagnosed with hypertension, but who otherwise enjoys good health. When assessing the response to an antihypertensive drug regimen, what blood pressure would be the goal of treatment?

140/90 mm Hg or lower

Approximately __________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 fat

A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective assessment data from a patient with hypertension, the nurse learns that the patient has a family history of hypertension and she herself has high cholesterol and lipid levels. The patient 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?

A family history of hypertension

The nurse is assessing the blood pressure for a patient who has hypertension and the nurse does not hear an auscultatory gap. What outcome may be documented in this circumstance?

A high diastolic or low systolic reading

A group of student nurses are practicing taking blood pressure. A 56-year-old male student has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, he exclaims, My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it? Which of the following responses by the nursing instructor would be best?

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 patient in hypertensive emergency is being cared for in the ICU. The patient has become hypovolemic secondary to natriuresis. What is the nurses most appropriate action?

Administer normal saline IV, as ordered.

The nurse is providing care for a patient with a diagnosis of hypertension. The nurse should consequently assess the patient for signs and symptoms of which other health problem?

Atherosclerosis

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?

Blood lipid 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?

Cardiac catheterization Echocardiography

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, is needed to classify and guide the treatment of hypertensive people at risk for

Cardiovascular damage

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 or related disorders increases significantly

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 CAD?

Clonidine

A patient with hypertension is walking up several times a night to urinate. What laboratory studies should the nurse assess that may indicate pathologic changes in the kidneys due to the hypertension?

Creatinine Blood urea nitrogen (BUN)

A patient in a hypertensive emergency is admitted to the ICU. The nurse anticipates that the patient will be treated with IV vasodilators, and that the primary goal of treatment is what?

Decrease the mean arterial pressure between 20% and 25% in the first hour of treatment

The nurse is reviewing the medication administration record of a patient who takes a variety of medications for the treatment of hypertension. What potential therapeutic benefits of anti hypertensives should the nurse identify?

Decreased peripheral resistance, Decreased blood volume, Decreased strength and rate of myocardial contractions

risk factors for secondary hypertension

Diabetes and oral contraceptives

A newly diagnosed patient with hypertension is prescribed Diuril, a thiazide diuretic. What patient education should the nurse provide to this patient?

Diuril can cause low blood pressure and dizziness, especially when you get up suddenly.

Aging Cardiovascular

Elderly people have impaired cardiovascular reflexes and are more sensitive to postural hypotension.

A patient has been diagnosed as being prehypertensive. What should the nurse encourage this patient to do to aid in preventing a progression to a hypertensive state?

Exercise on a regular basis.

Stimulates dopamine and alpha 2- adrenergic receptors

Fenoldopam

Blocks reabsorption of sodium and water in kidneys

Furosemide

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

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

Stimulates alpha 2 adrenergic receptors

Guanfacine

The nurse is providing care for a patient with a new diagnosis of hypertension. How can the nurse best promote the patients adherence to the prescribed therapeutic regimen?

Have the patient participate in monitoring his or her own BP.

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?

Heart rate Heart rhythm Character of apical and peripheral pulses

Cardiac output is the product of ______________ multiplied by _______________.

Heart rate multiplied by Stroke volume

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?

Hispanics

A 55-year-old patient comes to the clinic for a routine check-up. The patients BP is 159/100 mm Hg and the physician diagnoses hypertension after referring to previous readings. The patient asks why it is important to treat hypertension. What would be the nurses best response?

Hypertension greatly increases your risk of stroke and heart disease.

atherosclerotic heart disease

Hypertension is both a sign and a risk factor for

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

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?

Hypertensive emergencies are associated with evidence of target organ damage

______________________ and _______________________ are the two classes of hypertensive crisis that require immediate intervention.

Hypertensive emergency; Hypertensive urgency

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?

Hypertensive urgency

The medications of choice in hypertensive emergencies are those that have an immediate effect.

IV vasodilators, including sodium nitroprusside /Nitropress, nicardipine hydrochloride/ Cardene, clevidipine/Cleviprex, fenoldopam mesylate /Corlopam, enalaprilat, and nitroglycerin, have immediate actions that are short lived minutes to 4 hours, and they are therefore used for initial treatment

A patients medication regimen for the treatment of hypertension includes hydrochlorothiazide. Following administration of this medication, the nurse should anticipate what effect?

Increased urine output

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?

Isolated systolic Hypertension

A patient informs the nurse " I can't adhere to the dietary sodium decrease that is requires for the treatment of my hypertension". What can the nurse educate the client about regarding this statement?

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

The nurse is assessing a patient new to the clinic. Records brought to the clinic with the patient show the patient has hypertension and that her current BP readings approximate the readings from when she was first diagnosed. What contributing factor should the nurse first explore in an effort to identify the cause of the clients inadequate BP control?

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 120/80 mm Hg

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

causes of secondary hypertension.

Metabolic syndrome, renal disease, and coarctation of the aorta

Displaces norepinephrine from storage sites

Methyldopa

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

Noncompliance with recommended therapeutic regimen

The hospital nurse cares for many patients who have hypertension. What nursing diagnosis is most common among patients who are being treated for this health problem?

Noncompliance with therapeutic regimen related to adverse effects of prescribed therapy

A patient in hypertensive urgency is admitted to the hospital. The nurse should be aware of what goal of treatment for a patient in hypertensive urgency?

Normalizing BP within 24 to 48 hours

A nurse is teaching an adult female patient about the risk factors for hypertension. What should the nurse explain as risk factors for primary hypertension?

Obesity and high intake of sodium and saturated fat

risk factors for primary hypertension

Obesity, stress, high intake of sodium or saturated fat, and family history

Treatment of Hypertensive Urgencies

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. There is no evidence of target organ damage in hypertensive urgency.

The nurse is assessing a patient with severe hypertension. When performing a focused assessment of the eyes, what may be observed related to the hypertension?

Papilledema

A patient has been prescribed anti hypertensives. 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 patients care, what desired outcome should the nurse identify?

Patient takes medication as prescribed and reports any adverse effects.

The nurse is developing a nursing care plan for a patient who is being treated for hypertension. What is a measurable patient outcome that the nurse should include?

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

The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. Which of the following should the nurse integrate into the management of this clients hypertension?

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

A patient is taking amiloride and lisinopril for the treatment of hypertension. What laboratory studies should the nurse monitor while the patient is taking these two medications together?

Potassium level

During an adult patients last two office visits, the nurse obtained BP readings of 122/84 mm Hg and 130/88 mm Hg, respectively. How would this patients BP be categorized?

Prehypertensive

Blocks beta- adrenergic receptors

Propranolol

A patient is flying overseas for 1 week 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 can not take the medication, what condition becomes a concern?

Rebound hypertension

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?

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

The nurse is collaborating with the dietitian and a patient with hypertension to plan dietary modifications. These modifications should include which of the following?

Reduced intake of fat and sodium

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

. A patient with primary hypertension comes to the clinic complaining of 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 what?

Retinal blood vessel damage

A patient with primary hypertension comes to the clinic complaining of 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 what?

Retinal blood vessel damage

. A patient with primary hypertension complains of dizziness with ambulation. The patient is currently on an alpha-adrenergic blocker and the nurse assesses characteristic signs and symptoms of postural hypotension. When teaching this patient about risks associated with postural hypotension, what should the nurse emphasize?

Rising slowly from a lying or sitting position

A patient with secondary hypertension has come into the clinic for a routine check-up. The nurse is aware that the difference between primary hypertension and secondary hypertension is which of the following?

Secondary hypertension has a specific cause.

. The critical care nurse is caring for a patient just admitted in a hypertensive emergency. The nurse should anticipate the administration of what medication?

Sodium nitroprusside/ Nitropress

Inhibits aldosterone

Spironolactone

A patient comes to the walk-in clinic complaining of frequent headaches. While assessing the patients vital signs, the nurse notes the BP is 161/101 mm Hg. According to JNC 7, how would this patients BP be defined if a similar reading were obtained at a subsequent office visit?

Stage 2 hypertensive

A student nurse is taking care of an elderly patient with hypertension during a clinical experience. The instructor asks the student about the relationships between BP and age. What would be the best answer by the student?

Structural and functional changes in the cardiovascular system that occur with age contribute to increases in blood pressure.

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 of the following actions?

Taking the BP at least 10 minutes after nicotine or coffee ingestion

A patients recently elevated BP has prompted the primary care provider to prescribe furosemide (Lasix). The nurse should closely monitor which of the following?

The patients potassium level

A 40-year-old male newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the patient and advises that the patient should avoid tobacco use. What is the primary rationale behind that advice to the patient?

Tobacco use increases the patients concurrent risk of heart disease.

. The nurse is teaching a patient about some of the health consequences of uncontrolled hypertension. What health problems should the nurse describe?

Transient ischemic attacks, Cerebrovascular accident and Retinal hemorrhage

A patient 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 patient has done which of the following?

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. The nurses health education should include which of the following?

Use of strategies to prevent falls stemming from postural hypotension

A patient with newly diagnosed hypertension has come to the clinic for a follow-up visit. The patient asks the nurse why she has to come in so often. What would be the nurses best response?

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

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

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. Blood pressures are extremely elevated in both urgency and emergencies, Extremely close hemodynamic monitoring of the patients BP is required in both situations. The medications of choice in hypertensive emergencies are those with an immediate effect, such as IV vasodilators.

Loop diuretics

can cause potassium depletion.

Prolonged Uncontrolled Hypertension

can result in renal failure, myocardial infarction, stroke, impaired vision, left ventricular hypertrophy, and cardiac failure. G

Blood pressure is the product of _____________; multiplied by __________________.

cardiac output; peripheral resistance

The Seventh Report of the Joint National Committee/ JNC 7

defines stage 2 hypertension as a reading 160/100 mm Hg.

The Elderly

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. Kidney function and absorption decline with age; less antihypertensive medication is prescribed.

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.

Initial treatment goal for hypertensive emergencies

is to reduce the mean arterial pressure by 25% in the first hour of treatment, with further reduction over the next 24 hours. Lowering the BP too fast may cause hypotension in a patient whose body has adjusted to hypertension and could cause a stroke, MI, or visual changes.

Potential complications of hypertension include the following:

left ventricular hypertrophy; MI; heart failure; transient ischemic attacks/ TIAs; cerebrovascular accident; renal insufficiency and failure; and retinal hemorrhage

JNC 7 defines a blood pressure

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.

In cases of hypertensive urgency

oral agents can be administered with the goal of normalizing BP within 24 to 48 hours

Thiazide diuretics can cause

postural hypotension, which may be potentiated by alcohol, barbiturates, opioids, or hot weather.

Patients may experience _________________________ if antihypertensive medications are suddenly stopped.

rebound hypertension

If there is volume depletion secondary to natriuresis caused by the elevated BP,

then volume replacement with normal saline can prevent large, sudden drops in BP when antihypertensive medications are administered.

Blood pressures should be taken

with the patient seated with arm bare, supported, and at heart level. The patient should not have smoked tobacco or taken caffeine in the 30 minutes preceding the measurement. The patient 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.