Chapter 33 Hypertension with Study Questions

The nurse has just finished teaching a hypertensive patient about the newly prescribed ramipril (Altace). Which patient statement indicates that more teaching is needed?

"A little swelling around my lips and face is okay." Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an indication that the ACE inhibitor should be discontinued. The patient should be taught that if any swelling of the face or oral mucosa occurs, the health care provider should be immediately notified because this could be life threatening. The other patient statements indicate that the patient has an accurate understanding of ACE inhibitor therapy.

A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and nausea and has a blood pressure (BP) of 238/118 mm Hg. Which question should the nurse ask first?

"Have you been consistently taking your medications?" Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do not increase BP. Stressful events will increase BP but not usually to the level seen in this patient.

hypertension is often called the "_______________"

"silent killer" -because it is frequently asymptomatic until it becomes sever and target organs disease occurs -increase workload on the heart and organs and tissues. -secondary symptoms include: fatigue, dizziness, palpitations, angina and dyspnea

A patient with a history of chronic hypertension is being evaluated in the emergency department for a blood pressure of 200/140 mm Hg. Which patient assessment question is the priority?

- answer=does the pt have any HA or confusion? The nurse's priority assessments include neurologic deficits, retinal damage, heart failure, pulmonary edema, and renal failure. The headache or confusion could be seen with hypertensive encephalopathy from increased cerebral capillary permeability leading to cerebral edema. In addition, headache or confusion could represent signs and symptoms of a hemorrhagic stroke. Needing to urinate and taking antiseizure medication do not support a hypertensive emergency.

what are the common causes for orthostatic hypotension?

-dehydration -inadequate vasoconstrictor mechanisms to disease or drugs -supine to standing decrease in 20 mm in systolic -supine to standing decrease in 20mm in diastolic -increase of a HR of 20bpm

Increased SNS activity effect on bp

-increases BP and CO and SVR increases HR and cardiac contractility, produces widespread vasoconstriction in the peripheral arterioles, and promotes the release of renin.

pt teach pts about sodium

-reading labels of over the counter drugs -or read labels of packaged food -read about health products -toothpaste containing baking soda _to identify hidden sources of sodium

Target organ diseases

1. Heart ( Hypertensive Heart Disease) -LVH -MI -CAD 2.Brain (Cerebral Vascular Disease)(STROKE) (TRANSIENT ISCHEMIC ATTACK)(TIA) 3.Kidneys (Nephrosclorosis) -MICROALBUMINURIA -PROTEINURIA -SERUM CREATININE 4.Eyes (Retinal Damage) -NARROWING OF RETINAL ARTERIOLES -HEMORRHAGES OR EXUDATES W OR W/OUT PAPILLEDEMA

steps to blood pressure measurement

1. pt should have not smoked, exercised or ingested caffeine 30 min before bp reading 2.sit pt legs uncrossed.. feet on floor and back supported. 3. begin after pt rested 5 min 4. measure and record both arms 5.select the appropriated size 6.take the bp 7.for auscultatory measurement inflate 20mm or 30mm above the pts normal bp 8.deflate the cuff at 2-3mm per second 9.record the sbp the first or two Korotkoff sounds and the dbp when the sound disappears 10.take two more readings at intervals of 1 min 11.verbally tell pt or in writing 12. clean the bp cuffs in between pts

Primary hypertension Nursing Diagnosis

1.ineffective health management related to lack of knowledge of patho, complications, and management of hypertension 2.Anxiety related to complexity of management regimen 3.Sexual dysfunction related to side effects of antihypertensive drug

hypertension gerontologic considerations

1.loss of elasticity in the large arteries due to atherosclerosis 2.increased collagen content and stiffness in the myocardium 3.increased peripheral vascular resistance 4.decreased adrenergic receptors sensitivity 5.blunting of baroreceptors reflexes 6.decreased renal function 7.decreased renin response to sodium and water depletion.

When caring for elderly patients with hypertension, which information should the nurse consider when planning care?

1.ystolic blood pressure increases with aging 2.White coat syndrome is prevalent in elderly patients 3.Volume depletion contributes to orthostatic hypotension 4. Blood pressure drops 1 hour postprandially in many older patients.

The nurse on the intermediate care unit received change-of-shift report on four patients with hypertension. Which patient should the nurse assess first?

43-year-old with a (blood pressure (BP) of 160/92 who is complaining of chest pain The patient with chest pain may be experiencing acute myocardial infarction, and rapid assessment and intervention are needed. The symptoms of the other patients also show target organ damage but are not indicative of acute processes.

Which blood pressure (BP) finding by the nurse indicates that no changes in therapy are needed for a patient with stage 1 hypertension who has a history of diabetes mellitus?

128/76 mm Hg The goal for antihypertensive therapy for a patient with hypertension and diabetes mellitus is a BP <130/80 mm Hg. The BP of 102/60 may indicate overtreatment of the hypertension and an increased risk for adverse drug effects. The other two blood pressures indicate a need for modifications in the patient's treatment.

What does a lipid profile indicate?

provides information about additional risk factors related to atherosclerosis and CVD

prostaglandins

secreted by the renal medulla have a vasodilator effect on the systemic circulation. -this results in decreased SVR and lowering of BP

A patient is diagnosed with hypertension and nadolol (Corgard) is prescribed. The nurse should consult with the health care provider before giving this medication upon finding a history of a. asthma. b. peptic ulcer disease. c. alcohol dependency. d. myocardial infarction (MI).

ANS: A Nonselective β-blockers block β1- and β2-adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma. β-blockers will have no effect on the patient's peptic ulcer disease or alcohol dependency. β-blocker therapy is recommended after MI.

The nurse is reviewing the laboratory tests for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider? a. Serum creatinine of 2.6 mg/dL b. Serum potassium of 3.8 mEq/L c. Serum hemoglobin of 14.7 g/dL d. Blood glucose level of 98 mg/dL

ANS: A The elevated creatinine indicates renal damage caused by the hypertension. The other laboratory results are normal.

Which nursing action should the nurse take first in order to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes? a. Have the patient record dietary intake for 3 days. b. Give the patient a detailed list of low-sodium foods. c. Teach the patient about foods that are high in sodium. d. Help the patient make an appointment with a dietitian.

ANS: A The initial nursing action should be assessment of the patient's baseline dietary intake through a 3-day food diary. The other actions may be appropriate, but assessment of the patient's baseline should occur first.

Which BP finding by the nurse indicates that no changes in therapy are needed for a patient with stage 1 hypertension who has a history of heart failure? a. 108/64 mm Hg b. 128/76 mm Hg c. 140/90 mm Hg d. 136/ 82 mm Hg

ANS: B The goal for antihypertensive therapy for a patient with hypertension and heart failure is a BP of <130/80 mm Hg. The BP of 108/64 may indicate overtreatment of the hypertension and an increased risk for adverse drug effects. The other two blood pressures indicate a need for modifications in the patient's treatment.

Which assessment finding for a patient who is receiving furosemide (Lasix) to treat stage 2 hypertension is most important to report to the health care provider? a. Blood glucose level of 180 mg/dL b. Blood potassium level of 3.0 mEq/L c. Early morning BP reading of 164/96 mm Hg d. Orthostatic systolic BP decrease of 12 mm Hg

ANS: B Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening dysrhythmias. The health care provider should be notified of the potassium level immediately and administration of potassium supplements initiated. The elevated blood glucose and BP also indicate a need for collaborative interventions but will not require action as urgently as the hypokalemia. An orthostatic drop of 12 mm Hg is common and will require intervention only if the patient is symptomatic.

The nurse in the emergency department received change-of-shift report on four patients with hypertension. Which patient should the nurse assess first? a. 52-year-old with a BP of 212/90 who has intermittent claudication b. 43-year-old with a BP of 190/102 who is complaining of chest pain c. 50-year-old with a BP of 210/110 who has a creatinine of 1.5 mg/dL d. 48-year-old with a BP of 200/98 whose urine shows microalbuminuria

ANS: B The patient with chest pain may be experiencing acute myocardial infarction and rapid assessment and intervention is needed. The symptoms of the other patients also show target organ damage, but are not indicative of acute processes.

The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a hypertensive emergency. Which finding is most important to report to the health care provider? a. Urine output over 8 hours is 200 mL less than the fluid intake. b. The patient is unable to move the left arm and leg when asked to do so. c. Tremors are noted in the fingers when the patient extends the arms. d. The patient complains of a severe headache with pain at level 8/10 (0 to 10 scale).

ANS: B The patient's inability to move the left arm and leg indicates that a hemorrhagic stroke may be occurring and will require immediate action to prevent further neurologic damage. The other clinical manifestations also likely are caused by the hypertension and will require rapid nursing actions, but they do not require action as urgently as the neurologic changes.

The nurse obtains this information from a patient with prehypertension. Which finding is most important to address with the patient? a. Low dietary fiber intake b. No regular aerobic exercise c. Weight 5 pounds above ideal weight d. Drinks wine with dinner once a week

ANS: B The recommendations for preventing hypertension include exercising aerobically for 30 minutes most days of the week. A weight that is 5 pounds over the ideal body weight is not a risk factor for hypertension. The Dietary Approaches to Stop Hypertension (DASH) diet is high in fiber, but increasing fiber alone will not prevent hypertension from developing. The patient's alcohol intake will not increase the hypertension risk.

The RN is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside (Nipride). Which of the following nursing actions can the nurse delegate to an experienced LPN/LVN? a. Titrate nitroprusside to maintain BP at 160/100 mm Hg. b. Evaluate effectiveness of nitroprusside therapy on BP. c. Set up the automatic blood pressure machine to take BP every 15 minutes. d. Assess the patient's environment for adverse stimuli that might increase BP.

ANS: C LPN/LVN education and scope of practice include correct use of common equipment such as automatic blood pressure machines. The other actions require more nursing judgment and education and should be done by RNs.

Which action will be included in the plan of care when the nurse is caring for a patient who is receiving sodium nitroprusside (Nipride) to treat a hypertensive emergency? a. Organize nursing activities so that the patient has undisturbed sleep for 6 to 8 hours at night. b. Assist the patient up in the chair for meals to avoid complications associated with immobility. c. Use an automated noninvasive blood pressure machine to obtain frequent BP measurements. d. Place the patient on NPO status to prevent aspiration caused by nausea and the associated vomiting.

ANS: C Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV antihypertensive medications. This can be most easily accomplished with an automated BP machine or arterial line. The patient will require frequent assessments, so allowing 6 to 8 hours of undisturbed sleep is not appropriate. When patients are receiving IV vasodilators, bed rest is maintained to prevent decreased cerebral perfusion and fainting. There is no indication that this patient is nauseated or at risk for aspiration, so an NPO status is unnecessary.

A patient has been diagnosed with possible white coat hypertension. Which action will the nurse plan to take next? a. Schedule the patient for frequent BP checks in the clinic. b. Instruct the patient about the need to decrease stress levels. c. Tell the patient how to self-monitor and record BPs at home. d. Teach the patient about ambulatory blood pressure monitoring.

ANS: C Having the patient self-monitor BPs at home will provide a reliable indication about whether the patient has hypertension. Frequent BP checks in the clinic are likely to be high in a patient with white coat hypertension. Ambulatory blood pressure monitoring may be used if the data from self-monitoring is unclear. Although elevated stress levels may contribute to hypertension, instructing the patient about this is unlikely to reduce BP.

Which information should the nurse include when teaching a patient with newly diagnosed hypertension? a. Dietary sodium restriction will control BP for most patients. b. Most patients are able to control BP through lifestyle changes. c. Hypertension is usually asymptomatic until significant organ damage occurs. d. Annual BP checks are needed to monitor treatment effectiveness.

ANS: C Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle changes and sodium restriction are used to help manage blood pressure, but drugs are needed for most patients. BP should be checked by the health care provider every 3 to 6 months.

After giving a patient the initial dose of oral labetalol (Normodyne) for treatment of hypertension, which action should the nurse take? a. Encourage oral fluids to prevent dry mouth or dehydration. b. Instruct the patient to ask for help if heart palpitations occur. c. Ask the patient to request assistance when getting out of bed. d. Teach the patient that headaches may occur with this medication.

ANS: C Labetalol decreases sympathetic nervous system activity by blocking both α- and β-adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension. Heart palpitations, dehydration, and headaches are possible side effects of other antihypertensives.

A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and has a BP of 240/118 mm Hg. Which question should the nurse ask first? a. Did you take any acetaminophen (Tylenol) today? b. Do you have any recent stressful events in your life? c. Have you been consistently taking your medications? d. Have you recently taken any antihistamine medications?

ANS: C Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do not increase BP. Stressful events will increase BP but not usually to the level seen in this patient.

The charge nurse observes a new RN doing discharge teaching for a hypertensive patient who has a new prescription for enalapril (Vasotec). The charge nurse will need to intervene if the new RN tells the patient to a. check the BP with a home BP monitor every day. b. move slowly when moving from lying to standing. c. increase the dietary intake of high-potassium foods. d. make an appointment with the dietitian for teaching.

ANS: C The ACE inhibitors cause retention of potassium by the kidney, so hyperkalemia is a possible adverse effect. The other teaching by the new RN is appropriate for a patient with newly diagnosed hypertension who has just started therapy with enalapril.

During change-of-shift report, the nurse obtains this information about a hypertensive patient who received the first dose of propranolol (Inderal) during the previous shift. Which information indicates that the patient needs immediate intervention? a. The patient's most recent BP reading is 156/94 mm Hg. b. The patient's pulse has dropped from 64 to 58 beats/minute. c. The patient has developed wheezes throughout the lung fields. d. The patient complains that the fingers and toes feel quite cold.

ANS: C The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective β-blockers) is occurring. The nurse should immediately obtain an oxygen saturation measurement, apply supplemental oxygen, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes are associated with β-receptor blockade but do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated; however, this is not as urgently needed as addressing the bronchospasm.

Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new patient? a. Obtain a BP reading in each arm and average the results. b. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second. c. Have the patient sit in a chair with the feet flat on the floor. d. Assist the patient to the supine position for BP measurements.

ANS: C The patient should be seated with the feet flat on the floor. The BP is obtained in both arms, but the results of the two arms are not averaged. The patient does not need to be in the supine position. The cuff should be deflated at 2 to 3 mm Hg per second.

A 52-year-old patient who has no previous history of hypertension or other health problems suddenly develops a BP of 188/106 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that a. a BP recheck should be scheduled in a few weeks. b. the dietary sodium and fat content should be decreased. c. there is an immediate danger of a stroke and hospitalization will be required. d. more diagnostic testing may be needed to determine the cause of the hypertension.

ANS: D A sudden increase in BP in a patient over age 50 with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem. The BP will need rapid treatment and ongoing monitoring. If the patient has no other risk factors, a stroke in the immediate future is unlikely. There is no indication that dietary salt or fat intake have contributed to this sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this BP to an acceptable level.

The nurse has just finished teaching a hypertensive patient about the newly prescribed quinapril (Accupril). Which patient statement indicates that more teaching is needed? a. "The medication may not work as well if I take any aspirin." b. "The doctor may order a blood potassium level occasionally." c. "I will call the doctor if I notice that I have a frequent cough." d. "I won't worry if I have a little swelling around my lips and face."

ANS: D Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an indication that the ACE inhibitor should be discontinued. The patient should be taught that if any swelling of the face or oral mucosa occurs, the health care provider should be immediately notified because this could be life threatening. The other patient statements indicate that the patient has an accurate understanding of ACE inhibitor therapy.

When a patient with hypertension who has a new prescription for atenolol (Tenormin) returns to the health clinic after 2 weeks for a follow-up visit, the BP is unchanged from the previous visit. Which action should the nurse take first? a. Provide information about the use of multiple drugs to treat hypertension. b. Teach the patient about the reasons for a possible change in drug therapy. c. Remind the patient that lifestyle changes also are important in BP control. d. Question the patient about whether the medication is actually being taken.

ANS: D Since noncompliance with antihypertensive therapy is common, the nurse's initial action should be to determine whether the patient is taking the atenolol as prescribed. The other actions also may be implemented, but these would be done after assessing patient compliance with the prescribed therapy.

After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented, which diet choice indicates that the teaching has been effective? a. The patient avoids eating nuts or nut butters. b. The patient restricts intake of dietary protein. c. The patient has only one cup of coffee in the morning. d. The patient has a glass of low-fat milk with each meal.

ANS: D The Dietary Approaches to Stop Hypertension (DASH) recommendations for prevention of hypertension include increasing the intake of calcium-rich foods. Caffeine restriction and decreased protein intake are not included in the recommendations. Nuts are high in beneficial nutrients and 4 to 5 servings weekly are recommended in the DASH diet.

A patient has just been diagnosed with hypertension and has a new prescription for captopril (Capoten). Which information is important to include when teaching the patient? a. Check BP daily before taking the medication. b. Increase fluid intake if dryness of the mouth is a problem. c. Include high-potassium foods such as bananas in the diet. d. Change position slowly to help prevent dizziness and falls.

ANS: D The angiotensin-converting enzyme (ACE) inhibitors frequently cause orthostatic hypotension, and patients should be taught to change position slowly to allow the vascular system time to compensate for the position change. Increasing fluid intake may counteract the effect of the medication, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP does not need to be checked at home by the patient before taking the medication. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.

Which action should the nurse take when administering the initial dose of oral labetalol (Normodyne) to a patient with hypertension?

Ask the patient to request assistance when getting out of bed. Labetalol decreases sympathetic nervous system activity by blocking both á- and -adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension. Heart palpitations, dry mouth, dehydration, and headaches are possible side effects of other antihypertensives.

Which assessment finding for a patient who is receiving IV furosemide (Lasix) to treat stage 2 hypertension is most important to report to the health care provider?

Blood potassium level of 3.0 mEq/L Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening dysrhythmias. The health care provider should be notified of the potassium level immediately and administration of potassium supplements initiated. The elevated blood glucose and BP also indicate a need for collaborative interventions but will not require action as urgently as the hypokalemia. An orthostatic drop of 12 mm Hg is common and will require intervention only if the patient is symptomatic

A patient has just been diagnosed with hypertension and has been started on captopril (Capoten). Which information is important to include when teaching the patient about this medication?

Change position slowly to help prevent dizziness and falls. The angiotensin-converting enzyme (ACE) inhibitors frequently cause orthostatic hypotension, and patients should be taught to change position slowly to allow the vascular system time to compensate for the position change. Increasing fluid intake may counteract the effect of the medication, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP should be taken in the nondominant arm by newly diagnosed patients in the morning, before taking the medication, and in the evening. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.

Which nursing action should the nurse take first in order to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes?

Collect a detailed diet history. The initial nursing action should be assessment of the patient's baseline dietary intake through a thorough diet history. The other actions may be appropriate, but assessment of the patient's baseline should occur first.

Coronary Heart Disease

Hypertension disrupts the coronary artery endothelium. -this results in a stiff arterial wall w narrowed lumen, and accts for hight rate of CAD, Angina and MI.

Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new patient?

Have the patient sit in a chair with the feet flat on the floor. The patient should be seated with the feet flat on the floor. The BP is obtained in both arms, and the results of the two arms are not averaged. The patient does not need to be in the supine position. The cuff should be deflated at 2 to 3 mm Hg per second.

Which information should the nurse include when teaching a patient with newly diagnosed hypertension?

Hypertension is usually asymptomatic until target organ damage occurs. Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle changes (e.g., physical activity, dietary changes) are used to help manage blood pressure, but drugs are needed for most patients. Home BP monitoring should be taught to the patient and findings checked by the health care provider frequently when starting treatment for hypertension and then every 3 months once stable.

Left Ventricular Hyperthrophy

Increased cardiac workload and produces left ventricular hypertrophy (LVH) -LVH is compensatory mechanism that strengthens cardiac contraction and increases CO. -Increases contractility increases myocardial work and o2 demand. -LVH is associated w development of HF(heart failure)

Cerebrovascular disease

Most common risk for CVD is HTN -plaques are commonly found at the bifurcation of the common carotid artery and in the internal and external carotid arteries. -portions of the plaque break off and travel to cerebral vessels producing a thromboembolism -the patient may experience TIA(transient ischemic attack) or a stroke.

The nurse obtains the following information from a patient newly diagnosed with prehypertension. Which finding is most important to address with the patient?

No regular aerobic exercise The recommendations for preventing hypertension include exercising aerobically for 30 minutes most days of the week. A weight that is 5 pounds over the ideal body weight is not a risk factor for hypertension. The Dietary Approaches to Stop Hypertension (DASH) diet is high in fiber, but increasing fiber alone will not prevent hypertension from developing. The patient's alcohol intake is within guidelines and will not increase the hypertension risk.

The nurse is caring for a 70-year-old who uses hydrochlorothiazide (HydroDIURIL) and enalapril (Norvasc), but whose self-monitored blood pressure (BP) continues to be elevated. Which patient information may indicate a need for a change?

Patient uses ibuprofen (Motrin) daily to treat osteoarthritis. Because use of nonsteroidal antiinflammatory drugs (NSAIDs) can prevent adequate BP control, the patient may need to avoid the use of ibuprofen. A multivitamin tablet will help supply vitamin D, which may help lower BP. BP decreases while sleeping, so self-monitoring early in the morning will result in obtaining pressures that are at their lowest. The patient's alcohol intake is not excessive

A patient with hypertension who has just started taking atenolol (Tenormin) returns to the health clinic after 2 weeks for a follow-up visit. The blood pressure (BP) is unchanged from the previous visit. Which action should the nurse take first?

Question the patient about whether the medication is actually being taken. Because noncompliance with antihypertensive therapy is common, the nurse's initial action should be to determine whether the patient is taking the atenolol as prescribed. The other actions also may be implemented, but these would be done after assessing patient compliance with the prescribed therapy.

what diagnostic studies are performed in the pt w hypertension?

Routine Urinalysis BUN Serum Creatinine levels -these are used to screen for renal involvement and provide baseline information about kidney function

endocrine system

SNS releases Epinephrine along with a small fraction of NE by the adrenal medulla -Epinephrine activates B2 causing vasodilation and vasoconstriction. -A2 stimulates the adrenal cortex to release Aldosterone= stimulates the kidneys to retain sodium and water.. This increases blood volume and CO ..

The nurse is reviewing the laboratory test results for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider?

Serum creatinine of 2.8 mg/dL The elevated creatinine indicates renal damage caused by the hypertension. The other laboratory results are normal

The registered nurse (RN) is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside (Nipride). Which nursing action can the nurse delegate to an experienced licensed practical/vocational nurse (LPN/LVN)?

Set up the automatic blood pressure machine to take BP every 15 minutes. LPN/LVN education and scope of practice include the correct use of common equipment such as automatic blood pressure machines. The other actions require advanced nursing judgment and education, and should be done by RNs.

An older patient has been diagnosed with possible white coat hypertension. Which action will the nurse plan to take next?

Tell the patient how to self-monitor and record BPs at home. Having the patient self-monitor BPs at home will provide a reliable indication about whether the patient has hypertension. Regular BP checks in the clinic are likely to be high in a patient with white coat hypertension. Ambulatory blood pressure monitoring may be used if the data from self-monitoring are unclear. Although elevated stress levels may contribute to hypertension, instructing the patient about this is unlikely to reduce BP.

The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a hypertensive emergency. Which finding is most important to report to the health care provider?

The patient cannot move the left arm and leg when asked to do so. The patient's inability to move the left arm and leg indicates that a hemorrhagic stroke may be occurring and will require immediate action to prevent further neurologic damage. The other clinical manifestations are also likely caused by the hypertension and will require rapid nursing actions, but they do not require action as urgently as the neurologic changes.

After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented, which diet choice indicates that the teaching has been effective?

The patient has a glass of low-fat milk with each meal. For the prevention of hypertension, the Dietary Approaches to Stop Hypertension (DASH) recommendations include increasing the intake of calcium-rich foods. Caffeine restriction and decreased protein intake are not included in the recommendations. Nuts are high in beneficial nutrients and 4 to 5 servings weekly are recommended in the DASH diet.

During change-of-shift report, the nurse obtains the following information about a hypertensive patient who received the first dose of nadolol (Corgard) during the previous shift. Which information indicates that the patient needs immediate intervention?

The patient has developed wheezes throughout the lung fields. The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective -blockers) is occurring. The nurse should immediately obtain an oxygen saturation measurement, apply supplemental oxygen, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes are associated with -receptor blockade but do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated. However, this is not as urgently needed as addressing the bronchospasm.

Which action will be included in the plan of care when the nurse is caring for a patient who is receiving nicardipine (Cardene) to treat a hypertensive emergency?

Use an automated noninvasive blood pressure machine to obtain frequent blood pressure (BP) measurements. Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV antihypertensive medications. This can be most easily accomplished with an automated BP machine or arterial line. The patient will require frequent assessments, so allowing 6 to 8 hours of undisturbed sleep is not appropriate. When patients are receiving IV vasodilators, bed rest is maintained to prevent decreased cerebral perfusion and fainting. There is no indication that this patient is nauseated or at risk for aspiration, so an NPO status is unnecessary.

A patient with newly discovered high BP has an average reading of 158/98 mm Hg after 3 months of exercise and diet modifications. Which management strategy will be a priority for this patient? a. Medication will be required because the BP is still not at goal. b. BP monitoring should continue for another 3 months to confirm a diagnosis of hypertension. c. Lifestyle changes are less important, since they were not effective, and medications will be started. d. More vigorous changes in the patient's lifestyle are needed for a longer time before starting medications.

a

The nurse is providing care for a patient who has decreased cardiac output related to heart failure. What should the nurse recognize about cardiac output? a. Calculated by multiplying the patient's stroke volume by the heart rate b. The average amount of blood ejected during one complete cardiac cycle c. Determined by measuring the electrical activity of the heart and the patient's heart rate d. The patient's average resting heart rate multiplied by the patient's mean arterial blood pressure

a

hypertensive encephalopathy

a syndrome in which a sudden rise in BP is associated w severe HA, nausea, vomiting , seizures , confusion, and coma. manifestations -increased capillary permeability leading to cerebral edema and disruption of cerebral function. -on retinal exams exudates , hemorrhages and papilledema are found.

When caring for elderly patients with hypertension, which information should the nurse consider when planning care (select all that apply.)? a. Systolic blood pressure increases with aging. b. Blood pressures should be maintained near 120/80 mm Hg. c. White coat syndrome is prevalent in elderly patients. d. Volume depletion contributes to orthostatic hypotension. e. Blood pressure drops 1 hour postprandially in many older patients. f. Older patients will require higher doses of antihypertensive medications.

a, c, d, e

A patient is admitted to the hospital in hypertensive emergency (BP 244/142 mm Hg). Sodium nitroprusside is started to treat the elevated BP. Which management strategy(ies) would be most appropriate for this patient (select all that apply)? a. Measuring hourly urine output b. Decreasing the MAP by 50% within the first hour c. Continuous BP monitoring with an arterial line d. Maintaining bed rest and providing tranquilizers to lower the BP e. Assessing the patient for signs and symptoms of heart failure and changes in mental status

a, c, e

Which BP-regulating mechanism(s) can result in the development of hypertension if defective (select all that apply)? a. Release of norepinephrine b. Secretion of prostaglandins c. Stimulation of the sympathetic nervous system d. Stimulation of the parasympathetic nervous system e. Activation of the renin-angiotensin-aldosterone system

a, c, e

What are nonmodifiable risk factors for primary hypertension (select all that apply)? a. Age b. Obesity c. Gender d. Genetic link e. Ethnicity

a,c,d,e Hypertension progresses with increasing age. It is more prevalent in men up to age 45 and above the age of 64 in women. African Americans have a higher incidence of hypertension than do white Americans. Children and siblings of patients with hypertension should be screened and taught about healthy lifestyles.

A 78-year-old patient is admitted with a BP of 180/98 mm Hg. Which age-related physical changes may contribute to this patient's hypertension (select all that apply)? a. Decreased renal function b. Increased adrenergic receptor sensitivity c. Increased baroreceptor reflexes d. Increased collagen and stiffness of the myocardium e. Increased peripheral vascular resistance f. Loss of elasticity in large arteries from arteriosclerosis

a,d,e,f The age-related changes that contribute to hypertension include decreased renal function, increased peripheral vascular resistance, increased collagen and stiffness of the myocardium, and decreased elasticity in large arteries from arteriosclerosis.

The nurse teaches a patient with hypertension that uncontrolled hypertension may damage organs in the body primarily by which mechanism? a. Hypertension promotes atherosclerosis and damage to the walls of the arteries. b. Hypertension causes direct pressure on organs, resulting in necrosis and replacement of cells with scar tissue. c. Hypertension causes thickening of the capillary membranes, leading to hypoxia of organ systems. d. Hypertension increases blood viscosity, which contributes to intravascular coagulation and tissue necrosis distal to occlusions.

a.

What is the patient with primary hypertension likely to report? a. No symptoms b. Dyspnea on exertion c. Cardiac palpitations d. Dizziness and vertigo

a. Hypertension is often asymptomatic, especially if it is mild or moderate, and has been called the "silent killer."

During treatment of a patient with a BP of 222/148 mm Hg and confusion, nausea, and vomiting, the nurse initially titrates the medications to achieve which goal? a. Decrease the mean arterial pressure (MAP) to 129 mm Hg b. Lower the BP to the patient's normal within the second to third hour c. Reduce the systolic BP (SBP) to 158 mm Hg and the diastolic BP (DBP) to 111 mm Hg within the first 2 hours d. Decrease the SBP to 160 mm Hg and the DBP to between 100 and 110 mm Hg as quickly as possible

a. Initially the treatment goal in hypertensive emergencies is to reduce the mean arterial pressure (MAP) by no more than 20% to 25% in the first hour, with further gradual reduction over the next 24 hours. In this case the MAP is 172, so decreasing it by 25% equals 129. MAP = [(2 x diastolic)+systolic] / 3

A 42-year-old man has been diagnosed with primary hypertension with an average BP of 162/92 mm Hg on three consecutive clinic visits. What are four priority lifestyle modifications that should be explored in the initial treatment of the patient? a. b. c. d.

a. Dietary modifications to restrict sodium, cholesterol, and saturated fat; maintain intake of potassium, calcium, and magnesium; and promote weight reduction if overweight b. Daily moderate-intensity physical activity for at least 30 minutes on most days of the week c. Cessation of smoking (if a smoker) d. Moderation or cessation of alcohol intake; usually medications and monitor BP at home. Also, psychosocial risk factors must be addressed.

what is absorption a problem for older adults taking antihypertensive drugs?

absorption of some drugs may be altered as a result of decreased blood flow to the gut. -metabolism and excretion of drugs may also be prolonged.

what methods should you use to reduce orthostatic hypotension?

antihypertensive drugs should b started in low doses to increases slowly. -measure bp and hr sitting and supine and standing -move slowly in changing positions

baroreceptors

are located in the carotid arteries and the arch of the aorta. these cells sense the changes in BP and transmit this information to the vasomotor centers in the brainstem

Propranolol (Inderal) is prescribed for a patient diagnosed with hypertension. The nurse should consult with the health care provider before giving this medication when the patient reveals a history of

asthma. Nonselective -blockers block 1- and 2-adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma. -Blockers will have no effect on the patient's peptic ulcer disease or alcohol use. -Blocker therapy is recommended after MI.

why is taken the bp in the subclavian artery important?

atherosclerosis in the subclavian artery cause a falsely low reading on the side where the narrowing occurs.

What is most organ damage in hypertension related to? a. Increased fluid pressure exerted against organ tissue b. Atherosclerotic changes in vessels that supply the organs c. Erosion and thinning of blood vessels from constant pressure d. Increased hydrostatic pressure causing leakage of plasma into organ interstitial spaces

b

When teaching a patient about dietary management of stage 1 hypertension, which instruction is most appropriate? a. Restrict all caffeine. b. Restrict sodium intake. c. Increase protein intake. d. Use calcium supplements.

b

While obtaining subjective assessment data from a patient with hypertension, the nurse recognizes that a modifiable risk factor for the development of hypertension is a. a low-calcium diet. b. excessive alcohol intake. c. a family history of hypertension. d. consumption of a high-protein diet.

b

Which classification of drugs used to treat hypertension prevents the action of angiotensin II and promotes increased salt and water excretion? a. Thiazide diuretics b. Angiotensin II receptor blockers (ARBs) c. Direct vasodilators d. Angiotensin-converting enzyme (ACE) inhibitors

b. Angiotensin II receptor blockers (ARBs) prevent the action of angiotensin II and produce vasodilation and increased salt and water excretion.

The unit is very busy and short staffed. What could be delegated to the unlicensed assistive personnel (UAP)? a. Administer antihypertensive medications to stable patients. b. Obtain orthostatic blood pressure (BP) readings for older patients. c. Check BP readings for the patient receiving IV enalapril (Vasotec). d. Teach about home BP monitoring and use of automatic BP monitoring equipment

b. Unlicensed assistive personnel (UAP) may check postural changes in BP as directed. The licensed practical nurse (LPN) may administer antihypertensive medications to stable patients. The RN must monitor the patient receiving IV enalapril (Vasotec), as he or she is in a hypertensive crisis. The RN must also do the teaching related to home BP monitoring.

The nurse teaches a 28-yr-old man newly diagnosed with hypertension about lifestyle modifications to reduce his blood pressure. Which patient statement requires reinforcement of teaching? a. "I will avoid adding salt to my food during or after cooking." b. "If I lose weight, I might not need to continue taking medications." c. "I can lower my blood pressure by switching to smokeless tobacco." d. "Diet changes can be as effective as taking blood pressure medications.

c

How is secondary hypertension differentiated from primary hypertension? a. Has a more gradual onset than primary hypertension b. Does not cause the target organ damage that occurs with primary hypertension c. Has a specific cause, such as renal disease, that often can be treated by medicine or surgery d. Is caused by age-related changes in BP regulatory mechanisms in people over 65 years of age

c Secondary hypertension has an underlying cause that can often be treated, in contrast to primary or essential hypertension,which has no single known cause.

The nurse is teaching a women's group about prevention of hypertension. What information should be included in the teaching for all the women (select all that apply)? a. Lose weight. b. Limit nuts and seeds. c. Limit sodium and fat intake. d. Increase fruits and vegetables. e. Exercise 30 minutes most days.

c, d, e

Which manifestation is an indication that a patient is having a hypertensive emergency? a. Symptoms of a stroke with an elevated BP b. A systolic BP >200 mm Hg and a diastolic BP >120 mm Hg c. A sudden rise in BP accompanied by neurologic impairment d. A severe elevation of BP that occurs over several days or weeks

c. Hypertensive emergency, a type of hypertensive crisis, is a situation that develops over hours or days in which a patient's BP is severely elevated with evidence of acute target organ disease (e.g., cerebrovascular, cardiovascular, renal, or retinal). The neurologic manifestations are often similar to the presentation of a stroke but do not show the focal or lateralizing symptoms of stroke.

The patient who is being admitted has had a history of uncontrolled hypertension. High SVR is most likely to cause damage to which organ? a. Brain b. Retina c. Heart d. Kidney

c. The increased systemic vascular resistance (SVR) of hypertension directly increases the workload of the heart and heart failure occurs when the heart can no longer pump effectively against the increased resistance.

renal system and bp

contribute to bp regulation by controlling sodium excretion and extra cellular fluid (ECF) -Sodium retention results in water retention which causes increase of ECF volume. -this causes venous return to the heart and stroke volume. -Together they increase CO and BP

A priority consideration in the management of the older adult with hypertension is to a. prevent primary hypertension from converting to secondary hypertension. b. recognize that the older adult is less likely to adhere to the drug therapy regimen than a younger adult. c. ensure that the patient receives larger initial doses of antihypertensive drugs because of impaired absorption. d. use careful technique in assessing the BP of the patient because of the possible presence of an auscultatory gap.

d

In teaching a patient with hypertension about controlling the illness, the nurse recognizes that a. all patients with elevated BP require medication. b. obese persons must achieve a normal weight to lower BP. c. it is not necessary to limit salt in the diet if taking a diuretic. d. lifestyle modifications are indicated for all persons with elevated BP.

d

The blood pressure of a 71-year-old patient admitted with pneumonia is 160/70 mm Hg. What is an age-related change that contributes to this finding? a. Stenosis of the heart valves Incorrect b. Decreased adrenergic sensitivity c. Increased parasympathetic activity d. Loss of elasticity in arterial vessels

d

What is included in the correct technique for BP measurements? a. Always take the BP in both arms. b. Position the patient supine for all readings. c. Place the cuff loosely around the upper arm. d. Take readings at least two times at least 1 minute apart.

d. Correct technique in measuring BP includes taking two or more readings at least 1 minute apart. Initially BP measurements should be taken in both arms to detect any differences. If there is a difference, the arm with the higher reading should be used for all subsequent BP readings. The patient may be supine or sitting. The important point is that the arm being used is at the heart level and the cuff needs to fit snugly.

What does the nursing responsibility in the management of the patient with hypertensive urgency often include? a. Monitoring hourly urine output for drug effectiveness b. Titrating IV drug dosages based on BP measurements every 2 to 3 minutes c. Providing continuous electrocardiographic (ECG) monitoring to detect side effects of the drugs d. Instructing the patient to follow up with a health care professional within 24 hours after outpatient treatment

d. Hypertensive urgencies are often treated with oral drugs on an outpatient basis but it is important for the patient to be seen by a health care professional within 24 hours to evaluate the effectiveness of the treatment. Hourly urine measurements, titration of IV drugs, and ECG monitoring are indicated for hypertensive emergencies.

retinal damage

damage to the retinal vessels provides an indication of related vessel damage in the heart,brain and kidneys -blood vessels in the retina can be seen w a ophthalmoscope MANIFESTATIONS= -Blurred vision -retinal hemmorhage -Loss of vision

hypertensive urgency

develops over hours to days and does not have clinical evidence of target organ disease -it may require hospitalization to correct

A 56-year-old patient who has no previous history of hypertension or other health problems suddenly develops a blood pressure (BP) of 198/110 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that

diagnosis of a possible cause, treatment, and ongoing monitoring will be needed. A sudden increase in BP in a patient over age 50 with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem. The BP will need treatment and ongoing monitoring. If the patient has no other risk factors, a stroke in the immediate future is unlikely. There is no indication that dietary salt or fat intake have contributed to this sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this BP to an acceptable level.

Primary Hypertension

elevated bp without an identified cause and it accounts for 90% to 95% of all cases of hypertension . -tobacco -greater ideal body weight -excessive alcohol intake -diabetes

what is the DASH eating plan?

emphasizes Fruits,vegetables,fish, poultry, bean, seeds and nuts -it also lowers ur LDL

what drugs are preferred as first line drugs for HTN?

first line drugs are thiazide diuretic, a calcium channel blocker and an Ace inhibitor or ARB. -diuretic should always be the first or second drug ordered for most pts.

hypertensive emergency

have target organ disease and most often require hospitalization for prompt treatment is not obtained. -problems that may occur are encephalopathy intracranial subarachnoid hemorrhage heart failure MI renal failure Retinopathy

what is preferred sodium intake?

healthy adults should restrict sodium intake less than or equal to 2300mg/day -African Americans, Middle aged and older, hypertension pts and diabetes or chronic kidney disease should limit to 1500mg a day -Avoid canned soup or frozen dinners and DON't add salt to prepared meals at home

nephrosclerosis

hypertension is one of the leading causes of chronic kidney diseases especially African Americans -renal disease results from ischemia caused by narrowing of the renal blood vessels -LABORATORY INDICATIONS of renal disease -albuminaria -proteinuria -microscopic hematuria -elevated serum creatinine and BUN levels EARLY SIGNS -Nocturia

auscultatory gap? what is it?

in older adults some have a wide gap between the first Korotkoff sound and subsequent beats -failure to inflate the cuff high enough may result in underestimating SBP

The charge nurse observes a new registered nurse (RN) doing discharge teaching for a patient with hypertension who has a new prescription for enalapril (Vasotec). The charge nurse will need to intervene if the new RN tells the patient to

increase the dietary intake of high-potassium foods. The ACE inhibitors cause retention of potassium by the kidney, so hyperkalemia is a possible adverse effect. The other teaching by the new RN is appropriate for a patient with newly diagnosed hypertension who has just started therapy with enalapril.

hypertensive crisis

indicate either a hypertensive urgency or emergency. -systolic bp greater than 180mm -diastolic bp greater than 110mm -the diff of urgency and emergency is the absence or presence of target organ damage -very common when pt is taking crack or cocaine and amphetamines,PCP,LSD. it can cause seizure and MI and stroke and encephalopathy

what is important when taking Lebatolol???

instruct pt not to discontinue abruptly -abrupt cessation may precipitate angina or HF

Nurse Implementation HTN

is cost effective approach. Lifestyle modifications -follow the DASH DIET and reducing the sodium intake

secondary hypertension

is elevated bp w a specific cause that can often be identified and corrected. -should be suspected in people who suddenly have high bp.. ex:abdominal bruit heard over renal arteries(renal disease) -pre-pregnancy induced hypertension

SVR (systemic vascular resistance)

is the force opposing the movement of blood within the blood vessels. -the radius of the arterioles and arteries is the principal factor determining SVR -narrow= resistance of blood increases -dilate= resistance of blood decreases

auto regulation

is the physiologic process that maintains constant cerebral blood flow despite fluctuations in BP -normally as pressure in the cerebral blood vessel rises, the vessels constrict to maintain constant flow. -When bp exceeds the body ability to autoregulate the vessels dilate and cap permeability increases and cerebral edema develops. -Rise in intracranial pressure pt can die quickly from brain damage.

intermittent claudication

ischemic leg pain precipitated by activity and relieved w rest -is a classic symptom of peripheral vascular disease.

hypertensive encephalopathy

may occur after a marked rise in BP if the cerebral blood flow is not decreased by auto regulation

nursing considerations w Thiazides?

monitor orthostatic hypotension -thiazides may potentiate cardiotoxicity of digoxin by producing hypokalemia -NSAIDS can decrease diuretic and antihypertensive effect of thiazide diuretics and potentially cause RENAL impairment

Heart failure due to Hypertension

occurs when the hearts compensatory mechanisms are overwhelmed and the heart can no longer pump enough blood to meet the body's demands. -contractility is depressed and stroke volume and CO are decreased -PT will complain of SOB on exertion,paroxysmal nocturnal dyspnea and fatigue.

what does serum electrolytes indicate?

potassium is important to detect Hyperaldosteronism a cause in secondary hypertension -Blood glucose assist in the diagnosis in diabetes

ECG for hypertension?

provides a baseline information for heart status. -it can identify presence LVH, Cardiac Ischemia or previous MI. -If LVH is suspected echocardiogram is ordered.

stroke volume

the amount of blood pumped out of the left ventricle (approx 70ml)

what does creatinine indicate?

the glomerular filtration rate -decrease in creatinine clearance indicate renal insufficiency

why is NSAID teaching important when taking antihypertensive drugs?

there is the potential for adverse renal effects and/ or hyperkalemia when NSAIDs are used w ACE inhibitors ,ARBs or Aldosterone antagonists

cardiac output

total blood flow through the systemic or pulmonary circulation per minute -stroke volume X heart rate = CO