HTN (Brunner 27)
The nurse is caring for a client newly diagnosed with hypertension. Which statement by the client indicates the need for further teaching? - "I think I'm going to sign up for a yoga class twice a week to help reduce my stress." - "When getting up from bed, I will sit for a short period before standing up." - "If I take my blood pressure and it is normal, I don't have to take my blood pressure pills." - "I will consult a dietician to help get my weight under control."
"If I take my blood pressure and it is normal, I don't have to take my blood pressure pills." The client needs to understand the disease process and how lifestyle changes and medications can control hypertension. The client must take all medications as directed. A normal blood pressure indicates the medication is producing the desired effect. The other responses do not indicate the need for further teaching.
A client is taking 50 mg of oral spironolactone twice a day to assist with blood pressure control. While the nurse is performing the morning assessment, the client reports nausea, general muscle cramps, and weakness. The ECG strip shows a peaked, narrow T-wave, which is a change. What electrolyte imbalance does the nurse suspect? - Hyperkalemia - Hypernatremia - Hypokalemia - Hyponatremia
Hyperkalemia Potassium-sparing diuretics, such as spironolactone, can cause hyperkalemia, especially if given with an ACE inhibitor. Signs of hyperkalemia are nausea, diarrhea, abdominal cramps, and peaked narrow T-waves.
The nurse is discussing aging and the incidence of hypertension with an older adult. What lifestyle change will lower blood pressure for the older adult? - Exercise once a week. - Keep weight stable. - Add salt to foods for taste. - Sleep four hours each night.
Keep weight stable. Obesity can contribute to hypertension, so keeping weight stable is healthy. Salt can add to hypertension. The American Heart Association recommends exercising more than once a week for the older adult. Sleeping for four hours is not enough for rest.
Primary or essential hypertension accounts for about 95% of all hypertension diagnoses with an unknown etiology. Secondary hypertension accompanies specific conditions that create hypertension as a result of tissue damage. Which condition contributes to secondary hypertension? - acid-base imbalance - hepatic function - calcium deficit - arterial vasoconstriction
arterial vasoconstriction Secondary hypertension may accompany any primary condition that affects fluid volume or renal function, or causes arterial vasoconstriction.
Hypertension that can be attributed to an underlying cause is termed - primary hypertension. - isolated systolic hypertension. - secondary hypertension. - essential hypertension.
secondary hypertension. Secondary hypertension may be caused by a tumor of the adrenal gland (e.g., pheochromocytoma). Primary, or essential, hypertension has no known underlying cause. Isolated systolic hypertension is demonstrated by readings in which the systolic pressure exceeds 140 mm Hg and the diastolic measurement is normal or near normal (less than 90 mm Hg).
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 Four or five servings of vegetables are recommended in the DASH diet. The diet recommends two or fewer servings of lean meat, fish, and poultry; two or three servings of low-fat or fat-free dairy foods; and seven or eight servings of grains and grain products.
A client, newly admitted to the nursing unit, has a primary diagnosis of renal failure. When assessing the client, the nurse notes a blood pressure (BP) of 180/100. The nurse knows that this is what kind of hypertension? - Secondary - Malignant - Essential - Primary
Secondary Secondary hypertension is elevated BP that results from or is secondary to some other disorder. This type of hypertension is not primary, essential, or malignant.
The nurse is caring for a client with essential hypertension. The nurse reviews lab work and assesses kidney function. Which action of the kidney would the nurse evaluate as the body's attempt to regulate high blood pressure? - The kidney retains sodium and water. - The kidney retains water and excretes sodium. - The kidney excretes sodium and water. - The kidney retains sodium and excretes water.
The kidney excretes sodium and water. Hypernatremia (elevated serum sodium level) increases blood volume, which raises blood pressure. The kidney's response to the elevation in blood pressure is to excrete sodium and excess water. Any retention of sodium and water would increase blood volume and, thus, blood pressure. Sodium and water move together.
The nurse is obtaining a health history from a client with a blood pressure of 146/88 mm Hg. The client states that lifestyle changes have not been effective in lowering blood pressure. Which medication classification does the nurse anticipate first? - Beta-blocker - Thiazide diuretic - ACE inhibitors - Calcium channel blocker
Thiazide diuretic Clients with hypertension, unable to be lowered by lifestyle changes, usually are placed on a thiazide diuretic initially. However, most people with hypertension will need two or more antihypertensive medications to reduce their blood pressure.
The nurse is teaching a client about chronic untreated hypertension. What complication will the nurse explain to the client? - peripheral edema - stroke - right-sided heart failure - pulmonary insufficiency
stroke A stroke occurs if vessels in the brain rupture and bleed. If an aneurysm has developed in the aorta from chronic hypertension, it may burst and cause hemorrhage and shock. Peripheral edema, right-sided heart failure, and pulmonary insufficiency are not usually consequences of untreated chronic hypertension.
Which condition(s) indicates target organ damage from untreated/undertreated hypertension? Select all that apply. - Hyperlipidemia - Retinal damage - Stroke - Heart failure - Diabetes
Heart failure Retinal damage Stroke Target organs include the heart, kidney, brain, and eyes. Hyperlipidemia and diabetes are risk factors for development of hypertension.
A nurse 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. - Physical inactivity - Gallbladder disease - Frequent upper respiratory infections - Smoking - Diabetes mellitus
Smoking Diabetes mellitus Physical inactivity Risk factors for cardiovascular problems in clients with hypertension include smoking, dyslipidemia, diabetes mellitus, impaired renal function, obesity, physical inactivity, age, and family history.
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? - Normal - Prehypertensive - Hypertensive - Slightly hypertensive
Prehypertensive JNC7 defines a blood pressure of less than 120/80 mm Hg diastolic as normal, 120 to 129/80 to 89 mm Hg as prehypertension, and 140/90 mm Hg or higher as 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. - Older adults are less vulnerable to the pathophysiological effects of hypertension than are younger adults. - Blood pressure remains stable throughout adulthood but tends to be assessed more often by health care providers of older adults.
The incidence and prevalence of hypertension increase with age. The prevalence of hypertension increases with aging. Aging causes structural and functional changes in the heart and blood vessels, including atherosclerosis and decreased elasticity of the major blood vessels. The diagnostic criteria between older and younger adults do not differ. Older adults are not more immune to the damaging effects of high blood pressure.
The nurse is creating a community teaching demonstration focusing on the cause of blood pressure. When completing the visual aid, which body structures represent the mechanism of blood pressure? - Heart and blood vessels - Lung and arteries - Kidneys and autonomic nervous system - Brain and sympathetic nervous system
Heart and blood vessels Blood pressure is the force produced by the volume of the blood in arterial walls. It is represented by the formula: BP = CO (cardiac output) * PR (peripheral resistance). To highlight the mechanism of cardiac output, a heart would be on the visual aid and blood vessels.
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? - Calcium level - Magnesium level - Potassium level - Sodium level
Potassium level Amiloride (Midamor) is a potassium-sparing diuretic, meaning that it causes potassium retention. The nurse should monitor for hyperkalemia (elevated potassium level) if given with an ACE inhibitor, such as lisinopril (Zestril) or angiotensin receptor blocker.
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? - 125/85 or lower - 150/95 or lower - 130/80 or lower - 145/95 or lower
130/80 or lower The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) specifies a lower goal pressure of 130/80 for people with diabetes mellitus.
Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage? - Primary hypertension - Hypertensive emergency - Hypertensive urgency - Secondary hypertension
Hypertensive emergency A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage. Hypertensive urgency is a situation in which blood pressure is severely elevated but there is no evidence of actual or probable target organ damage. Secondary hypertension is high blood pressure from an identified cause, such as renal disease. Primary hypertension denotes high blood pressure from an unidentified source.
A nurse is assessing a client and notes a blood pressure (BP) of 205/115. The client has had BP's within normal limits up until this time. The client reports a sudden onset severe headache. The nurse recognizes this as probable malignant hypertension. What would be the nurse's first action? - Administer the ordered antihypertensive. - Notify the health care provider. - Call a code. - Wait 15 minutes and reassess the vital signs.
Notify the health care provider. Malignant hypertension is fatal unless BP is quickly reduced. Even with intensive treatment, the kidneys, brain, and heart may be permanently damaged.
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 - Postural hypotension and resulting injury - Rebound hypertension - Sexual dysfunction
Postural hypotension and resulting injury Antihypertensive medication can cause hypotension, especially postural hypotension that may result in injury. Rebound hypertension occurs when antihypertensive medication is stopped abruptly. Sexual dysfunction may occur, especially with beta blockers, but other medications are available should this problem ensue. This is not immediately a priority concern. Antihypertensive medications do not usually cause postural hypertension.
A nurse is teaching a client with severe hypertension about the damage this condition can cause to the body. What system/organs will the nurse note are particularly targeted for damage due to severe hypertension? - Sensory - Musculoskeletal - Integumentary - Gastrointestinal
Sensory Prolonged elevated blood pressure eventually damages blood vessels throughout the body, particularly in target organs such as the heart, kidneys, brain, and eyes. The usual consequences of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, renal failure, strokes, and impaired vision.
The nurse is conducting a service project for a local elderly community group on the topic of hypertension. The nurse will relay that which risk factors and cardiovascular problems are related to hypertension? Select all that apply - Age ≥65 in women - Overweight/obesity - Smoking - Elevated high-density lipoprotein (HDL) cholesterol - Decreased low-density lipoprotein (LDL) levels
Smoking Overweight/obesity Age ≥65 in women Major risk factors (in addition to hypertension) include smoking, dyslipidemia (high LDL, low high-density lipoprotein cholesterol), diabetes mellitus, impaired renal function, obesity, physical inactivity, age (younger than 45 years for men, 65 years and older for women), and family history of cardiovascular disease.
During the physical assessment of a client with hypertension, what would the nurse expect to be the most obvious finding? - Hypotension in either one or both systolic or diastolic measurements. - Client is underweight. - Client is anemic. - Sustained increase of either one or both systolic or diastolic measurements.
Sustained increase of either one or both systolic or diastolic measurements. The most obvious finding during a physical assessment is a sustained elevation of one or both blood pressure measurements. A client being overweight might depict having hypertension. An anemic client does not display any traits of having hypertension.
A client who is newly diagnosed with hypertension is going to be starting antihypertensive medicine. What is one of the main things the client and the client's spouse should watch for? - blurred vision - persistent cough - dizziness - tremor
dizziness A common adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. The client and the client's spouse should be alerted to this possibility and provided with some tips for managing dizziness.
A 66-year-old client presents to the emergency department reporting severe headache and mild nausea for the past 6 hours. Upon assessment, the client's BP is 210/120 mm Hg. The client has a history of hypertension and takes 1.0 mg clonidine twice daily. Which question is most important for the nurse to ask the client next? - "Did you take any medication for your headache?" - "Do you have a dry mouth or nasal congestion?" - "Are you having chest pain or shortness of breath?" - "Have you taken your prescribed clonidine today?"
"Have you taken your prescribed clonidine today?" The nurse must ask whether the client has taken his prescribed clonidine. Clients need to be informed that rebound hypertension can occur if antihypertensive medications are suddenly stopped. Specifically, a side effect of clonidine is rebound or withdrawal hypertension. Although the other questions may be asked, it is most important to inquire whether the client has taken the prescribed hypertension medication given the client's severely elevated BP.
A client is placed on a low-sodium (500 mg/day) diet. Which client statement indicates that the nurse's nutrition teaching plan has been effective? - "I chose a tossed salad with sardines and oil and vinegar dressing for lunch." - "I can still eat a ham-and-cheese sandwich with potato chips for lunch." - "I'm glad I can still have chicken bouillon." - "I chose broiled chicken with a baked potato for dinner."
"I chose broiled chicken with a baked potato for dinner." The client's choice of a baked potato with broiled chicken indicates effective nutrition teaching because potatoes and chicken are relatively low in sodium. Ham, sardines, and bouillon are extremely high in sodium and shouldn't be included in a low-sodium diet.
Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension? - "Limiting my salt intake to 2 grams per day will improve my blood pressure." - "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." To lower blood pressure, a client should limit daily salt intake to 2 g or less. Alcohol intake is associated with a higher incidence of hypertension, poor compliance with treatment, and refractory hypertension. Moderate caffeine and fat intake don't significantly affect blood pressure
A patient is being treated for hypertensive emergency. When treating this patient, the priority goal is to lower the mean blood pressure (BP) by up to which percentage in the first hour? - 40% - 35% - 45% - 25%
25% The therapeutic goals are reduction of the mean BP by up to 25% within the first hour of treatment, a further reduction to a goal pressure of about 160/100 mm Hg over a period of 2 to 6 hours, and then a more gradual reduction in pressure to the target goal over a period of days.
The nurse is explaining the DASH diet to a client diagnosed with hypertension. The client inquires about how many servings of fruit per day can be consumed on the diet. What is the nurse's best response? - 4 or 5 servings per day - 7 or 8 servings per day - 2 or fewer servings per day - 2 or 3 servings per day
4 or 5 servings per day The client can consume 4 or 5 servings of fruit per day on the DASH diet. The servings for grains and grain product is 7 or 8. Two or 3 servings of low-fat or fat-free dairy foods can be consumed per day. Meat, fish, and poultry servings are 2 or fewer per day.
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 systolic pressure reading - A high diastolic or low systolic reading - A low diastolic reading - A normal reading
A high diastolic or low systolic reading An auscultatory gap is when the Korotkoff sounds disappear for a brief period as the cuff is being deflated. Failure to notice an auscultatory gap can result in erroneously high diastolic or low systolic pressure readings (Ogedegbe & Pickering, 2010).
The nurse is evaluating the types of medications prescribed for a client's hypertension. Which of the following medication classifications establishes an action on vasoconstrictive hormones in the blood stream? Beta-blocker ACE inhibitor Calcium channel blocker Loop diuretic
ACE inhibitor The angiotensin-converting enzyme (ACE) inhibitor's primary action is to prevent the conversion of angiotensin I to angiotensin II, a potent vasoconstricting hormone in the blood. A beta-blocker blocks the beta-adrenergic receptors decreasing sympathetic nervous system stimulation. Loop diuretics excrete water from the loop of Henle, reducing circulating blood volume. Calcium channel blockers dilate coronary and peripheral arteries.
The nurse is caring for a client with hypertension. The nurse is correct to realize that a 24-hour urine is ordered to determine if the cause of hypertension is related to the dysfunction of what? - Thymus - Thyroid gland - Adrenal gland - Pituitary gland
Adrenal gland The 24-hour urine collection specimen is ordered to determine dysfunction of the adrenal gland. The 24-hour urine detects elevated catecholamines. The other options are not evaluated by a 24-hour urine.
A 56-year-old man visits his primary care provider infrequently but has now presented with complaints of transient visual disturbances. Assessment of the patient has yielded few remarkable findings with the exception of blood pressure (BP) of 169/106 mm Hg. When do signs and symptoms of hypertension typically appear? - During the prehypertension stage of the disease - After target organ damage has occurred - Once the patient's average BP crosses the threshold of 140/90 mm Hg - After hypertension becomes an irreversible condition
After target organ damage has occurred Hypertension may be asymptomatic and remain so for many years; however, when signs and symptoms appear, vascular damage related to the organs served by the involved vessels has occurred. This fact underlies the need for screening and early intervention.
An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed the client hydrochlorothiazide and enalapril. What will the nurse be sure to include in educating this client? - Change positions (lying or sitting to standing) slowly. - Eat plenty of salty food to prevent hypotension. - Do not become dependent on canes, walkers, or handrails. - Check blood pressure every day for signs of rebound hypertension.
Change positions (lying or sitting to standing) slowly. Antihypertensive medications can cause hypotension, especially postural hypotension that may result in injury. The nurse teaches clients to change positions slowly when moving from a lying or sitting position to a standing position. Rebound hypertension occurs when antihypertensive medications are stopped abruptly. The nurse also counsels elderly clients to use supportive devices such as handrails and walkers to prevent falls that could result from dizziness. Eating salty foods could defeat the purpose of taking the antihypertensive medications.
A nurse is providing education about hypertension to a community group. What are possible consequences of untreated hypertension? Select all that apply. - Coronary artery disease - Myocardial infarction - Stroke - Tension pneumothorax - Pancreatitis
Coronary artery disease Myocardial infarction Stroke People with hypertension may remain asymptomatic for many years. When specific signs and symptoms appear, however, they usually indicate vascular damage. Coronary artery disease with angina and myocardial infarction are common consequences of hypertension. Cerebrovascular involvement may lead to a stroke. Tension pneumothorax and pancreatitis are not directly related to hypertension.
A diabetic client visits a walk-in clinic and asks the nurse to take a blood pressure (BP) reading. The measurements are 150/90 mm Hg. Which of the following would the nurse expect as the treatment to normalize the client's BP? - Daily exercise - Low-fat diet - Smoking cessation programs - Drug therapy
Drug therapy The nurse would expect drug therapy to be recommended for the client. Smoking cessation, a low-fat diet, and daily exercise may be useful in the prehypertension stage. A client with diabetes should have BP levels below 139/80 mm Hg to avoid drug therapy.
A patient with long-standing hypertension is admitted to the hospital with hypertensive urgency. The physician 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 - Tilt-table test - Stress test
Echocardiography Left ventricular hypertrophy can be assessed by echocardiography, but not by any of the other measures listed.
A client 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 (HCTZ) and atenolol. What treatment plan will the nurse educate the client about? - Continuing the medication and reducing dietary sodium - Gradual reducing the HCTZ and the atenolol and continuing to reduce sodium intake - Discontinuing the HCTZ and atenolol and continuing to reduce sodium intake - Gradually reducing the atenolol and continuing the HCTZ
Gradual reducing the HCTZ and the atenolol and continuing to reduce sodium intake When the blood pressure is less than 140/90 mm Hg for at least 1 year, gradual reduction of the types and doses of medication is indicated. Continuing to reduce sodium intake is a healthy lifestyle measure than anyone with hypertension should make.
The staff educator is talking to a group of new emergency department nurses about hypertensive crises. The nurse educator is aware that hypertensive urgency differs from hypertensive emergency in what way? - Hypertensive urgency is treated with rest and tranquilizers to lower BP. - Hypertensive emergencies are associated with evidence of target organ damage. - The patient's blood pressure (BP) is always higher in a hypertensive emergency. - Close hemodynamic monitoring is required during treatment of hypertensive emergencies.
Hypertensive emergencies are associated with evidence of target organ damage. Hypertensive emergencies are acute, life-threatening blood pressure 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 emergency; however, there is no evidence of target organ damage in hypertensive urgency. Extremely close hemodynamic monitoring of the patient's blood pressure is required in both. The medications of choice in hypertensive emergencies are those with an immediate effect, such as IV vasodilators. 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.
A client is being seen at the clinic on a monthly basis for assessment of blood pressure. The client has been checking blood pressure at home as well and has reported a systolic pressure of 158 and a diastolic pressure of 64. What does the nurse suspect this client is experiencing? - Isolated systolic hypertension - Primary hypertension - Secondary hypertension - Hypertensive urgency
Isolated systolic hypertension As a result of changes that occur with aging, the aorta and large arteries are less able to accommodate the volume of blood pumped out by the heart (stroke volume), and the energy that would have stretched the vessels instead elevates the systolic blood pressure, resulting in an elevated systolic pressure without a change in diastolic pressure. This condition, known as isolated systolic hypertension, is more common in older adults and is associated with significant cardiovascular and cerebrovascular morbidity and mortality (Chobanian et al., 2003).
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? - 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 - 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
Lowering and controlling the blood pressure without adverse effects and without undue cost The objective of nursing care for patients with hypertension focuses on lowering and controlling the blood pressure without adverse effects and without undue cost.
The nurse teaches the client which guidelines regarding lifestyle modifications for hypertension? - Limit aerobic physical activity to 15 minutes, three times per week - Stop alcohol intake - Reduce smoking to no more than four cigarettes per day - Maintain adequate dietary intake of fruits and vegetables
Maintain adequate dietary intake of fruits and vegetables Guidelines include adopting the Dietary Approaches to Stop Hypertension (DASH) eating plan: consume a diet rich in fruits, vegetables, and low-fat dairy products and reduced amounts of saturated and total fat; reduce dietary sodium intake to no more than 100 mmol/day (2.4 g sodium or 6 g sodium chloride); engage in regular aerobic physical activity such as brisk walking (at least 30 min/day, most days of the week); moderate alcohol consumption, limiting consumption to no more than two drinks (e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and to no more than one drink per day in women and lighter-weight people. Tobacco should be avoided because anyone with high blood pressure is already at increased risk for heart disease, and smoking amplifies this risk.
A 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? - Discussing methods for stress reduction - Advising smoking cessation - Administering glycemic control - Purchasing a self-monitoring BP cuff
Purchasing a self-monitoring BP cuff Because this client finds visiting the doctor time-consuming just for a BP reading, as the nurse, you can suggest the use of an automatic cuff at a local pharmacy, or purchasing a self-monitoring cuff. Discussing methods to reduce stress, advising smoking cessation, and achieving glycemic control would constitute client education in managing hypertension.
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 50% within the first hour of treatment. - Reduce the blood pressure to about 140/80 mm Hg. - Reduce the blood pressure by 20% to 25% within the first hour of treatment. - Rapidly reduce the blood pressure so the client will not suffer a stroke.
Reduce the blood pressure by 20% to 25% within the first hour of treatment. A hypertensive emergency is a situation in which blood pressures are extremely elevated and must be lowered immediately (not necessarily to less than 140/90 mm Hg) to halt or prevent damage to the target organs (Chobanian et al., 2003; Rodriguez et al., 2010). Hypertensive emergencies are acute, life-threatening blood pressure elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. The therapeutic goals are reduction of the mean blood pressure by 20% to 25% within the first hour of treatment, a further reduction to a goal pressure of about 160/100 mm Hg over a period of up to 6 hours, and then a more gradual reduction in pressure over a period of days.
Which finding indicates that hypertension is progressing to target organ damage? - Urine output of 60 mL over 2 hours - Chest x-ray showing pneumonia - Retinal blood vessel damage - Blood urea nitrogen concentration of 12 mg/dL
Retinal blood vessel damage Explanation: Symptoms suggesting that hypertension is progressing to the extent that target organ damage is occurring must be detected early so that appropriate treatment can be initiated. All body systems must be assessed to detect any evidence of vascular damage. An eye examination with an ophthalmoscope is important because retinal blood vessel damage indicates similar damage elsewhere in the vascular system. The client is questioned about blurred vision, spots in front of the eyes, and diminished visual acuity. The heart, nervous system, and kidneys are also carefully assessed. A BUN concentration of 12 mg/dL and urine output of 60 mL over 2 hours are normal findings. The presence of pneumonia does not indicate target organ damage.
The nurse is caring for a client prescribed bumetanide for the treatment of stage 2 hypertension. Which finding indicates the client is experiencing an adverse effect of the medication? - Serum potassium value of 3.0 mEq/L - Urine output of 90 mL 1 hour after medication administration - Electrocardiogram (EGG) tracing demonstrating peaked T waves - Blood glucose value of 160 mg/dL
Serum potassium value of 3.0 mEq/L Bumetanide is a loop diuretic that can cause fluid and electrolyte imbalances. Clients taking these medications may experience a low serum potassium concentration. ECG changes associated with an elevated serum potassium concentration include peaked T waves. Diuresis is a desired effect postadministration of bumetanide. The serum glucose concentration is elevated and requires intervention; however, this elevation is not associated with the administration of bumetanide.
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 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
To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less The end goal of hypertension treatment is to prevent complications and death by achieving and maintaining arterial blood pressure at 140/90 or lower for most people. To achieve this end goal, the client is taught to make the following lifestyle changes (these are not end goals; they are ways to reach the end goal listed above): (1) maintaining a normal body mass index (about 24; greater than 25 is considered overweight); maintaining a waist circumference of less than 40 inches for men and 35 inches for women; limiting alcohol intake to no more than 2 drinks for men and 1 drink for women per day; engaging in aerobic activity at least 30 minutes per day most days of the week.
