N355 Ch 31: Assessment and Management of Patients With Hypertension
It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine -decreases circulating blood volume. -decreases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. -increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. -increases the heart rate, constricts arterioles, and increases the heart's ability to eject blood.
Correct response: increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. Explanation: The nurse recommends smoking cessation for clients with hypertension because nicotine raises the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. Reduced oral fluids decrease the circulating blood volume.
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." -"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." -"When getting up from bed, I will sit for a short period before standing up."
Correct response: "If I take my blood pressure and it is normal, I don't have to take my blood pressure pills." Explanation: 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. p. 895
A 77-year-old client presents to the local community center for a blood pressure (BP) screening; BP is recorded as 180/90 mm Hg. The client has a history of hypertension but currently is not taking the prescribed medications. Which question is most appropriate for the nurse to ask the client first? -"Are you having trouble paying for your medications?" -"Are you able to get to your pharmacy to pick up your medications?" -"Can you tell me the reasons you aren't taking your medications?" -"What medications are you prescribed?"
Correct response: "Can you tell me the reasons you aren't taking your medications?" Explanation: It is important for the nurse to first ascertain why the client is not taking prescribed medications. Adherence to the therapeutic program may be more difficult for older adults. The medication regimen can be difficult to remember, and the expense can be a challenge. Monotherapy (treatment with a single agent), if appropriate, may simplify the medication regimen and make it less expensive. The other questions are appropriate, but the priority is to determine why the medication regimen is not being followed. p. 896
A nurse is caring for a client who has hypertension and diabetes mellitus. The client's blood pressure this morning was 150/92 mm Hg. When the client asks the nurse what his or her blood pressure should be, what is the nurse's most appropriate response? -"Your blood pressure is fine. Just keep doing what you're doing." -"The current recommendation is for everyone to have blood pressure of 140/90 mm Hg or lower." -"The lower the better. Blood pressure of 130/80 mm Hg is best for everyone." -"Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg."
Correct response: "Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg." Explanation: An individual with diabetes mellitus should strive for blood pressure of 120/80 mm Hg or less. An individual without diabetes should strive for blood pressure of 140/90 mm Hg or less. P. 887
The nurse is volunteering at a community blood pressure screening. A client, never diagnosed with hypertension, presents with a blood pressure of 158/90 mm Hg. Which assessment questions, asked by the nurse, are appropriate? Select all that apply. -"Have you recently drunk a caffeinated beverage?" -"Did you have a beer after work?" "Do you have a friend accompanying you?" -"Are you married and with children?" -"Do you smoke?"
Correct response: "Have you recently drunk a caffeinated beverage?" "Do you smoke?" Explanation: At a community blood pressure clinic, the nurse would assess for common factors for a blood pressure to be elevated. Factors that can affect blood pressures readings include smoking or drinking coffee within 30 minutes of the reading. One beer after work should not affect the blood pressure reading, and some individuals may find it relaxing. Social situations are difficult to assess in a community blood pressure clinic. The client would be referred to having another blood pressure reading and, if elevated, referred to a physician. p. 894
A nurse is teaching a client with newly diagnosed hypertension who asks if there is any harm in stopping antihypertensive medication. What is the nurse's best response? -"Rebound hypotension can occur." -"Postural hypotension can occur." -"Rebound hypertension can occur." -"Postural hypertension can occur."
Correct response: "Rebound hypertension can occur." Explanation: Clients need to be informed that rebound hypertension can occur if they stop antihypertensive medications suddenly. This can be extremely dangerous and have serious consequences. Hypotension would not be a problem with discontinuation of antihypertensive medications. p.896
A nurse is educating a client about monitoring blood pressure readings at home. What will the nurse be sure to emphasize? -"Sit with legs crossed when taking your blood pressure." -"Sit quietly for 5 minutes prior to taking blood pressure." -"Be sure the forearm is well supported above heart level while taking blood pressure." -"Avoid smoking cigarettes for 8 hours prior to taking blood pressure."
Correct response: "Sit quietly for 5 minutes prior to taking blood pressure." Explanation: Instructions for the client regarding measuring the blood pressure at home include the following: (1) Avoid smoking cigarettes or drinking caffeine for 30 minutes before measuring blood pressure. (2) Sit quietly for 5 minutes before the measurement. (3) Have the forearm supported at heart level, with both feet on the ground during the measurement of the blood pressure. P. 894
What risk factors would cause the nurse to become concerned that the client may have atherosclerotic heart disease? Select all that apply. -lowered triglyceride levels -obesity -diabetes -hypertension -family history of early cardiovascular -events -active lifestyle
Correct response: -hypertension -diabetes -obesity -family history of early -cardiovascular events Explanation: Risk factors for atherosclerotic heart disease include hypertension, dyslipidemia (including high total, low-density lipoprotein [LDL], and triglyceride levels as well as low high-density lipoprotein [HDL] levels), obesity, diabetes, a family history of early cardiovascular events, metabolic syndrome, a sedentary lifestyle, and obstructive sleep apnea. p.885
A nurse is discussing with a nursing student how to accurately measure blood pressure. What statement by the student indicates an understanding of the education? -The size of the cuff does not matter as long as it fits snugly around the arm. -A cuff that is too large will give a false high blood pressure. -A cuff that is too small will give a false high blood pressure. -A cuff that is too small will give a false low blood pressure.
Correct response: A cuff that is too small will give a false high blood pressure. Explanation: Using a cuff that is too small will give a false high blood pressure measurement, while using a cuff that is too large results in a false low blood pressure measurement. p. 894
An older adult client visits the clinic for a blood pressure check. The client's hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about blood pressure medicine? -A possible adverse effect of blood pressure medicine is dizziness when you stand. -There are no adverse effects from blood pressure medicine. -Take the medicine on an empty stomach. -A severe drop in blood pressure is possible.
Correct response: A possible adverse effect of blood pressure medicine is dizziness when you stand. Explanation: A possible adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. Teaching should include tips for managing syncope and dizziness. The nurse would not teach the client to take the medicine on an empty stomach. p. 896
A client is being seen at the clinic for a routine physical when the nurse notes the client's blood pressure is 150/97. The client is considered to be a healthy, well-nourished young adult. What type of hypertension does this client have? -Essential (primary) -Pathologic -Secondary -Malignant
Correct response: Essential (primary) Explanation: Essential or primary hypertension, about 95% of cases, is sustained elevated BP with no known cause. This client does not have secondary, pathologic, or malignant hypertension. p. 885
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? -Brain and sympathetic nervous system -Kidneys and autonomic nervous system -Heart and blood vessels -Lung and arteries
Correct response: Heart and blood vessels Explanation: Blood pressure is the force produced by the volume of the blood in arterial walls. It is represented by the formula: BP= CO (cardiac output)× PR (peripheral resistance). To highlight the mechanism of cardiac output, a heart would be on the visual aid and blood vessels. p. 885
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 -Making sure that the patient adheres to the therapeutic medication regimen -Lowering and controlling the blood pressure without adverse effects and without undue cost -Instructing the patient to enter a weight loss program and begin an exercise regimen
Correct response: Lowering and controlling the blood pressure without adverse effects and without undue cost Explanation: The objective of nursing care for patients with hypertension focuses on lowering and controlling the blood pressure without adverse effects and without undue cost. p. 895
Which finding indicates that hypertension is progressing to target organ damage? -Chest x-ray showing pneumonia -Blood urea nitrogen concentration of 12 mg/dL -Urine output of 60 mL over 2 hours -Retinal blood vessel damage
Correct response: 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. p. 897
The nurse is instructing a client who is newly prescribed an antihypertensive medication. Which nursing instruction is emphasized to maintain client safety? -Do not operate a motor vehicle. -Take the medication at the same time daily. -Sit on the edge of the chair and rise slowly. -Use a pillbox to store daily medication.
Correct response: Sit on the edge of the chair and rise slowly. Explanation: The nursing instruction emphasized to maintain client safety is to sit on the edge of the chair before rising slowly. By doing so, the client reduces the possibility of falls related to postural hypotension. Using a pillbox to store medications and taking the medication at the same time daily is good medication management instruction. There is no reason when taking antihypertensive medications to restrict driving. p. 896
The nurse is caring for an older adult client who has come to the clinic for a yearly physical. When assessing the client, the nurse notes the blood pressure (BP) is 140/93. The nurse knows that in older clients what happens that may elevate the systolic BP? -Increase in calcium intake -Loss of arterial elasticity -Decrease in cardiac output -Decrease in blood volume
Correct response: Sit on the edge of the chair and rise slowly. Explanation: The nursing instruction emphasized to maintain client safety is to sit on the edge of the chair before rising slowly. By doing so, the client reduces the possibility of falls related to postural hypotension. Using a pillbox to store medications and taking the medication at the same time daily is good medication management instruction. There is no reason when taking antihypertensive medications to restrict driving. p.896
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. -Diabetes mellitus -Frequent upper respiratory infections -Gallbladder disease -Physical inactivity -Smoking
Correct response: Smoking Diabetes mellitus Physical inactivity Explanation: Risk factors for cardiovascular problems in clients with hypertension include smoking, dyslipidemia, diabetes mellitus, impaired renal function, obesity, physical inactivity, age, and family history. p.887
The nurse assesses a healthy middle-aged client with a blood pressure of 158/90 mm Hg. In which classification of hypertension is the client according to the latest guidelines? -Normal blood pressure -Elevated blood pressure -Stage 1 hypertension -Stage 2 hypertension
Correct response: Stage 2 hypertension Explanation: The latest guidelines (November 2017) released by the American College of Cardiology and the American Heart Association are: Normal blood pressure: Systolic less than 120 mm Hg and diastolic less than 80 mm Hg. Elevated blood pressure: Systolic between 120 and 129 mm Hg and diastolic less than 80 mm Hg. Stage 1 hypertension: Systolic between 130 and 139 mm Hg or diastolic between 80 and 89 mm Hg. Stage 2 hypertension: Systolic of 140 or greater mm Hg or diastolic of 90 or greater mm Hg.
Which statements are true when the nurse is measuring blood pressure (BP)? Select all that apply. -Using a BP cuff that is too large will give a higher BP measurement. -The client's BP should be measured 1 hour before consuming alcohol. -The client's arm should be positioned at the level of the heart. -The client should sit quietly while BP is being measured. -Using a BP cuff that is too small will give a higher BP measurement.
Correct response: Using a BP cuff that is too small will give a higher BP measurement. The client's arm should be positioned at the level of the heart. The client should sit quietly while BP is being measured. Explanation: These statements are all true when measuring a BP. When using a BP cuff that is too large, the reading will be lower than the actual BP. The client should avoid smoking cigarettes or drinking caffeine for 30 minutes before BP is measured.
When measuring blood pressure in each arm of a healthy adult, the nurse recognizes that the pressures -differ no more than 5 mm Hg between arms. -may vary 10 mm Hg or more between arms. -must be equal in both arms. -may vary, with the higher pressure found in the left arm.
Correct response: differ no more than 5 mm Hg between arms. Explanation: Normally, in the absence of disease of the vasculature, arm pressures differ by no more than 5 mm Hg. The pressures in each arm do not have to be equal to be considered normal. Pressures that vary more than 10 mm Hg between arms are an abnormal finding. The left arm pressure is not anticipated to be higher than the right as a normal anatomical variant. p.894
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? -tremor -persistent cough -dizziness -blurred vision
Correct response: dizziness Explanation: A common adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. The client and the client's spouse should be alerted to this possibility and provided with some tips for managing dizziness. p. 897
A client who was recently diagnosed with prehypertension is to meet with a dietitian and return for a follow-up with the cardiologist in 6 months. What would this client's treatment likely include? -nonpharmacological interventions -procedural interventions -observation only -pharmacological interventions
Correct response: nonpharmacological interventions Explanation: Nonpharmacologic interventions are used for clients with prehypertension. p. 889
Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through: -laboratory tests. -using a sphygmomanometer. -ophthalmic examination. -an MRI.
Correct response: ophthalmic examination. Explanation: Papilledema is an edema of the optic nerves, and thus needs an ophthalmic examination for detection. p. 887
According to the classification of hypertension diagnosed in older adults, hypertension that can be attributed to an underlying cause is termed: -isolated systolic. -essential. -secondary. -primary.
Correct response: secondary. Explanation: 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). p. 885
The nurse is teaching a client about chronic untreated hypertension. What complication will the nurse explain to the client? -stroke peripheral edema pulmonary insufficiency right-sided heart failure
Correct response: stroke Explanation: A stroke occurs if vessels in the brain rupture and bleed. If an aneurysm has developed in the aorta from chronic hypertension, it may burst and cause hemorrhage and shock. Peripheral edema, right-sided heart failure, and pulmonary insufficiency are not usually consequences of untreated chronic hypertension. p. 887