NU142- Chapter 31: Assessment and Management of Patients With Hypertension
A client diagnosed with hypertension begins drug therapy using an antihypertensive agent. The nurse instructs the client's spouse to remove any objects in the home that can lead to falls. Which client statement confirms that the teaching has been successful?
"Antihypertensive drugs can lead to falls."
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 broiled chicken with a baked potato for dinner."
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 nurse is educating a client about monitoring blood pressure readings at home. What will the nurse be sure to emphasize?
"Sit quietly for 5 minutes prior to taking 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?
25%
According to the DASH diet, how many servings of vegetables should a person consume each day?
4 or 5
A nurse is discussing with a nursing student how to accurately measure blood pressure. What statement by the student indicates an understanding of the education?
A cuff that is too small will give a false high blood pressure.
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.
The nurse is administering metoprolol to a client. What type of medication should the nurse educate the client about?
Beta blocker
The nurse is caring for an elderly client with a diagnosis of hypertension, who is taking several antihypertensive medications. Which safety precaution is the nurse most likely to reinforce?
Changing positions slowly related to possible hypotension
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
Which diagnostic method is recommended to determine whether left ventricular hypertrophy has occurred?
Echocardiography
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)
The nurse is teaching a client who is experiencing dizziness to rise slowly from a sitting or lying position. What is the rationale for the teaching?
Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain.
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
A nurse is educating about lifestyle modifications for a group of clients with newly diagnosed hypertension. While discussing dietary changes, which point would the nurse emphasize?
It takes 2 to 3 months for the taste buds to adapt to decreased salt intake.
The nurse teaches the client which guideline regarding lifestyle modification for hypertension?
Maintain adequate dietary intake of potassium
A client is admitted to the intensive care unit (ICU) with a diagnosis of hypertension emergency/crisis. The client's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV nitroprusside. Upon assessment, which finding requires immediate intervention by the nurse?
Numbness and weakness in the left arm
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 hypotension and resulting injury
Which adrenergic inhibitor acts directly on the blood vessels, producing vasodilation?
Prazosin
When measuring the blood pressure in each arm of a healthy adult client, the nurse recognizes that which statement is true?
Pressures should not differ more than 5 mm Hg between arms.
Which term is refers to hypertension in which blood pressure that is controlled with therapy becomes uncontrolled (abnormally high) when the therapy is discontinued?
Rebound
The nurse is caring for a client newly diagnosed with secondary hypertension. Which condition contributes to the development of secondary hypertension?
Renal disease
Which finding indicates that hypertension is progressing to target organ damage?
Retinal blood vessel damage
Which term describes high blood pressure from an identified cause, such as renal disease?
Secondary hypertension
A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. What are risk factors for cardiovascular problems in clients with hypertension? Select all that apply.
Smoking Diabetes mellitus Physical inactivity
The nurse is caring for a client who is prescribed medication for the treatment of hypertension. The nurse recognizes that which medication conserves potassium?
Spironolactone
Which diuretic medication conserves potassium?
Spironolactone
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 excretes sodium and water.
The nurse observes a certified nursing assistant (CNA) obtaining a blood pressure reading with a cuff that is too small for the patient. The nurse informs the CNA that using a cuff that is too small can affect the reading results in what way?
The results will be falsely elevated.
dyslipdemia
abnormal blood lipid levels, including high total, low-density lipoprotein, and triglyceride levels as well as low high-density lipoprotein levels
The nurse is administering medications on a medical-surgical unit. A client is ordered to receive 40 mg oral nadolol for the treatment of hypertension. Before administering the medication, the nurse should
check the client's heart rate.
Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress
decreases the production of neurotransmitters that constrict peripheral arterioles.
primary hypertension
denotes high blood pressure from an unidentified cause also called essential hypertension
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.
A client who is newly diagnosed with hypertension is going to be starting antihypertensive medicine. What is one of the main things the client and the client's spouse should watch for?
dizziness
The nurse is teaching a client about hypertension and the effects on the left ventricle. What diagnostic test will the nurse describe?
echocardiography
secondary hypertension
high blood pressure from an identified cause, such as kidney disease
A blood pressure (BP) of 140/90 mm Hg is considered to be
hypertension.
The nurse understands that client education related to antihypertensive medication should include which of the following?
inform client to avoid over-the-counter cold and sinus medications
monotherapy
medication therapy with a single agent
According to the classification of hypertension diagnosed in older adults, hypertension that can be attributed to an underlying cause is termed
secondary.
The nurse is teaching a client about chronic untreated hypertension. What complication will the nurse explain to the client?
stroke
The nurse is seeing a client for the first time and has just checked the client's blood pressure. The nurse would consider the client prehypertensive if:
systolic BP is between 120 and 139 mm Hg.
The nurse understands that an overall goal of hypertension management is that
there is no indication of target organ damage.
When teaching a client about hypertension and lifestyle changes what does the nurse emphasizes should be included in the diet?
Fresh fruits and vegetables
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 which of the following?
The adrenal gland
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?" "Do you smoke?"
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?
"Why are you not taking your medications?"
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?
Drug therapy
Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage?
Hypertensive emergency
A client experiences orthostatic hypotension while receiving furosemide to treat hypertension. How will the nurse intervene?
Instruct the client to sit for several minutes before standing.
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
A client is admitted to the emergency room with a blood pressure reading of 200/130 mm Hg. What are this client's therapeutic goals? Select all that apply.
Reduction of the mean blood pressure by 25% within the first hour. Achievement of a goal pressure of about 160/100 within 2 to 6 hours. Reduction to a target goal pressure over a period of days.
hypertensive emergency
a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage
hypertensive urgency
a situation in which blood pressure is severely elevated but there is no evidence of impending or progressive target organ damage
The nurse is caring for a client with a blood pressure of 210/100 mm Hg in the emergency room. What is the most appropriate route of administration for antihypertensive agents?
continuous IV infusion
Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through:
ophthalmic examination.
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
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?
Loss of arterial elasticity
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
isolated systolic hypertension
a condition most commonly seen in the older adult in which the systolic pressure is greater than 140 mm Hg and the diastolic pressure is less than 80 mm Hg
A client with high blood pressure is receiving an antihypertensive drug. When developing a client teaching plan to minimize orthostatic hypotension, which instruction should the nurse include?
"Flex your calf muscles, avoid alcohol, and change positions slowly."
A nurse working in the clinic is seeing a client who has just been prescribed a new medication for hypertension. The client asks why hypertension is sometimes called the "silent killer." What is the best response by the nurse?
"Hypertension often causes no symptoms."
Hypertension is diagnosed when the client demonstrates a systolic blood pressure greater than ______ mm Hg or a diastolic blood pressure greater than _____ mm Hg over a sustained period.
130, 80
A client with newly diagnosed hypertension asks what to do to decrease the risk for related cardiovascular problems. Which risk factor is not modifiable by the client?
Age
A nurse is teaching about lifestyle modifications to a group of clients with known hypertension. Which statement would the nurse include in the education session?
Engage in aerobic activity at least 30 minutes/day most days of the week.
When administering benazepril with spironolactone, the nurse should be aware that which electrolyte imbalance may occur?
Hyperkalemia
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?
Keep weight stable.
The nurse teaches the client which guidelines regarding lifestyle modifications for hypertension?
Maintain adequate dietary intake of fruits and vegetables
The nurse is caring for a client with long-standing hypertension. As a client advocate, which instruction is most helpful in preventing further complications?
Obtain a regular appointment with eye doctor.
A 35-year-old client has been diagnosed with hypertension. The client is a stock broker, smokes daily, and has diabetes. During a follow-up appointment, the client states that regular visits to the doctor just to check blood pressure (BP) are cumbersome and time consuming. As the nurse, which aspect of client teaching would you recommend?
Purchasing a self-monitoring BP cuff
Which of the following is the nurse most correct to recognize as a direct effect of client hypertension?
Renal dysfunction resulting from atherosclerosis
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
The nurse is instructing a client who is newly prescribed an antihypertensive medication. Which nursing instruction is emphasized to maintain client safety?
Sit on the edge of the chair and rise slowly.
Which statements are true when the nurse is measuring blood pressure (BP)? Select all that apply.
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.
rebound hypertension
blood pressure that is controlled with medication and becomes uncontrolled (abnormally high) with the abrupt discontinuation of medication
What risk factors would cause the nurse to become concerned that the client may have atherosclerotic heart disease? Select all that apply.
hypertension diabetes obesity family history of early cardiovascular events
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
