practice - htn
A nurse is teaching an adult female patient about the risk factors for hypertension. What should the nurse explain as risk factors for primary hypertension? A)Obesity and high intake of sodium and saturated fat B)Diabetes and use of oral contraceptives C)Metabolic syndrome and smoking D)Renal disease and coarctation of the aorta
A) Obesity and high intake of sodium and saturated fat Obesity, stress, high intake of sodium or saturated fat, and family history are all risk factors for primary hypertension. Diabetes and oral contraceptives are risk factors for secondary hypertension. Metabolic syndrome, renal disease, and coarctation of the aorta are causes of secondary hypertension.
A patient with primary hypertension comes to the clinic complaining of a gradual onset of blurry vision and decreased visual acuity over the past several weeks. The nurse is aware that these symptoms could be indicative of what? A)Retinal blood vessel damage B)Glaucoma C)Cranial nerve damage D)Hypertensive emergency
A) Retinal blood vessel damage Blurred vision, spots in front of the eyes, and diminished visual acuity can mean retinal blood vessel damage indicative of damage elsewhere in the vascular system as a result of hypertension. Glaucoma and cranial nerve damage do not normally cause these symptoms. A hypertensive emergency would have a more rapid onset.
Despite a high dosage, a male patient who is taking nifedipine (Procardia XL) for antihypertensive therapy continues to have blood pressures over 140/90 mmHg. What should the nurse do next? A. Assess his adherence to therapy. B. Ask him to make an exercise plan. C. Instruct him to use the DASH diet. D. Request a prescription for a thiazide diuretic.
A. Assess his adherence to therapy. A long-acting calcium-channel blocker such as nifedipine causes vascular smooth muscle relaxation resulting in decreased SVR and arterial BP and related side effects. The patient data the nurse has about this patient is very limited, so the nurse needs to assess his adherence to therapy.
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. Hypertension promotes atherosclerosis and damage to the walls of the arteries. Hypertension is a major risk factor for the development of atherosclerosis by mechanisms not yet fully known. However, once atherosclerosis develops, it damages the walls of arteries and reduces circulation to target organs and tissues.
The nurse is reviewing the medication administration record of a patient who takes a variety of medications for the treatment of hypertension. What potential therapeutic benefits of antihypertensives should the nurse identify? Select all that apply. A)Increased venous return B)Decreased peripheral resistance C)Decreased blood volume D)Decreased strength and rate of myocardial contractions E)Decreased blood viscosity
B) Decreased peripheral resistance C) Decreased blood volume D) Decreased strength and rate of myocardial contractions The medications used for treating hypertension decrease peripheral resistance, blood volume, or the strength and rate of myocardial contraction. Antihypertensive medications do not increase venous return or decrease blood viscosity.
A patient's medication regimen for the treatment of hypertension includes hydrochlorothiazide. Following administration of this medication, the nurse should anticipate what effect? A)Drowsiness or lethargy B)Increased urine output C)Decreased heart rate D)Mild agitation
B) Increased urine output Thiazide diuretics lower BP by reducing circulating blood volume; this results in a short-term increase in urine output. These drugs do not cause bradycardia, agitation, or drowsiness.
The nurse is caring for a patient admitted with a history of hypertension. The patient's medication history includes hydrochlorothiazide (Hydrodiuril) daily for the past 10 years. Which parameter would indicate the optimal intended effect of this drug therapy? A. Weight loss of 2 lb B. Blood pressure 128/86 C. Absence of ankle edema D. Output of 600 mL per 8 hours
B. Blood pressure 128/86 Hydrochlorothiazide may be used alone as monotherapy to manage hypertension or in combination with other medications if not effective alone. After the first few weeks of therapy, the diuretic effect diminishes, but the antihypertensive effect remains. Since the patient has been taking this medication for 10 years, the most direct measurement of its intended effect would be the blood pressure.
The nurse admits a 73-year-old male patient with dementia for treatment of uncontrolled hypertension. The nurse will closely monitor for hypokalemia if the patient receives which medication? A. Clonidine (Catapres) B. Bumetanide (Bumex) C. Amiloride (Midamor) D. Spironolactone (Aldactone)
B. Bumetanide (Bumex) Bumetanide is a loop diuretic. Hypokalemia is a common adverse effect of this medication. Amiloride is a potassium-sparing diuretic. Spironolactone is an aldosterone-receptor blocker. Hyperkalemia is an adverse effect of both amiloride and spironolactone. Clonidine is a central-acting α-adrenergic antagonist and does not cause electrolyte abnormalities.
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. Restrict sodium intake The patient should decrease intake of sodium. This will help to control hypertension, which can be aggravated by excessive salt intake, which in turn leads to fluid retention. Caffeine and protein intake do not affect hypertension. Calcium supplements are not recommended to lower BP.
When providing dietary instruction to a patient with hypertension, the nurse would advise the patient to restrict intake of which meat? A. Broiled fish B. Roasted duck C. Roasted turkey D. Baked chicken breast
B. Roasted duck Roasted duck is high in fat, which should be avoided by the patient with hypertension. Weight loss may slow the progress of atherosclerosis and overall CVD risk. The other meats are lower in fat and are therefore acceptable in the diet.
When assessing the patient for orthostatic hypotension, after taking the blood pressure (BP) and pulse (P) in the supine position, what should the nurse do next? A. Repeat BP and P in this position. B. Take BP and P with patient sitting. C. Record the BP and P measurements. D. Take BP and P with patient standing.
B. Take BP and P with patient sitting. When assessing for orthostatic changes in BP after measuring BP in the supine position, the patient is placed in a sitting position and BP is measured within 1 to 2 minutes and then repositioned to the standing position with BP measured again, within 1 to 2 minutes. The results are then recorded with a decrease of 20 mm Hg or more in SBP, a decrease of 10 mm Hg or more in DBP, and/or an increase in pulse of greater than or equal to 20 beats/minute from supine to standing indicating orthostatic hypotension.
The nurse teaches a 28-year-old man newly diagnosed with hypertension about lifestyle modifications to reduce his blood pressure. Which statement by the patient requires an intervention by the nurse? 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. "I can lower my blood pressure by switching to smokeless tobacco." Nicotine contained in tobacco products (smoking and chew) cause vasoconstriction and increase blood pressure. Persons with hypertension should restrict sodium to 1500 mg/day by avoiding foods high in sodium and not adding salt in preparation of food or at meals. Weight loss can decrease blood pressure between 5 to 20 mm Hg. Following dietary recommendations (such as the DASH diet) lowers blood pressure, and these decreases compare with those achieved with blood pressure-lowering medication.
The nurse is caring for a patient admitted with chronic obstructive pulmonary disease (COPD), angina, and hypertension. Before administering the prescribed daily dose of atenolol 100 mg PO, the nurse assesses the patient carefully. Which adverse effect is this patient at risk for, given the patient's health history? A. Hypocapnia B. Tachycardia C. Bronchospasm D. Nausea and vomiting
C. Bronchospasm Atenolol is a cardioselective β1-adrenergic blocker that reduces blood pressure and could affect the β2-receptors in the lungs with larger doses or with drug accumulation. Although the risk of bronchospasm is less with cardioselective β-blockers than nonselective β-blockers, atenolol should be used cautiously in patients with COPD.
The patient has chronic hypertension. Today she has gone to the ED, and her blood pressure has risen to 200/140. What is the priority assessment for the nurse to make? A. Is the patient pregnant? B. Does the patient need to urinate? C. Does the patient have a headache or confusion? D. Is the patient taking antiseizure medications as prescribed?
C. Does the patient have a headache 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. Pregnancy can lead to secondary hypertension. Needing to urinate and taking antiseizure medication do not support a hypertensive emergency.
When teaching how lisinopril (Zestril) will help lower the patient's blood pressure, which mechanism of action should the nurse use to explain it? A. Blocks β-adrenergic effects. B. Relaxes arterial and venous smooth muscle. C. Inhibits conversion of angiotensin I to angiotensin II. D. Reduces sympathetic outflow from central nervous system.
C. Inhibits conversion of angiotensin I to angiotensin II. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that inhibits the conversion of angiotensin I to angiotensin II, which reduces angiotensin II-mediated vasoconstriction and sodium and water retention. Beta blockers result in vasodilation and decreased heart rate. Direct vasodilators relax arterial and venous smooth muscle. Central acting α-adrenergic antagonists reduce sympathetic outflow from the CNS to produce vasodilation and decreased SVR and BP.
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. Limit sodium and fat intake. D. Increase fruits and vegetables. E. Exercise 30 minutes most days. Primary prevention of hypertension is to make lifestyle modifications that prevent or delay the increase in BP. Along with exercise for 30 minutes on most days, the DASH eating plan is a healthy way to lower BP by limiting sodium and fat intake, increasing fruits and vegetables, and increasing nutrients that are associated with lowering BP. Nuts and seeds and dried beans are used for protein intake. Weight loss may or may not be necessary for the individual.
In caring for a patient admitted with poorly controlled hypertension, which laboratory test result should the nurse understand as indicating the presence of target organ damage? A. BUN of 15 mg/dL B. Serum uric acid of 3.8 mg/dL C. Serum creatinine of 2.6 mg/dL D. Serum potassium of 3.5 mEq/L
C. Serum creatinine of 2.6 mg/dL The normal serum creatinine level is 0.6-1.3 mg/dL. This elevated level indicates target organ damage to the kidneys. The other lab results are within normal limits.
A 55-year-old patient comes to the clinic for a routine check-up. The patient's BP is 159/100 mm Hg and the physician diagnoses hypertension after referring to previous readings. The patient asks why it is important to treat hypertension. What would be the nurse's best response? A)Hypertension can cause you to develop dangerous blood clots in your legs that can migrate to your lungs. B)Hypertension puts you at increased risk of type 1 diabetes and cancer in your age group. C)Hypertension is the leading cause of death in people your age. D)Hypertension greatly increases your risk of stroke and heart disease.
D) Hypertension greatly increases your risk of stroke and heart disease. Hypertension, particularly elevated systolic BP, increases the risk of death, stroke, and heart failure in people older than 50 years. Hypertension is not a direct precursor to pulmonary emboli, and it does not put older adults at increased risk of type 1 diabetes or cancer. It is not the leading cause of death in people 55 years of age
The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in what way? A)The BP is always higher in a hypertensive emergency. B)Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies. C)Hypertensive urgency is treated with rest and benzodiazepines to lower BP. D)Hypertensive emergencies are associated with evidence of target organ damage
D) Hypertensive emergencies are associated with evidence of target organ damage Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. Blood pressures are extremely elevated in both urgency and emergencies, but there is no evidence of target organ damage in hypertensive urgency. Extremely close hemodynamic monitoring of the patient's BP is required in both situations. 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 patient's recently elevated BP has prompted the primary care provider to prescribe furosemide (Lasix). The nurse should closely monitor which of the following? A)The client's oxygen saturation level B)The patient's red blood cells, hematocrit, and hemoglobin C)The patient's level of consciousness D)The patient's potassium level
D) The patient's potassium level Loop diuretics can cause potassium depletion. They do not normally affect level of consciousness, erythrocytes, or oxygen saturation.
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." The nurse's correct response is which of the following? a) "Hypertension often causes no symptoms." b) "Hypertension often causes no pain." c) "Hypertension often kills early in the disease process." d) "Hypertension is difficult to diagnose."
a) "Hypertension often causes no symptoms." Hypertension is sometimes called the "silent killer" because people with it are often symptom free. Physical examination may reveal no abnormalities other than elevated blood pressure. People with hypertension may remain asymptomatic for many years. The usual consequences of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, renal failure, strokes, and impaired vision. Pain is not usually an issue, but that is not why hypertension is called the "silent killer." Hypertension is easily diagnosed by taking a series of blood pressure readings. (less) Chapter 31: Assessment and Management of Patients With Hypertension - Page 862
The nurse is developing a teaching plan for a patient diagnosed with hypertension. It would be important to emphasize which of the following as part of the plan of care? a) Limiting sodium intake in the diet b) Limiting cigarette smoking to 1 pack a week c) Limiting activity to prevent over exertion d) Limiting alcohol to a can of beer to four times a day to thin the blood
a) Limiting sodium intake in the diet Research findings indicate that smoking cessation, weight loss, reduced alcohol and sodium intake, and regular physical activity are effective lifestyle adaptations to reduce blood pressure. Limiting one's daily alcohol to 24 ounces of beer for men is recommended. Table salt should be limited to 1 teaspoon daily. Page 864
Decreasing hypertension is the main focus of the medical cardiology practice where you practice nursing. Different goals apply to different age groups for managing and reducing blood pressures. Angie Dodd, a 54-year-old nurse, is beginning medical management of her recently diagnosed hypertension. What is considered the most important strategy in her treatment? a) Reducing her systolic pressure below 140 mmHg b) Reducing her systolic pressure below 130 mmHg c) Reducing her diastolic pressure below 80 mmHg d) Reducing her diastolic pressure below 90 mmHg
a) Reducing her systolic pressure below 140 mmHg Currently, it is believed that in persons older than 50 years of age, reducing the systolic pressure below 140 mm Hg is more important than decreasing the diastolic blood pressure.Page 864
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? a. Serum creatinine of 2.8 mg/dL c. Serum hemoglobin of 14.7 g/dL b. Serum potassium of 4.5 mEq/L d. Blood glucose level of 96 mg/dL
a. Serum creatinine of 2.8 mg/dL The elevated serum creatinine indicates renal damage caused by the hypertension. The other laboratory results are normal.
The nurse on the intermediate care unit received change-of-shift report on four patients with hypertension. Which patient should the nurse assess *first*? a. 48-yr-old with a blood pressure of 160/92 mm Hg who reports chest pain b. 52-yr-old with a blood pressure of 198/90 mm Hg who has intermittent claudication c. 50-yr-old with a blood pressure of 190/104 mm Hg who has a creatinine of 1.7 mg/dL d. 43-yr-old with a blood pressure of 172/98 mm Hg whose urine shows microalbuminuria
a. 48-yr-old with a blood pressure of 160/92 mm Hg who reports 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 nursing action should the nurse take *first* to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes? a. Collect a detailed diet history. b. Provide a list of low-sodium foods. c. Help the patient make an appointment with a dietitian. d. Teach the patient about foods that are high in potassium.
a. 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.
A patient with newly discovered high BP has an average reading of 158/98 mmHg 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. Medication will be required because the BP is still not at goal
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. Release of norepinephrine c. Stimulation of the sympathetic nervous system e. Activation of the renin-angiotensin-aldosterone system
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 a. increase the dietary intake of high-potassium foods. b. make an appointment with the dietitian for teaching. c. check the blood pressure (BP) at home at least once a day. d. move slowly when moving from lying to sitting to standing.
a. 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.
Target organ damage from untreated/undertreated hypertension includes which of the following? Select all that apply. a) Hyperlipidemia b) Stroke c) Diabetes d) Retinal damage e) Heart failure
b) Stroke d) Retinal damage e) Heart failure Target organ systems include cardiac, cerebrovascular, peripheral vascular, renal, and the eye. Hyperlipidemia and diabetes are risk factors for development of hypertension.
Choose the statements that correctly match the hypertensive medication with its side effect. Select all that apply. a) Beta-blockers may cause sedation. b) With thiazide diuretics, monitor serum potassium levels. c) Direct vasodilators may cause headache and tachycardia. d) With ACE inhibitors, assess for bradycardia. e) With adrenergic inhibitors, cough is a common side effect.
b) With thiazide diuretics, monitor serum potassium levels. c) Direct vasodilators may cause headache and tachycardia. Thiazide diuretics may deplete potassium; many clients will need potassium supplementation. Angiotensin-converting enzyme (ACE) inhibitors can induce a mild to severe dry cough. Beta-blockers may induce decreased heart rate; pulse rate should be assessed before administration. Direct vasodilators may cause headache and increased heart rate. Adrenergic inhibitors can cause sedation and fatigue. - Page 867
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 to follow up on these findings? a. "Have you recently taken any antihistamines?" b. "Have you consistently taken your medications?" c. "Did you take any acetaminophen (Tylenol) today?" d. "Have there been recent stressful events in your life?"
b. "Have you consistently taken 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.
Which blood pressure (BP) finding by the nurse indicates that no changes in therapy are needed for a 48-yr-old patient with newly diagnosed hypertension? a. 98/56 mm Hg b. 128/76 mm Hg c. 128/92 mm Hg d. 142/78 mm Hg
b. 128/76 mm Hg The 8th Joint National Committee's recommended goal for antihypertensive therapy for a 30- to 59-yr-old patient with hypertension is a BP below 140/90 mm Hg. The BP of 98/56 mm Hg 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.
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*? a. Tell the patient why a change in drug dosage is needed. b. Ask the patient if the medication is being taken as prescribed. c. Inform the patient that multiple drugs are often needed to treat hypertension. d. Question the patient regarding any lifestyle changes made to help control BP.
b. Ask the patient if the medication is being taken as prescribed. Because nonadherence 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 adherence with the prescribed therapy.
A client has hypertension and high risk factors for cardiovascular disease. The client is overwhelmed with the recommended lifestyle changes. What action by the nurse is best? a. Assess the client's support system. b. Assist in finding one change the client can control. c. Determine what stressors the client faces in daily life. d. Inquire about delegating some of the client's obligations.
b. Assist in finding one change the client can control. All options are appropriate when assessing stress and responses to stress. However, this client feels overwhelmed by the suggested lifestyle changes. Instead of looking at all the needed changes, the nurse should assist the client in choosing one the client feels optimistic about controlling. Once the client has mastered that change, he or she can move forward with another change. Determining support systems, daily stressors, and delegation opportunities does not directly impact the client's feelings of control
Which action will the nurse in the hypertension clinic take to obtain an accurate baseline blood pressure (BP) for a new patient? a. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second. b. Have the patient sit in a chair with the feet flat on the floor. c. Assist the patient to the supine position for BP measurements. d. Obtain two BP readings in the dominant arm and average the results.
b. 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.
The nurse obtains the following information from a patient newly diagnosed with prehypertension. Which finding is *most* important to address with the patient? a. Low dietary fiber intake b. No regular physical exercise c. Drinks a beer with dinner every night d. Weight is 5 pounds above ideal weight
b. No regular physical 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.
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? a. Blood glucose level of 175 mg/dL b. Serum potassium level of 3.0 mEq/L c. Orthostatic systolic BP decrease of 12 mm Hg d. Most recent blood pressure (BP) reading of 168/94 mm Hg
b. Serum 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 will require intervention only if the patient is symptomatic.
An older patient has been diagnosed with possible white coat hypertension. Which planned action by the nurse *best* addresses the suspected cause of the hypertension? a. Instruct the patient about the need to decrease stress levels. b. Teach the patient how to self-monitor and record BPs at home. c. Schedule the patient for regular blood pressure (BP) checks in the clinic. d. Inform the patient and caregiver that major dietary changes will be needed.
b. Teach the patient how to self-monitor and record BPs at home. In the phenomenon of "white coat" hypertension, patients have elevated BP readings in a clinical setting and normal readings when BP is measured elsewhere. 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. There is no evidence that this patient has elevated stress levels or a poor diet, and those factors do not cause white coat hypertension.
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 250 mL less than the fluid intake. b. The patient cannot 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 headache with pain at level 7 of 10 (0 to 10 scale).
b. 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 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.
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? a) Calcium channel blocker b) Loop diuretic c) ACE inhibitor d) Beta-blocker
c) 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. Page 869
Which ethnic background would the nurse screen for hypertension at an early age? a) Mexican population b) Japanese population c) African American population d) Asian population
c) African American population The African American population is at the highest risk for development of hypertension. The other ethnic backgrounds have a lower risk.
A nurse is teaching about lifestyle modifications to a group of clients with known hypertension. Which of the following statements would the nurse include in the education session? a) Limit alcohol consumption to no more that 3 drinks per day. b) Maintain a waist circumference of 45 (men) and 40 (women) inches or less. c) Engage in aerobic activity at least 30 minutes/day most days of the week. d) Maintain a body mass index between 30 and 35.
c) Engage in aerobic activity at least 30 minutes/day most days of the week. Recommmended lifestye modifications to prevent and manage hypertension include 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, and engaging in aerobic activity at least 30 minutes per day most days of the week.
Which of the following findings indicates that hypertension is progressing to target organ damage? a) Blood urea nitrogen (BUN) level of 12 mg/dL b) Chest x-ray showing pneumonia c) Retinal blood vessel damage d) Urine output of 60 cc/mL over 2 hours
c) Retinal blood vessel damage 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 patient 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 level and 60 cc/mL over 2 hours are normal findings. The presence of pneumonia does not indicate target organ damage. Page 872
The nurse is caring for a patient prescribed loop diuretic Bumex (bumetanide) for the treatment of stage 2 hypertension. Which of the following indicates the patient is experiencing an adverse effect of the medication? a) Urine output of 90 cc/mL 1 hour after medication administration b) Blood glucose value of 160 mg/dL c) Serum potassium value of 3.0 mEq/L d) Electrocardiogram (EGG) tracing demonstrating peaked T waves
c) Serum potassium value of 3.0 mEq/L Bumex is a loop diuretic that can cause fluid and electrolyte imbalances. Patients taking these medications may experience a low serum potassium level. ECG changes associated with an elevated serum potassium levels include peaked T waves. Diuresis is a desired effect postadministration of Bumex. The serum glucose level is elevated and requires intervention; however, this elevation is not associated with the administer.
The nurse is obtaining a healthy history from a client with blood pressure of 146/88 mm Hg. The client states that lifestyle changes have not been effective in lowering the blood pressure. Which medication classification does the nurse anticipate first? a) Beta-blocker b) ACE inhibitors c) Thiazide diuretic d) Calcium channel blocker
c) 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. - Page 867
It is appropriate for the nurse to recommend smoking cessation for patients with hypertension because nicotine a) decreases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. b) decreases circulating blood volume. c) increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. d) increases the heart rate, constricts arterioles, and increases the heart's ability to eject blood.
c) increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. The nurse recommends smoking cessation for patients 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. - Page 871
A student nurse asks what "essential hypertension" is. It is also known as "primary hypertension." What response by the registered nurse is best? a. "It means it is caused by another disease." b. "It means it is 'essential' that it be treated." c. "It is hypertension with no specific cause." d. "It refers to severe and life-threatening hypertension."
c. "It is hypertension with no specific cause." Essential (primary) hypertension is the most common type of hypertension and has no specific cause such as an underlying disease process. Hypertension that is due to another disease process is called secondary hypertension. A severe, life-threatening form of hypertension is malignant hypertension.
A patient has just been diagnosed with hypertension and has been started on captopril . Which information is *most* important to include when teaching the patient about this drug? a. Include high-potassium foods such as bananas in the diet. b. Increase fluid intake if dryness of the mouth is a problem. c. Change position slowly to help prevent dizziness and falls. d. Check blood pressure (BP) in both arms before taking the drug.
c. 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 drug, 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 drug, and in the evening. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.
Which information is *most* important for the nurse to include when teaching a patient with newly diagnosed hypertension? a. Most people are able to control BP through dietary changes. b. Annual BP checks are needed to monitor treatment effectiveness. c. Hypertension is usually asymptomatic until target organ damage occurs. d. Increasing physical activity alone controls blood pressure (BP) for most people.
c. 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 BP, 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 when stable.
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 *most* effective? a. The patient avoids eating nuts or nut butters. b. The patient restricts intake of chicken and fish. c. The patient drinks low-fat milk with each meal. d. The patient has two cups of coffee in the morning.
c. The patient drinks 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.
A 56-yr-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 a. a BP recheck should be scheduled in a few weeks. b. dietary sodium and fat content should be decreased. c. diagnosis, treatment, and ongoing monitoring will be needed. d. there is an immediate danger of a stroke, requiring hospitalization.
c. diagnosis, treatment, and ongoing monitoring will be needed. A sudden increase in BP in a patient older than age 50 years 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.
Propranolol (Inderal) is prescribed for a patient diagnosed with hypertension. The nurse should consult with the health care provider before giving this drug when the patient reveals a history of a. daily alcohol use. b. peptic ulcer disease. c. reactive airway disease. d. myocardial infarction (MI).
c. reactive airway disease. Nonselective b-blockers block b1- and b2-adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma. b-Blockers will have no effect on the patient's peptic ulcer disease or alcohol use. b-Blocker therapy is recommended after MI.
A nurse is discussing with a nursing student how to accurately measure blood pressure. Which of the following points does the nurse emphasize? a) The size of the cuff does not matter as long as it fits snugly around the arm. b) A cuff that is too small will give a false low blood pressure. c) A cuff that is too large will give a false high blood pressure. d) A cuff that is too small will give a false high blood pressure.
d) A cuff that is too small will give a false high blood pressure. 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.
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? a) Being sure to keep follow-up appointments b) Walking as far as the client is able every day c) Eating extra potassium due to loss of potassium related to medications d) Changing positions slowly related to possible hypotension
d) Changing positions slowly related to possible hypotension The elderly have impaired cardiovascular reflexes and thus are more sensitive to the extracellular volume depletion caused by diuretics and to the sympathetic inhibition caused by adrenergic antagonists. The nurse teaches clients to change positions slowly when moving from a lying or sitting position to a standing position. This will help prevent falls. Eating extra potassium is not a good idea if taking a potassium-sparing diuretic. The other choices are good teaching points, but not necessarily safety precautions.
You are doing the final checklist before sending home a 63-year-old female who has been newly diagnosed with hypertension. She is going to be starting her first antihypertensive medicine. What is one of the main things you should tell her and her husband to watch for? a) Tremor b) Persistent cough c) Blurred vision d) Dizziness
d) Dizziness A common adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. Therefore, you should both alert the patient and her husband to this possibility and provide them with some tips for managing dizziness. (less) - Page 872
Which diagnostic is the recommended method of determining whether left ventricular hypertrophy has occurred? a) ECG b) Blood chemistry c) BUN d) Echocardiogram
d) Echocardiogram An echocardiogram is recommended method of determining whether hypertrophy has occurred. ECG and blood chemistry are part of the routine work up. Renal damage may be suggested by elevations in BUN and creatinine levels. p 864
Which of the following describes a situation in which the blood pressure is severely elevated and there is evidence of actual or probable target organ damage? a) Hypertensive urgency b) Secondary hypertension c) Primary hypertension d) Hypertensive emergency
d) 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 patient is being treated for hypertensive emergency. When treating this patient, the priority goal is to lower the mean blood pressure (BP) by which percentage in the first hour? a) 45% b) 35% c) 40% d) Up to 25%
d) Up to 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.
Which action should the nurse take when giving the initial dose of oral labetalol to a patient with hypertension? a. Encourage the use of hard candy to prevent dry mouth. b. Teach the patient that headaches often occur with this drug. c. Instruct the patient to call for help if heart palpitations occur. d. Ask the patient to request assistance before getting out of bed.
d. Ask the patient to request assistance before getting out of bed. Labetalol decreases sympathetic nervous system activity by blocking both a and b 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.
The nurse is caring for a 70-yr-old patient who uses hydrochlorothiazide and enalapril (Vasotec) but whose self-monitored blood pressure (BP) continues to be elevated. Which patient information may indicate a need for a change? a. Patient takes a daily multivitamin tablet. b. Patient checks BP daily just after getting up. c. Patient drinks wine three to four times a week. d. Patient uses ibuprofen to (Motrin) treat osteoarthritis.
d. Patient uses ibuprofen (Motrin) 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.
The registered nurse (RN) is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside . Which nursing action can the nurse delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Evaluate effectiveness of nitroprusside therapy on blood pressure (BP). b. Assess the patient's environment for adverse stimuli that might increase BP. c. Titrate nitroprusside to decrease mean arterial pressure (MAP) to 115 mm Hg. d. Set up the automatic noninvasive BP machine to take readings every 15 minutes.
d. Set up the automatic noninvasive BP machine to take readings every 15 minutes. LPN/LVN education and scope of practice include the correct use of common equipment such as automatic noninvasive blood pressure machines. The other actions require advanced 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 nicardipine (Cardene) to treat a hypertensive emergency? a. Organize nursing activities so that the patient has undisturbed sleep for 8 hours at night. b. Keep the patient NPO to prevent aspiration caused by nausea and possible vomiting. c. Assist the patient up in the chair for meals to avoid complications associated with immobility. d. Use an automated noninvasive blood pressure machine to obtain frequent measurements.
d. Use an automated noninvasive blood pressure machine to obtain frequent 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 8 hours of undisturbed sleep is not reasonable. 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.
In teaching a patient with hypertension about controlling the condition, 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. lifestyle modifications are indicated for all persons with elevated BP
A major consideration in the management of the older adult with hypertension is to: (idk about this question/answer...) 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. use careful technique in assessing the BP of the patient because of the possible presence of an auscultatory gap