Prep U Chapter 31: Assessment and Management of Patients With Hypertension

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? "Do you have a dry mouth or nasal congestion?" "Are you having chest pain or shortness of breath?" "Did you take any medication for your headache?" "Have you taken your prescribed clonidine today?"

"Have you taken your prescribed clonidine today?"

Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension? "I should eliminate caffeine from my diet to lower my blood pressure." "A glass of red wine each day will 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."

"Limiting my salt intake to 2 grams per day will improve my blood pressure."

While in nursing school, you discover the prevalence of high blood pressure in the United States and are amazed at its frequency of occurrence. Which of the following is closest to approximately how many people have high blood pressure? 1 in 4 adults 1 in 10 adults 1 in 5 adults 1 in 7 adults

1 in 4 adults

Prehypertension BP reading

120-139 SBP 80-89 DBP

The nurse is caring for a patient with systolic blood pressure of 135 mm Hg. This finding would be classified as 1. normal. 2. prehypertension. 3. stage 1 hypertension. 4. stage 2 hypertension.

2. prehypertension.

The nurse is explaining the DASH diet to a patient diagnosed with hypertension. The patients inquires about how many servings of fruit per day can be consumed on the diet. The nurse would be correct in stating which of the following?

4 or 5

Which of the following client scenarios would be correct for the nurse to identify as a client with secondary hypertension? A client diagnosed with kidney disease A client with excessive alcohol intake A client experiencing depression A client of advanced age

A client diagnosed with kidney disease

The nurse planning care of a patient admitted to the hospital with HTN. What objective will help to meet the needs of this pt? A. Lowering and controlling the BP without adverse effects and without undue cost B. making sure that the patient adheres to the therapeutic medication regimen C. instructing the patient to enter a weight loss program and begin an exercise regimen D. scheduling the patient for all follow-up visits and making phone calls to the home to ensure adherence

A. making sure that the patient adheres to therapeutic medication regimen

A patient informs the nurse, "I can't adhere to the dietary sodium decrease that is required for the treatment of my HTN" What can the nurse educate the client about regarding this statement? A. If dietary sodium isn't restricted, the patient will be unable to control the blood pressure and will be at risk for stroke. B. The patient can speak to the physician about increasing the dosage of medication instead of reducing the added salt. C. It takes 2-3 months for the taste buds to adapt to changes in salt intake. D. The patient should use other methods of flavoring foods.

C. It takes 2-3 months for the taste buds to adapt to changes in salt intake.

Hypertension is defined as "sustained elevations in systolic or diastolic blood pressures that exceed prehypertension levels." What are some of the consequences of hypertension that make it such a health menace in the United States? a) Cerebrovascular accident b) Cardiac failure c) Renal disease d) All options are correct.

D) All options are correct

The nurse is assessing BP for a pt who has HTn and the nurse does not hear an auscultatory gap. What outcome may be documented in this circumstance? A. a low diastolic reading B. a high systolic pressure reading C. a normal reading D. a high diastolic or low systolic reading

D. a high diastolic or low systolic reading

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) Malignant Secondary Pathologic

Essential (primary)

What is the most common chronic disease in the US

HTN

Physical/Diagnostic Assessment

History and Physical Exam Laboratory tests Urinalysis Blood chemistry Cholesterol levels ECG Echocardiogram

When administering an angiotensin-converting enzyme (ACE) inhibitor with spironolactone, the nurse should be aware that which electrolyte imbalance may occur? Hypokalemia Hypercalcemia Hypocalcemia Hyperkalemia

Hyperkalemia

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.

Medical Management Pharmacological Gerontological

Pharmacological Decrease peripheral resistance Decrease blood volume Decrease strength/rate of myocardial contraction Medications - Table 31-4, pp. 890-893 Gerontological Management follows similar protocol Attention to medication choices Attention to barriers to therapy

A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. Which of the following are risk factors for cardiovascular problems in clients with hypertension? Choose all that apply. Gallbladder disease Physical inactivity Smoking Diabetes mellitus Frequent upper respiratory infections

Physical inactivity Smoking Diabetes mellitus

Which of the following adrenergic inhibitors acts directly on the blood vessels, producing vasodilation?

Prazosin hydrochloride (Minipress)

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 Administering glycemic control Purchasing a self-monitoring BP cuff Advising smoking cessation

Purchasing a self-monitoring BP cuff

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 Essential Secondary Primary

Rebound

A 55-year-old black male is found to have a blood pressure of 150/90 mm Hg during a work-site health screening. What should the nurse do?

Recommend he have his blood pressure rechecked within 2 weeks.

Which finding indicates that hypertension is progressing to target organ damage? Blood urea nitrogen concentration of 12 mg/dL Chest x-ray showing pneumonia Urine output of 60 mL over 2 hours Retinal blood vessel damage

Retinal blood vessel damage

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? Malignant Primary Secondary Essential

Secondary

HTN Risk factors

Stress Diabetes mellitus Smoking Chronic kidney disease Obesity Dyslipidemia Physical inactivity Family history Older age Alcohol consumption

The nursing student is part of a group of nursing students who are making a presentation on chronic hypertension. What is one subject the nursing student would need to include in the presentation as a possible consequence of untreated chronic hypertension? Stroke Right-sided heart failure Pulmonary insufficiency Peripheral edema

Stroke

A client comes to the emergency department complaining of visual changes and a severe headache. The nurse measures the client's blood pressure at 210/120 mm Hg. However, the client denies having hypertension or any other disorder. After diagnosing malignant hypertension (hypertensive emergency), a life-threatening disorder, the physician initiates emergency intervention. What is the most common cause of malignant hypertension (hypertensive emergency)? Pheochromocytoma Untreated hypertension Dissecting aortic aneurysm Pyelonephritis

Untreated hypertension

When treating hypertensive emergencies, the nurse identifies the most appropriate route of administration for antihypertensive agents as being which of the following? a) Sublingual b) Continuous IV infusion c) Oral d) Intramuscular

b) Continuous IV infusion

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 must be equal in both arms. differ no more than 5 mm Hg between arms. may vary 10 mm Hg or more between arms. may vary, with the higher pressure found in the left arm.

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? persistent cough tremor dizziness blurred vision

dizziness

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 prehypertension. hypertension. normal. a hypertensive emergency.

hypertension.

A client with a history of hypertension is receiving client education about structures that regulate arterial pressure. Which structure is a component of that process? kidneys parasympathetic nervous system limbic system lungs

kidneys

monotherapy

medication therapy with a single agent

A client with high blood pressure is receiving an antihypertensive drug. The nurse knows that antihypertensive drugs commonly cause fatigue and dizziness, especially on rising. When developing a client teaching plan to minimize orthostatic hypotension, which instruction should the nurse include? "Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising." "Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night." "Rest between demanding activities, eat plenty of fruits and vegetables, and drink 6 to 8 cups of fluid daily." "Flex your calf muscles, avoid alcohol, and change positions slowly."

"Flex your calf muscles, avoid alcohol, and change positions slowly."

A client with newly diagnosed hypertension asks what she can do to decrease the risk for related cardiovascular problems. Which of the following risk factors is not modifiable by the client? 1. Dyslipidemia 2. Obesity 3. Age 4. Inactivity

3. Age

Approximately what percentage of adults in the United States have hypertension? 20 30 40 50

30

A nurse is discussing with a group of nursing students how to accurately measure blood pressure. The nurse is sure to include all the following information except: 1. Routinely calibrate the sphygmomanometer. 2. Center the cuff bladder directly over the brachial artery. 3. Initially take the blood pressure in both arms. 4. Position the forearm above the level of the heart.

4. Position the forearm above the level of the heart.

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

The nurse is caring for a client newly diagnosed with secondary hypertension. Which of the following conditions contributes to the development of secondary hypertension? a) Hepatic function b) Renal disease c) Acid-based imbalance d) Calcium deficit

B) Renal disease

A student nurse is taking care of an elderly patient with hypertension during a clinical experience. The instructor asks the student about the relationships between BP and age. What would be the best answer by the student? A)Because of reduced smooth muscle tone in blood vessels, blood pressure tends to go down with age, not up. B)Decreases in the strength of arteries and the presence of venous insufficiency cause hypertension in the elderly. C)Structural and functional changes in the cardiovascular system that occur with age contribute to increases in blood pressure. D)The neurologic system of older adults is less efficient at monitoring and regulating blood pressure.

C)Structural and functional changes in the cardiovascular system that occur with age contribute to increases in blood pressure.

The nurse is caring for a client with hypertension who is experiencing complications. What diagnostic test evaluates the efficiency or inefficiency of the heart to pump blood? Echocardiography Multiple gated acquisition (MUGA) scan Chest radiography Computed tomography scan

Multiple gated acquisition (MUGA) scan

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? Urine output of 90 mL 1 hour after medication administration Blood glucose value of 160 mg/dL Serum potassium value of 3.0 mEq/L Electrocardiogram (EGG) tracing demonstrating peaked T waves

Serum potassium value of 3.0 mEq/L

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 Chlorthalidone Chlorothiazide Furosemide

Spironolactone

Of the following diuretic medications, which conserves potassium?

Spironolactone (Aldactone)

During the physical assessment of a client with hypertension, what would you 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.

Definition of HTN and diagnosis

Systolic blood pressure reading > 140 mm Hg Diastolic blood pressure reading > 90 mm HG 2 average or more BP measurements during 2 or more contacts with HCP

HTN Clinical Manifestations

Usually NO symptoms other than elevated blood pressure Symptoms related to organ damage - seen late and are serious Retinal and other eye changes Renal damage Myocardial infarction Cardiac hypertrophy Stroke

Medical Management

Weight reduction DASH - Dietary Approaches to Stop Hypertension (Table 31-3, p. 889) Reduction in dietary sodium Physical activity Moderation of alcohol consumption

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

A community health nurse teaching a group of adults about preventing and treating hypertension. The nurse should encourage these participants to collaborate with their primary care providers and regularly monitor which of the following? A)Heart rate B)Sodium levels C)Potassium levels D)Blood lipid levels

D)Blood lipid levels

A patient in hypertensive urgency is admitted to the hospital. The nurse should be aware of what goal of treatment for a patient in hypertensive urgency? A)Normalizing BP within 2 hours B)Obtaining a BP of less than 110/70 mm Hg within 36 hours C)Obtaining a BP of less than 120/80 mm Hg within 36 hours D)Normalizing BP within 24 to 48 hours

D)Normalizing BP within 24 to 48 hours

A 44-year-old client has a history of hypertension. As her nurse, you engage her in client education to make her aware of structures that regulate arterial pressure. Which of the following structures is a component of that process? a) Parasympathetic nervous system b) Lungs c) Kidneys d) Limbic system

C. kidneys

The home health nurse is caring for a patient who has a comorbidity of hypertension. What assessment question most directly addresses the possibility of worsening hypertension? A)Are you eating less salt in your diet? B)How is your energy level these days? C)Do you ever get chest pain when you exercise? D)Do you ever see spots in front of your eyes?

D)Do you ever see spots in front of your eyes?

Which statements are true when the nurse is measuring blood pressure (BP)? Select all that apply. The client should sit quietly while BP is being measured. 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. Using a BP cuff that is too small will give a higher BP measurement. Using a BP cuff that is too large will give a higher BP measurement.

The client should sit quietly while BP is being measured. The client's arm should be positioned at the level of the heart. Using a BP cuff that is too small will give a higher BP measurement.

Which of the following are among the lifestyle changes that can help prevent and control hypertension? Choose all that apply. a) Increased intake of dietary sodium b) Weight reduction c) Increased physical activity d) Increased intake of dietary protein e) Substitution of low-fat for whole dairy products in diet

b) Weight reduction c) Increased physical activity e) Substitution of low-fat for whole dairy products in diet

Hypertension that can be attributed to an underlying cause is termed isolated systolic hypertension. essential hypertension. secondary hypertension. primary hypertension.

secondary hypertension.

Normal BP reading

<120 SBP <80 DBP

Stage II HTN BP Reading

>160 SBP >100 DBP

A diastolic blood pressure of 90 mm Hg is classified as normal. prehypertension. stage 1 hypertension. stage 2 hypertension.

stage 1 hypertension.

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%

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. He asks the nurse what his blood pressure should be. The nurse's most appropriate response is: "The lower the better. Blood pressure of 120/80 mm Hg is best for everyone." "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." "Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg."

"Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg."

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'm glad I can still have chicken bouillon." "I chose a tossed salad with sardines and oil and vinegar dressing for lunch." "I chose broiled chicken with a baked potato for dinner." "I can still eat a ham-and-cheese sandwich with potato chips for lunch."

"I chose broiled chicken with a baked potato for dinner."

During a routine physical examination, the nurse assesses a blood pressure reading of 150/90 mm Hg. The patient's blood work indicates several abnormal results. The health care provider informs the nurse that he suspects that the patient has metabolic syndrome. The nurse knows that this diagnosis is associated with three classic signs/symptoms. Select all that apply.

-A blood pressure reading greater than 130/85 mm Hg -Dyslipidemia and/or abdominal obesity -Insulin resistance

The nurse is completing a cardiac assessment on a patient. The patient has a blood pressure (BP) reading of 126/80. The nurse would identify this blood pressure reading as which of the following? 1. Prehypertension 2. Normal 3. Stage 1 hypertension 4. Stage 2 hypertension

1. Prehypertension

A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. For a client without diabetes mellitus, the target blood pressure is 140/90 or lower. Because this client has diabetes mellitus, the target blood pressure will be which of the following? 130/80 or lower 145/95 or lower 125/85 or lower 150/95 or lower

130/80 or lower

Stage 1 HTN BP reading

140-159 SBP 90-99 DBP

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? 1. Cardiac catheterization 2. Echocardiography 3. Stress test 4. Tilt-table test

2. Echocardiography

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? 1. Chest pain score of 3 (on a scale of 1 to 10) 2. Numbness and weakness in the left arm 3. Urine output of 40 mL over the past hour 4. Nausea and severe headache

2. Numbness and weakness in the left arm

Which condition(s) indicates target organ damage from untreated/undertreated hypertension? Select all that apply. 1. Diabetes 2. Stroke 3. Heart failure 4. Retinal damage 5. Hyperlipidemia

2. Stroke 3. Heart failure 4. Retinal damage

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 1. weigh the client. 2. check the client's heart rate. 3. check the client's urine output. 4. check the client's serum K+ level.

2. check the client's heart rate.

HTN stats By ethnicity, gender, 1o vs 2o

32.6% of adults in United States; 45.9% of those with poor control Prevalence by gender, ethnicity: 32.9% Caucasian men 30.1% Caucasian women 44.9% African-American men 46.1% African American women 20.6% Hispanic men 29.9% Hispanic women 95% with primary hypertension (unidentified cause) 5% with secondary hypertension (identified cause: renal disease, pregnancy

The nurse is caring for a client with accelerated hypertension. Which body system would the nurse assess to identify early signs of blood pressure progression? 1. Kidney 2. Heart 3. Musculoskeletal system 4. Eyes

4. Eyes

A nurse is caring for a client with hypertension. The physician orders furosemide (lasix) 2 mg/kg to be given intravenously. The client weighs 24 kg. The medication comes in a single-use vial that contains 40 mg in 4 mL (10 mg/mL). How much will the nurse draw up for this client's dose? 4.8 mL 0.48 mL 2.4 mL 0.24 mL

4.8 mL

A nurse is assisting with with checking blood pressures at a local health care fair. To which client would the nurse pay particular attention?

A 40-year-old African-American man

A community health nurse is screening for hypertension. Which of the following clients would the nurse focus on most intensively? A Hispanic teenager A middle-aged African-American man A 45-year-old Asian woman A postmenopausal Caucasian woman

A middle-aged African-American man

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."

The nurse is teaching a patient diagnosed with hypertension about the DASH diet. How many servings of meat, fish, and poultry should a patient consume per day? a) 2 or fewer b) 7 or 8 c) 4 or 5 d) 2 or 3

A) 2 or fewer

A nurse is teaching the Dietary Approaches To Stop Hypertension (DASH) diet to clients who have been newly diagnosed with hypertension. Which of the following information will the nurse include? a) Seven to eight whole grain products per day b) Seven to eight fruits per day c) Three to four regular dairy foods per day d) Four to five servings of meat, fish, or poultry per day

A) Seven to eight whole grain products per day

The nurse is caring for a client with essential hypertension. The nurse reviews labwork and assesses kidney function. Which action of the kidney would the nurse evaluate as the body's attempt to regulate high blood pressure? a) The kidney excretes sodium and water. b) The kidney retains sodium and excretes water. c) The kidney retains sodium and water. d) The kidney retains water and excretes sodium.

A) The kidney excretes sodium and water.

A patient has been prescribed antihypertensives. After assessment and analysis, the nurse has identified a nursing diagnosis of risk for ineffective health maintenance related to nonadherence to therapeutic regimen. When planning this patient's care, what desired outcome should the nurse identify? a)Patient takes medication as prescribed and reports any adverse effects. b)Patient's BP remains consistently below 140/90 mm Hg. c)Patient denies signs and symptoms of hypertensive urgency. d)Patient is able to describe modifiable risk factors for hypertension.

A)Patient takes medication as prescribed and reports any adverse effects.

The nurse is developing a nursing care plan for a patient who is being treated for hypertension. What is a measurable patient outcome that the nurse should include? A)Patient will reduce Na+ intake to no more than 2.4 g daily. B)Patient will have a stable BUN and serum creatinine levels. C)Patient will abstain from fat intake and reduce calorie intake. D)Patient will maintain a normal body weight.

A)Patient will reduce Na+ intake to no more than 2.4 g daily.

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

A patient has come to the clinic for a follow-up assessment that will include a BP reading. To ensure an accurate reading, the nurse should confirm that the patient has done which of the following? A)Tried to rest quietly for 5 minutes before the reading is taken B)Refrained from smoking for at least 8 hours C)Drunk adequate fluids during the day prior D)Avoided drinking coffee for 12 hours before the visit

A)Tried to rest quietly for 5 minutes before the reading is taken

dyslipidemia

abnormal blood lipid levels, including high total, low-density lipoprotein, and triglyceride levels as well as low high-density lipoprotein levels

A nurse educator is teaching a small group of clients about hypertension and dietary changes that will assist in lowering blood pressure readings. The nurse is specifically discussing the (Dietary Approaches to Stop Hypertension (DASH) diet and teaches the clients that the food group with the largest number of servings per day is which of the following? a) Low-fat or fat-free dairy foods b) Grains and grain products c) Fruits d) Vegetables

B) Grains and grain products

Nursing Process Assessment Diagnosis Planning & Goals Interventions Evaluation

Assessment Parameters for measuring blood pressure - Chart 31-2, p. 894 Comprehensive systems assessment Adherence to medication regimen Diagnosis Nursing diagnoses Knowledge deficit/patient education Non-adherence to therapeutic regimen Planning and Goals Patient understanding of disease and treatment Patient participation in self-care No complications Interventions Patient education for full plan of care Referral to sites for education materials Rebound hypertension Adherence to plan - data show poor adherence: 50% stop medication in 1 year; 54% achieve control Monitoring for potential complications Evaluation- Expected Patient Outcomes Maintains tissue perfusion No signs of impairment Complies with self-care regimen Modifies risk factors Adheres to plan of care Experiences no complications No signs of organ damage

As recommended follow-up for a person diagnosed with prehypertension initially, it's recommended the person gets his or her blood pressure rechecked within which timeframe? a) Confirm within 2 months b) 1 year c) Evaluate within 1 month d) 2 year

B) 1 year

Which of the following nursing diagnosis is the nurse most correct to choose when caring for a client with long-standing hypertension? a) Impaired Gas Exchange b) Ineffective Tissue Perfusion c) Risk for Decreased Cardiac Output d) Activity Intolerance

B) Ineffective Tissue Perfusion

A nurse providing education about hypertension to a community group is reviewing consequences of the disease. Which of the following would the nurse identify as target organs for hypertensive damage? Choose all that apply. a) Stomach b) Kidneys c) Brain d) Eyes e) Heart

B) kidneys C) brain D) eyes E) heart

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 nurse is providing care for a patient with a new diagnosis of hypertension. How can the nurse best promote the patient's adherence to the prescribed therapeutic regimen? A)Screen the patient for visual disturbances regularly. B)Have the patient participate in monitoring his or her own BP. C)Emphasize the dire health outcomes associated with inadequate BP control. D)Encourage the patient to lose weight and exercise regularly.

B)Have the patient participate in monitoring his or her own BP.

The hospital nurse cares for many patients who have hypertension. What nursing diagnosis is most common among patients who are being treated for this health problem? A)Deficient knowledge regarding the lifestyle modifications for management of hypertension B)Noncompliance with therapeutic regimen related to adverse effects of prescribed therapy C)Deficient knowledge regarding BP monitoring D)Noncompliance with treatment regimen related to medication costs

B)Noncompliance with therapeutic regimen related to adverse effects of prescribed therapy

The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. Which of the following should the nurse integrate into the management of this client's hypertension? A)Ensure that the patient receives a larger initial dose of antihypertensive medication due to impaired absorption. B)Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion. C)Recognize that an older adult is less likely to adhere to his or her medication regimen than a younger patient. D)Carefully assess for weight loss because of impaired kidney function resulting from normal aging.

B)Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion.

The nursing lab instructor is teaching student nurses how to take blood pressure. To ensure accurate measurement, the lab instructor would teach the students to AVOID which of the following actions? A)Measuring the BP after the patient has been seated quietly for more than 5 minutes B)Taking the BP at least 10 minutes after nicotine or coffee ingestion C)Using a cuff with a bladder that encircles at least 80% of the limb D)Using a bare forearm supported at heart level on a firm surface

B)Taking the BP at least 10 minutes after nicotine or coffee ingestion

The nurse is administering the morning mediations to a patient on the cardiac telemetry unit. Atenolol has been prescribed for this patient. Prior to administration, the nurse would tell the patient that the medication is which type of antihypertensive? Angiotensin-converting enzyme (ACE) inhibitor Diuretic Beta blocker Vasodilator

Beta blocker

HTN Pathophysiology

Blood pressure = product of cardiac output multiplied by peripheral resistance Cardiac output = product of heart rate multiplied by stroke volume ↑ Cardiac output or ↑ peripheral resistance can → hypertension Increased sympathetic nervous system Increased renal absorption of sodium Expansion of extracellular fluid volume Decreased vasodilation of arterioles Resistance to insulin action

Sequelae of HTN

Blood vessel damage: heart, kidney, brain, eyes Organ damage: MI, stroke, renal failure, impaired vision, heart failure Blood pressure control is critical

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 telemetry strip shows a peaked, narrow T-wave, which is a change. What electrolye imbalance does the nurse suspect? a) Hyponatremia b) Hypernatremia c) Hyperkalemia d) Hypokalemia

C) Hyperkalemia

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

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

modification that has been found to have the greatest effect in reducing blood pressure measurements. a) Sodium reduction b) Adopting the DASH approach to eating c) Weight reduction d) Physical activity

C) Weight reduction

A group of student nurses are practicing taking blood pressure. A 56-year-old male student has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, he exclaims, "My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it?" Which of the following responses by the nursing instructor would be best? A)"Yes. Hypertension is prevalent among men; it is fortunate we caught this during your routine examination." B)"We will need to reevaluate your blood pressure because your age places you at high risk for hypertension." C)"A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made." D) "You have no need to worry. Your pressure is probably elevated because you are being tested."

C)"A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made."

A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective assessment data from a patient with hypertension, the nurse learns that the patient has a family history of hypertension and she herself has high cholesterol and lipid levels. The patient says she smokes one pack of cigarettes daily and drinks about a pack of beer every day. The nurse notes what nonmodifiable risk factor for hypertension? A)Hyperlipidemia B)Excessive alcohol intake C)A family history of hypertension D)Closer adherence to medical regimen

C)A family history of hypertension

The nurse is providing care for a patient with a diagnosis of hypertension. The nurse should consequently assess the patient for signs and symptoms of which other health problem? A)Migraines B)Atrial-septal defect C)Atherosclerosis D)Thrombocytopenia

C)Atherosclerosis

A patient in a hypertensive emergency is admitted to the ICU. The nurse anticipates that the patient will be treated with IV vasodilators, and that the primary goal of treatment is what? A)Lower the BP to reduce onset of neurologic symptoms, such as headache and vision changes. B)Decrease the BP to a normal level based on the patient's age. C)Decrease the mean arterial pressure between 20% and 25% in the first hour of treatment. D)Reduce the BP to £ 120/75 mm Hg as quickly as possible.

C)Decrease the mean arterial pressure between 20% and 25% in the first hour of treatment.

A newly diagnosed patient with hypertension is prescribed Diuril, a thiazide diuretic. What patient education should the nurse provide to this patient? A)Eat a banana every day because Diuril causes moderate hyperkalemia. B)Take over-the-counter potassium pills because Diuril causes your kidneys to lose potassium. C)Diuril can cause low blood pressure and dizziness, especially when you get up suddenly. D)Diuril increases sodium levels in your blood, so cut down on your salt.

C)Diuril can cause low blood pressure and dizziness, especially when you get up suddenly.

The nurse is assessing a patient new to the clinic. Records brought to the clinic with the patient show the patient has hypertension and that her current BP readings approximate the readings from when she was first diagnosed. What contributing factor should the nurse first explore in an effort to identify the cause of the client's inadequate BP control? A)Progressive target organ damage B)Possibility of medication interactions C)Lack of adherence to prescribed drug therapy D)Possible heavy alcohol use or use of recreational drugs

C)Lack of adherence to prescribed drug therapy

The nurse is collaborating with the dietitian and a patient with hypertension to plan dietary modifications. These modifications should include which of the following? A)Reduced intake of protein and carbohydrates B) Increased intake of calcium and vitamin D C)Reduced intake of fat and sodium D)Increased intake of potassium, vitamin B12 and vitamin D

C)Reduced intake of fat and sodium

The critical care nurse is caring for a patient just admitted in a hypertensive emergency. The nurse should anticipate the administration of what medication? A)Warfarin (Coumadin) B)Furosemide (Lasix) C)Sodium nitroprusside (Nitropress) D)Ramipril (Altace)

C)Sodium nitroprusside (Nitropress)

An older adult is newly diagnosed with primary hypertension and has just been started on a beta-blocker. The nurse's health education should include which of the following? A)Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the beta-blocker B)Maintaining a diet high in dairy to increase protein necessary to prevent organ damage C)Use of strategies to prevent falls stemming from postural hypotension D)Limiting exercise to avoid injury that can be caused by increased intracranial pressure

C)Use of strategies to prevent falls stemming from postural hypotension

A nurse is providing education about hypertension to a community group. One client reports that his doctor has diagnosed him with hypertension, but that he feels just fine. He asks, "What would happen if I did not treat my hypertension?" Which of the following are possible consequences of untreated hypertension? Choose all that apply. Stroke Tension pneumothorax Coronary artery disease Pancreatitis Myocardial infarction

Coronary artery disease Myocardial infarction Stroke

The nurse is caring for a patient with an intracranial hemorrhage. The patient is having a hypertensive emergency. Which of the following nursing intervention would take priority in this patient? a) Maintaining the BP at a significantly higher than normal level to prevent orthostatic hypotension. b) Reduction of the BP to 160/100 mm Hg within the half hour of treatment c) Reduction of the mean BP by up to 50% within the first hour of treatment d) Avoid lowering the blood pressure (BP) too quickly

D) Avoid lowering the blood pressure (BP) too quickly

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.

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

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

A patient with newly diagnosed hypertension has come to the clinic for a follow-up visit. The patient asks the nurse why she has to come in so often. What would be the nurse's best response? A)We do this so you don't suffer a stroke. B)We do this to determine how your blood pressure changes throughout the day. C)We do this to see how often you should change your medication dose. D)We do this to make sure your health is stable. We'll then monitor it at routinely scheduled intervals.

D)We do this to make sure your health is stable. We'll then monitor it at routinely scheduled intervals.

Which diagnostic method is recommended to determine whether left ventricular hypertrophy has occurred? Blood chemistry Echocardiography Electrocardiography Blood urea nitrogen

Echocardiography

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? Maintain a waist circumference of 45 inches (114 cm) (men) and 40 inches (102 cm) (women) or less. Limit alcohol consumption to no more that 3 drinks per day. Maintain a body mass index between 30 and 35. Engage in aerobic activity at least 30 minutes/day most days of the we

Engage in aerobic activity at least 30 minutes/day most days of the week

A pt arrives at the clinic for a follow-up visit for treatment of HTN. The nurse obtains a BP reading of 180/110 but finds no evidence of impending or progressive organ damage when performing the assessment on the patient. What situation does the nurse understand this patient is experiencing? A. hypertensive emergency B. primary hypertension C. secondary hypertension D. hypertensive urgency

D. hypertensive urgency

You are the triage nurse in a walk-in clinic when a diabetic client visits the clinic and asks you to take her blood pressure (BP). 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 Smoking cessation programs Daily exercise Low-fat diet

Drug therapy

A nurse educator is providing information about hypertension to a small group of clients. A participant asks what she can do to decrease her blood pressure and thus her risk for heart problems. The nurse describes modifiable and nonmodifiable risk factors. Which of the following risk factors can the client modify? Family history of cardiovascular disease Age (older than 55 years for men, 65 years for women) Dyslipidemia Ethnicity

Dyslipidemia

Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage? Primary hypertension Secondary hypertension Hypertensive urgency Hypertensive emergency

Hypertensive emergency

HTN Crisis Emergency vs urgency

Hypertensive emergency Elevated blood pressure to > 180 SBP and/or > 120DBP Must be lowered immediately to prevent organ damage Acute, life-threatening episodes: pregnancy, MI, dissecting AAA, intracranial hemorrhage Reduction of blood pressure by 25% within 1 hour Administration of IV medications Close monitoring of blood pressure changes Hypertensive urgency Blood pressure elevated but without evidence of impending organ damage Associated with severe headaches, nosebleeds, anxiety Oral doses of fast-acting agents Close monitoring of blood pressure changes Goal: normalize blood pressure within 24 to 48 hours

Aging is positively correlated to the incidence of hypertension. This is due to three of the following four structural or functional changes. Which choice is not considered a cause? Increased arterial resistance to left ventricular ejection Decreased elasticity of the major blood vessels Atherosclerosis Increased ability to exert diastolic pressure

Increased ability to exert diastolic pressure

A client experiences orthostatic hypotension while receiving frusemide (Lasix) to treat hypertension. How should the nurse intervene? Administer I.V. fluids as ordered. Administer a vasodilator as ordered. Insert an indwelling urinary catheter as ordered. Instruct the client to sit for several minutes before standing.

Instruct the client to sit for several minutes before standing.

A patient is being seen at the clinic on a monthly basis for assessment of blood pressure. The patient has been checking her 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 patient is experiencing? Isolated systolic hypertension Hypertensive urgency Primary hypertension Secondary hypertension

Isolated systolic hypertension

HTN Common Problems

Left ventricular hypertrophy Myocardial infarction Heart failure Transient ischemic attack (TIA) Cerebrovascular disease (stroke) Renal insufficiency Chronic kidney disease Retinal hemorrhage

The nurse is caring for an 82-year-old male 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? Decrease in blood volume Increase in calcium intake Decrease in cardiac output Loss of arterial elasticity

Loss of arterial elasticity

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? Making sure that the patient adheres to the therapeutic medication regimen Scheduling the patient for all follow-up visits and making phone calls to the home to ensure adherence 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

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? Maintain adequate dietary intake of fruits and vegetables Stop alcohol intake Reduce smoking to no more than four cigarettes per day Limit aerobic physical activity to 15 minutes, three times per week

Maintain adequate dietary intake of fruits and vegetables

A client hospitalized for treatment of hypertension is being prepared for discharge. Which teaching topic should the nurse should be sure to cover?

Maintaining a low-sodium diet

A client with hypertension visits the health clinic for a routine checkup. The nurse measures the client's blood pressure at 184/92 mm Hg and notes a 5-lb (2.3-kg) weight gain within the past month. Which nursing diagnosis reflects the most serious problem in managing a client with hypertension?

Noncompliance (nonadherence to therapeutic regimen)

Stages of HTN Tx at each stage Inc risk for what

PreHTN-intended to alert person and care giver to risk of progressing to Stage I and Stage II modify risk behaviors, LIFESTYLE CHANGES Stage I-initiate treatment with medications Inc risk for: stroke, MI, heart failure, death, atherosclerotic heart disease

Epidemiology of HTN Risk factors Effective tx

Risk: Premature death Disability If not treated, related to: myocardial infarction; heart failure; stroke; chronic kidney disease Effective tx: Lifestyle changes (diet, exercise, smoking cessation) Medication regimens

Which of the following terms describes high blood pressure from an identified cause, such as renal disease?

Secondary hypertension

Which term describes high blood pressure from an identified cause, such as renal disease? Primary hypertension Rebound hypertension Hypertensive emergency Secondary hypertension

Secondary hypertension

Which diuretic medication conserves potassium? Chlorothiazide Furosemide Chlorthalidone Spironolactone

Spironolactone

Gerontological issues

Structural changes in heart and blood vessels Atherosclerotic plaque Impaired vasodilation Decreased elasticity of blood vessels Aorta, large arteries - problems with stroke volume Elevated systolic pressure, normal diastolic Isolated systolic hypertension High morbidity, mortality

The nurse is seeing a client for the first time and has just checked the client's blood pressure. For what value would the nurse consider the client prehypertensive?

Systolic BP is between 120 and 130 mm Hg.

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.

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

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 will relay that risk factors and cardiovascular problems related to hypertension include which of the following? Select all that apply. a) Decreased low-density lipoprotein (LDL) levels. b) Obesity (BMI ≥ 30 kg/m2) c) Smoking d) Age ≥55 in men e) Elevated high-density lipoprotein (HDL) cholesterol

b) Obesity (BMI ≥ 30 kg/m2) c) Smoking d) Age ≥55 in men

rebound hypertension

blood pressure that is controlled with medication and becomes uncontrolled (abnormally high) with the abrupt discontinuation of medication

Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress increases the production of neurotransmitters that constrict peripheral arterioles. increases blood volume and improves the potential for greater cardiac output. increases the resistance that the heart must overcome to eject blood. decreases the production of neurotransmitters that constrict peripheral arterioles.

decreases the production of neurotransmitters that constrict peripheral arterioles.

The nurse understands that client education related to antihypertensive medication should include which of the following? inform client that recommended lifestyle changes are not necessary inform client to discontinue antihypertensives once blood pressure is normal inform client to avoid over-the-counter cold and sinus medications inform client if a dosage of medication is missed , to double the next scheduled dose

inform client to avoid over-the-counter cold and sinus medications

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? procedural interventions observation only nonpharmacological interventions pharmacological interventions

nonpharmacological interventions

Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through: ophthalmic examination. an MRI. using a sphygmomanometer. laboratory tests.

ophthalmic examination.

It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position provide time for the heart to reduce the rate of contraction to resupply oxygen to the brain. help reduce the work required by the heart to resupply oxygen to the brain. provide time for the heart to increase the rate of contraction to resupply oxygen to the brain. help reduce the blood pressure to resupply oxygen to the brain.

provide time for the heart to increase the rate of contraction to resupply oxygen to the brain.

A patient with hypertension is waking up several times a night to urinate. The nurse knows that what laboratory studies may indicate pathologic changes in the kidneys due to the hypertension? (Select all that apply) A. creatinine B. blood urea nitrogen (BUN) C. complete blood count (CBC) D. urine for culture and sensitivity E. AST and ALT

A. creatinine B. blood urea nitrogen (BUN)

The nurse and a dietitian are instructing the client on a low-sodium diet needed to lower the blood pressure. Which question, asked by the nurse, is most important?

"How do you prepare your food?"

Which of the following diagnostic tests may reveal an enlarged left ventricle? a) Fluorescein angiography b) Positron emission tomography (PET) scan c) Echocardiography d) Computed tomographic scan

c) Echocardiography

The nurse is performing an assessment on a pt to determine the effects of HTN on the heart and blood vessels. What specific assessment data will assist in determining this complication? (Select all that apply) A. heart rate B. respiratory rate C. heart rhythm D. character of apical and peripheral pulses E. lung sounds

A. heart rate C. heart rhythm D. character of apical and peripheral pulses

A nurse is educating a client about monitoring blood pressure readings at home. Which of the following will the nurse be sure to emphasise? a) "Sit quietly for 5 minutes prior to taking blood pressure." b) "Be sure the forearm is well supported above heart level while taking blood pressure." c) "Avoid smoking cigarettes for 8 hours prior to taking blood pressure." d) "Sit with legs crossed when taking your blood pressure."

A) "Sit quietly for 5 minutes prior to taking blood pressure."

A 77-year-old client has newly diagnosed stage 2 hypertension. The physician has prescribed the client a thiazide and an angio-converting enzyme inhibitor. The nurse is concerned about postural hypotension. Which of the following will the nurse be sure to include in education for this client? a) Change positions (lying or sitting to standing) slowly. b) Check blood pressure every day for signs of rebound hypertension. c) Eat plenty of salty food to prevent hypotension. d) Do not become dependent on canes, walkers, or handrails.

A) Change positions (lying or sitting to standing) slowly.

You're seeing a patient in a low-income clinic for the first time and have just checked her BP. You're entering her as prehypertensive because: a) Her diastolic blood pressure is between 80 and 89 mm Hg. b) Her systolic BP is above 180 mm Hg. c) Her diastolic blood pressure is at 100 mm Hg. d) Her systolic BP is between 120 and 130 mm Hg.

A) Her diastolic blood pressure is between 80 and 89 mm Hg.

The nurse understands that patient education related to antihypertensive medication should include all of the following instructions EXCEPT which of the following? a) If a dosage of medication is missed, double up on the next one to catch up. b) Avoid over the counter (OTC) cold, weight reduction, and sinus medications. c) Avoid hot baths, exercise, and alcohol within 3 hours of taking vasodilators. d) Do not stop antihypertensive medication abruptly.

A) If a dosage of medication is missed, double up on the next one to catch up.

Management of hypertension includes three of the following four goals, depending on the primary and secondary causes. Select all that apply. a) Impairing the synthesis of norepinephrine. b) Modifying the rate of myocardial contraction. c) Decreasing renal absorption of sodium. d) Increasing the force of cardiac output to overcome peripheral resistance.

A) Impairing the synthesis of norepinephrine B) Modifying the rate of myocardial contraction C) Decreasing renal absorption of sodium

The nurse teaches the patient which of the following guidelines regarding lifestyle modifications for hypertension? a) Maintain adequate dietary intake of potassium b) Stop alcohol intake c) Limit aerobic physical activity to 15 minutes, three times per week d) Reduce smoking to no more than four cigarettes per day

A) Maintain adequate dietary intake of potassium

A 59-year-old client has just received a diagnosis of hypertension from his cardiologist after the completion of diagnostics. After discussing the diagnosis and its consequences with the physician, the client asks you questions regarding his condition. What can the client do to decrease the consequences of his hypertension? Select all that apply. a) Manage stress effectively. b) Use smokeless tobacco. c) Lose weight. d) Get plenty of rest.

A) Manage stress effectively. C) Lose weight.

A 77-year-old client has newly diagnosed stage 2 hypertension for which the physician has prescribed a thiazide and an angio-converting enzyme inhibitor. The nurse is concerned about the client's risk for postural hypotension because of these medications, as well as for what other reason? a) Older adults have impaired cardiovascular reflexes. b) Older adults require large doses of these medications to control their blood pressure. c) Older adults have trouble remembering to measure their blood pressure at home. d) These medications often cause rebound hypertension.

A) Older adults have impaired cardiovascular reflexes.

A 77-year-old client has newly diagnosed stage 2 hypertension. The physician has prescribed a thiazide and an angio-converting enzyme inhibitor. About what is the nurse most concerned? a) Postural hypotension and resulting injury b) Postural hypertension and resulting injury c) Rebound hypertension d) Sexual dysfunction

A) Postural hypotension and resulting injury

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

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? a) The adrenal gland b) The thymus c) The thyroid gland d) The pituitary gland

A) The adrenal gland

Why is it important for the nurse to implement measures to relieve emotional stress for patients with hypertension? a) The reduction of stress decreases the production of neurotransmitters that constrict peripheral arterioles. b) The reduction of stress increases the blood volume and improves the potential for greater cardiac output. c) The reduction of stress increases the resistance that the heart must overcome to eject blood. d) The reduction of stress increases the production of neurotransmitters that constrict peripheral arterioles.

A) The reduction of stress decreases the production of neurotransmitters that constrict peripheral arterioles.

A patient has severe CAD and HTN. Which medication order should the nurse consult with the physician about that is contraindicated for a patient with severe CAD? A. clonidine (catapres) B. amiloride (midamor) C. bumetanide (bumex) D. methyldopa (aldomet)

A. clonidine (catapres)

A patient being seen at the clinic on a monthly basis for assessment of BP. The patient has been checking her Bp at home as well and has reported a systolic pressure of 158 and a diastolic pressure of 64. What does the nurse suspect this patient is experiencing? A. isolated systolic hypertension B. secondary hypertension C. primary hypertension D. hypertensive urgency

A. isolated systolic hypertension

A patient is brought to the ER with complaints of bad headache and increase in BP. The BP reading is 260/180 mm Hg. What is the therapeutic goal for reduction of the mean blood pressure? A. reduce the BP by 20% to 25% within the first hour of treatment B. reduce the BP to about 140/80 mm Hg C. rapidly reduce the BP so the pt will not suffer a stroke D. reduce the BP by 50% within the first hour of treatment

A. reduce the BP by 20% to 25% within the first hour of treatment

A 66-year-old client presents to the emergency room (ER) complaining of a severe headache and mild nausea for the last 6 hours. Upon assessment, the patient's BP is 210/120 mm Hg. The patient has a history of HTN for which he takes 1.0 mg clonidine (Catapres) twice daily for. Which of the following questions is most important for the nurse to ask the patient next? a) "Are you having chest pain or shortness of breath?" b) "Have you taken your prescribed Catapres today?" c) "Did you take any medication for your headache?" d) "Do you have a dry mouth or nasal congestion?"

B) "Have you taken your prescribed Catapres today?"

Officially, hypertension is diagnosed when the patient demonstrates a systolic blood pressure greater than ______ mm Hg and a diastolic blood pressure greater than _____ mm Hg over a sustained period. a) 120, 70 b) 140, 90 c) 130, 80 d) 110, 60

B) 140, 90

According to the DASH diet, how many servings of vegetables should a person consume per day? a) 7 or 8 b) 4 or 5 c) 2 or fewer d) 2 or 3

B) 4 or 5

A female client, aged 82 years, visits the clinic for a blood pressure (BP) check. Her hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about her blood pressure medicine? a) Take the medicine on an empty stomach. b) A possible adverse effect of blood pressure medicine is dizziness when you stand. c) There are no adverse effects from blood pressure medicine. d) A severe drop in blood pressure is possible.

B) A possible adverse effect of blood pressure medicine is dizziness when you stand.

A client with newly diagnosed hypertension asks what she can do to decrease the risk for related cardiovascular problems. Which of the following risk factors is modifiable by the client? a) Impaired renal function b) Dyslipidemia c) Age d) Family history

B) Dyslipidemia

When teaching a patient about hypertension and lifestyle changes the nurse emphasizes that which of the following should be included in the diet? a) Chloride-containing foods b) Fresh fruits and vegetables c) Whole milk and cheeses d) A glass of red wine

B) Fresh fruits and vegetables

A client, newly prescribed a low-sodium diet due to hypertension, is asking for help with meal choices. The client provides four meal choices, which are favorites. Which selection would be best? a) Hot dog with ketchup and relish on whole wheat bun b) Green pepper stuffed with diced tomatoes and chicken c) Creamed chipped beef over toast with mashed potatoes d) Toasted cheese sandwich on whole wheat toast with tomato soup

B) Green pepper stuffed with diced tomatoes and chicken

When measuring the blood pressure in each of the patient's arms, the nurse recognizes that in the healthy adult, which of the following is true? a) Pressures may vary 10 mm Hg or more between arms. b) Pressures should not differ more than 5 mm Hg between arms. c) Pressures must be equal in both arms. d) Pressures may vary, with the higher pressure found in the left arm.

B) Pressures should not differ more than 5 mm Hg between arms

Which of the following terms is given to hypertension in which blood pressure that is controlled with therapy becomes uncontrolled (abnormally high) with the discontinuation of therapy? a) Primary b) Rebound c) Essential d) Secondary

B) Rebound

A patient is brought to the emergency department with complaints 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? a) Reduce the blood pressure by 50% within the first hour of treatment. b) Reduce the blood pressure by 20% to 25% within the first hour of treatment. c) Rapidly reduce the blood pressure so the patient will not suffer a stroke. d) Reduce the blood pressure to about 140/80 mm Hg.

B) Reduce the blood pressure by 20% to 25% within the first hour of treatment.

A nursing class is practicing measurement of blood pressure. One otherwise healthy participant, 46 years old, is 138/90. This man requires follow-up. In which classification of hypertension is he according to the JNC 7 (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood pressure) recommendation? a) Stage 2 with compelling indications b) Stage 1 c) Stage 1 with compelling indications d) Stage 2

B) Stage 1

A client in a clinic setting has just been diagnosed with hypertension. She asks what the end goal is for treatment. The correct reply from the nurse is which of the following? a) To stop smoking and increase physical activity to 30 minutes/day most days of the week b) To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less c) To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less d) To lose weight, achieve a body mass index of 24 or less, and to eat a diet rich in fruits and vegetables

B) To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less

A patient is taking amiloride (Midamor) and lisinopril (Zestril) for the treatment of HTN. What laboratory studies should the nurse monitor while the patient is taking these two medications together? A. magnesium level B. potassium level C. calcium level D. sodium level

B. potassium level

A patient is flying overseas for 1 week for business and packed antiHTN medications in a suitcase. After arriving, the pt found that the luggage had been stolen. If the patient cannot take the medication, what condition becomes a concern? A. isolated systolic hypertension B. rebound hypertension C. angina D. left ventricular hypertrophy

B. rebound 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. The nurse knows that the teaching has been successful when the client restates which of the following? a) "Insomnia is a common side effect of antihypertensive medications." b) "Constant thirst is a common side effect of antihypertensive therapy." c) "Antihypertensive drugs can lead to falls." d) "Antihypertensives can lead to memory loss."

C) "Antihypertensive drugs can lead to falls."

When monitoring a patient who has HYPERTENSION & CHRONIC KIDNEY DISEASE, the target pressure for this individual should be less than which blood pressure reading? a) 120/70 mm Hg b) 110/60 mm Hg c) 130/80 mm Hg d) 140/90 mm Hg

C) 130/80 mm Hg

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

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

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 of the following conditions contribute to secondary hypertension? a) Calcium deficit b) Hepatic function c) Arterial vasoconstriction d) Acid-base imbalance

C) Arterial vasoconstriction

Which of the following conditions contributes to secondary hypertension? a) Acid-based imbalance b) Calcium deficit c) Arterial vasoconstriction d) Hepatic function

C) Arterial vasoconstriction

A nurse is educating about lifestyle modifications for a group of clients with newly diagnosed hypertension. While discussing dietary changes, which of the following points would the nurse emphasize? a) The taste buds never adapt to decreased salt intake. b) A person with hypertension should never consume alcohol. c) It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. d) There is usually no need to change alcohol consumption for clients with hypertension.

C) It takes 2 to 3 months for the taste buds to adapt to decreased salt intake.

A nurse is providing education about lifestyle modifications to a group of clients who have been newly diagnosed with hypertension. The nurse would include all the following statements except: a) Engage in aerobic activity at least 30 minutes/day most days of the week. b) Maintain a waist circumference of 40 (men) and 35 (women) inches or less. c) Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women. d) Maintain a normal body mass index of about 24.

C) Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women.

An 87-year-old client was just recently diagnosed with prehypertension. She is to meet with a dietitian and return for a follow-up with her cardiologist in 6 months. As her nurse, what would you expect her treatment to include? a) Procedural interventions b) No intervention, just observation c) Nonpharmacological interventions d) Pharmacological interventions

C) Nonpharmacological interventions

The best way to detect PAPILLEDEMA is through: a) An MRI b) Laboratory tests c) Ophthalmic examination d) Using a sphygmomanometer

C) Ophthalmic examination

A systolic blood pressure of 135 mm Hg would be classified as which of the following? a) Stage 2 hypertension b) Stage 1 hypertension c) Prehypertension d) Normal

C) Prehypertension

The nurse is completing a cardiac assessment on a patient. The patient has a blood pressure (BP) reading of 126/80. The nurse would identify this blood pressure reading as which of the following? a) Stage 1 hypertension b) Normal c) Prehypertension d) Stage 2 hypertension

C) Prehypertension

Which of the following is the nurse most correct to recognize as a direct effect of client hypertension? a) Hyperglycemia resulting from insulin receptor resistance b) Emphysema related to poor gas exchange c) Renal dysfunction resulting from atherosclerosis d) Anemia resulting from bone marrow suppression

C) Renal dysfunction resulting from atherosclerosis

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

The nurse is employed in a physician's office and is caring for a client present for an annual exam. A blood pressure of 124/84 mm Hg is documented. Following revised guidelines for identifying hypertension, which educational pamphlet is help? a) Use of beta-blockers for treatment of hypertension b) Diagnostic testing for determining cardiac functioning c) Stress reduction to lower prehypertensive state d) Increasing fluids for low blood pressure

C) Stress reduction to lower prehypertensive state

Target organ damage from untreated/undertreated hypertension includes which of the following? Select all that apply. a) Diabetes b) Hyperlipidemia c) Stroke d) Heart failure e) Retinal damage

C) Stroke D) Heart failure E) Retinal damage

The nurse understands that an overall goal of hypertension management includes which of the following? a) The patient maintains a normal blood pressure reading. b) There are no complaints of sexual dysfunction. c) There is no indication of target organ damage. d) There is no complaint of postural hypotension.

C) There is no indication of target organ damage.

What is the most common cause of malignant hypertension? a) Pheochromocytoma b) Dissecting aortic aneurysm c) Untreated hypertension d) Pyelonephritis

C) Untreated hypertension

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? a) Kidneys and autonomic nervous system b) Brain and sympathetic nervous system c) Heart and blood vessels d) Lung and arteries

C) heart and blood vessels

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.

A patient has been diagnosed with preHTN and has been encouraged to exercise regularly and begin a weight loss program. After what period of time does the nurse tell the patient to return for a follow-up visit? A. 2 months B. 6 months C. 1 year D. 2 years

C. 1 year

A patient with HTN has been able to maintain a BP of 130/70 mm Hg for 1 year while reducing dietary sodium and taking HCTZ and atenolol. What treatment plan will the nurse educate the patient about? A. continuing the medication and reducing dietary sodium B. discontinuing the HCTZ and atenolol and continuing to reduce sodium intake C. gradual reducing the HCTZ and the atenolol and continuing to reduce sodium intake D. gradually reducing the atenolol and continuing the HCTZ

C. gradual reducing the HCTZ and the atenolol and continuing to reduce sodium intake

The nurse is caring for a female client who has had 25 mg of oral hydrochlorothiazide added to her medication regimen for the treatment of hypertension (HTN). Which of the following instructions should the nurse give the patient? a) "You may drink alcohol while taking this medication." b) "Take this medication before going to bed." c) "You may develop dry mouth or nasal congestion while on this medication." d) "Increase the amount of fruits and vegetables you eat."

D) "Increase the amount of fruits and vegetables you eat."

A 77-year-old woman presents to the local community center for a blood pressure screening. The women's blood pressure is recorded as 180/90 mm Hg. The woman has a history of hypertension, but she currently is not taking her medications. Which of the following questions is most appropriate for the nurse to ask the patient first? a) "Are you having trouble paying for your medication?" b) "What medications are you prescribed?" c) "Are you able to get to your pharmacy to pick up your medications?" d) "Why is it that you are not taking your medications?"

D) "Why is it that you are not taking your medications?"

The nurse is caring for an elderly client with a diagnosis of hypertension, who is taking several antihypertensive medications. Which saftey 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

Thiazide diuretics are part of this treatment approach for most complications except for: a) Diabetes mellitus b) Heart failure c) Recurrent stroke prevention d) Chronic kidney disease

D) Chronic kidney disease

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

It is important for the nurse to encourage the patient to rise slowly from a sitting or lying position because: a) Gradual changes in position provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain. b) Gradual changes in position help reduce the blood pressure to resupply oxygen to the brain. c) Gradual changes in position help reduce the heart's work to resupply oxygen to the brain. d) Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain.

D) Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain

Which of the following is true regarding the African American population and the development of hypertension? a) Higher incidence of nonfatal stroke b) Decreased rate of stage 2 hypertension c) Later onset of disease d) Greater rate of stage 2 hypertension

D) Greater rate of stage 2 hypertension

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

Which of the following would be inconsistent as a component of metabolic syndrome? a) Elevated triglyceride levels b) Abdominal obesity c) Hypertension d) Hypotension

D) Hypotension

Which of the following would be inconsistent with a hypertensive urgency? a) Severe headache b) Epistaxis c) Anxiety d) Intracranial hemorrhage

D) Intracranial hemorrhage

A patient is admitted to the ICU with a diagnosis of hypertension emergency/crisis. The patient's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV Nitropress (nitroprusside). Upon assessment, which of the following patient findings requires immediate intervention by the nurse? a) Nausea and severe headache b) Chest pain score of 3/10 (on a scale of 1 to 10) c) Urine output of 40 cc/mL over the last hour d) Left arm numbness and weakness

D) Left arm numbness and weakness

The physician is ordering a test for the hypertensive client that will be able to evaluate whether the client has experienced heart damage. Which diagnostic test would the nurse anticipate to determine heart damage? a) Blood chemistry b) Fluorescein angiography c) Chest radiograph d) Multiple gated acquisition scan (MUGA)

D) Multiple gated acquisition scan (MUGA)

The nurse in an oncology clinic notes that the client being treated has hypertension. What tumor is a predisposing condition for secondary hypertension? a) Wilms' tumor b) Astrocytoma c) Lymphoma d) Pheochromocytoma

D) Pheochromocytoma

A nurse is discussing with students how to accurately measure blood pressures. Which of the following information is the nurse certain to emphasize? a) Position the client's forearm above the level of the heart. b) Center the cuff bladder directly over the radial artery. c) The size of the cuff does not matter as long as it fits snugly around the arm. d) Routinely calibrate the sphygmomanometer.

D) Routinely calibrate the sphygmomanometer

The nurse is instructing a client who is newly prescribed an antihypertensive medication. Which nursing instruction is emphasized to maintain client safety? a) Do not operate a motor vehicle. b) Use a pillbox to store daily medication. c) Take the medication at the same time daily. d) Sit on the edge of the chair and rise slowly.

D) Sit on the edge of the chair and rise slowly.

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

You are part of a group of nursing students who are making a presentation on chronic hypertension. What is one subject you would need to include in your presentation as a possible consequence of untreated chronic hypertension? a) Right-sided heart failure b) Pulmonary insufficiency c) Peripheral edema d) Stroke

D) stroke

The nurse is assessing a patient with severe hypertension. When performing a focused assessment of the eyes, what does the nurse understand may be observed related to the hypertension? A. cataracts B. glaucoma C. retinal detachment D. papilledema

D. papilledema

Lifestyle modifications are recommended to prevent and manage hypertension. Select the modification that has been found to have the greatest effect in reducing blood pressure measurements.

Weight reduction

Which of the following statements are true when the nurse is measuring blood pressure (BP)? Select all that apply. a) Using a BP cuff that is too large will give a higher BP measurement. b) The patient's arm should be positioned at the level of the heart. c) The patient's BP should be taken 1 hour after the consumption of alcohol. d) Using a BP cuff that is too small will give a higher BP measurement. e) Ask the patient to sit quietly while the BP is being measured.

b) The patient's arm should be positioned at the level of the heart. d) Using a BP cuff that is too small will give a higher BP measurement. e) Ask the patient to sit quietly while the BP is being measured.

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.

According to the classification of hypertension diagnosed in the older adult, hypertension that can be attributed to an underlying cause is termed

secondary.