Ch. 32 Hypertension

The nurse teaches a 28-yr-old man newly diagnosed with hypertension about lifestyle modifications to reduce his blood pressure. Which patient statement requires reinforcement of teaching? "I will avoid adding salt to my food during or after cooking." "If I lose weight, I might not need to continue taking medications." "I can lower my blood pressure by switching to smokeless tobacco." "Diet changes can be as effective as taking blood pressure medications."

"I can lower my blood pressure by switching to smokeless tobacco." Rationale: 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 (e.g., the DASH diet) lowers blood pressure, and these decreases compare with those achieved with blood pressure-lowering medication.

A 44-yr-old man is diagnosed with hypertension and receives a prescription for benazepril (Lotensin). After providing teaching, which statement by the patient indicates correct understanding? "If I take this medication, I will not need to follow a special diet." "It is normal to have some swelling in my face while taking this medication." "I will need to eat foods such as bananas and potatoes that are high in potassium." "If I develop a dry cough while taking this medication, I should notify my doctor."

"If I develop a dry cough while taking this medication, I should notify my doctor." Rationale: Benazepril is an angiotensin-converting enzyme inhibitor. The medication inhibits breakdown of bradykinin, which may cause a dry, hacking cough. Other adverse effects include hyperkalemia. Swelling in the face could indicate angioedema and should be reported immediately to the prescriber. Patients taking drug therapy for hypertension should also attempt lifestyle modifications to lower blood pressure such as a reduced sodium diet.

The nurse is caring for a patient admitted with a history of hypertension. The patient's medication history includes hydrochlorothiazide daily for the past 10 years. Which parameter would indicate the optimal intended effect of this drug therapy? A. BP 128/78 mm Hg B. Weight loss of 2 lb C. Absence of ankle edema D. Output of 600 mL per 8 hours

A. BP 128/78 mm Hg Rationale: 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. Because 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-yr-old male patient with dementia for treatment of uncontrolled hypertension. The nurse will closely monitor for hypokalemia if the patient receives which medication? Clonidine (Catapres) Bumetanide (Bumex) Amiloride (Midamor) Spironolactone (Aldactone)

Bumetanide (Bumex) Rationale: 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.

The nurse is teaching a women's group about ways to prevent hypertension. What information should the nurse include? (Select all that apply.) Lose weight. Limit beef consumption. Limit sodium and fat intake. Increase fruits and vegetables. Exercise 30 minutes most days.

Limit beef consumption. Limit sodium and fat intake. Increase fruits and vegetables. Exercise 30 minutes most days. Rationale: 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. Beef includes saturated fats, which should be limited. Weight loss may or may not be necessary, depending on the person.

The nurse is caring for a patient with hypertension who is scheduled to receive a dose of metoprolol (Lopressor). The nurse should withhold the dose and consult the prescribing provider for which vital sign taken just before administration? O2 saturation 93% Pulse 48 beats/min Respirations 24 breaths/min Blood pressure 118/74 mm Hg

Pulse 48 beats/min

When teaching a patient about dietary management of stage 1 hypertension, which instruction is appropriate? Increase water intake. Restrict sodium intake. Increase protein intake. Use calcium supplements.

Restrict sodium intake. Rationale: 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. Protein intake does not affect hypertension. Calcium supplements are not recommended to lower blood pressure.

When providing dietary teaching to a patient with hypertension, the nurse would teach the patient to restrict intake of which meat? Broiled fish Roasted duck Roasted turkey Baked chicken breast

Roasted duck Rationale: 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 cardiovascular disease risk. The other meats are lower in fat and are therefore acceptable in the diet.

A pt with newly discovered high BP has avg reading of 158/98 mm Hg after 3 months of exercise and diet modifications. Which management strategy will be a priority for this pt? a. drug therapy will be needed bc BP is still not at goal b. BP monitoring should continue for 3 months to confirm a diagnosis of HTN c. lifestyle changes are less important since they were not effective, and drugs will be started d. more changes in pt lifestyle are needed for longer time before starting drug therapy

a

A pt is admitted to hospital in hypertensive emergency (BP 244/142). Na nitroprusside is started to treat the elevated BP. Which management strategies would be most appropriate for this pt? (select all that apply) a. measure hourly urine output b. continuous BP monitoring with an arterial line c. decreasing MAP by 50% within the first hour d. maintaining bed rest and giving tranquilizers to lower the BP e. assessing the pt for signs and symptoms of heart failure and changes in mental status

a, b, e

which BP regulating mech can result in development of hypertension if defective? select all that apply a. release of NE b. secretion of prostaglandins c. stimulation of SNS e. activation of renin-angiotensin-aldosterone sys

a, c, e Rationale: Norepinephrine (NE) is released from the sympathetic nervous system nerve endings and activates receptors found in the vascular smooth muscle. When the α-adrenergic receptors in smooth muscle of the blood vessels are stimulated by NE, vasoconstriction results. Increased sympathetic nervous system stimulation produces increased vasoconstriction and increased renin release. Increased renin levels activate the renin-angiotensin-aldosterone system, leading to an elevation in BP.

Despite a high dosage, a male patient who is taking nifedipine (Procardia XL) for antihypertensive therapy continues to have blood pressures over 140/90 mm Hg. What should the nurse do next? a. Assess his adherence to therapy. b. Ask him to make an exercise plan. c. Teach him to follow the DASH diet. d. Request a prescription for a thiazide diuretic.

a. Assess his adherence to therapy. Rationale: A long-acting calcium-channel blocker such as nifedipine causes vascular smooth muscle relaxation, resulting in decreased systemic vascular resistance and arterial blood pressure and related side effects. The patient data the nurse has about this patient is very limited, so the nurse needs to begin by assessing adherence to therapy

The nurse supervises an unlicensed assistant personnel (UAP) who is taking the blood pressure of an obese patient admitted with heart failure. Which action by the UAP will require the nurse to intervene? a. Deflating the blood pressure cuff at a rate of 8 to 10 mm Hg/sec b. Waiting 2 minutes after position changes to take orthostatic pressures c. Taking the blood pressure with the patient's arm at the level of the heart d. Taking a forearm blood pressure if the largest cuff will not fit the patient's upper arm

a. Deflating the blood pressure cuff at a rate of 8 to 10 mm Hg/sec Rationale: The cuff should be deflated at a rate of 2 to 3 mm Hg/sec. The arm should be supported at the level of the heart for accurate blood pressure measurements. Using a cuff that is too small causes a falsely high reading and too large causes a falsely low reading. If the maximum size blood pressure cuff does not fit the upper arm, the forearm may be used. Orthostatic blood pressures should be taken within 1 to 2 minutes of repositioning the patient.

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 scar tissue. c. Hypertension causes thickening of the capillary membranes, leading to hypoxia of organ systems. d. Hypertension increases blood viscosity, which causes intravascular coagulation and tissue necrosis distal to occlusions.

a. Hypertension promotes atherosclerosis and damage to the walls of the arteries. Rationale: Hypertension is a major risk factor for the development of atherosclerosis by mechanisms not yet fully known. However, when atherosclerosis develops, it damages the walls of arteries and reduces circulation to target organs and tissues.

Which information should the nurse consider when planning care for older adult patients with hypertension? (Select all that apply.) a. Systolic blood pressure increases with aging. b. White coat syndrome is prevalent in older patients. c. Volume depletion contributes to orthostatic hypotension. d. Blood pressures should be maintained near 120/80 mm Hg. e. Blood pressure drops 1 hour after eating in many older patients. f. Older patients require higher doses of antihypertensive medications.

a. Systolic blood pressure increases with aging. b. White coat syndrome is prevalent in older patients. c. Volume depletion contributes to orthostatic hypotension. d. Blood pressures should be maintained near 120/80 mm Hg. e. Blood pressure drops 1 hour after eating in many older patients. Rationale: Systolic blood pressure increases with age and patients older than age 60 years should be maintained below 150/90 mm Hg. Older adults are more likely to have elevated blood pressure when taken by health care providers (white coat syndrome). Older patients have orthostatic hypotension related to dehydration, reduced compensatory mechanisms, and medications. One hour after eating, many older patients have a drop in blood pressure. Lower doses of medications may be needed to control blood pressures in older adults related to decreased absorption rates and excretion ability.

while obtaining subjective assessment data from a pt with hypertension, the nurse recognizes that a modifiable risk factor for the development of hypertension is a. low ca diet b. excess alc intake c. fam history of hypertension d. consumption of high protein diet

b Rationale: Alcohol intake is a modifiable risk factor for hypertension. Excessive alcohol intake is strongly associated with hypertension. Males with hypertension should limit their daily intake of alcohol to 2 drinks per day, and one drink per day for females with hypertension.

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 Rationale: 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.

A patient with a history of chronic hypertension is being evaluated in the emergency department for a blood pressure of 200/140 mm Hg. Which patient assessment question is the priority? 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? Rationale: 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. In addition, headache or confusion could represent signs and symptoms of a hemorrhagic stroke. 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 explain? 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. Rationale: Lisinopril is an angiotensin-converting enzyme inhibitor that inhibits the conversion of angiotensin I to angiotensin II, which reduces angiotensin II-mediated vasoconstriction and sodium and water retention. β-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 central nervous system to produce vasodilation and decreased systemic vascular resistance and blood pressure.

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. Serum uric acid of 3.8 mg/dL b. Serum creatinine of 2.6 mg/dL c. Serum potassium of 3.5 mEq/L d. Blood urea nitrogen of 15 mg/dL

c. Serum creatinine of 2.6 mg/dL Rationale: The normal serum creatinine level is 0.6 to 1.3 mg/dL. This elevated level indicates target organ damage to the kidneys. The other laboratory results are within normal limits.

The UAP is taking orthostatic vital signs. In the supine position, the blood pressure (BP) is 130/80 mm Hg, and the heart rate (HR) is 80 beats/min. In the sitting position, the BP is 140/80, and the HR is 90 beats/min. Which action should the nurse instruct the UAP to take next? a. Repeat BP and HR in this position. b. Record the BP and HR measurements. c. Take BP and HR with patient standing. d. Return the patient to the supine position.

c. Take BP and HR with patient standing. Rationale: The vital signs taken do not reflect orthostatic changes, so the UAP will continue with the measurements while the patient is standing. There is no need to repeat or delay the readings. The patient does not need to return to the supine position. When assessing for orthostatic changes, the UAP will take the BP and pulse in the supine position, then place the patient in a sitting position for 1 to 2 minutes and repeat the readings, and then reposition to the standing position for 1 to 2 minutes and repeat the readings. Results consistent with orthostatic changes would have a decrease of 20 mm Hg or more in systolic BP, a decrease of 10 mm Hg or more in diastolic BP, and/or an increase in HR of greater than or equal to 20 beats/min with position changes.

A priority consideration in management of older adult with hypertension is to: a. prevent primary hypertension from converting to secondary HTN b. recognize that older adults is less likely to adhere to drug therapy regimen than younger adults c. ensure pt receives larger initial dose of antihypertensive drugs bc of impaired absorption d. use precise technique in assessing BP of pt bc of possible presence of an auscultatory gap

d Rationale: Measure urine output hourly to assess renal perfusion. Patients treated with IV sodium nitroprusside should have continuous intraarterial BP monitoring. Hypertensive crisis can cause encephalopathy, intracranial or subarachnoid hemorrhage, acute left ventricular failure, MI, renal failure, dissecting aortic aneurysm, and retinopathy. The initial treatment goal is to decrease the mean arterial pressure (MAP) by no more than 25% within minutes to 1 hour. Patients receiving IV antihypertensive drugs may be restricted to bed rest. Getting up (e.g., to use the toilet/commode) may cause severe cerebral ischemia and fainting.

in teaching a pt with hypertension about controlling the illness, the nurse recognizes that a. all pt with elevated BP need drug therapy b. obese person must achieve normal weight to lower BP c. it is not necessary to limit salt in diet if taking diuretic d. lifestyle mod are needed for all person with elevated BP

d Rationale: The patient has hypertension, stage 1. Lifestyle modifications will continue, but starting drug therapy is a priority. Reducing BP can help to prevent serious complications related to hypertension.

A 67-yr-old woman with hypertension is admitted to the emergency department with a blood pressure of 234/148 mm Hg and was started on nitroprusside (Nitropress). After 1 hour of treatment, the mean arterial blood pressure (MAP) is 55 mm Hg. Which nursing action is a priority? a. Start an infusion of 0.9% normal saline at 100 mL/hr. b. Maintain the current administration rate of the nitroprusside. c. Request insertion of an arterial line for accurate blood pressure monitoring. d. Stop the nitroprusside infusion and assess the patient for potential complications.

d. Stop the nitroprusside infusion and assess the patient for potential complications. Rationale: Nitroprusside is a potent vasodilator medication. A blood pressure of 234/118 mm Hg would have a calculated MAP of 177 mm Hg. Subtracting 25% (or 44 mm Hg) = 133 mm Hg. The initial treatment goal is to decrease MAP by no more than 25% within minutes to 1 hour. For this patient, the goal MAP would be around 133 mm Hg. Minimal MAP required to perfuse organs is around 60 to 65 mm Hg. Lowering the blood pressure too rapidly may decrease cerebral, coronary, or renal perfusion and could precipitate a stroke, myocardial infarction, or renal failure. The priority is to stop the nitroprusside infusion and then use fluids only if necessary to support restoration of MAP.