CH 32 Hypertension

Which medication should be used with caution in patients with diabetes because the drug may depress the tachycardia associated with hypoglycemia? 1 Diltiazem 2 Metoprolol 3 Prednisone 4 Hydromorphone

2 Metoprolol, a β-adrenergic receptor blocker (β-blocker), slows the heart rate. Tachycardia is a classic symptom of hypoglycemia; therefore patients must be made aware of the failure of the heart rate to respond to decreasing glucose levels and should be instructed to look for other signs of hypoglycemia. Diltiazem and hydromorphone will not affect blood sugars or signs/symptoms of hypoglycemia. Prednisone will increase, not decrease, blood sugar levels.

A patient who is prescribed lisinopril asks about the side effects of this medication. Which side effects would the nurse describe? Select all that apply. 1 Cough 2 Edema 3 Impotence 4 Hypotension 5 Muscle stiffness

1, 4 Cough and hypotension are side effects of angiotensin-converting enzyme (ACE) inhibitors. Peripheral edema is a side effect of calcium channel blockers. Impotence is a side effect of thiazide diuretics, aldosterone receptor blockers, central-acting α-adrenergic antagonists, peripheral-acting α-adrenergic antagonists, β-adrenergic blockers, and mixed α1- and β1-blockers. Muscle stiffness is not associated with an ACE inhibitor.

A patient admitted with a history of hypertension has been taking hydrochlorothiazide daily for the past 10 years. Which parameter would the nurse evaluate to indicate the effectiveness of this drug therapy? 1 Weight loss of 2 lb 2 BP of 118/76 3 Absence of ankle edema 4 Urine output of 600 mL per eight hours

2 Because the patient has been taking this medication for 10 years, the most direct measurement of its long-term intended effect would be normal BP. 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, so weight loss, absence of edema, and urine output would not be as pertinent.

Which information would the nurse teach to a patient who has a new prescription for doxazosin? 1 "Monitor yourself for a fast heart rate, which is a common side effect." 2 "Make position changes slowly, especially from lying down to standing." 3 "The medication also improves breathing by decreasing chest congestion." 4 "It is common for patients who take this medication to experience nausea."

2 Doxazosin is an α-adrenergic blocker and can cause marked orthostatic hypotension. For this reason, the patient should be instructed to rise slowly, especially when moving from a recumbent to a standing position. It is recommended to take the medication at bedtime to reduce the risk of associated orthostatic hypotension. Tachycardia, respiratory effects, and nausea are not evident with the medication.

A patient has not reached goal BP despite taking full doses of an appropriate three-drug therapy regimen, including a diuretic. Which finding in the patient history is the likely cause of resistant hypertension? 1 Increasing obesity 2 Excess pepper intake 3 Consumes peppermints 4 Erectile dysfunction (ED) medication

1 An increase in obesity is one of the causes of resistant hypertension. Licorice (rather than peppermint), excess salt (rather than pepper) intake, and oral contraceptives (rather than ED medications) are also possible causes of resistant hypertension.

A patient with hypertension receives a prescription for chlorothiazide. Which item would the nurse instruct the patient to limit? Correct1 Nonsteroidal antiinflammatory drugs (NSAIDs) Incorrect2 Ginkgo biloba 3 Grapefruit juice 4 Potassium-rich foods

1 Chlorothiazide is a diuretic, which inhibits NaCl reabsorption in the distal convoluted tubule. It increases the excretion of sodium and chloride. NSAIDs can decrease the diuretic and antihypertensive effects of thiazide diuretics and potentially cause renal impairment. Ginkgo biloba and grapefruit juice will not decrease the effectiveness of chlorothiazide. Chlorothiazide can cause hypokalemia; patients are advised to supplement with potassium-rich foods.

A patient whose BP is 200/120 mm Hg receives a prescription for clonidine. Which side effect requires the patient to avoid hazardous activities? 1 Drowsiness 2 Orthostatic hypotension 3 Rapid decrease in BP 4 Rebound hypertension

1 Clonidine is an adrenergic inhibitor that reduces sympathetic outflow from the central nervous system. It lowers BP by reducing peripheral sympathetic tone, dilating the blood vessels, and decreasing the systemic vascular resistance. Drowsiness is a side effect of the drug, and the patient is advised to avoid engaging in hazardous activities because this can increase the risk of injury. The drug also causes orthostatic hypotension, so the patient is advised to change position slowly. The drug does not cause a rapid decrease in BP. The drug can cause rebound hypertension if discontinued abruptly.

Which mechanism of hypertension causes target organ damage? 1 Promotion of atherosclerosis and damage to the walls of the arteries 2 Thickening of the capillary membranes, leading to hypoxia of organs 3 Direct pressure on organs that results in necrosis and replacement of cells with scar tissue 4 Increased blood viscosity that contributes to intravascular coagulation and tissue necrosis

1 Hypertension is a major risk factor for the development of atherosclerosis by mechanisms not yet fully known. However, once atherosclerosis develops, it damages the walls of arteries and reduces circulation to target organs and tissues. Hypertension does not thicken capillary membranes, cause direct pressure on organs, or increase blood viscosity.

A patient who has been taking clonidine for 10 years tells the nurse, "I decided to quit taking the medication a few days ago." For which manifestation would the nurse monitor this patient? 1 Tremors 2 Lethargy 3 Dysphasia 4 Bradycardia

1 Sudden discontinuation may cause withdrawal syndrome, including rebound hypertension, tachycardia, headache, tremors, apprehension, and sweating, Bradycardia, lethargy, and dysphasia are not indicators of withdrawal syndrome.

A patient presents to the emergency department with a sudden rise in BP and a severe headache. Which precaution will the nurse take while administering the prescribed IV labetalol? 1 Keeping the patient supine 2 Monitoring for tachycardia 3 Maintaining seizure precautions 4 Taking the BP every five minutes

1 The patient is experiencing a hypertensive crisis. Labetalol is an α- and β-adrenergic blocker and reduces BP by causing vasodilation and a decrease in heart rate. Patients must be kept supine during IV administration because of the severe orthostatic hypotension that occurs with the medication. The medication will decrease, not increase, the heart rate. The BP should be assessed every two to three minutes during the initial administration of the drug. Seizure activity is not an adverse effect of the medication.

A patient is diagnosed with primary hypertension and asks the nurse what caused the condition. Which response would the nurse give? 1 "There is no identified cause." 2 "A decrease in plasma renin levels." 3 "Too much plaque in the blood vessels." 4 "Kidney disease is the most common cause."

1 There is not one exact cause of primary hypertension; there are several contributing factors. Renal or kidney disease is a cause of secondary hypertension. An increase, not a decrease, in plasma renin levels is a contributing factor in the development of primary hypertension. Hypertension speeds up the process of atherosclerosis in the peripheral blood vessels.

As treatment for hypertensive crisis, a patient has received sodium nitroprusside for three days. For which reason would the nurse plan to monitor the patient's thiocyanate levels? 1 The medication has a long half-life. 2 The medication is metabolized to cyanide, then thiocyanate. 3 An increased level indicates interactions with other drugs the patient is taking. 4 An increased level indicates adverse effects on target organs caused by the medication.

2 Sodium nitroprusside causes arterial vasodilation and reduces systemic vascular resistance. This, in turn, decreases the BP. Sodium nitroprusside is metabolized to cyanide and then to thiocyanate, which can reach lethal levels. Therefore thiocyanate levels should be monitored in patients receiving the drug for more than three days or at doses greater than or equal to 4 mcg/kg/min. An increased level does not indicate adverse effects on target organs. It does not indicate interactions with other medications. The cause of concern and the need to assess the thiocyanate level do not relate to the medication's half-life.

Which laboratory test result indicates the presence of target organ damage in a patient with hypertension? 1 Serum uric acid of 3.8 mg/dL 2 Serum creatinine of 2.6 mg/dL 3 Serum potassium of 3.5 mEq/L 4 Blood urea nitrogen (BUN) of 15 mg/dL

2 The normal serum creatinine level is 0.6 to 1.3 mg/dL. This elevated level of 2.6 mg/dL indicates target organ damage to the kidneys. BUN of 15 mg/dL, serum uric acid of 3.8 mg/dL, and serum potassium of 3.5 mEq/L are within normal limits.

Which instruction is important for the nurse to provide to a patient about the management of stage 1 hypertension? 1 Restrict all caffeine. 2 Restrict sodium intake. 3 Increase protein intake. 4 Use calcium supplements.

2 The patient should decrease the intake of sodium. This will help to control hypertension, which can be aggravated by excessive salt intake, which in turn leads to fluid retention. Caffeine and protein intake do not affect hypertension. Calcium supplements are not recommended to lower BP.

Which actions of a diuretic medication help to control BP? Select all that apply. 1 Vasodilation 2 Reduces plasma volume 3 Promotes sodium and water excretion 4 Reduces vascular response to catecholamines 5 Prevents extracellular calcium from moving into the cells

2, 3, 4 Diuretics are an important component of BP treatment. Diuretics tend to reduce the plasma volume by promoting the excretion of sodium and water. The net result is a reduction in the circulating volume, which causes a decrease in the BP. Diuretics also reduce the vascular response to catecholamines. The blood vessels do not constrict in response to catecholamines; as a result, the BP is reduced. Diuretics do not cause vasodilation or prevent the movement of extracellular calcium into the cells; these effects are brought about by calcium channel blockers.

Which changes in vital signs indicate that a patient who has just stood up is experiencing postural hypotension? 1 Increased systolic BP and/or decreased heart rate (HR) 2 Increased diastolic BP and/or decreased HR 3 Decreased systolic BP, decreased diastolic BP, and/or increased HR 4 Decreased systolic BP, increased diastolic BP, and no change in HR

3 A decrease in both systolic and diastolic BP and an increase in HR would be seen in a patient with postural hypotension. BP drops as the volume of circulating blood decreases when a patient abruptly stands from a lying or sitting position. The HR increases as the heart attempts to compensate by increasing the amount of circulating blood by increasing cardiac output. Increased systolic BP and decreased HR; increased diastolic BP and increased HR; and decreased systolic BP, increased diastolic BP, and no change in HR are all incorrect.

The nurse is teaching an older patient with hypertension about developing an exercise program. Which instructions would the nurse include? 1 Perform weightlifting on a daily basis. 2 Perform flexibility and balance exercises daily. 3 Perform muscle-strengthening activities twice a week. 4 Perform high-intensity activity for 30 minutes on most days.

3 All adults should perform muscle-strengthening activities using the major muscles of the body at least twice a week. Weightlifting is not recommended for a patient with hypertension because it may increase BP. Flexibility and balance exercises are recommended at least twice a week for older adults, especially those at risk for falls. It is recommended to perform moderate-intensity aerobic physical activity for at least 30 minutes on most days (i.e., more than five days a week).

A patient is hospitalized with uncontrolled hypertension. Which diagnostic study will the nurse expect to be prescribed? 1 Cardiac MRI 2 Thyroid function tests 3 Ophthalmic examination 4 CT scan of the head

3 An ophthalmic exam is performed to assess the appearance of the retina and identify target organ damage. It can provide important information about the severity and duration of hypertension. A cardiac MRI, a CT of the head, or thyroid function tests will not provide useful information about hypertension.

A patient with hypertension receives a prescription for lisinopril. Which mechanism of action would the nurse expect from this medication? 1 Blocks α-adrenergic effects 2 Relaxes arterial and venous smooth muscle 3 Inhibits conversion of angiotensin I to angiotensin II 4 Reduces sympathetic outflow from the central nervous system (CNS)

3 Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that inhibits the conversion of angiotensin I to angiotensin II, which reduces angiotensin II-mediated vasoconstriction and sodium and water retention. β-adrenergic receptor blockers (β-blockers) result in vasodilation and a decreased heart rate. Direct vasodilators relax arterial and venous smooth muscle. Central-acting α-adrenergic antagonists reduce sympathetic outflow from the CNS to produce vasodilation and decreased systemic vascular resistance (SVR) and BP.

A patient with hypertension asks the nurse, "What can I do to decrease my BP?" Which information will the nurse provide? 1 "Reduce sodium intake to less than 3000 mg per day." 2 "Restrict alcohol consumption to no more than three drinks daily." 3 "Perform moderate-intensity aerobic physical activity for at least 30 minutes daily." 4 "Reduce weight by 10 pounds, which decreases BP by 20 to 30 mm Hg."

3 Moderate physical activity, such as walking for at least 30 minutes, on at least five days per week is recommended to reduce BP. For those with hypertension, sodium should be restricted to less than or equal to 1500 mg per day. Alcohol consumption should be restricted to no more than one drink per day for women and no more than two drinks per day for men. Weight reduction by 20 lbs leads to a reduction in systolic BP of 5 to 20 mm Hg.

Which systolic BP (SBP) measurement correlates with stage 1 hypertension? 1 118 mm Hg 2 129 mm Hg 3 132 mm Hg 4 142 mm Hg

3 Stage 1 hypertension is defined as an SBP of 130 to 139 or a diastolic BP (DBP) of 80 to 89 mm Hg. Normal BP is defined as an SBP of less than 120 mm Hg and a DBP of less than 80 mm Hg. Elevated BP is defined as an SBP between 120 and 129 mm Hg and a DBP of less than 80 mm Hg. Hypertension (stage 1) is defined as an SBP between 130 and 139 mm Hg and a DBP between 80 and 89 mm Hg. Hypertension (stage 2) is defined as an SBP of greater than 140 mm Hg and a DBP of greater than 90 mm Hg. If either the SBP or DBP is outside of a range, the higher measurement determines the classification.

The nurse notes that there is a difference in a patient's BP and heart rate (HR) when the patient changes position from supine to standing. The differences are a decrease of 20 mm Hg in systolic BP, a decrease of 10 mm Hg in diastolic BP, and an increase in the HR of 20 beats/minute. Which interpretation would the nurse make about the patient's condition? 1 Hypertensive crisis 2 An auscultatory gap 3 Resistant hypertension 4 Orthostatic hypotension

4 A decrease in BP with a change of position indicates orthostatic hypotension. It may manifest as light-headedness, dizziness, or syncope. Intravascular volume loss and inadequate vasoconstrictor mechanisms related to disease or medications are common causes. A hypertensive crisis is characterized by severely elevated BP with or without the presence of target organ damage. An auscultatory gap is commonly seen in elderly patients as a wide gap between the first Korotkoff sound and subsequent beats. Resistant hypertension is a condition in which the patient fails to reach BP goals despite an effective treatment regimen.

An adult patient with no medical history is being seen in a clinic for a routine physical exam. The patient's BP reading is 158/92. The patient asks the nurse: "Does this mean that I have hypertension?" Which response would the nurse provide? 1 "Do not worry. Everything is fine." 2 "It is a normal BP reading for an adult." 3 "Yes, you have hypertension because your BP is over 140/90." 4 "You need a follow-up BP check to make that determination."

4 A diagnosis of hypertension will not be made based on one elevated BP reading. Considering the fact that the patient does not have any medical problems and that this reading is the first elevated BP reading, a follow-up office visit is required. Providing false reassurance to the patient is leading to misinformation. Normal BP is defined as a systolic BP (SBP) of less than 120 mm Hg and a diastolic BP (DBP) of less than 80 mm Hg, so a reading of 158/92 is not normal.

A patient with hypertension has been prescribed an antihypertensive medication. During a follow-up visit, the patient asks if the medication can be stopped because the BP is now within the normal range. Which response would the nurse provide? 1 "You may stop the medication now because your BP is normal." 2 "Begin taking half-doses of the medication because the BP has decreased." 3 "You may stop taking the medication only if you maintain a healthy lifestyle." 4 "Continue the medication unless your health care provider advises discontinuing it."

4 Antihypertensive medications are effective at reducing BP; however, the medications should not be stopped abruptly because this can cause a severe hypertensive reaction. The medications should be discontinued only after consulting with the health care provider. The medication should not be stopped even if the BP measurements show normal readings. Medications should be taken regularly for sustained therapeutic effects. A reduction of the dosage may reduce the efficacy of the drug. Lifestyle modifications are necessary to reduce cardiovascular risks; however, antihypertensive medications should also be used for effective reduction of BP.

A patient's BP reading is 142/91 mm Hg. How should the nurse classify the BP? 1 Normal 2 Prehypertension 3 Hypertension, stage 1 4 Hypertension, stage 2

4 Normal BP is defined as a systolic BP (SBP) of less than 120 mm Hg and a diastolic BP (DBP) of less than 80 mm Hg. Elevated BP is defined as an SBP between 120 and 129 mm Hg and a DBP of less than 80 mm Hg. Hypertension (stage 1) is defined as an SBP between 130 and 139 mm Hg and a DBP between 80 and 89 mm Hg. Hypertension (stage 2) is defined as an SBP of greater than 140 mm Hg and a DBP of greater than 90 mm Hg. If either the SBP or DBP is outside of a range, the higher measurement determines the classification.

The nurse is assessing a patient for orthostatic hypotension. First, the nurse measured the BP and heart rate (HR) with the patient in the supine position. Which action would the nurse take next? 1 Repeat BP and HR every 15 minutes in the supine position. 2 Ask the patient to stand, and then measure the BP and HR within 15 minutes. 3 Move the patient to a standing position and immediately measure the BP and HR. 4 Move the patient to a sitting position and measure the BP and HR within two minutes.

4 When assessing for orthostatic changes, after measuring the BP and HR in the supine position, the patient then is placed in a sitting position, and the BP and HR are measured within one to two minutes. The patient is then repositioned to the standing position, and BP and HR are measured again within one to two minutes. The results then are recorded, with a decrease of 20 mm Hg or more in systolic BP (SBP), a decrease of 10 mm Hg or more in diastolic BP (DBP), or an increase in the pulse of greater than or equal to 20 beats/minute from supine to standing indicating orthostatic hypotension.

A patient has been prescribed atenolol. Which condition should the nurse question the patient about before administering the drug? 1 Asthma 2 Dry cough 3 Depression 4 Diabetes mellitus

4 Diabetes mellitus Atenolol is a cardioselective β-1 blocker that reduces BP by blocking β-adrenergic effects. It should be used with caution in patients with diabetes mellitus because it depresses the tachycardia associated with hypoglycemia and may hinder diagnosing hypoglycemia. A history of asthma, dry cough, or depression does not affect the administration of the drug. Noncardioselective β-adrenergic receptor blockers (β-blockers) should not be used in patients with asthma because of the risk of bronchospasm, but this is not the case with atenolol because it is cardioselective. Angiotensin-converting enzymes may cause a dry cough. Reserpine should not be administered in patients with depression because this may cause the condition to worsen.