ch13: htn
A 77-year-old client presents to the local community center for a blood pressure (BP) screening; BP is recorded as 180/90 mm Hg. The client has a history of hypertension but currently is not taking the prescribed medications. Which question is most appropriate for the nurse to ask the client first? "Are you able to get to your pharmacy to pick up your medications?" "Can you tell me the reasons you aren't taking your medications?" "Are you having trouble paying for your medications?" "What medications are you prescribed?"
"Can you tell me the reasons you aren't taking your medications?" It is important for the nurse to first ascertain why the client is not taking prescribed medications. Adherence to the therapeutic program may be more difficult for older adults. The medication regimen can be difficult to remember, and the expense can be a challenge. Monotherapy (treatment with a single agent), if appropriate, may simplify the medication regimen and make it less expensive. The other questions are appropriate, but the priority is to determine why the medication regimen is not being followed.
A client with high blood pressure is receiving an antihypertensive drug. When developing a client teaching plan to minimize orthostatic hypotension, which instruction should the nurse include? "Flex your calf muscles, avoid alcohol, and change positions slowly." "Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising." "Rest between demanding activities, eat plenty of fruits and vegetables, and drink 6 to 8 cups of fluid daily." "Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night."
"Flex your calf muscles, avoid alcohol, and change positions slowly." Measures that minimize orthostatic hypotension include flexing the calf muscles to boost blood return to the heart, avoiding alcohol and straining at stool, changing positions slowly, eating a high-protein snack at night, wearing elastic stockings, and holding onto a stationary object when rising. Although the client should rest between demanding activities and consume plenty of fluids and fiber (contained in fruits and vegetables) to maintain a balanced diet, these measures don't directly relieve orthostatic hypotension.
A 55-year-old male client newly diagnosed with hypertension returns to the physician's office for a routine follow-up appointment after several months of treatment with metoprolol. During the initial assessment, the nurse records the client's blood pressure (BP) as 180/90 mm Hg. The client states that the medication is not taken as prescribed. Which is the best response by the nurse? "Your hypertension must be treated with medications; you need to take your metoprolol every day." "It is very important for you to take your medication as prescribed, or you could experience a stroke." "The medication you were prescribed may cause sexual dysfunction; are you experiencing this side effect?" "Be certain to discuss your noncompliance with your medication regimen with the physician."
"The medication you were prescribed may cause sexual dysfunction; are you experiencing this side effect?" The nurse needs to understand why the client is not taking the medication. Metoprolol is a beta-blocker. All clients should be informed that beta-blockers might cause sexual dysfunction and that other medications are available if problems with sexual function occur. The other statements, although true, are not therapeutic and would not elicit the reason why the client was not taking the medication as prescribed.
A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. What will the nurse specify about this client's target blood pressure? 145/95 or lower 150/95 or lower 130/80 or lower 125/85 or lower
130/80 or lower The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) specifies a lower goal pressure of 130/80 for people with diabetes mellitus.
According to the DASH diet, how many servings of vegetables should a person consume each day? 2 or fewer 2 or 3 4 or 5 7 or 8
4 or 5 Four or five servings of vegetables are recommended in the DASH diet. The diet recommends two or fewer servings of lean meat, fish, and poultry; two or three servings of low-fat or fat-free dairy foods; and seven or eight servings of grains and grain products.
The nurse is explaining the DASH diet to a client diagnosed with hypertension. The client inquires about how many servings of fruit per day can be consumed on the diet. What is the nurse's best response? 7 or 8 servings per day 2 or 3 servings per day 4 or 5 servings per day 2 or fewer servings per day
4 or 5 servings per day The client can consume 4 or 5 servings of fruit per day on the DASH diet. The servings for grains and grain product is 7 or 8. Two or 3 servings of low-fat or fat-free dairy foods can be consumed per day. Meat, fish, and poultry servings are 2 or fewer per day.
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? Lowering and controlling the blood pressure without adverse effects and without undue cost Making sure that the patient adheres to the therapeutic medication regimen Instructing the patient to enter a weight loss program and begin an exercise regimen Scheduling the patient for all follow-up visits and making phone calls to the home to ensure adherence
Lowering and controlling the blood pressure without adverse effects and without undue cost The objective of nursing care for patients with hypertension focuses on lowering and controlling the blood pressure without adverse effects and without undue cost.
The nurse is instructing a student on the proper technique for measuring blood pressure (BP). Which student action indicates a need for further teaching? Positions the arm at waist level Palpates the systolic pressure before auscultating blood pressure Centers the blood pressure cuff bladder directly over the brachial artery Wraps the blood pressure cuff firmly around the arm
Positions the arm at waist level Positioning the arm above the heart level will give a falsely low reading. Placing the arm below the heart will falsely elevate the reading. All other options are correct steps in achieving an accurate blood pressure.
A patient comes to the walk-in clinic. While assessing the patient's vital signs, the nurse assesses the patient's blood pressure at 128/89 mm Hg. According to JNC7, how would this patient's blood pressure be classified? Hypertensive Slightly hypertensive Prehypertensive Normal
Prehypertensive JNC7 defines a blood pressure of less than 120/80 mm Hg diastolic as normal, 120 to 129/80 to 89 mm Hg as prehypertension, and 140/90 mm Hg or higher as hypertensive.
A client is brought to the emergency department with reports 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? Reduce the blood pressure by 50% within the first hour of treatment. Reduce the blood pressure by 20% to 25% within the first hour of treatment. Reduce the blood pressure to about 140/80 mm Hg. Rapidly reduce the blood pressure so the client will not suffer a stroke.
Reduce the blood pressure by 20% to 25% within the first hour of treatment. A hypertensive emergency is a situation in which blood pressures are extremely elevated and must be lowered immediately (not necessarily to less than 140/90 mm Hg) to halt or prevent damage to the target organs (Chobanian et al., 2003; Rodriguez et al., 2010). Hypertensive emergencies are acute, life-threatening blood pressure elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. The therapeutic goals are reduction of the mean blood pressure by 20% to 25% within the first hour of treatment, a further reduction to a goal pressure of about 160/100 mm Hg over a period of up to 6 hours, and then a more gradual reduction in pressure over a period of days.
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 condition contributes to secondary hypertension? hepatic function calcium deficit acid-base imbalance arterial vasoconstriction
arterial vasoconstriction vSecondary hypertension may accompany any primary condition that affects fluid volume or renal function, or causes arterial vasoconstriction.
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? "Have you taken your prescribed clonidine today?" "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?" The nurse must ask whether the client has taken his prescribed clonidine. Clients need to be informed that rebound hypertension can occur if antihypertensive medications are suddenly stopped. Specifically, a side effect of clonidine is rebound or withdrawal hypertension. Although the other questions may be asked, it is most important to inquire whether the client has taken the prescribed hypertension medication given the client's severely elevated BP.
The nurse is assessing the blood pressure for a patient who has hypertension and the nurse does not hear an auscultatory gap. What outcome may be documented in this circumstance? A low diastolic reading A high systolic pressure reading A normal reading A high diastolic or low systolic reading
A high diastolic or low systolic reading An auscultatory gap is when the Korotkoff sounds disappear for a brief period as the cuff is being deflated. Failure to notice an auscultatory gap can result in erroneously high diastolic or low systolic pressure readings (Ogedegbe & Pickering, 2010).
An older adult client visits the clinic for a blood pressure check. The client's hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about blood pressure medicine? A severe drop in blood pressure is possible. Take the medicine on an empty stomach. There are no adverse effects from blood pressure medicine. A possible adverse effect of blood pressure medicine is dizziness when you stand.
A possible adverse effect of blood pressure medicine is dizziness when you stand. A possible adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. Teaching should include tips for managing syncope and dizziness. The nurse would not teach the client to take the medicine on an empty stomach.
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? Loop diuretic Calcium channel blocker ACE inhibitor Beta-blocker
ACE inhibitor The angiotensin-converting enzyme (ACE) inhibitor's primary action is to prevent the conversion of angiotensin I to angiotensin II, a potent vasoconstricting hormone in the blood. A beta-blocker blocks the beta-adrenergic receptors decreasing sympathetic nervous system stimulation. Loop diuretics excrete water from the loop of Henle, reducing circulating blood volume. Calcium channel blockers dilate coronary and peripheral arteries.
A client has severe coronary artery disease (CAD) and hypertension. Which medication order should the nurse consult with the health care provider about that is contraindicated for a client with severe CAD? Bumetanide Methyldopa Amiloride Clonidine
Clonidine Clonidine (Catapres) is contraindicated for clients with severe coronary artery disease.
When administering benazepril with spironolactone, the nurse should be aware that which electrolyte imbalance may occur? Hyperkalemia Hypocalcemia Hypercalcemia Hypokalemia
Hyperkalemia ACE inhibitors like benazepril (Lotensin) and angiotensin receptor blockers (ARBs) block aldosterone and may cause hyperkalemia when used with a potassium sparing diuretic such as spironolactone (Aldactone). Hypercalcemia and hypocalcemia would not occur as an imbalance.
A client is taking 50 mg of oral spironolactone twice a day to assist with blood pressure control. While the nurse is performing the morning assessment, the client reports nausea, general muscle cramps, and weakness. The ECG strip shows a peaked, narrow T-wave, which is a change. What electrolyte imbalance does the nurse suspect? Hyponatremia Hyperkalemia Hypernatremia Hypokalemia
Hyperkalemia Potassium-sparing diuretics, such as spironolactone, can cause hyperkalemia, especially if given with an ACE inhibitor. Signs of hyperkalemia are nausea, diarrhea, abdominal cramps, and peaked narrow T-waves.
A team of public health nurses are strategizing around a new initiative that will address screening, education, and management of hypertension in residents of the community. Which of the following facts surrounding hypertension should underlie the nurses' design of this health initiative? Hypertension is among the health problems that are most difficult to treat successfully. Hypertension is difficult to identify in many of the individuals who are at highest risk of the problem. Hypertension tends to be inadequately managed in many of the people who have been diagnosed with the problem. Many of the pathophysiological effects of hypertension are poorly understood in the health literature.
Hypertension tends to be inadequately managed in many of the people who have been diagnosed with the problem. Many of the deleterious effects of hypertension are due to the fact that the problem is grossly undermanaged. The negative consequences of hypertension are not primarily due to a lack of scientific understanding, difficulty in diagnosis, or a lack of treatment options.
The staff educator is talking to a group of new emergency department nurses about hypertensive crises. The nurse educator is aware that hypertensive urgency differs from hypertensive emergency in what way? The patient's blood pressure (BP) is always higher in a hypertensive emergency. Close hemodynamic monitoring is required during treatment of hypertensive emergencies. Hypertensive emergencies are associated with evidence of target organ damage. Hypertensive urgency is treated with rest and tranquilizers to lower BP.
Hypertensive emergencies are associated with evidence of target organ damage. Hypertensive emergencies are acute, life-threatening blood pressure elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. Blood pressures are extremely elevated in both urgency and emergency; however, there is no evidence of target organ damage in hypertensive urgency. Extremely close hemodynamic monitoring of the patient's blood pressure is required in both. The medications of choice in hypertensive emergencies are those with an immediate effect, such as IV vasodilators. Oral doses of fast-acting agents such as beta-adrenergic blocking agents, angiotensin-converting enzyme inhibitors, or alpha agonists are recommended for the treatment of hypertensive urgencies.
A client is being seen at the clinic on a monthly basis for assessment of blood pressure. The client has been checking blood pressure at home as well and has reported a systolic pressure of 158 and a diastolic pressure of 64. What does the nurse suspect this client is experiencing? Isolated systolic hypertension Secondary hypertension Primary hypertension Hypertensive urgency
Isolated systolic hypertension As a result of changes that occur with aging, the aorta and large arteries are less able to accommodate the volume of blood pumped out by the heart (stroke volume), and the energy that would have stretched the vessels instead elevates the systolic blood pressure, resulting in an elevated systolic pressure without a change in diastolic pressure. This condition, known as isolated systolic hypertension, is more common in older adults and is associated with significant cardiovascular and cerebrovascular morbidity and mortality (Chobanian et al., 2003).
The nurse is conducting a service project for a local elderly community group on the topic of hypertension. The nurse will relay that which risk factors and cardiovascular problems are related to hypertension? Select all that apply. Decreased low-density lipoprotein (LDL) levels Overweight/obesity Age ≥65 in women Elevated high-density lipoprotein (HDL) cholesterol Smoking
Overweight/obesity Age ≥65 in women Smoking Major risk factors (in addition to hypertension) include smoking, dyslipidemia (high LDL, low high-density lipoprotein cholesterol), diabetes mellitus, impaired renal function, obesity, physical inactivity, age (younger than 45 years for men, 65 years and older for women), and family history of cardiovascular disease.
When measuring the blood pressure in each arm of a healthy adult client, the nurse recognizes that which statement is true? Pressures may vary 10 mm Hg or more between arms. Pressures may vary, with the higher pressure found in the left arm. Pressures must be equal in both arms. Pressures should not differ more than 5 mm Hg between arms.
Pressures should not differ more than 5 mm Hg between arms. Normally, in the absence of any disease of the vasculature, arm pressures differ by no more than 5 mm Hg. The pressures in each arm do not have to be equal to be considered normal. Pressures that vary more than 10 mm Hg between arms are an abnormal finding. The left arm pressure is not anticipated to be higher than the right as a normal anatomic variant.
A 35-year-old client has been diagnosed with hypertension. The client is a stock broker, smokes daily, and has diabetes. During a follow-up appointment, the client states that regular visits to the doctor just to check blood pressure (BP) are cumbersome and time consuming. As the nurse, which aspect of client teaching would you recommend? Purchasing a self-monitoring BP cuff Discussing methods for stress reduction Advising smoking cessation Administering glycemic control
Purchasing a self-monitoring BP cuff Because this client finds visiting the doctor time-consuming just for a BP reading, as the nurse, you can suggest the use of an automatic cuff at a local pharmacy, or purchasing a self-monitoring cuff. Discussing methods to reduce stress, advising smoking cessation, and achieving glycemic control would constitute client education in managing hypertension.
A 40-year-old man newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the patient and advises that the patient should avoid tobacco use. What is the rationale behind that advice to the patient? Smoking directly causes high blood pressure. Smoking increases cardiac output. Smoking causes obesity, which exacerbates hypertension. Smoking increases the risk of heart disease.
Smoking increases the risk of heart disease. Smoking does not cause high blood pressure, but it does increase the risk for heart disease. A patient with hypertension is already at an increased risk of heart disease. Smoking does not directly cause obesity and it does not increase cardiac output.
The nurse is obtaining a health history from a client with a blood pressure of 146/88 mm Hg. The client states that lifestyle changes have not been effective in lowering blood pressure. Which medication classification does the nurse anticipate first? Calcium channel blocker Beta-blocker Thiazide diuretic ACE inhibitors
Thiazide diuretic Clients with hypertension, unable to be lowered by lifestyle changes, usually are placed on a thiazide diuretic initially. However, most people with hypertension will need two or more antihypertensive medications to reduce their blood pressure.
A client in a clinic setting has just been diagnosed with hypertension. When the client asks what the end goal is for treatment, what is the nurse's best response? To stop smoking and increase physical activity to 30 minutes/day most days of the week To lose weight, achieve a body mass index of 24 or less, and to eat a diet rich in fruits and vegetables To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less
To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less The end goal of hypertension treatment is to prevent complications and death by achieving and maintaining arterial blood pressure at 140/90 or lower for most people. To achieve this end goal, the client is taught to make the following lifestyle changes (these are not end goals; they are ways to reach the end goal listed above): (1) maintaining a normal body mass index (about 24; greater than 25 is considered overweight); maintaining a waist circumference of less than 40 inches for men and 35 inches for women; limiting alcohol intake to no more than 2 drinks for men and 1 drink for women per day; engaging in aerobic activity at least 30 minutes per day most days of the week.
The nurse is discussing the role of lifestyle modifications with a patient who has a diagnosis of primary hypertension. Which of the following lifestyle modifications typically results in the greatest reduction in blood pressure (BP)? Reduction in salt intake Weight loss Vigilant blood pressure monitoring Reduction in alcohol intake
Weight loss Research has demonstrated that a weight loss of only 10 pounds may result in a 5 to 20 mm Hg reduction in systolic BP, offering tangible results to the patient. Limiting alcohol and sodium intake are important lifestyle modifications, but neither causes as large an effect on BP as weight loss. Blood pressure monitoring is important but does not directly cause a reduction in blood pressure.
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? limbic system parasympathetic nervous system kidneys lungs
kidneys The autonomic nervous system, the kidneys, and various endocrine glands regulate arterial pressure.