Chapter 27- hypertension

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

"Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg." Explanation: An individual with diabetes mellitus should strive for blood pressure of 120/80 mm Hg or less. An individual without diabetes should strive for blood pressure of 140/90 mm Hg or less. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Medical Management, p. 870.

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? - "Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night." -"Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising." - "Flex your calf muscles, avoid alcohol, and change positions slowly." - "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." Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Quality and Safety Nursing Alert, p. 879.

The nurse is caring for a client who has had 25 mg of oral hydrochlorothiazide added to the medication regimen for the treatment of hypertension. Which instruction should the nurse give the client? - "Take this medication before going to bed." - "Increase the amount of fruits and vegetables you eat." -"You may develop nasal congestion or depression while taking this medication." -"You may drink alcohol while taking this medication."

"Increase the amount of fruits and vegetables you eat." Explanation: Thiazide diuretics cause loss of sodium, potassium, and magnesium, so the client should be encouraged to eat fruits and vegetables that are high in potassium. Diuretics cause increased urination; the client should not take the medication before going to bed. Thiazide diuretics do not cause dry mouth or nasal congestion; both side effects are associated with alpha2-agonists. Postural hypotension may be potentiated by alcohol. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, TABLE 27-4 Oral Medication Therapy for Hypertension, p. 872.

The nurse is teaching a client about recommended follow-up for a person initially diagnosed with prehypertension. What time frame will the nurse advise the client to have the blood pressure (BP) rechecked? -1 year -2 years -Confirm within 2 months -Evaluate within 1 month

1 year Explanation: A client with an initial BP in the prehypertension range should have another BP check in 1 year. A normal BP should be rechecked in 2 years. Grade 1 hypertension should be confirmed and followed up within 2 months. Grade 2 hypertension should be evaluated or referred to a source of care within 1 month. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, p. 866.

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 Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, TABLE 27-3, p. 871.

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. Increased blood urea nitrogen and serum creatinine levels A blood pressure reading greater than 130/85 mm Hg Dyslipidemia and/or abdominal obesity Insulin resistance

A blood pressure reading greater than 130/85 mm Hg Dyslipidemia and/or abdominal obesity Insulin resistance Explanation: Pathologic changes in the kidneys, indicated by increased blood urea nitrogen and serum creatinine levels, are not part of the metabolic syndrome that is a risk factor for hypertension. However, with advanced cardiovascular disease, these signs may occur. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Clinical Manifestations, p. 869.

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

A client diagnosed with kidney disease Explanation: Secondary hypertension is an elevated blood pressure that results from or is secondary to some other disorder such as kidney disease, a tumor of the adrenal medulla, or atherosclerosis. Depression alone is typically not associated with hypertension. Advanced age and alcohol intake are considered factors for essential hypertension. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, p. 866.

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? -Beta-blocker -ACE inhibitor -Loop diuretic -Calcium channel blocker

ACE inhibitor Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, TABLE 27-4 Oral Medication Therapy for Hypertension, p. 872.

A client with newly diagnosed hypertension asks what to do to decrease the risk for related cardiovascular problems. Which risk factor is not modifiable by the client? -Age -Obesity -Inactivity -Dyslipidemia

Age Explanation: Age and family history for cardiovascular disease are risk factors that cannot be changed. Obesity, inactivity, and dyslipidemia are risk factors that can be improved by the client through dietary changes, exercise, and other healthy lifestyle choices. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, p. 866. Chapter 27: Assessment and Management of Patients with Hypertension - Page 866

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. Which client statement confirms that the teaching has been successful? - "Antihypertensive drugs can lead to falls." - "Constant thirst is a common side effect of antihypertensive therapy." -"Insomnia is a common side effect of antihypertensive medications." -"Antihypertensives can lead to memory loss."

Antihypertensive drugs can lead to falls." Explanation: One of the side effects of all antihypertensive drugs is hypotension, which can lead to falls. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Continuing and Transitional Care, p. 879. Gg

A client has been prescribed three medications for hypertension and the nurse measured a blood pressure of 180/80. Which question will the nurse ask the client first? "Have you stopped exercising?" "Are you still taking the medication?" "Are you following the low-sodium diet?" "How much stress are you experiencing?"

Are you still taking the medication?" Explanation: If blood pressure medication is stopped abruptly, the client is at risk for rebound hypertension. Since the client has had normal blood pressure measurements over the last 3 months, the first question that should be asked when the blood pressure is elevated is to find out if the client is still taking the medication. Physical inactivity, sodium, and stress can cause elevated blood pressure, however, based upon the client's history, asking about medications would be the first important question to ask the client. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Educating Patients About Self-Care, p. 878. Chapter 27: Assessment and Management of Patients with Hypertension - Page 878

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 having trouble paying for your medications?" -"Can you tell me the reasons you aren't taking your medications?" - "What medications are you prescribed?" -"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?" Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, NURSING PROCESS, The Patient with Hypertension, p. 879.

An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed the client hydrochlorothiazide and enalapril. What will the nurse be sure to include in educating this client? -Change positions (lying or sitting to standing) slowly. -Check blood pressure every day for signs of rebound hypertension. -Do not become dependent on canes, walkers, or handrails. -Eat plenty of salty food to prevent hypotension.

Change positions (lying or sitting to standing) slowly. Explanation: Antihypertensive medications can cause hypotension, especially postural hypotension that may result in injury. The nurse teaches clients to change positions slowly when moving from a lying or sitting position to a standing position. Rebound hypertension occurs when antihypertensive medications are stopped abruptly. The nurse also counsels elderly clients to use supportive devices such as handrails and walkers to prevent falls that could result from dizziness. Eating salty foods could defeat the purpose of taking the antihypertensive medications. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Continuing and Transitional Care, p. 879.

The nurse is caring for an elderly client with a diagnosis of hypertension, who is taking several antihypertensive medications. Which safety precaution is the nurse most likely to reinforce? -Changing positions slowly related to possible hypotension -Eating extra potassium due to loss of potassium related to medications -Being sure to keep follow-up appointments -Walking as far as the client is able every day

Changing positions slowly related to possible hypotension Explanation: The elderly have impaired cardiovascular reflexes and thus are more sensitive to the extracellular volume depletion caused by diuretics and to the sympathetic inhibition caused by adrenergic antagonists. The nurse teaches clients to change positions slowly when moving from a lying or sitting position to a standing position. This will help prevent falls. Eating extra potassium is not a good idea if taking a potassium-sparing diuretic. The other choices are good teaching points, but not necessarily safety precautions. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Continuing and Transitional Care, p. 879. Chapter 27: Assessment and Management of Patients with Hypertension - Page 879

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? -Clonidine -Amiloride -Bumetanide -Methyldopa

Clonidine Explanation: Clonidine (Catapres) is contraindicated for clients with severe coronary artery disease. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, TABLE 27-4 Oral Medication Therapy for Hypertension, p. 874. Chapter 27: Assessment and Management of Patients with Hypertension - Page 874

A client diagnosed with primary hypertension comes to the clinic for a follow-up visit to determine effectiveness of medication regimen. Which retinal changes will be the focus of the client's assessment? Select all that apply. -Hemorrhages -Glaucoma -Cranial nerve damage Cotton wool spots -Papilledema

Cotton wool spots Papilledema Hemorrhages Retinal changes such as hemorrhages, arteriolar narrowing, and cotton-wool spots (opaque fluffy white patches on the retina of the eye) occur with hypertension. In severe hypertension, papilledema (swelling of the optic disc) may also be seen as indicative of damage elsewhere in the vascular system as a result of hypertension. Glaucoma and cranial nerve damage are not normally caused by hypertension. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, Clinical Manifestations, p. 868.

client has just been diagnosed with prehypertension. What would the nurse instruct this client to do to restore blood pressure below hypertensive levels? -Increase iodine intake -Decrease sodium intake -Increase fluid intake -Avoid over-the-counter decongestants

Decrease sodium intake Explanation: The nurse should instruct clients with prehypertension to avoid or decrease sodium and iodine intake. Increasing fluid intake raises circulating blood volume and systemic vascular resistance. Over-the-counter decongestants decrease pulmonary congestion and not hypertension. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, p. 866.

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? -Cardiac catheterization -Echocardiography -Stress test -Tilt-table test

Echocardiography Explanation: Left ventricular hypertrophy can be assessed by echocardiography, but not by any of the other measures listed. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Assessment and Diagnostic Findings, p. 870. Chapter 27: Assessment and Management of Patients with Hypertension - Page 870

A nurse is teaching about lifestyle modifications to a group of clients with known hypertension. Which statement would the nurse include in the education session? -Maintain a body mass index between 30 and 35. -Engage in aerobic activity at least 30 minutes/day most days of the week. - -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.

Engage in aerobic activity at least 30 minutes/day most days of the week. Explanation: Recommended lifestyle modifications to prevent and manage hypertension include maintaining a normal body mass index (about 24; greater than 25 is considered overweight), maintaining a waist circumference of less than 40 inches for men and 35 inches for women, limiting alcohol intake to no more than 2 drinks for men and 1 drink for women per day, and engaging in aerobic activity at least 30 minutes per day most days of the week. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, TABLE 27-2 Lifestyle Modifications to Prevent and Manage Hypertension, p. 871.

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? -Secondary -Pathologic -Malignant -Essential (primary)

Essential (primary) Explanation: Essential or primary hypertension, about 95% of cases, is sustained elevated BP with no known cause. This client does not have secondary, pathologic, or malignant hypertension. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, p. 866.

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? -Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night." - "Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising." - "Flex your calf muscles, avoid alcohol, and change positions slowly." -"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." Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Quality and Safety Nursing Alert, p. 879.

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

Green pepper stuffed with diced tomatoes and chicken Explanation: Fresh vegetables are low in sodium. Chicken with with fresh diced tomatoes and green pepper is a good low-sodium, high vegetable and protein selection. Cheese and soup (tomato and creamed) are high in sodium. Processed meats such as hot dogs and condiments such as ketchup are high in sodium. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, TABLE 27-2 Lifestyle Modifications to Prevent and Manage Hypertension, p. 871. Chapter 27: Assessment and Management of Patients with Hypertension - Page 871

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?" Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension , TABLE 27-4 Oral Medication Therapy for Hypertension (continued), p. 874.

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

Hypertensive emergency Explanation: A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage. Hypertensive urgency is a situation in which blood pressure is severely elevated but there is no evidence of actual or probable target organ damage. Secondary hypertension is high blood pressure from an identified cause, such as renal disease. Primary hypertension denotes high blood pressure from an unidentified source. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertensive Crises, Hypertensive Emergency, p. 880.

A patient arrives at the clinic for a follow-up visit for treatment of hypertension. The nurse obtains a blood pressure 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? -Hypertensive emergency -Primary hypertension -Secondary hypertension -Hypertensive urgency

Hypertensive urgency Explanation: Hypertensive urgency describes a situation in which blood pressure is very elevated but there is no evidence of impending or progressive target organ damage (Chobanian et al., 2003). Elevated blood pressures associated with severe headaches, nosebleeds, or anxiety are classified as urgencies. In these situations, oral agents can be administered with the goal of normalizing blood pressure within 24 to 48 hours (Rodriguez et al., 2010). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertensive urgency, p. 879.

A client diagnosed with hypertension informs the nurse that they are not taking prescribed antihypertensive medications due to an absence of symptoms. What is the most appropriate response by the nurse? -Inform the client that this is why hypertension is known as "the silent killer." -Inform the client that remaining unmedicated is all right in conjunction with routine follow-up. -Suggest that the client try an herbal supplement instead. -Inform the client there should be no problems as long as she a low sodium diet is maintained.

Inform the client that this is why hypertension is known as "the silent killer." Explanation: Hypertension is known as "the silent killer" because many people never experience any troubling symptoms until they are in an extremely dangerous medical position. Sometimes the condition actually leads to death without any warning. That is why it is important to take medications as prescribed in addition to following the recommended diet. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Clinical Manifestations, p. 868.

A client experiences orthostatic hypotension while receiving furosemide to treat hypertension. How will the nurse intervene? Administer I.V. fluids as ordered. Administer an isosorbide 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. Explanation: To minimize the effects of orthostatic hypotension, the nurse should instruct the client to rise slowly, such as by sitting for several minutes before standing. Administering I.V. fluids would be inappropriate (unless the client were dehydrated) because doing so would counteract the effects of furosemide and could cause fluid imbalance. Administering a vasodilator, isosorbide, would further reduce the client's blood pressure, worsening orthostatic hypotension. Inserting an indwelling urinary catheter would make it easier to monitor urine output, but wouldn't minimize the effects of orthostatic hypotension. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Continuing and Transitional Care, p. 879.

Which of the following would be inconsistent with a hypertensive urgency? -Intracranial hemorrhage -Severe headache -Epistaxis -Anxiety

Intracranial hemorrhage Explanation: Elevated blood pressure in hypertensive urgency is associated with severe headache, epistaxis, and anxiety. An example of a hypertensive emergency is a myocardial infarction, intracranial hemorrhage, or dissecting aortic aneurysm. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertensive Crises, p. 879.

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 Explanation: 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). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Gerontologic Considerations, p. 879.

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

It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. Explanation: It takes 2 to 3 months for the taste buds to adapt to changes in salt intake. Knowing this may help the client adjust to reduced salt intake. The client should be advised to limit alcohol intake. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Increasing Knowledge, p. 878.

Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension? - "A glass of red wine each day will lower my blood pressure." -"I should eliminate caffeine from my diet to 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." Explanation: To lower blood pressure, a client should limit daily salt intake to 2 g or less. Alcohol intake is associated with a higher incidence of hypertension, poor compliance with treatment, and refractory hypertension. Moderate caffeine and fat intake don't significantly affect blood pressure Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, TABLE 27-2 Lifestyle Modifications to Prevent and Manage Hypertension, p. 871.

The nurse is caring for an older adult 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? -Loss of arterial elasticity -Decrease in blood volume -Increase in calcium intake -Decrease in cardiac output

Loss of arterial elasticity Explanation: In older clients, systolic BP may be elevated because of loss of arterial elasticity (arteriosclerosis). Systolic BP would not become elevated by a decrease in blood volume, an increase in calcium intake, or a decrease in cardiac output. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, TABLE 27-1 Comparing Blood Pressure Classifications by Key Guidelines for Adults Age 18 and Older, p. 866.

The nurse is caring for an older adult 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? -Loss of arterial elasticity -Decrease in blood volume -Increase in calcium intake -Decrease in cardiac output

Loss of arterial elasticity Explanation: In older clients, systolic BP may be elevated because of loss of arterial elasticity (arteriosclerosis). Systolic BP would not become elevated by a decrease in blood volume, an increase in calcium intake, or a decrease in cardiac output. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, TABLE 27-1 Comparing Blood Pressure Classifications by Key Guidelines for Adults Age 18 and Older, p. 866. Chapter 27: Assessment and Management of Patients with Hypertension - Page 866

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 Explanation: The objective of nursing care for patients with hypertension focuses on lowering and controlling the blood pressure without adverse effects and without undue cost. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Nursing Interventions, p. 878.

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

Numbness and weakness in the left arm Explanation: Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. The finding of numbness and weakness in left arm may indicate the client is experiencing neurological symptoms associated with an ischemic stroke because of the severely elevated BP; immediate intervention is required. Urine output of 40 mL/h is within normal limits. The other findings are likely caused by the hypertension and require intervention, but they do not require action as urgently as the neurologic changes. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertensive Crises, Hypertensive Emergency, p. 880.

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? -Cataracts -Glaucoma -Retinal detachment -Papilledema

Papilledema Explanation: Physical examination may reveal no abnormalities other than elevated blood pressure. Occasionally, retinal changes such as hemorrhages, exudates (fluid accumulation), arteriolar narrowing, and cotton-wool spots (small infarctions) occur. In severe hypertension, papilledema (swelling of the optic disc) may be seen. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Clinical Manifestations, p. 868.

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 Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension

An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for? -Postural hypertension and resulting injury -oRebound hypertension -Sexual dysfunction -Postural hypotension and resulting injury

Postural hypotension and resulting injury Explanation: Antihypertensive medication can cause hypotension, especially postural hypotension that may result in injury. Rebound hypertension occurs when antihypertensive medication is stopped abruptly. Sexual dysfunction may occur, especially with beta blockers, but other medications are available should this problem ensue. This is not immediately a priority concern. Antihypertensive medications do not usually cause postural hypertension. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Medical Management, p. 870.

client is taking amiloride and lisinopril for the treatment of hypertension. What laboratory studies should the nurse monitor while the client is taking these two medications together? -Magnesium level -Potassium level -Calcium level -Sodium level

Potassium level Explanation: Amiloride (Midamor) is a potassium-sparing diuretic, meaning that it causes potassium retention. The nurse should monitor for hyperkalemia (elevated potassium level) if given with an ACE inhibitor, such as lisinopril (Zestril) or angiotensin receptor blocker. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, TABLE 27-4 Oral Medication Therapy for Hypertension, p. 873.

Which adrenergic inhibitor acts directly on the blood vessels, producing vasodilation? -Prazosin -Reserpine -Propranolol -Clonidine

Prazosin Explanation: Prazosin is a peripheral vasodilator acting directly on the blood vessels. It is not used in angina and coronary artery disease, however, because it induces tachycardia if not preceded by administration of propranolol and a diuretic. Reserpine impairs synthesis and reuptake of norepinephrine. Propranolol blocks the beta-adrenergic receptors of the sympathetic nervous system, especially the sympathetics to the heart, producing a slower heart rate and lowered blood pressure. Clonidine acts through the central nervous system, apparently through centrally mediated alpha-adrenergic stimulation in the brain, reducing blood pressure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, TABLE 27-4 Oral Medication Therapy for Hypertension (continued), p. 874. Chapter 27: Assessment and Management of Patients with Hypertension - Page 874

A nurse is teaching a client with newly diagnosed hypertension who asks if there is any harm in stopping antihypertensive medication. What is the nurse's best response? - "Rebound hypertension can occur." -"Postural hypotension can occur." - "Rebound hypotension can occur." -"Postural hypertension can occur."

Rebound hypertension can occur." Explanation: Clients need to be informed that rebound hypertension can occur if they stop antihypertensive medications suddenly. This can be extremely dangerous and have serious consequences. Hypotension would not be a problem with discontinuation of antihypertensive medications. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Educating Patients About Self-Care, p. 878.

A nurse is teaching a client with newly diagnosed hypertension who asks if there is any harm in stopping antihypertensive medication. What is the nurse's best response? "Rebound hypertension can occur." "Postural hypotension can occur." "Rebound hypotension can occur." "Postural hypertension can occur."

Rebound hypertension can occur." Explanation: Clients need to be informed that rebound hypertension can occur if they stop antihypertensive medications suddenly. This can be extremely dangerous and have serious consequences. Hypotension would not be a problem with discontinuation of antihypertensive medications. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Educating Patients About Self-Care, p. 878. Chapter 27: Assessment and Management of Patients with Hypertension - Page 878

An older adult client is found to have a blood pressure of 150/90 mm Hg during a work-site health screening. What should the nurse do? -Consider this to be a normal finding for the client's age. -Recommend the client have blood pressure rechecked within 6 months. -Recommend the client have blood pressure rechecked within 2 weeks. -Recommend the client see a health care provider immediately for further evaluation

Recommend the client have blood pressure rechecked within 2 weeks. Explanation: The nurse should recommend the client have blood pressure rechecked within 2 weeks because a blood pressure of 150/90 mm Hg isn't considered normal. Six months is too long to wait. The client does not yet need to see a health care provider. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Continuing and Transitional Care, p. 879.

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 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 50% within the first hour of treatment.

Reduce the blood pressure by 20% to 25% within the first hour of treatment. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertensive Crises, p. 880.

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

Renal dysfunction resulting from atherosclerosis Explanation: The nurse is most correct to realize high blood pressure damages the arterial vascular system and accelerates atherosclerosis. The effect of the atherosclerosis impairs circulation to the kidney, resulting in renal failure. Neither anemia, hyperglycemia, nor emphysema occurs as a direct effect of hypertension. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, p. 866.

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

Smoking Diabetes mellitus Physical inactivity Risk factors for cardiovascular problems in clients with hypertension include smoking, dyslipidemia, diabetes mellitus, impaired renal function, obesity, physical inactivity, age, and family history. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Chart 27-1, p. 867. Chapter 27: Assessment and Management of Patients with Hypertension - Page 867

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

Retinal blood vessel damage Explanation: Symptoms suggesting that hypertension is progressing to the extent that target organ damage is occurring must be detected early so that appropriate treatment can be initiated. All body systems must be assessed to detect any evidence of vascular damage. An eye examination with an ophthalmoscope is important because retinal blood vessel damage indicates similar damage elsewhere in the vascular system. The client is questioned about blurred vision, spots in front of the eyes, and diminished visual acuity. The heart, nervous system, and kidneys are also carefully assessed. A BUN concentration of 12 mg/dL and urine output of 60 mL over 2 hours are normal findings. The presence of pneumonia does not indicate target organ damage. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, Clinical Manifestations, p. 868.

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? -Primary -Essential -Secondary -Malignant

Secondary Explanation: Secondary hypertension is elevated BP that results from or is secondary to some other disorder. This type of hypertension is not primary, essential, or malignant. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, p. 867. Chapter 27: Assessment and Management of Patients with Hypertension - Page 867

A nurse is teaching a client with severe hypertension about the damage this condition can cause to the body. What system/organs will the nurse note are particularly targeted for damage due to severe hypertension? -Sensory -Musculoskeletal -Gastrointestinal -Integumentary

Sensory Explanation: Prolonged elevated blood pressure eventually damages blood vessels throughout the body, particularly in target organs such as the heart, kidneys, brain, and eyes. The usual consequences of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, renal failure, strokes, and impaired vision. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, p. 866.

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

Sit on the edge of the chair and rise slowly. Explanation: The nursing instruction emphasized to maintain client safety is to sit on the edge of the chair before rising slowly. By doing so, the client reduces the possibility of falls related to postural hypotension. Using a pillbox to store medications and taking the medication at the same time daily is good medication management instruction, but not necessarily related to safety. When taking antihypertensive medications, there is no reason to restrict driving. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Medical Management, p. 870.

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

Sit quietly for 5 minutes prior to taking blood pressure." Explanation: Instructions for the client regarding measuring the blood pressure at home include the following: (1) Avoid smoking cigarettes or drinking caffeine for 30 minutes before measuring blood pressure. (2) Sit quietly for 5 minutes before the measurement. (3) Have the forearm supported at heart level, with both feet on the ground during the measurement of the blood pressure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Chart 27-3 Measuring Blood Pressure, p. 869.

The nurse is instructing a client with hypertension. What will the nurse teach the client to do before measuring the blood pressure at home? Select all that apply. Drink a glass of water. Sit quietly for 5 minutes. Do not smoke for 30 minutes. Avoid talking during measurement. Place the forearm at heart level on a firm surface.

Sit quietly for 5 minutes. Do not smoke for 30 minutes. Avoid talking during measurement. Place the forearm at heart level on a firm surface. selection: Explanation: The client with hypertension will be instructed to measure the blood pressure at home. Before measuring the blood pressure, the client should be instructed to sit quietly for 5 minutes, avoid smoking 30 minutes before the measurement, avoid talking during the measurement, and to place the forearm at heart level on a firm surface. These instructions help ensure the client's blood pressure measurement is accurate. There is no reason for the client to drink a glass of water before measuring the blood pressure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Chart 27-3 Measuring Blood Pressure, p. 869.

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

Smoking Diabetes mellitus Physical inactivity Explanation: Risk factors for cardiovascular problems in clients with hypertension include smoking, dyslipidemia, diabetes mellitus, impaired renal function, obesity, physical inactivity, age, and family history. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Chart 27-1, p. 867.

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. -Smoking -Elevated high-density lipoprotein (HDL) cholesterol -Overweight/obesity -Age ≥65 in women -Decreased low-density lipoprotein (LDL) levels

Smoking Overweight/obesity Age ≥65 in women 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, Chart 27-1, p. 867.

Which diuretic medication conserves potassium? -Furosemide -Spironolactone -Chlorothiazide -Chlorthalidone

Spironolactone Explanation: Spironolactone is known as a potassium-sparing diuretic. Furosemide causes loss of potassium from the body. Chlorothiazide and chlorthalidone cause mild hypokalemia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, TABLE 27-4 Oral Medication Therapy for Hypertension (continued), p. 873. Chapter 27: Assessment and Management of Patients with Hypertension - Page 873

The nurse assesses a healthy middle-aged client with a blood pressure of 158/90 mm Hg. In which classification of hypertension is the client according to the latest guidelines? -Normal blood pressure -Elevated blood pressure -Stage 1 hypertension -Stage 2 hypertension

Stage 2 hypertension Explanation: The latest guidelines (November 2017) released by the American College of Cardiology and the American Heart Association are: Normal blood pressure: Systolic less than 120 mm Hg and diastolic less than 80 mm Hg. Elevated blood pressure: Systolic between 120 and 129 mm Hg and diastolic less than 80 mm Hg. Stage 1 hypertension: Systolic between 130 and 139 mm Hg or diastolic between 80 and 89 mm Hg. Stage 2 hypertension: Systolic of 140 or greater mm Hg or diastolic of 90 or greater mm Hg. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, p. 866. Chapter 27: Assessment and Management of Patients with Hypertension - Page 866

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 helpful? -Increasing fluids for low blood pressure -Stress reduction to lower prehypertensive state -Use of beta-blockers for treatment of hypertension -Diagnostic testing for determining cardiac functioning

Stress reduction to lower prehypertensive state Explanation: A blood pressure of 124/84 mm Hg is now considered to be in the lower range of prehypertension. Knowledge of stress reduction may be helpful in lowering the blood pressure without medication therapy. A blood pressure of 124/84 mm Hg is not considered a low blood pressure or in need of medication therapy due to hypertension. Diagnostic testing for cardiac functioning is not typical for a client with prehypertension. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, p. 866. Chapter 27: Assessment and Management of Patients with Hypertension - Page 866

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

The kidney excretes sodium and water. Explanation: Hypernatremia (elevated serum sodium level) increases blood volume, which raises blood pressure. The kidney's response to the elevation in blood pressure is to excrete sodium and excess water. Any retention of sodium and water would increase blood volume and, thus, blood pressure. Sodium and water move together. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension

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 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 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 Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Nursing Interventions, p. 878.

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? -arterial vasoconstriction -hepatic function -calcium deficit -acid-base imbalance

arterial vasoconstriction Explanation: Secondary hypertension may accompany any primary condition that affects fluid volume or renal function, or causes arterial vasoconstriction. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, p. 866.

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 -check the client's heart rate. -check the client's serum K+ level. -check the client's urine output. -weigh the client.

check the client's heart rate. Explanation: Nadolol is a beta-blocker. A desired effect of this medication is to reduce the pulse rate in clients with tachycardia and elevated blood pressure (BP). The nurse should check the client's heart rate (HR) before administering nadolol to ensure that the pulse is not less than 60 beats per minute. The other interventions are not indicated before administering a beta-blocker medication. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, TABLE 27-4 Oral Medication Therapy for Hypertension (continued), p. 873

The nurse is caring for a client with a blood pressure of 210/100 mm Hg in the emergency room. What is the most appropriate route of administration for antihypertensive agents? -continuous IV infusion -sublingual -intramuscular -oral

continuous IV infusion Explanation: The medications of choice in hypertensive emergencies are best managed through the continuous IV infusion of a short-acting titratable antihypertensive agent. The nurse avoids the sublingual and IM routes as their absorption and dynamics are unpredictable. The oral route would not have as quick an onset as a continuous IV infusion. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, TABLE 27-4 Oral Medication Therapy for Hypertension, p. 872.

A nurse is discussing with a nursing student how to accurately measure blood pressure. What statement by the student indicates an understanding of the education? -A cuff that is too small will give a false high blood pressure. -A cuff that is too small will give a false low blood pressure. -A cuff that is too large will give a false high blood pressure. -The size of the cuff does not matter as long as it fits snugly around the arm.

cuff that is too small will give a false high blood pressure. Explanation: Using a cuff that is too small will give a false high blood pressure measurement, while using a cuff that is too large results in a false low blood pressure measurement. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Chart 27-3, p. 869.

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 the resistance that the heart must overcome to eject blood. -increases blood volume and improves the potential for greater cardiac output. -decreases the production of neurotransmitters that constrict peripheral arterioles.

decreases the production of neurotransmitters that constrict peripheral arterioles. Explanation: Reduced stress decreases the production of neurotransmitters that constrict peripheral arterioles. Reduced stress may assist in reducing blood volume and resistance to the heart. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, Diagnosis, p. 878.

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? -dizziness -persistent cough -blurred vision -tremor

dizziness Explanation: A common adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. The client and the client's spouse should be alerted to this possibility and provided with some tips for managing dizziness. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, TABLE 27-4 Oral Medication Therapy for Hypertension, p. 873.

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

high diastolic or low systolic reading Explanation: 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). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Chart 27-3 Measuring Blood Pressure, p. 869.

What risk factors would cause the nurse to become concerned that the client may have atherosclerotic heart disease? Select all that apply. -hypertension -diabetes -obesity -lowered triglyceride levels -active lifestyle -family history of early cardiovascular events

hypertension diabetes obesitym family history of early cardiovascular events Explanation: Risk factors for atherosclerotic heart disease include hypertension, dyslipidemia (including high total, low-density lipoprotein [LDL], and triglyceride levels as well as low high-density lipoprotein [HDL] levels), obesity, diabetes, a family history of early cardiovascular events, metabolic syndrome, a sedentary lifestyle, and obstructive sleep apnea. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, pp. 866-867. Chapter 27: Assessment and Management of Patients with Hypertension - Page 866-867

It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine -increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. -decreases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. -increases the heart rate, constricts arterioles, and increases the heart's ability to eject blood. -decreases circulating blood volume.

increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. Explanation: The nurse recommends smoking cessation for clients with hypertension because nicotine raises the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. Reduced oral fluids decrease the circulating blood volume. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, NURSING PROCESS, The Patient with Hypertension,

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 Explanation: The autonomic nervous system, the kidneys, and various endocrine glands regulate arterial pressure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Clinical Manifestations, p. 869.

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? -nonpharmacological interventions -pharmacological interventions -procedural interventions -observation only

nonpharmacological interventions Explanation: Nonpharmacologic interventions are used for clients with prehypertension. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension

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

ophthalmic examination. Explanation: Papilledema is an edema of the optic nerves, and thus needs an ophthalmic examination for detection. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Clinical Manifestations, p. 868.

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

ophthalmic examination. Explanation: Papilledema is an edema of the optic nerves, and thus needs an ophthalmic examination for detection. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Clinical Manifestations, p. 868.

An older adult client visits the clinic for a blood pressure (BP) 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 the blood pressure medicine? -Take the medicine on an empty stomach. -A possible adverse effect of blood pressure medicine is dizziness when you stand. -There are no adverse effects from blood pressure medicine. -A severe drop in blood pressure is possible.

possible adverse effect of blood pressure medicine is dizziness when you stand. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Continuing and Transitional Care, p. 879.

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

provide time for the heart to increase the rate of contraction to resupply oxygen to the brain. Explanation: 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 increase its rate of contraction to resupply oxygen to the brain, not blood pressure or heart rate. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, NURSING PROCESS, The Patient with Hypertension, p. 879.

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

secondary hypertension. Explanation: Secondary hypertension may be caused by a tumor of the adrenal gland (e.g., pheochromocytoma). Primary, or essential, hypertension has no known underlying cause. Isolated systolic hypertension is demonstrated by readings in which the systolic pressure exceeds 140 mm Hg and the diastolic measurement is normal or near normal (less than 90 mm Hg). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, p. 867.

According to the classification of hypertension diagnosed in older adults, hypertension that can be attributed to an underlying cause is termed -primary. -essential. -secondary. -isolated systolic.

secondary. Explanation: Secondary hypertension may be caused by a tumor of the adrenal gland (e.g., pheochromocytoma). Primary, or essential, hypertension has no known underlying cause. Isolated systolic hypertension is demonstrated by readings in which the systolic pressure exceeds 140 mm Hg and the diastolic measurement is normal or near normal (less than 90 mm Hg). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, p. 867. Chapter 27: Assessment and Management of Patients with Hypertension - Page 867

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

stage 1 hypertension. Explanation: The latest guidelines (November 2017) released by the American College of Cardiology and the American Heart Association indicate that a systolic blood pressure of 135 mm Hg is classified as stage 1 hypertension. The guidelines are: Normal blood pressure: Systolic less than 120 mm Hg and diastolic less than 80 mm Hg. Elevated blood pressure: Systolic between 120 and 129 mm Hg and diastolic less than 80 mm Hg. Stage 1 hypertension: Systolic between 130 and 139 mm Hg or diastolic between 80 and 89 mm Hg. Stage 2 hypertension: Systolic of 140 or greater mm Hg or diastolic of 90 or greater mm Hg. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, TABLE 27-1 Comparing Blood Pressure Classifications by Key Guidelines for Adults Age 18 and Older, p. 866.

The nurse is teaching a client about chronic untreated hypertension. What complication will the nurse explain to the client? -peripheral edema -right-sided heart failure -stroke -pulmonary insufficiency

stroke Explanation: A stroke occurs if vessels in the brain rupture and bleed. If an aneurysm has developed in the aorta from chronic hypertension, it may burst and cause hemorrhage and shock. Peripheral edema, right-sided heart failure, and pulmonary insufficiency are not usually consequences of untreated chronic hypertension. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Clinical Manifestations, p. 868.

The nurse is seeing a client for the first time and has just checked the client's blood pressure. The nurse would consider the client prehypertensive if: -diastolic BP is between 70 and 79 mm Hg. -diastolic BP is 100 mm Hg. -systolic BP is between 120 and 139 mm Hg. -systolic BP is above 180 mm Hg.

systolic BP is between 120 and 139 mm Hg. Explanation: Once the systolic BP goes above 120 mm Hg, the patient is considered prehypertensive, according to the National Heart, Lung, and Blood Institute's (2015) definition. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 27: Assessment and Management of Patients with Hypertension, Hypertension, p. 866.