Chapter 33: Hypertension (1-23)

Propranolol (Inderal) is prescribed for a patient diagnosed with hypertension. The nurse should consult with the health care provider before giving this medication when the patient reveals a history of a. asthma. b. daily alcohol use. c. peptic ulcer disease. d. myocardial infarction (MI).

ANS: A Nonselective β-blockers block β1- and β2-adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma. β-Blockers will have no effect on the patient's peptic ulcer disease or alcohol use. β-Blocker therapy is recommended after MI.

The nurse is reviewing the laboratory test results for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider? a. Serum creatinine of 2.8 mg/dL b. Serum potassium of 4.5 mEq/L c. Serum hemoglobin of 14.7 g/dL d. Blood glucose level of 96 mg/dL

ANS: A The elevated creatinine indicates renal damage caused by the hypertension. The other laboratory results are normal.

When providing dietary instruction to a patient with hypertension, the nurse would advise the patient to restrict intake of which meat? a) Broiled fish b) Roasted duck c) Roasted turkey d) Baked chicken breast

b) Roasted duck Roasted duck is high in fat, which should be avoided by the patient with hypertension. Weight loss may slow the progress of atherosclerosis and overall CVD risk. The other meats are lower in fat and are therefore acceptable in the diet.

Which assessment finding for a patient who is receiving IV furosemide (Lasix) to treat stage 2 hypertension is most important to report to the health care provider? a. Blood glucose level of 175 mg/dL b. Blood potassium level of 3.0 mEq/L c. Most recent blood pressure (BP) reading of 168/94 mm Hg d. Orthostatic systolic BP decrease of 12 mm Hg

ANS: B Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening dysrhythmias. The health care provider should be notified of the potassium level immediately and administration of potassium supplements initiated. The elevated blood glucose and BP also indicate a need for collaborative interventions but will not require action as urgently as the hypokalemia. An orthostatic drop of 12 mm Hg is common and will require intervention only if the patient is symptomatic.

The nurse understands that which medication may increase the risk of hypoglycemia unawareness in a patient with diabetes mellitus? 1 Cardizem (Diltiazem) 2 Metoprolol (Lopressor) 3 Prednisone (Deltazone) 4 Hydromorphone (Dilaudid)

2 Metoprolol, a beta blocker, slows the heart rate. Tachycardia is a classic symptom of hypoglycemia, therefore patients must be made aware of failure of the heart rate to respond to decreasing blood sugars and should be instructed to look for other signs of hypoglycemia. Text Reference - p. 718

The nurse providing dietary instruction to a patient with hypertension would advise the patient to cut down on the intake of which foods? Select all that apply. 1 Canned vegetables 2 Red meat 3 Baked chicken 4 Canned fruit 5 Processed cheeses

1, 2, 5 Foods high in fat and sodium—including canned vegetables, red meat, and processed cheeses—should be avoided by the patient with hypertension. Baked chicken and canned fruit are low in sodium and fat. Text Reference - p. 716

A patient is admitted to the hospital in hypertensive emergency (BP 244/142 mmHg). Sodium nitroprusside is started to treat the elevated BP. Which management strategy(ies) would be appropriate for this patient (select all that apply)? a. Measuring hourly urine output b. Decreasing the MAP by 50% within the first hour c. Continuous BP monitoring with an intraarterial line d. Maintaining bed rest and providing tranquilizers to lower the BP e. Assessing the patient for signs and symptoms of heart failure and changes in mental status

a,c, & e

A patient arrives at a medical clinic for a checkup. The patient's blood pressure (BP) is 150/94 mm Hg. All other assessment findings are within normal limits. The nurse reviews the patient's file from previous visits, and there is no history of elevated blood pressure. What could be the reason for a falsely high blood pressure? 1 The blood pressure cuff might have been too small. 2 There may be atherosclerosis in the subclavian artery. 3 The patient may have smoked the day before the BP measurement. 4 The patient may have engaged in strenuous exercises the day before the BP measurement.

1 BP measurements should be performed using proper technique to get an accurate reading. BP measurements may be falsely high if the BP cuff is too small as it puts undue pressure on the artery. If the subclavian artery has atherosclerosis, the BP measurement would be falsely low. Smoking and engaging in strenuous exercise should be avoided 30 minutes before the BP measurement, as they can alter the measurement. Smoking or engaging in strenuous exercise one day before a BP measurement will not affect the readings. Text Reference - p. 723

The nurse is caring for a patient with hypertension who is scheduled to receive a dose of esmolol (Brevibloc). The nurse should withhold the dose and consult the prescribing health care provider for which vital sign taken just before administration? 1 Pulse 48 2 Respirations 24 3 Blood pressure 118/74 4 Oxygen saturation 93%

1 Because esmolol is a β1 -adrenergic blocking agent, it can cause hypotension and bradycardia as adverse effects. The nurse should withhold the dose and consult with the health care provider for parameters regarding pulse-rate limits. Text Reference - p. 718 TEST-TAKING TIP: Have confidence in your initial response to an item because it more than likely is the correct answer.

The nurse is taking the blood pressure of an older patient and compares the result to the previous reading. The nurse observes that the systolic blood pressure of the previous reading was 30 mm Hg higher than the reading the nurse just obtained. Which of these is a possible explanation? 1 An aucultatory gap may be present. 2 The patient's hypertension is improving. 3 The equipment the nurse used is not working properly.

1 Careful technique is important in assessing blood pressure in older adults. Some older people have a wide gap between the first Korotkoff sound and subsequent beats. This is called the auscultatory gap. Failure to inflate the cuff high enough may result in underestimating systolic blood pressure. Text Reference - p. 725

A patient is being discharged from the hospital. The primary health care provider prescribes propranolol (Inderal) for hypertension. Which instruction should the nurse include in the patient's discharge teaching plan? 1 Do not stop taking abruptly. 2 Take initial doses at bedtime. 3 Monitor for peripheral edema. 4 Take with orange juice.

1 Do not stop taking this medication abruptly because this may cause rebound hypertension. Alpha 1-adrenergic blockers initial dose should be taken at bedtime because of the possible profound orthostatic hypotension with syncope within 90 minutes after initial dose. Calcium channel blockers may cause peripheral edema. Beta blockers are not potassium wasting, so it is not necessary to take with orange juice. Text Reference - p. 725

The nurse is preparing a presentation on complications of hypertension. Which information would the nurse include? Select all that apply. 1 Stroke as a result of carotid artery atherosclerosis 2 Heart failure as a result of increased heart contractility 3 Blurred vision or loss of vision secondary to retinal damage 4 Right ventricular hypertrophy as a result of increased workload 5 Coronary artery disease caused by an increase in the elasticity of arterial walls

1, 3 Embolic stroke may be a result of cerebral blood flow obstruction by a portion of atherosclerotic plaque or a blood clot formed in the carotid arteries. Hypertension leads to retinal damage that is manifested by blurred vision or loss of vision and retinal hemorrhage. Heart failure is a result of decreased heart contractility along with decreased stroke volume and cardiac output. Hypertension leads to increased cardiac workload that causes left ventricular hypertrophy. Coronary artery disease is caused by decreased elasticity of arterial walls and narrowing of the lumen. Text Reference - p. 713

A patient is prescribed lisinopril (Prinivil) for the treatment of hypertension. The patient asks about side effects of this medication. Which side effects should the nurse include? Select all that apply. 1 Cough 2 Edema 3 Dizziness 4 Impotence 5 Hypotension 6 Muscle stiffness

1, 3, 5 Cough, dizziness, and hypotension are side effects of angiotensin-converting enzyme (ACE) inhibitors. Peripheral edema is a side effect of calcium channel blockers. Impotence is a side effect for thiazide diuretics, aldosterone receptor blockers, central-acting alpha-adrenergic antagonists, peripheral-acting alpha-adrenergic antagonists, beta-adrenergic blockers, and mixed alpha 1 and beta 1 blockers. Muscle stiffness is not associated with an ACE inhibitor. Text Reference - p. 724

A nurse is teaching a patient who has been prescribed medication for hypertension about care and management of hypertension. What should the nurse teach the patient? Select all that apply. 1 Explain the meaning of the blood pressure (BP) values. 2 Assure patient that short-term therapy will cure hypertension. 3 Explain the potential dangers of uncontrolled hypertension. 4 Supplement the diet with foods high in sodium. 5 Exercise after taking medication prescribed for hypertension. 6 Avoid altering dosage without consulting health care provider.

1, 3, 6 The nurse should explain the meaning of the systolic blood pressure (SBP) and diastolic blood pressure (DBP) values. The nurse should also explain the potential dangers of uncontrolled hypertension and dangers of altering the dosage without consulting the health care provider. The nurse should inform the patient that long-term therapy and follow-up care are essential to treat hypertension, and that therapy will not cure but should control hypertension. The patient should avoid foods high in sodium; instead, supplement diet with foods high in potassium. The patient should avoid strenuous exercise, hot baths, and excessive amounts of alcohol within 3 hours of medication. Text Reference - p. 724

A nurse works in a medical unit. The nurse has assessed the patients and planned care for them. Which activities can be delegated to unlicensed assistive personnel (UAP)? Select all that apply. 1 Report high or low BP readings to the registered nurse. 2 Make appropriate referrals to other health care professionals. 3 Teach patients about lifestyle management and medication use. 4 Check for postural changes in BP. 5 Assess patients for hypertension risk factors and develop risk modification plans

1, 4 Reporting high or low BP readings and checking for postural changes in BP are repetitive activities and do not require nursing judgment. Therefore, these activities can be delegated to unlicensed assistive personnel. Making appropriate referrals requires understanding of the collaborative care and judgment regarding the requirement of the referrals; this activity cannot be delegated and is the role of a registered nurse. Patient education about lifestyle management and medication use requires sound knowledge; therefore, this activity should be performed by the nurse. Assessment and development of risk modification plans requires assessment and planning skills; this activity should not be delegated and should be performed by the nurse. Text Reference - p. 724

The nurse records normal blood pressure (BP) for a patient with a family history of hypertension and diabetes. What should the nurse teach the patient to specifically address the risks of hypertension? Select all that apply. 1 Increase caloric intake. 2 Avoid foods high in sodium. 3 Reduce the use of tobacco products. 4 Take brisk walks. 5 Avoid overexertion with muscle-strengthening activities

1, 4 The nurse should teach the patient to adopt lifestyle changes, such as avoiding foods high in sodium and taking brisk walks. A decrease in caloric intake helps to reduce weight and prevent hypertension. The patient should completely avoid use of tobacco products, as the nicotine contained in tobacco causes vasoconstriction and increases BP. All adults should perform muscle-strengthening activities to maintain and increase endurance and strength of muscles. Text Reference - p. 716

A 68-year-old patient is diagnosed with orthostatic hypotension. Which statement by the patient indicates the need for further teaching? 1 "I should change positions slowly so I do not become lightheaded." 2 "This may be caused by my blood pressure medications, which I should stop taking immediately." 3 "My heart is functioning normally so I should continue to exercise regularly." 4 "I should continue to limit my salt intake as a method to prevent high blood pressure."

2 Blood pressure medications may contribute to orthostatic hypotension; however, medications should not be discontinued unless advised by the health care provider. Changing positions slowly, continued exercise, and limitation of salt intake are all correct ways to promote cardiovascular health and safety associated with the hypotension. Text Reference - p. 752

In reviewing medication instructions with a patient prescribed lisinopril (Zestril), the nurse should include which statement? 1 "You should not take this medication if you have asthma." 2 "You may develop a dry cough while taking this medication." 3 "Never take this medication on an empty stomach." 4 "Discontinue use of this medication if you develop a drop in your blood pressure."

2 Lisinopril is an ACE-inhibitor. A common side effect is a dry cough. This medication is safe for use with asthma, can be taken on an empty stomach, and should not be discontinued unless instructed by a health care provider.

A nurse is providing care for a patient who continues to experience hypertension despite taking a calcium channel blocker daily. A diuretic has been prescribed. How does a diuretic help control blood pressure? Select all that apply. 1 It causes vasodilation. 2 It reduces plasma volume. 3 It promotes sodium and water excretion. 4 It reduces the vascular response to catecholamines. 5 It prevents extracellular calcium from moving into the cells.

2, 3, 4 Diuretics are an important component of BP treatment. Diuretics tend to reduce the plasma volume by promoting excretion of sodium and water. The net result is a reduction in the circulating volume, which causes a decrease in the BP. Diuretics also reduce the vascular response to catecholamines. The blood vessels do not constrict in response to catecholamines; as a result, the BP is reduced.

The nurse is obtaining data from a patient who has been on medication for hypertension and diabetes for four years. The patient has been experiencing blurred vision due to retinal damage caused by hypertension. What are the other manifestations of target organ disease? Select all that apply. 1 Pneumonia 2 Nocturia 3 Aneurysm 4 Transient ischemic attack 5 Anemia

2, 3, 4 Hypertension affects the kidneys; the earliest manifestation of renal disease is nocturia. Hypertension speeds up the process of atherosclerosis in the peripheral blood vessels leading to aneurysms. Adequate control of blood pressure (BP) reduces the risk of transient ischemic attack. Text Reference - p. 714

A patient with hypertension has been prescribed an antihypertensive medication. During a follow-up visit, the patient asks if the medication can be stopped because the blood pressure (BP) is now within the normal range. Which nursing response is appropriate? 1 Stop the medication since the BP is normal. 2 Reduce the dose of the medication since the BP has decreased. 3 Continue the medication until the health care provider advises to discontinue it. 4 Stop taking the medication and manage the BP with lifestyle modifications.

3 Antihypertensive medications are effective at reducing BP; however, the medications should not be stopped abruptly as this can cause a severe hypertensive reaction. The medications should be discontinued only after consulting with the primary health care provider. The medication should not be stopped even if the BP measurements show normal readings. Medications should be taken regularly for sustained therapeutic effects. A reduction of the dose may reduce the efficacy of the drug. Lifestyle modifications are necessary to reduce cardiovascular risks; however, antihypertensive medications should also be used for effective reduction of BP. Text Reference - p. 724

The nurse understands that catapres (Clonidine) has which side effects? 1 Cough and confusion 2 Sweating and shaking 3 Dry mouth and sedation 4 Gynecomastia and dizziness

3 Dry mouth and sedation are side effects of central-acting alpha-adrenergic antagonists. Cough is a possible side effect of angiotensin-converting enzyme inhibitor. Confusion, sweating, and shaking are not common side effects for hypertension drug therapy. Gynecomastia is a side effect of aldosterone receptor blockers. Dizziness is a side effect for hypertension drug therapy, but not along with gynecomastia. Text Reference - p. 717

A patient reports chest pain and is admitted to the emergency department. The patient is obese, smokes cigarettes, and drinks alcohol in moderate amounts. The patient had taken labetalol (Normodyne) for high blood pressure for one week and then stopped taking the medication the morning of admission. The nurse recognizes that the probable reason for the patient's angina is what? 1 Leading a sedentary lifestyle after a lifetime of obesity 2 Smoking cigarettes 3 Stopping labetalol abruptly after a week of treatment 4 Alcohol consumption

3 Labetalol (Normodyne) is an alpha- and beta-adrenergic blocker and reduces BP by causing vasodilatation and a decrease in heart rate. The patient should not stop the drug abruptly as it may precipitate angina and heart failure. Obesity, a sedentary lifestyle, smoking, and alcohol consumption are risk factors for cardiovascular disease but are unlikely to cause angina. Text Reference - p. 718

A patient is scheduled a dose of metoprolol (Lopressor). The nurse should withhold the dose and consult the health care provider after noting which assessment finding? 1 Migraine headache 2 Pulse 112 beats/minute 3 Expiratory wheezing 4 Blood sugar 217 mg/dL

3 Metoprolol is a β-adrenergic-blocking agent that reduces blood pressure and could affect the β2-receptors in the lungs with larger doses or with drug accumulation. It should be used cautiously in patients with wheezing or respiratory disorders because it could cause bronchospasm, a potentially life-threatening adverse effect. Metoprolol will not worsen migraine, will decrease the elevated pulse rate, and will not lower or further elevate the blood sugar. Text Reference - p. 718

The nurse just received the shift report. Which patient should the nurse assess first? 1 The patient who is complaining about dizziness and whose blood pressure (BP) is 150/92. 2 The patient with a hip fracture who is complaining about pain 2 out of 10 3 The patient who is complaining about severe headache and has a nose bleed 4 The patient complaining of fatigue and who just received an angiotensin-converting enzyme (ACE) inhibitor.

3 Severe headache and nose bleed are signs of hypertensive crisis that is an emergency situation, and therefore the nurse has to see this patient first. Dizziness is one of the symptoms of hypertension and the patient has an elevated blood pressure, but it is not an emergency situation. Pain 2 out of 10 is mild pain and therefore this patient is not a priority. Fatigue is one of the symptoms of hypertension, but the patient just received antihypertensive medication. Text Reference - p. 714

While measuring a patient's BP, a nurse finds that there is a difference in BP and heart rate when the patient changes position form supine to standing. There is a decrease of 20 mm Hg in systolic BP (SBP), a decrease of 10 mm Hg in diastolic BP (DBP), and an increase in the heart rate of 20 beats/minute. How should the nurse interpret these findings? 1 The patient has resistant hypertension. 2 The patient has an auscultatory gap. 3 The patient is experiencing a hypertensive crisis. 4 The patient is experiencing orthostatic hypotension.

4 A decrease in BP with change of position indicates orthostatic hypotension. It may manifest as light-headedness, dizziness, or syncope. Intravascular volume loss and inadequate vasoconstrictor mechanisms related to disease or medications are common causes. Text Reference - p. 722

The nurse is assessing a patient taking full doses of an appropriate three-drug therapy regimen, including a diuretic. The patient is exhibiting resistant hypertension. What behavior would the nurse discuss with the patient as a cause for resistant hypertension? 1 Mild exercise 2 Minimal salt intake 3 Adherence to drug regimen 4 Increasing obesity

4 An increase in obesity is one of the causes of resistant hypertension. The patient should exercise regularly, limit salt in diet to adequate levels, and adhere to the drug regimen. These behaviors are good health guidelines that can be used to prevent resistant hypertension. Text Reference - p. 722

Which item on the patient's dinner tray should not be taken in large quantities by the patient prescribed furosemide (Lasix) for hypertension? 1 Coffee 2 Ice cream 3 Grapefruit juice 4 Chicken noodle soup

4 Furosemide , a diuretic, causes fluid loss to decrease blood pressure. Chicken noodle soup is high in sodium and may cause increased fluid retention, negating the effects of the medication and increasing the blood pressure. Text Reference - p. 717

A nurse is caring for a patient admitted to the hospital with a diagnosis of hypertension. The primary health care provider prescribes prazosin (Minipress). What is the priority nursing intervention? 1 Check for history of depression. 2 Do not give with grapefruit juice. 3 Monitor for cardiac dysrhythmias. 4 Assess for orthostatic hypotension

4 Low blood pressure or postural hypotension can cause a fall from dizziness. The peripheral-acting alpha-adrenergic antagonist reserpine (Serpasil) is contraindicated in patients with a history of depression. Administrating grapefruit juice with certain calcium channel blockers may increase the serum concentrations, resulting in toxicity. The direct vasodilator minoxidil (Loniten) may cause EKG changes of flattened and inverted T waves. Text Reference - p. 718

A nurse provides care to a patient who is admitted to an emergency department with hypertensive crisis. The patient had been taking sodium nitroprusside (Nipride) for the past three days. What is the reason that blood tests to assess thiocyanate levels are prescribed for this patient? 1 The patient may have very low BP due to the sodium nitroprusside. 2 The patient may have adverse effects on target organs. 3 The patient may have reduced excretion of sodium nitroprusside. 4 The patient may have toxic levels of sodium nitroprusside.

4 Sodium nitroprusside causes arterial vasodilation and reduces systemic vascular resistance. This in turn decreases the blood pressure. Sodium nitroprusside is metabolized to cyanide and then to thiocyanate, which can reach lethal levels. Therefore, thiocyanate levels should be monitored in patients receiving the drug for more than 3 days or at dosesgreaterthan4mcg/kg/min. In hypertensive crisis, the patient usually has very high BP despite the BP lowering effect of sodium nitroprusside. Serum thiocyanate levels do not indicate adverse effects of hypertension on target organs or reduced excretion of sodium nitroprusside. Text Reference - p. 719

The nurse has just finished teaching a hypertensive patient about the newly prescribed ramipril (Altace). Which patient statement indicates that more teaching is needed? a. "A little swelling around my lips and face is okay." b. "The medication may not work as well if I take any aspirin." c. "The doctor may order a blood potassium level occasionally." d. "I will call the doctor if I notice that I have a frequent cough."

ANS: A Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an indication that the ACE inhibitor should be discontinued. The patient should be taught that if any swelling of the face or oral mucosa occurs, the health care provider should be immediately notified because this could be life threatening. The other patient statements indicate that the patient has an accurate understanding of ACE inhibitor therapy.

The charge nurse observes a new registered nurse (RN) doing discharge teaching for a patient with hypertension who has a new prescription for enalapril (Vasotec). The charge nurse will need to intervene if the new RN tells the patient to a. increase the dietary intake of high-potassium foods. b. make an appointment with the dietitian for teaching. c. check the blood pressure (BP) with a home BP monitor at least once a day. d. move slowly when moving from lying to sitting to standing.

ANS: A The ACE inhibitors cause retention of potassium by the kidney, so hyperkalemia is a possible adverse effect. The other teaching by the new RN is appropriate for a patient with newly diagnosed hypertension who has just started therapy with enalapril.

Which nursing action should the nurse take first in order to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes? a. Collect a detailed diet history. b. Provide a list of low-sodium foods. c. Help the patient make an appointment with a dietitian. d. Teach the patient about foods that are high in potassium.

ANS: A The initial nursing action should be assessment of the patient's baseline dietary intake through a thorough diet history. The other actions may be appropriate, but assessment of the patient's baseline should occur first.

The nurse on the intermediate care unit received change-of-shift report on four patients with hypertension. Which patient should the nurse assess first? a. 43-year-old with a (blood pressure (BP) of 160/92 who is complaining of chest pain b. 52-year-old with a BP of 212/90 who has intermittent claudication c. 50-year-old with a BP of 190/104 who has a creatinine of 1.7 mg/dL d. 48-year-old with a BP of 172/98 whose urine shows microalbuminuria

ANS: A The patient with chest pain may be experiencing acute myocardial infarction, and rapid assessment and intervention are needed. The symptoms of the other patients also show target organ damage but are not indicative of acute processes.

A patient with hypertension who has just started taking atenolol (Tenormin) returns to the health clinic after 2 weeks for a follow-up visit. The blood pressure (BP) is unchanged from the previous visit. Which action should the nurse take first? a. Inform the patient about the reasons for a possible change in drug dosage. b. Question the patient about whether the medication is actually being taken. c. Inform the patient that multiple drugs are often needed to treat hypertension. d. Question the patient regarding any lifestyle changes made to help control BP.

ANS: B Because noncompliance with antihypertensive therapy is common, the nurse's initial action should be to determine whether the patient is taking the atenolol as prescribed. The other actions also may be implemented, but these would be done after assessing patient compliance with the prescribed therapy.

A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and nausea and has a blood pressure (BP) of 238/118 mm Hg. Which question should the nurse ask first? a. "Did you take any acetaminophen (Tylenol) today?" b. "Have you been consistently taking your medications?" c. "Have there been any recent stressful events in your life?" d. "Have you recently taken any antihistamine medications?"

ANS: B Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do not increase BP. Stressful events will increase BP but not usually to the level seen in this patient.

Which blood pressure (BP) finding by the nurse indicates that no changes in therapy are needed for a patient with stage 1 hypertension who has a history of diabetes mellitus? a. 102/60 mm Hg b. 128/76 mm Hg c. 139/90 mm Hg d. 136/82 mm Hg

ANS: B The goal for antihypertensive therapy for a patient with hypertension and diabetes mellitus is a BP <130/80 mm Hg. The BP of 102/60 may indicate overtreatment of the hypertension and an increased risk for adverse drug effects. The other two blood pressures indicate a need for modifications in the patient's treatment.

Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new patient? a. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second. b. Have the patient sit in a chair with the feet flat on the floor. c. Assist the patient to the supine position for BP measurements. d. Obtain two BP readings in the dominant arm and average the results.

ANS: B The patient should be seated with the feet flat on the floor. The BP is obtained in both arms, and the results of the two arms are not averaged. The patient does not need to be in the supine position. The cuff should be deflated at 2 to 3 mm Hg per second.

The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a hypertensive emergency. Which finding is most important to report to the health care provider? a. Urine output over 8 hours is 250 mL less than the fluid intake. b. The patient cannot move the left arm and leg when asked to do so. c. Tremors are noted in the fingers when the patient extends the arms. d. The patient complains of a headache with pain at level 8/10 (0 to 10 scale).

ANS: B The patient's inability to move the left arm and leg indicates that a hemorrhagic stroke may be occurring and will require immediate action to prevent further neurologic damage. The other clinical manifestations are also likely caused by the hypertension and will require rapid nursing actions, but they do not require action as urgently as the neurologic changes.

The nurse obtains the following information from a patient newly diagnosed with prehypertension. Which finding is most important to address with the patient? a. Low dietary fiber intake b. No regular aerobic exercise c. Weight 5 pounds above ideal weight d. Drinks a beer with dinner on most nights

ANS: B The recommendations for preventing hypertension include exercising aerobically for 30 minutes most days of the week. A weight that is 5 pounds over the ideal body weight is not a risk factor for hypertension. The Dietary Approaches to Stop Hypertension (DASH) diet is high in fiber, but increasing fiber alone will not prevent hypertension from developing. The patient's alcohol intake is within guidelines and will not increase the hypertension risk.

The registered nurse (RN) is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside (Nipride). Which nursing action can the nurse delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Titrate nitroprusside to decrease mean arterial pressure (MAP) to 115 mm Hg. b. Evaluate effectiveness of nitroprusside therapy on blood pressure (BP). c. Set up the automatic blood pressure machine to take BP every 15 minutes. d. Assess the patient's environment for adverse stimuli that might increase BP.

ANS: C LPN/LVN education and scope of practice include the correct use of common equipment such as automatic blood pressure machines. The other actions require advanced nursing judgment and education, and should be done by RNs.

An older patient has been diagnosed with possible white coat hypertension. Which action will the nurse plan to take next? a. Schedule the patient for regular blood pressure (BP) checks in the clinic. b. Instruct the patient about the need to decrease stress levels. c. Tell the patient how to self-monitor and record BPs at home. d. Inform the patient that ambulatory blood pressure monitoring will be needed.

ANS: C Having the patient self-monitor BPs at home will provide a reliable indication about whether the patient has hypertension. Regular BP checks in the clinic are likely to be high in a patient with white coat hypertension. Ambulatory blood pressure monitoring may be used if the data from self-monitoring are unclear. Although elevated stress levels may contribute to hypertension, instructing the patient about this is unlikely to reduce BP.

Which action should the nurse take when administering the initial dose of oral labetalol (Normodyne) to a patient with hypertension? a. Encourage the use of hard candy to prevent dry mouth. b. Instruct the patient to ask for help if heart palpitations occur. c. Ask the patient to request assistance when getting out of bed. d. Teach the patient that headaches may occur with this medication.

ANS: C Labetalol decreases sympathetic nervous system activity by blocking both á- and β-adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension. Heart palpitations, dry mouth, dehydration, and headaches are possible side effects of other antihypertensives.

During change-of-shift report, the nurse obtains the following information about a hypertensive patient who received the first dose of nadolol (Corgard) during the previous shift. Which information indicates that the patient needs immediate intervention? a. The patient's most recent blood pressure (BP) reading is 158/91 mm Hg. b. The patient's pulse has dropped from 68 to 57 beats/minute. c. The patient has developed wheezes throughout the lung fields. d. The patient complains that the fingers and toes feel quite cold.

ANS: C The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective β-blockers) is occurring. The nurse should immediately obtain an oxygen saturation measurement, apply supplemental oxygen, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes are associated with β-receptor blockade but do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated. However, this is not as urgently needed as addressing the bronchospasm.

A 56-year-old patient who has no previous history of hypertension or other health problems suddenly develops a blood pressure (BP) of 198/110 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that a. a BP recheck should be scheduled in a few weeks. b. dietary sodium and fat content should be decreased. c. there is an immediate danger of a stroke and hospitalization will be required. d. diagnosis of a possible cause, treatment, and ongoing monitoring will be needed.

ANS: D A sudden increase in BP in a patient over age 50 with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem. The BP will need treatment and ongoing monitoring. If the patient has no other risk factors, a stroke in the immediate future is unlikely. There is no indication that dietary salt or fat intake have contributed to this sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this BP to an acceptable level.

The nurse is caring for a 70-year-old who uses hydrochlorothiazide (HydroDIURIL) and enalapril (Norvasc), but whose self-monitored blood pressure (BP) continues to be elevated. Which patient information may indicate a need for a change? a. Patient takes a daily multivitamin tablet. b. Patient checks BP daily just after getting up. c. Patient drinks wine three to four times a week. d. Patient uses ibuprofen (Motrin) daily to treat osteoarthritis.

ANS: D Because use of nonsteroidal antiinflammatory drugs (NSAIDs) can prevent adequate BP control, the patient may need to avoid the use of ibuprofen. A multivitamin tablet will help supply vitamin D, which may help lower BP. BP decreases while sleeping, so self-monitoring early in the morning will result in obtaining pressures that are at their lowest. The patient's alcohol intake is not excessive.

After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented, which diet choice indicates that the teaching has been effective? a. The patient avoids eating nuts or nut butters. b. The patient restricts intake of chicken and fish. c. The patient has two cups of coffee in the morning. d. The patient has a glass of low-fat milk with each meal.

ANS: D For the prevention of hypertension, the Dietary Approaches to Stop Hypertension (DASH) recommendations include increasing the intake of calcium-rich foods. Caffeine restriction and decreased protein intake are not included in the recommendations. Nuts are high in beneficial nutrients and 4 to 5 servings weekly are recommended in the DASH diet.

Which action will be included in the plan of care when the nurse is caring for a patient who is receiving nicardipine (Cardene) to treat a hypertensive emergency? a. Keep the patient NPO to prevent aspiration caused by nausea and possible vomiting. b. Organize nursing activities so that the patient has undisturbed sleep for 6 to 8 hours at night. c. Assist the patient up in the chair for meals to avoid complications associated with immobility. d. Use an automated noninvasive blood pressure machine to obtain frequent blood pressure (BP) measurements.

ANS: D Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV antihypertensive medications. This can be most easily accomplished with an automated BP machine or arterial line. The patient will require frequent assessments, so allowing 6 to 8 hours of undisturbed sleep is not appropriate. When patients are receiving IV vasodilators, bed rest is maintained to prevent decreased cerebral perfusion and fainting. There is no indication that this patient is nauseated or at risk for aspiration, so an NPO status is unnecessary.

Which information should the nurse include when teaching a patient with newly diagnosed hypertension? a. Increasing physical activity will control blood pressure (BP) for most patients. b. Most patients are able to control BP through dietary changes. c. Annual BP checks are needed to monitor treatment effectiveness. d. Hypertension is usually asymptomatic until target organ damage occurs.

ANS: D Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle changes (e.g., physical activity, dietary changes) are used to help manage blood pressure, but drugs are needed for most patients. Home BP monitoring should be taught to the patient and findings checked by the health care provider frequently when starting treatment for hypertension and then every 3 months once stable.

A patient has just been diagnosed with hypertension and has been started on captopril (Capoten). Which information is important to include when teaching the patient about this medication? a. Check blood pressure (BP) in both arms before taking the medication. b. Increase fluid intake if dryness of the mouth is a problem. c. Include high-potassium foods such as bananas in the diet. d. Change position slowly to help prevent dizziness and falls.

ANS: D The angiotensin-converting enzyme (ACE) inhibitors frequently cause orthostatic hypotension, and patients should be taught to change position slowly to allow the vascular system time to compensate for the position change. Increasing fluid intake may counteract the effect of the medication, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP should be taken in the nondominant arm by newly diagnosed patients in the morning, before taking the medication, and in the evening. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.

The nurse admits a 73-year-old male patient with dementia for treatment of uncontrolled hypertension. The nurse will closely monitor for hypokalemia if the patient receives which medication? A Clonidine (Catapres) B Bumetanide (Bumex) C Amiloride (Midamor) D Spironolactone (Aldactone)

B Bumetanide (Bumex) Bumetanide is a loop diuretic. Hypokalemia is a common adverse effect of this medication. Amiloride is a potassium-sparing diuretic. Spironolactone is an aldosterone-receptor blocker. Hyperkalemia is an adverse effect of both amiloride and spironolactone. Clonidine is a central-acting α-adrenergic antagonist and does not cause electrolyte abnormalities.

The nurse supervises an unlicensed assistant personnel (UAP) who is taking the blood pressure of 58-year-old female patient admitted with heart failure. The patient is obese. The nurse should intervene if what is observed? A The UAP waits 2 minutes after position changes to take orthostatic pressures. B The UAP deflates the blood pressure cuff at a rate of 8 to 10 mm Hg per second. C The UAP takes the blood pressure with the patient's arm at the level of the heart. D The UAP takes a forearm blood pressure because the largest cuff will not fit the patient's upper arm.

B The UAP deflates the blood pressure cuff at a rate of 8 to 10 mm Hg per second. The cuff should be deflated at a rate of 2 to 3 mm Hg per second. The arm should be supported at the level of the heart for accurate blood pressure measurements. If the maximum size blood pressure cuff does not fit the upper arm, the forearm may be used. Orthostatic blood pressures should be taken within 1 to 2 minutes of repositioning the patient.

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

C "I can lower my blood pressure by switching to smokeless tobacco." Nicotine contained in tobacco products (smoking and chew) cause vasoconstriction and increase blood pressure. Persons with hypertension should restrict sodium to 1500 mg/day by avoiding foods high in sodium and not adding salt in preparation of food or at meals. Weight loss can decrease blood pressure between 5 to 20 mm Hg. Following dietary recommendations (such as the DASH diet) lowers blood pressure, and these decreases compare with those achieved with blood pressure-lowering medication.

The nurse is teaching a women's group about prevention of hypertension. What information should be included in the teaching for all the women (select all that apply)? A Lose weight. B Limit nuts and seeds. C Limit sodium and fat intake. D Increase fruits and vegetables. E Exercise 30 minutes most days.

C Limit sodium and fat intake. D Increase fruits and vegetables. E Exercise 30 minutes most days. Primary prevention of hypertension is to make lifestyle modifications that prevent or delay the increase in BP. Along with exercise for 30 minutes on most days, the DASH eating plan is a healthy way to lower BP by limiting sodium and fat intake, increasing fruits and vegetables, and increasing nutrients that are associated with lowering BP. Nuts and seeds and dried beans are used for protein intake. Weight loss may or may not be necessary for the individual.

A 67-year-old woman with a history of coronary artery disease and prior myocardial infarction is admitted to the emergency department with a blood pressure of 234/148 mm Hg and started on IV nitroprusside (Nitropress). What should the nurse determine as an appropriate goal for the first hour of treatment? A Mean arterial pressure lower than 70 mm Hg B Mean arterial pressure no more than 120 mm Hg C Mean arterial pressure no lower than 133 mm Hg D Mean arterial pressure between 70 and 110 mm Hg

C Mean arterial pressure no lower than 133 mm Hg The initial treatment goal is to decrease mean arterial pressure by no more than 25% within minutes to 1 hour. If the patient is stable, the goal for BP is 160/100 to 110 mm Hg over the next 2 to 6 hours. Lowering the blood pressure too much may decrease cerebral, coronary, or renal perfusion and could precipitate a stroke, myocardial infarction, or renal failure. Additional gradual reductions toward a normal blood pressure should be implemented over the next 24 to 48 hours if the patient is clinically stable.

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

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

A 65-year-old patient without any past medical problems has his or her blood pressure checked at a primary health care provider's office during an annual physical examination. The blood pressure (BP) reading is 158/92. The patient is asking the nurse who was checking the blood pressure: "Does this mean that I have hypertension?" What is the most appropriate answer from the nurse? 1 "Do not worry, everything is fine." 2 "It is a normal blood pressure reading for a person of your age." 3 "Yes, you have hypertension because your BP is over 140/90." 4 "You need to have a follow-up appointment to recheck your BP."

The diagnosis of hypertension is made based on two or more elevated blood pressure readings. Considering the fact that the patient does not have any medical problems and that this reading is the first elevated blood pressure reading, a follow-up office visit is required. Providing false reassurance to the patient is leading to misinformation. For any person of age 18 and older, BP higher than 140/90 is considered elevated. Diagnosing the patient with a medical diagnosis is not within the nursing scope of practice and cannot be done based on one elevated BP reading. Text Reference - p. 715

The nurse assessing a patient records a systolic blood pressure (SBP) as 142 mm Hg and diastolic blood pressure (DBP) as 91 mm Hg. How should the nurse classify the patient's blood pressure (BP)? 1 Normal 2 Prehypertension 3 Hypertension stage 1 4 Hypertension stage 2

The patient's BP can be classified as hypertension stage I, where SBP ranges between 140-159 mm Hg, and DBP is between 90-99 mm Hg. In normal BP, SBP is less than 120 mm Hg, and DBP is less than 80 mm Hg. In the case of prehypertension, SBP ranges between 120-139 mm Hg, and DBP is between 80-89 mm Hg. In hypertension stage II, SBP is 160 mm Hg or more, and DBP is 100 mm Hg or more. Text Reference - p. 712

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

a) Assess his adherence to therapy. A long-acting calcium-channel blocker such as nifedipine causes vascular smooth muscle relaxation resulting in decreased SVR and arterial BP and related side effects. The patient data the nurse has about this patient is very limited, so the nurse needs to assess his adherence to therapy.

The nurse teaches a patient with hypertension that uncontrolled hypertension may damage organs in the body primarily by which mechanism? a) Hypertension promotes atherosclerosis and damage to the walls of the arteries. b) Hypertension causes direct pressure on organs, resulting in necrosis and replacement of cells with scar tissue. c) Hypertension causes thickening of the capillary membranes, leading to hypoxia of organ systems. d) Hypertension increases blood viscosity, which contributes to intravascular coagulation and tissue necrosis distal to occlusions.

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

The nurse is caring for a patient with hypertension who is scheduled to receive a dose of esmolol (Brevibloc). The nurse should withhold the dose and consult the prescribing physician for which vital sign taken just before administration? a) Pulse 48 b) Respirations 24 c) Blood pressure 118/74 d) Oxygen saturation 93%

a) Pulse 48 Because esmolol is a β1-adrenergic blocking agent, it can cause hypotension and bradycardia as adverse effects. The nurse should withhold the dose and consult with the health care provider for parameters regarding pulse rate limits.

Which BP-regulating mechanism(s) can result in the development of hypertension if defective (select all that apply)? a. Release of norepinephrine b. Secretion of prostaglandins c. Stimulation of the sympathetic nervous system d. Stimulation of the parasympathetic nervous system e. Activation of the renin-angiotensin-aldosterone system

a, c, e

A patient with newly discovered high BP has an average reading of 158/98 mmHg after 3 months of exercise and diet modifications. Which management strategy will be a priority for this patient? a. Medication will be required because the BP is still not at goal b. BP monitoring should continue for another 3 months to confirm a diagnosis of hypertension c. Lifestyle changes are less important, since they were not effective, and medications will be started d. More vigorous changes in the patient's lifestyle are needed for a longer time before starting medications

a. Medication will be required because the BP is still not at goal

The nurse is caring for a patient admitted with a history of hypertension. The patient's medication history includes hydrochlorothiazide (Hydrodiuril) daily for the past 10 years. Which parameter would indicate the optimal intended effect of this drug therapy? a) Weight loss of 2 lb b) Blood pressure 128/86 c) Absence of ankle edema d) Output of 600 mL per 8 hours

b) Blood pressure 128/86 Hydrochlorothiazide may be used alone as monotherapy to manage hypertension or in combination with other medications if not effective alone. After the first few weeks of therapy, the diuretic effect diminishes, but the antihypertensive effect remains. Since the patient has been taking this medication for 10 years, the most direct measurement of its intended effect would be the blood pressure.

When teaching a patient about dietary management of stage 1 hypertension, which instruction is most appropriate? a) Restrict all caffeine. b) Restrict sodium intake. c) Increase protein intake. d) Use calcium supplements.

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

When assessing the patient for orthostatic hypotension, after taking the blood pressure (BP) and pulse (P) in the supine position, what should the nurse do next? a) Repeat BP and P in this position. b) Take BP and P with patient sitting. c) Record the BP and P measurements. d) Take BP and P with patient standing.

b) Take BP and P with patient sitting. When assessing for orthostatic changes in BP after measuring BP in the supine position, the patient is placed in a sitting position and BP is measured within 1 to 2 minutes and then repositioned to the standing position with BP measured again, within 1 to 2 minutes. The results are then recorded with a decrease of 20 mm Hg or more in SBP, a decrease of 10 mm Hg or more in DBP, and/or an increase in pulse of greater than or equal to 20 beats/minute from supine to standing indicating orthostatic hypotension.

In teaching a patient with hypertension about controlling the condition, the nurse recognizes that: a. all patients with elevated BP require medication b. obese persons must achieve a normal weight to lower BP c. It is not necessary to limit salt in the diet if taking a diuretic d. lifestyle modifications are indicated for all persons with elevated BP

d. lifestyle modifications are indicated for all persons with elevated BP

While obtaining subjective assessment date from a patient with hypertension, the nurse recognizes that a modifiable risk factor for the development of hypertension is: a. a low-calcium diet b. excessive alcohol consumption c. a family history of hypertension d. consumption of a high-protein diet

b. excessive alcohol consumption

The nurse is caring for a patient admitted with chronic obstructive pulmonary disease (COPD), angina, and hypertension. Before administering the prescribed daily dose of atenolol 100 mg PO, the nurse assesses the patient carefully. Which adverse effect is this patient at risk for, given the patient's health history? a) Hypocapnia b) Tachycardia c) Bronchospasm d) Nausea and vomiting

c) Bronchospasm Atenolol is a cardioselective β1-adrenergic blocker that reduces blood pressure and could affect the β2-receptors in the lungs with larger doses or with drug accumulation. Although the risk of bronchospasm is less with cardioselective β-blockers than nonselective β-blockers, atenolol should be used cautiously in patients with COPD.

The patient has chronic hypertension. Today she has gone to the ED, and her blood pressure has risen to 200/140. What is the priority assessment for the nurse to make? a) Is the patient pregnant? b) Does the patient need to urinate? c) Does the patient have a headache or confusion? d) Is the patient taking antiseizure medications as prescribed?

c) Does the patient have a headache or confusion? The nurse's priority assessments include neurologic deficits, retinal damage, heart failure, pulmonary edema, and renal failure. The headache or confusion could be seen with hypertensive encephalopathy from increased cerebral capillary permeability leading to cerebral edema. Pregnancy can lead to secondary hypertension. Needing to urinate and taking antiseizure medication do not support a hypertensive emergency.

When teaching how lisinopril (Zestril) will help lower the patient's blood pressure, which mechanism of action should the nurse use to explain it? a) Blocks β-adrenergic effects. b) Relaxes arterial and venous smooth muscle. c) Inhibits conversion of angiotensin I to angiotensin II. d) Reduces sympathetic outflow from central nervous system.

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

In caring for a patient admitted with poorly controlled hypertension, which laboratory test result should the nurse understand as indicating the presence of target organ damage? a) BUN of 15 mg/dL b) Serum uric acid of 3.8 mg/dL c) Serum creatinine of 2.6 mg/dL d) Serum potassium of 3.5 mEq/L

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

In reviewing medication instructions with a patient being discharged on antihypertensive medications, which statement would be most appropriate for the nurse to make when discussing guanethidine (Ismelin)? a) "A fast heart rate is a side effect to watch for while taking guanethidine." b) "Stop the drug and notify your doctor if you experience any nausea or vomiting." c) "Because this drug may affect the lungs in large doses, it may also help your breathing." d) "Make position changes slowly, especially when rising from lying down to a standing position."

d) "Make position changes slowly, especially when rising from lying down to a standing position." Guanethidine is a peripheral-acting α-adrenergic antagonist and can cause marked orthostatic hypotension. For this reason, the patient should be instructed to rise slowly, especially when moving from a recumbent to a standing position. Support stockings may also be helpful. Tachycardia or lung effects are not evident with guanethidine.

A major consideration in the management of the other adult with hypertension is to: a. prevent primary hypertension from converting to secondary hypertension b. recognize that the older adult is less likely to adhere to the drug therapy regimen than a younger adult c. ensure that the patient receives larger initial doses of antihypertensive drugs because of impaired absorption d. use careful technique in assessing the BP of the patient because of the possible presence of ab auscultatory gap

d. use careful technique in assessing the BP of the patient because of the possible presence of ab auscultatory gap