Chapter 35 - Hypertension (Questions)
The nurse obtains a blood pressure of 180/75 mm Hg for a client. What is the client's mean arterial pressure (MAP)? ____________________
ANS: 110 MAP = (DBP + 1/3 Pulse pressure)
The nurse is caring for a client who is experiencing a hypertensive crisis and is receiving sodium nitroprusside. Which of the following time frequencies should the nurse assess the clients' blood pressure and pulse during the initial administration of this medication? a. 2-3 minutes b. 5-10 minutes c. 15-30 minutes d. Hourly
ANS: A Administered intravenously, the drugs have a rapid (within seconds to minutes) onset of action. The client's BP and pulse should be taken every 2-3 minutes during the initial administration of these drugs.
The nurse is caring for a client with hypertension and has a prescription for nadolol. Which of the following assessment findings should the nurse report to the health care provider before administering this medication? a. Asthma b. Peptic ulcer disease c. Alcohol dependency d. Myocardial infarction
ANS: A Nonselective b-adrenergic blockers can cause bronchospasm, putting the client with a history of asthma at high risk. b-adrenergic blockers will have no effect on the client's peptic ulcer disease or alcohol dependency. b-adrenergic blocker therapy is recommended after MI.
The nurse is reviewing the laboratory test results for a client who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider? a. Serum creatinine of 230 mcmol/L b. Serum potassium of 3.8 mmol/L c. Serum hemoglobin of 147 g/L d. Blood glucose level of 5.3 mmol/L
ANS: A The elevated creatinine indicates renal damage caused by the hypertension. The other laboratory results are normal.
Which of the following nursing actions should the nurse take first in order to assist a client with newly diagnosed stage 1 hypertension in making needed dietary changes? a. Have the client record dietary intake for 3 days. b. Give the client a detailed list of low-sodium foods. c. Teach the client about foods that are high in sodium. d. Help the client make an appointment with a dietitian.
ANS: A The initial nursing action should be assessment of the client's baseline dietary intake through a 3-day diet history. The other actions may be appropriate, but assessment of the client's baseline should occur first.
Which of the following assessment findings for a client who is receiving furosemide to treat stage 2 hypertension is most important to report to the health care provider? a. Blood glucose level of 10 mmol/L b. Blood potassium level of 3.0 mmol/L c. Early morning BP reading of 164/96 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 client is symptomatic.
The nurse in the emergency department received change-of-shift report on these four clients with hypertension. Which of the following clients should the nurse assess first? a. 52-year-old with a BP of 212/90 who has intermittent claudication b. 43-year-old with a BP of 190/102 who is complaining of chest pain c. 50-year-old with a BP of 210/110 who has a creatinine of 133 mcmol/L d. 48-year-old with a BP of 200/98 whose urine shows microalbuminuria
ANS: B The client with chest pain may be experiencing acute myocardial infarction and rapid assessment and intervention is needed. The symptoms of the other clients also show target organ damage, but are not indicative of acute processes.
Which of the following BP findings by the nurse indicate that no changes in therapy are needed for a client with stage 1 hypertension who has a history of heart failure? a. 108/64 mm Hg b. 128/76 mm Hg c. 140/90 mm Hg d. 136/82 mm Hg
ANS: B The goal for antihypertensive therapy for a client with hypertension and heart failure is a BP of <130/80 mm Hg. The BP of 108/64 may indicate overtreatment of the hypertension and an increased risk for adverse effects of drugs. The other two blood pressures indicate a need for modifications in the client's treatment.
The nurse obtains this information from a client with prehypertension. Which of the following findings is most important to address with the client? a. Low dietary fibre intake b. No regular aerobic exercise c. BMI of 23 kg/m2 d. Drinks wine with dinner once a week
ANS: B The recommendations for preventing hypertension include exercising aerobically for 30-60 minutes four to seven days a week. A BMI of 23 kg/m2 is within the normal BMI range. The Dietary Approaches to Stop Hypertension (DASH) diet is high in fibre, but increasing fibre alone will not prevent hypertension from developing. The client's alcohol intake will not increase the hypertension risk.
Which of the following actions should the nurse include in the plan of care for a client who is receiving sodium nitroprusside to treat a hypertensive emergency? a. Organize nursing activities so that the client has undisturbed sleep for 6 to 8 hours at night. b. Assist the client up in the chair for meals to avoid complications associated with immobility. c. Use an automated noninvasive blood pressure machine to obtain frequent BP measurements. d. Place the client on NPO status to prevent aspiration caused by nausea and the associated vomiting.
ANS: C Frequent monitoring of BP is needed when the client is receiving rapid-acting IV antihypertensive medications. This can be most easily accomplished with an automated BP machine or arterial line. The client will require frequent assessments, so allowing 6 to 8 hours of undisturbed sleep is not appropriate. When clients are receiving IV vasodilators, bed rest is maintained to prevent decreased cerebral perfusion and fainting. There is no indication that this client is nauseated or at risk for aspiration, so an NPO status is unnecessary.
The nurse is assessing a client who is being investigated for possible white coat hypertension. Which of the following actions should the nurse implement first? a. Schedule the client for frequent BP checks in the clinic. b. Instruct the client about the need to decrease stress levels. c. Tell the client how to self-monitor and record BPs at home. d. Teach the client about ambulatory blood pressure monitoring.
ANS: C Having the client self-monitor BPs at home will provide a reliable indication about whether the client has hypertension. Frequent BP checks in the clinic are likely to be high in a client with white coat hypertension. Ambulatory blood pressure monitoring may be used if the data from self-monitoring is unclear. Although elevated stress levels may contribute to hypertension, instructing the client about this is unlikely to reduce BP.
Which of the following information should the nurse include when teaching a client with newly diagnosed hypertension? a. Dietary sodium restriction will control BP for most clients. b. Most clients are able to control BP through lifestyle changes. c. Hypertension is usually asymptomatic until significant organ damage occurs. d. Annual BP checks are needed to monitor treatment effectiveness.
ANS: C Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle changes and sodium restriction are used to help manage blood pressure, but drugs are needed for most clients. BP should be checked by the health care provider every 3-6 months.
The nurse is caring for a client with hypertension and has just administered the initial dose of labetalol. Which of the following actions should the nurse take? a. Encourage oral fluids to prevent dry mouth or dehydration. b. Instruct the client to ask for help if heart palpitations occur. c. Ask the client to request assistance when getting out of bed. d. Teach the client that headaches may occur with this medication.
ANS: C Labetalol decreases sympathetic nervous system activity by blocking both a- and b-adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension. Heart palpitations, dehydration, and headaches are possible adverse effects of other antihypertensives.
The nurse is admitting a client with a history of hypertension and is being treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor to the emergency department. The client has symptoms of a severe headache and has a BP of 240/118 mm Hg. Which of the following questions should the nurse ask first? a. Did you take any acetaminophen today? b. Do you have any recent stressful events in your life? c. Have you been consistently taking your medications? d. Have you recently taken any antihistamine medications?
ANS: C 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 client.
The charge nurse observes a new RN doing discharge teaching for a client who is hypertensive and has a new prescription for enalapril. Which of the following actions by the new RN should cause the charge nurse to intervene in the client's care? a. Check the BP with a home BP monitor every day. b. Move slowly when moving from lying to standing. c. Increase the dietary intake of high-potassium foods. d. Make an appointment with the dietitian for teaching.
ANS: C 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 client with newly diagnosed hypertension who has just started therapy with enalapril.
Which of the following actions should the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new client? a. Obtain a BP reading in each arm and average the results. b. Deflate the BP cuff at a rate of 5-10 mm Hg/second. c. Have the client sit in a chair. d. Assist the client to the supine position for BP measurements.
ANS: C The client should be seated to assess the initial BP and P. The BP is obtained in both arms, but the results of the two arms are not averaged. The client does not need to be in the supine position. The cuff should be deflated at 2-3 mm Hg/second.
During change-of-shift report, the nurse obtains this information about a client who is hypertensive and received the first dose of propranolol during the previous shift. Which of the following information indicates that the client needs immediate intervention? a. The client's most recent BP reading is 156/94 mm Hg. b. The client's pulse has dropped from 64 to 58 beats/minute. c. The client has developed wheezes throughout the lung fields. d. The client complains that the fingers and toes feel quite cold.
ANS: C The most urgent concern for this client is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective b-adrenergic 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 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.
The nurse is caring for a 52-year-old client who has no previous history of hypertension or other health problems and has suddenly developed a BP of 188/106 mm Hg. After reconfirming the BP, which of the following information is best for the nurse to tell the client? a. A BP recheck should be scheduled in a few weeks. b. The dietary sodium and fat content should be decreased. c. There is an immediate danger of a stroke and hospitalization will be required. d. More diagnostic testing may be needed to determine the cause of the hypertension.
ANS: D A sudden increase in BP in a client over age 50 or under age 20 with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem. The BP will need rapid treatment and ongoing monitoring. If the client has no other risk factors, a stroke in the immediate future is unlikely. There is no indication that dietary salt or fat intake has 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 has just finished teaching a client who is hypertensive about the newly prescribed quinapril. Which of the following client statements indicates that more teaching is needed? a. "The medication may not work as well if I take any Aspirin." b. "My health care provider may order a blood potassium level occasionally." c. "I will call my health care provider if I notice that I have a frequent cough." d. "I won't worry if I have a little swelling around my lips and face."
ANS: D Angioneurotic edema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an indication that the ACE inhibitor should be discontinued. The client 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 client statements indicate that the client has an accurate understanding of ACE inhibitor therapy.
When a client with hypertension who has a new prescription for atenolol returns to the health clinic after 2 weeks for a follow-up visit, the BP is unchanged from the previous visit. Which of the following actions should the nurse take first? a. Provide information about the use of multiple drugs to treat hypertension. b. Teach the client about the reasons for a possible change in drug therapy. c. Remind the client that lifestyle changes also are important in BP control. d. Ask the client about whether the medication is actually being taken.
ANS: D Since nonadherence with antihypertensive therapy is common, the nurse's initial action should be to determine whether the client is taking the atenolol as prescribed. The other actions also may be implemented, but these would be done after assessing client compliance with the prescribed therapy.
The nurse is teaching a client with stage 1 hypertension about diet modifications that should be implemented. Which of the following diet choices indicates that the teaching has been effective? a. The client avoids eating nuts or nut butters. b. The client restricts intake of dietary protein. c. The client has only one cup of coffee in the morning. d. The client has a glass of low-fat milk with each meal.
ANS: D The Dietary Approaches to Stop Hypertension (DASH) recommendations for prevention of hypertension 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 4-5 servings weekly are recommended in the DASH diet.
The nurse is caring for a client who has just diagnosed with hypertension and has a new prescription for captopril. Which of the following information is important to include when teaching the client? a. Check BP daily 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 clients 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 client is taught to use gum or hard candy to relieve dry mouth. The BP does not need to be checked at home by the client before taking the medication. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.