Exam 3 - Chapter 13 Patients with Hypertension

A client is instructed to reduce his intake of daily sodium intake so that the total amount is what his body needs. The nurse should instruct the client to reduce sodium intake to: 1. 500 mg a day. 2. 1000 mg a day. 3. 2500 mg a day. 4. 4500 mg a day

1. 500 mg a day. A human body needs about 500 mg of sodium each day. The average intake of sodium for individuals in the United States is between 4000 to 6000 mg a day

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. Papilledema is an edema of the optic nerves, and thus needs an ophthalmic examination for detection.

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

Intracranial hemorrhage 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.

Which of the following should the nurse instruct a client who is newly diagnosed with hypertension? It is a lifelong process. It can be managed easily. It is a short-term problem. It happens only in the very poor and treatment is expensive.

It is a lifelong process. Treatment of hypertension is a lifelong process. It requires lifestyle modification and occurs in all racial and economical groups. Hypertension can either be easy or difficult to manage.

A client is planning to use nicotine gum to aid with cigarette cessation. Which of the following should the nurse instruct the client as adverse effects of using nicotine gum? (Select all that apply.) 1. Rapid heart rate may result. 2. Mild headaches can occur. 3. A sore mouth and throat are possible. 4. Abnormal dreams are common. 5. Pruritis is possible. 6. Nausea can occur.

1. Rapid heart rate may result. 2. Mild headaches can occur. 3. A sore mouth and throat are possible. 6. Nausea can occur.

The nurse is considering the risk factors for a clients development of primary hypertension. Which of the following would be considered nonmodifiable risk factors for the client? (Select all that apply.) 1. Age 2. Stress 3. Gender 4. Ethnicity 5. Regular exercise 6. Limits fat and salt in diet

1. Age 3. Gender 4. Ethnicity

A client diagnosed with hypertension should be instructed by the nurse to avoid which of the following foods? 1. Cold cuts 2. Bananas 3. Milk 4. Oatmeal

1. Cold cuts Cold cuts are processed meats that are usually high in sodium and may cause water retention and an increase in blood pressure. The rest of the foods really have no effect on blood pressure.

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." 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.

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." 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

The nurse is performing health education-related lifestyle modifications for a patient who has been newly diagnosed with hypertension. As a component of these modifications, the DASH (Dietary Approaches to Stop Hypertension) eating plan has been recommended to the patient. Which of the nurse's recommendations is most congruent with this eating plan? "Try to buy and consume as many organic and natural foods as you can." "Try to replace the complex carbohydrates in your diet with protein-rich foods." "Try to reduce the overall amount of fat that is in your diet." "If you eat four of five small meals each day, you'll find that you're able to reduce your calorie intake."

"Try to reduce the overall amount of fat that is in your diet." The DASH eating plan emphasizes fruits, vegetables, fiber, potassium, and low-fat dairy products, and a reduction in animal protein, fat, and saturated fat. Organic foods and small, frequent meals are not components of the DASH eating plan.

The blood pressure measurement for a client is very different from the one that was assessed a few hours previously. The nurse should suspect that the blood pressure measurement is false when which of the following is assessed in the client? 1. Client needs to void. 2. Client smoked a cigarette 10 minutes prior to the measurement. 3. The examination room is very warm. 4. Doors are slamming and children are crying in the environment. 5. Client just had lunch. 6. Client slept for 8 hours the previous night.

1. Client needs to void. 2. Client smoked a cigarette 10 minutes prior to the measurement. 3. The examination room is very warm. 4. Doors are slamming and children are crying in the environment. Factors that cause false blood pressure readings include anxiety, full urinary bladder, excessively warm room, recent tobacco use, and loud or repetitive noises. Eating a meal or having 8 hours of sleep are not known to cause a false blood pressure reading

Which of the following assessment questions would be appropriate for the nurse to use when assessing a client for hypertension? (Select all that apply.) 1. Do you consume alcohol products? How much? How long? 2. Do you use nicotine products? How much? How long? 3. Do you experience nosebleeds? 4. Do you get hungry at night? 5. Do you experience cold sweats? 6. Do you experience headaches?

1. Do you consume alcohol products? How much? How long? 2. Do you use nicotine products? How much? How long? 3. Do you experience nosebleeds? 6. Do you experience headaches? The nurse will often ask the client questions about risks of hypertension. Asking about alcohol and nicotine product use will tell you about increased risk factors. Nosebleeds and headaches are often associated with hypertension. Although cold sweats and hunger are symptoms a patient may report, they are not indicative of hypertension.

.Which of the following should the nurse tell a client when instructing on ways to reduce the risk factors for hypertension? (Select all that apply.) 1. Smoking 2. Diet 3. Exercise 4. Family history 5. Race 6. Stress

1. Smoking 2. Diet 3. Exercise 6. Stress

The nurse is explaining the DASH diet to a client diagnosed with hypertension. The client inquires about how many servings of fruit per day can be consumed on the diet. What is the nurse's best response? 4 or 5 servings per day 7 or 8 servings per day 2 or 3 servings per day 2 or fewer servings per day

4 or 5 servings per day The client can consume 4 or 5 servings of fruit per day on the DASH diet. The servings for grains and grain product is 7 or 8. Two or 3 servings of low-fat or fat-free dairy foods can be consumed per day. Meat, fish, and poultry servings are 2 or fewer per day.

The nurse is 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 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.

After a series of visits to her care provider, a 40-year-old woman has been diagnosed with primary hypertension and metabolic syndrome. In addition to her persistently high blood pressure (BP) readings, what criterion would contribute to the woman's diagnosis of metabolic syndrome? Serum sodium levels of ≥135 mmol/L Abnormal lipid levels Increased serum creatinine and/or blood urea nitrogen (BUN) levels Presence of proteinuria

Abnormal lipid levels Metabolic syndrome, or syndrome X, occurs when three of the following symptoms are present: BP elevation greater than 130/85, insulin resistance, dyslipidemia, and/or abdominal obesity.

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 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.

Which condition contributes to secondary hypertension? Hepatic function Arterial vasoconstriction Calcium deficit Acid-based imbalance

Arterial vasoconstriction Secondary hypertension may accompany any primary condition that affects fluid volume or renal function or causes arterial vasoconstriction. Calcium deficiency or acid-based imbalance does not contribute to hypertension.

An adult patient's blood pressure readings have ranged from 138/92 to 154/100 during the past several weeks. As a result, the patient's nurse practitioner has ordered diagnostic follow-up. Which of the following diagnostic tests should the nurse prioritize when assessing the patient for target organ damage? C-reactive protein (CRP) levels Sodium, chloride, and potassium levels Arterial blood gas (ABG) results Blood urea nitrogen (BUN) and creatinine levels

Blood urea nitrogen (BUN) and creatinine levels Nephropathy is a common consequence of hypertension; this problem would be manifested by increased BUN and creatinine levels. Electrolyte levels are also assessed, but these are less sensitive and specific to target organ damage. Abnormal ABGs and CRP levels are not common indicators of target organ damage.

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

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." 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.

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 Clonidine (Catapres) is contraindicated for clients with severe coronary artery disease.

A client with newly diagnosed hypertension asks how to decrease the risk for related cardiovascular problems. What risk factor is modifiable by the client? Age Impaired renal function Family history Dyslipidemia

Dyslipidemia Age, family history, and impaired renal function are risk factors for cardiovascular disease related to hypertension that the client cannot change. Obesity, inactivity, and dyslipidemia are risk factors that the client can improve through diet, exercise, and other healthy lifestyle changes.

Which diagnostic method is recommended to determine whether left ventricular hypertrophy has occurred? Echocardiography Electrocardiography Blood chemistry Blood urea nitrogen

Echocardiography An echocardiogram is recommended method of determining whether hypertrophy has occurred. Electrocardiography and blood chemistry are part of the routine workup. Renal damage may be suggested by elevations in blood urea nitrogen and creatinine concentrations.

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. 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.

The nurse is creating a community teaching demonstration focusing on the cause of blood pressure. When completing the visual aid, which body structures represent the mechanism of blood pressure? Lung and arteries Heart and blood vessels Brain and sympathetic nervous system Kidneys and autonomic nervous system

Heart and blood vessels Blood pressure is the force produced by the volume of the blood in arterial walls. It is represented by the formula: BP= CO (cardiac output)× PR (peripheral resistance). To highlight the mechanism of cardiac output, a heart would be on the visual aid and blood vessels.

Which condition(s) indicates target organ damage from untreated/undertreated hypertension? Select all that apply. Heart failure Retinal damage Diabetes Hyperlipidemia Stroke

Heart failure Retinal damage Stroke Target organs include the heart, kidney, brain, and eyes. Hyperlipidemia and diabetes are risk factors for development of hypertension.

When administering benazepril with spironolactone, the nurse should be aware that which electrolyte imbalance may occur? Hyperkalemia Hypokalemia Hypercalcemia Hypocalcemia

Hyperkalemia ACE inhibitors like benazepril (Lotensin) and angiotensin receptor blockers (ARBs) block aldosterone and may cause hyperkalemia when used with a potassium sparing diuretic such as spironolactone (Aldactone). Hypercalcemia and hypocalcemia would not occur as an imbalance.

A client is prescribed Spironolactone (Aldactone) for blood pressure control. Which of the following should the nurse assess in this client as a potential side effect? . Hypokalemia 2. Hyperkalemia 3. Hyponatremia 4. Hypernatremia

Hyperkalemia Spironolactone (Aldactone) is a potassium-sparing diuretic. Side effects include hyperkalemia. Hypokalemia and hyponatremia are side effects of the thiazide diuretics. Hypernatremia is not a known side effect of any antihypertensive medication

Which term describes a situation in which blood pressure is very elevated but there is no evidence of impending or progressive target organ damage? Hypertensive urgency Hypertensive emergency Primary hypertension Secondary hypertension

Hypertensive urgency Hypertensive urgency is a situation in which blood pressure is severely elevated but there is no evidence of actual or probable target organ damage. A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage. Primary hypertension denotes high blood pressure from an unidentified source. Secondary hypertension is high blood pressure from an identified cause, such as renal disease.

When administering benazepril with spironolactone, the nurse should be aware that which electrolyte imbalance may occur? Hyperkalemia Hypokalemia Hypercalcemia Hypocalcemia

Hypokalemia ACE inhibitors like benazepril (Lotensin) and angiotensin receptor blockers (ARBs) block aldosterone and may cause hyperkalemia when used with a potassium sparing diuretic such as spironolactone (Aldactone). Hypercalcemia and hypocalcemia would not occur as an imbalance.

Management of hypertension includes three of the following four goals, depending on the primary and secondary causes. Select all that apply. Impairing the synthesis of norepinephrine. Modifying the rate of myocardial contraction. Increasing the force of cardiac output to overcome peripheral resistance. Decreasing renal absorption of sodium.

Impairing the synthesis of norepinephrine. Modifying the rate of myocardial contraction. Decreasing renal absorption of sodium. Increasing the force of cardiac output would only increase peripheral resistance, thus increasing blood pressure. The other actions would all help regulate hypertension.

The nurse is discussing aging and the incidence of hypertension with an older adult. What lifestyle change will lower blood pressure for the older adult? Add salt to foods for taste. Exercise once a week. Keep weight stable. Sleep four hours each night.

Keep weight stable. Obesity can contribute to hypertension, so keeping weight stable is healthy. Salt can add to hypertension. The American Heart Association recommends exercising more than once a week for the older adult. Sleeping for four hours is not enough for rest.

The nurse is assessing a client for a heart murmur. Which of the following should be included in this assessment? (Select all that apply.) 1. Blood pressure 2. Heart rate 3. Location 4. Radiation 5. Timing 6. Intensity

Location Radiation Timing Intensity

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 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.

The nurse is planning the care of a patient admitted to the hospital with hypertension. What objective will help to meet the needs of this patient? Lowering and controlling the blood pressure without adverse effects and without undue cost Making sure that the patient adheres to the therapeutic medication regimen Instructing the patient to enter a weight loss program and begin an exercise regimen Scheduling the patient for all follow-up visits and making phone calls to the home to ensure adherence

Lowering and controlling the blood pressure without adverse effects and without undue cost The objective of nursing care for patients with hypertension focuses on lowering and controlling the blood pressure without adverse effects and without undue cost.

A nurse is assessing a client and notes a blood pressure (BP) of 205/115. The client has had BP's within normal limits up until this time. The client reports a sudden onset severe headache. The nurse recognizes this as probable malignant hypertension. What would be the nurse's first action? Administer the ordered antihypertensive. Notify the health care provider. Call a code. Wait 15 minutes and reassess the vital signs.

Notify the health care provider. Malignant hypertension is fatal unless BP is quickly reduced. Even with intensive treatment, the kidneys, brain, and heart may be permanently damaged.

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.. 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.

A 35-year-old client has been diagnosed with hypertension. The client is a stock broker, smokes daily, and has diabetes. During a follow-up appointment, the client states that regular visits to the doctor just to check blood pressure (BP) are cumbersome and time consuming. As the nurse, which aspect of client teaching would you recommend? Purchasing a self-monitoring BP cuff Discussing methods for stress reduction Advising smoking cessation Administering glycemic control

Purchasing a self-monitoring BP cuff Because this client finds visiting the doctor time-consuming just for a BP reading, as the nurse, you can suggest the use of an automatic cuff at a local pharmacy, or purchasing a self-monitoring cuff. Discussing methods to reduce stress, advising smoking cessation, and achieving glycemic control would constitute client education in managing hypertension.

The nurse is assessing a clients precordium. Which of the following should be included in this assessment? (Select all that apply.) Palpate the precordium. Palpate temperature and pulses of extremities. Assess blood pressure. Percuss the precordium. Auscultate heart sounds. Identify the location and timing of heart sounds.

Palpate the precordium. Palpate temperature and pulses of extremities. Percuss the precordium. Auscultate heart sounds. Identify the location and timing of heart sounds.

The nurse is instructing a student on the proper technique for measuring blood pressure (BP). Which student action indicates a need for further teaching? Positions the arm at waist level Palpates the systolic pressure before auscultating blood pressure Centers the blood pressure cuff bladder directly over the brachial artery Wraps the blood pressure cuff firmly around the arm

Positions the arm at waist level Positioning the arm above the heart level will give a falsely low reading. Placing the arm below the heart will falsely elevate the reading. All other options are correct steps in achieving an accurate blood pressure.

A patient comes to the walk-in clinic. While assessing the patient's vital signs, the nurse assesses the patient's blood pressure at 128/89 mm Hg. According to JNC7, how would this patient's blood pressure be classified? Hypertensive Normal Slightly hypertensive Prehypertensive

Prehypertensive JNC7 defines a blood pressure of less than 120/80 mm Hg diastolic as normal, 120 to 129/80 to 89 mm Hg as prehypertension, and 140/90 mm Hg or higher as hypertensive.

When measuring the blood pressure in each arm of a healthy adult client, the nurse recognizes that which statement is true? Pressures must be equal in both arms. Pressures may vary 10 mm Hg or more between arms. Pressures should not differ more than 5 mm Hg between arms. Pressures may vary, with the higher pressure found in the left arm.

Pressures should not differ more than 5 mm Hg between arms. Normally, in the absence of any disease of the vasculature, arm pressures differ by no more than 5 mm Hg. The pressures in each arm do not have to be equal to be considered normal. Pressures that vary more than 10 mm Hg between arms are an abnormal finding. The left arm pressure is not anticipated to be higher than the right as a normal anatomic variant.

.A client, receiving a transfusion of packed red blood cells, asks the nurse why it is needed since she knows the body makes new blood. Which of the following should the nurse respond to this client? It will take 30 days for you body to make the new blood cells. Your body will make the new blood cells in about 60 days It takes at least 3 months for your body to make enough blood cells to replace what you have lost. Red blood cells last about 120 days. Your body needs to have a constant supply to replace the

Red blood cells last about 120 days. Your body needs to have a constant supply to replace the

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 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.

A patient newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a patient with prolonged uncontrolled hypertension is at risk for developing what health problem? Renal failure Right ventricular hypertrophy Glaucoma Anemia

Renal failure When uncontrolled hypertension is prolonged, it can result in renal failure, myocardial infarction, stroke, impaired vision, left ventricular hypertrophy, and cardiac failure. Glaucoma and anemia are not associated with hypertension.

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. 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. There is no reason when taking antihypertensive medications to restrict driving.

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." 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.

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

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.

Mr. Faulkner is a 69-year-old man who has enjoyed generally good health for his entire adult life. As a result, he has been surprised to receive a new diagnosis of hypertension after a series of visits to his primary care provider. The nurse who is working with Mr. Faulkner should recognize which of the following aspects of aging and hypertension? The diagnostic criteria for hypertension in adults over 65 differ from those for younger adults. The incidence and prevalence of hypertension increase with age. Blood pressure remains stable throughout adulthood but tends to be assessed more often by health care providers of older adults. Older adults are less vulnerable to the pathophysiological effects of hypertension than are younger adults.

The incidence and prevalence of hypertension increase with age. The prevalence of hypertension increases with aging. Aging causes structural and functional changes in the heart and blood vessels, including atherosclerosis and decreased elasticity of the major blood vessels. The diagnostic criteria between older and younger adults do not differ. Older adults are not more immune to the damaging effects of high blood pressure.

A client in a clinic setting has just been diagnosed with hypertension. When the client asks what the end goal is for treatment, what is the nurse's best response? To 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 The end goal of hypertension treatment is to prevent complications and death by achieving and maintaining arterial blood pressure at 140/90 or lower for most people. To achieve this end goal, the client is taught to make the following lifestyle changes (these are not end goals; they are ways to reach the end goal listed above): (1) maintaining a normal body mass index (about 24; greater than 25 is considered overweight); maintaining a waist circumference of less than 40 inches for men and 35 inches for women; limiting alcohol intake to no more than 2 drinks for men and 1 drink for women per day; engaging in aerobic activity at least 30 minutes per day most days of the week.

The nurse is instructing a client on the impact of cigarette smoking and the development of hypertension. Which of the following would not be appropriate for the nurse to include in these instructions? Tobacco damages the lining of the artery walls. Tobacco temporarily constricts blood vessels, increasing pulse and blood pressure. Tobacco thins the blood and makes the person at risk for bleeding. Carbon monoxide in tobacco smoke replaces the oxygen in the blood, forcing the heart to work harder to supply oxygen.

Tobacco thins the blood and makes the person at risk for bleeding. Tobacco and smoking have been shown to increase heart rate and blood pressure because of vasoconstriction and the accumulation of plaque on the artery walls. Because of the replacement of oxygen with carbon monoxide from tobacco smoke, the heart has to work harder to supply oxygen to the organs. There is no evidence that smoking thins the blood and causes bleeding

The nurse is caring for a client with hypertension. The nurse is correct to realize that a 24-hour urine is ordered to determine if the cause of hypertension is related to the dysfunction of which of the thyroid gland adrenal gland pituitary gland thymus

adrenal gland The 24-hour urine collection specimen is ordered to determine dysfunction of the adrenal gland. The 24-hour urine detects elevated catecholamines. The other options are not evaluated by a 24-hour urine.

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 Secondary hypertension may accompany any primary condition that affects fluid volume or renal function, or causes arterial vasoconstriction.

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. Reduced stress decreases the production of neurotransmitters that constrict peripheral arterioles. Reduced stress may assist in reducing blood volume and resistance to the heart.

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 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.

A client is surprised to learn that she has high blood pressure. Which of the following should the nurse assess in this client? The presence or occurrence of: nausea pain headache fear

headache With very elevated blood pressure, headache is the most commonly reported symptom. Although pain and nausea may be reported, they are not the most common. Fear is not commonly associated with hypertension though it may occur with an onset of pain or nausea.

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 obesity family history of early cardiovascular events 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.

A 56-year-old man has sought care because the automated blood pressure machine in his pharmacy indicated a blood pressure reading of 146/96 mm Hg. He has said to the nurse, "My pressure has never been this high. Will I need to take medication to reduce it?" Which of the following responses by the nurse would be best? "Yes. Hypertension is prevalent among males; it's fortunate we caught this during your routine examination." "Quite likely, because your age places you at high risk for hypertension." "A single elevated blood pressure doesn't confirm hypertension. You'll need to have your blood pressure reassessed several times before a diagnosis can be made." "You have no need to worry. Your pressure was probably elevated because of your anxiety."

"A single elevated blood pressure doesn't confirm hypertension. You'll need to have your blood pressure reassessed several times before a diagnosis can be made." Hypertension is confirmed by two or more readings with systolic pressure of at least 140 mm Hg and diastolic pressure of at least 90 mm Hg. Thus, it would be premature to presume a diagnosis of hypertension. The nurse should not provide false reassurance; the patient does need to have his blood pressure reevaluated.

The nurse is performing patient education for a patient who has been prescribed hydrochlorothiazide and metoprolol (Lopressor) for the treatment of hypertension. What teaching point should the nurse emphasize when teaching the patient about this medication regimen? "It's best not to take aspirin for pain while you're taking your antihypertensives." "Avoid taking over-the-counter decongestants because they can increase your blood pressure (BP)." "Most allergy medications can't be taken with BP meds, so make sure to check with your doctor or pharmacist." "If you get an infection, make sure that your care provider knows you have hypertension before he or she prescribes an antibiotic."

"Avoid taking over-the-counter decongestants because they can increase your blood pressure (BP)." Patients should be cautioned to avoid over-the-counter medications, especially nasal decongestants containing vasoconstrictors, which can further elevate BP. Aspirin, antibiotics, and antihistamines are not necessarily contraindicated in patients being treated for hypertension.

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." Measures that minimize orthostatic hypotension include flexing the calf muscles to boost blood return to the heart, avoiding alcohol and straining at stool, changing positions slowly, eating a high-protein snack at night, wearing elastic stockings, and holding onto a stationary object when rising. Although the client should rest between demanding activities and consume plenty of fluids and fiber (contained in fruits and vegetables) to maintain a balanced diet, these measures don't directly relieve orthostatic hypotension.

A 66-year-old client presents to the emergency department reporting severe headache and mild nausea for the past 6 hours. Upon assessment, the client's BP is 210/120 mm Hg. The client has a history of hypertension and takes 1.0 mg clonidine twice daily. Which question is most important for the nurse to ask the client next? "Have you taken your prescribed clonidine today?" "Do you have a dry mouth or nasal congestion?" "Are you having chest pain or shortness of breath?" "Did you take any medication for your headache?"

"Have you taken your prescribed clonidine today?" The nurse must ask whether the client has taken his prescribed clonidine. Clients need to be informed that rebound hypertension can occur if antihypertensive medications are suddenly stopped. Specifically, a side effect of clonidine is rebound or withdrawal hypertension. Although the other questions may be asked, it is most important to inquire whether the client has taken the prescribed hypertension medication given the client's severely elevated BP.

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." 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.

Which of the following should the nurse instruct a client who desires to reduce his blood pressure through increasing physical activity? 1. Regular exercise can lower the blood pressure by 5 to 10 mmHg. 2. Regular exercise must be done 7 days a week. 3. Regular exercise has to be done for at least 2 hours each day. 4. Regular exercise is the participation in aerobic activities.

1. Regular exercise can lower the blood pressure by 5 to 10 mmHg. Regular exercise can lower blood pressure by 5 to 10 mmHg. Regular exercise should be done 5 days a week for 60 minutes or 20 minutes of vigorous exercise at least 3 times a week to be effective. Regular exercise includes aerobic activity, flexibility, and strengthening exercises

A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. What will the nurse specify about this client's target blood pressure? 145/95 or lower 130/80 or lower 150/95 or lower 125/85 or lower

130/80 or lower The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) specifies a lower goal pressure of 130/80 for people with diabetes mellitus.

The nurse is teaching a client diagnosed with hypertension about the DASH diet. How many servings of meat, fish, and poultry should the client consume per day? 2 or fewer 2 or 3 4 or 5 7 or 8

2 or fewer Two or fewer servings of lean meat, fish, and poultry are recommended in the DASH diet. The diet also recommends two or three servings of low-fat or fat-free dairy foods, four or five servings of fruits and vegetables, and seven or eight servings of grains and grain products.

The nurse uses a blood pressure cuff that is too small for the circumference of the clients arm. How will this size of blood pressure cuff affect the clients blood pressure measurement? 1. Falsely low 2. Falsely high 3. Not clearly heard 4. More time consuming

2. Falsely high The blood pressure cuff must be the appropriate size to get an accurate reading. A cuff that is too small could result in a falsely high reading. A blood pressure cuff that is too large could result in a falsely low reading. The cuff size may not affect the nurses ability to hear the blood pressure sounds. An incorrect blood pressure cuff size will not be more time consuming to use

A client asks the nurse why she should be concerned about the amount of sodium in ice cream. Which of the following should the nurse respond to this client Sodium is used to enhance the flavor. 2. Sodium is used to emulsify the ice cream. 3. Sodium is used to prevent mold. 4. Sodium is used as a preservative

2. Sodium is used to emulsify the ice cream. Sodium is used in ice cream as an emulsifier. Sodium in canned or processed foods is used to enhance flavor. Sodium is used to prevent mold in cheese, breads, and cakes. Sodium is used as a preservative in cured meats and sausages

A clients blood pressure has been measured at 130/86 mmHg on two separate occasions. The nurse realizes this clients blood pressure reading would be categorized as being: 1. normal. 2. prehypertension. 3. stage 1 hypertension. 4. stage 2 hypertension.

2. prehypertension. Prehypertension is a new designation used to identify individuals at high risk for the development of hypertension. Systolic blood pressure of 120 to 139 and diastolic blood pressure of 80 to 90 are values for prehypertension. A normal blood pressure is less than or equal to 120 mmHg systolic and less than or equal to 80 mmHg diastolic. Stage 1 hypertension is a systolic blood pressure between 140 to 159 and a diastolic pressure between 90 to 99. Stage 2 hypertension is a systolic reading greater than or equal to 160 and a diastolic pressure of greater than or equal to 100 mmHg.

The nurse is administering an anticoagulant to a client. Which of the following medications are anticoagulants? (Select all that apply.) 1. Acetylsalicylic acid 2. Clopidogrel 3. Dalteparin 4. Reteplase 5. Tirofiban 6. Warfarin

3. Dalteparin 6. Warfarin

Which of the following should the nurse instruct a client who is scheduled for a stress test? 1. Eat nothing before the test. 2. Expect to feel chest pain. 3. The test will take between 20 and 50 minutes. 4. You will be videotaped performing the test.

3. The test will take between 20 and 50 minutes. The nurse should instruct the client that the test will take between 20 to 50 minutes to complete. The client may be permitted to eat a light meal before the test. Eating nothing before the test is not standard. Chest pain during the test should be reported. The client will not be videotaped performing the test. The client will be monitored during the test.

.A client is diagnosed with isolated systolic hypertension. The nurse realizes that this diagnosis means the client is experiencing a systolic pressure: 1. greater than 140 mmHg and a diastolic pressure greater than 90 mmHg. 2. greater than 90 mmHg and a diastolic pressure greater than 60 mmHg. 3. greater than 140 mmHg and a diastolic pressure lower than 90 mmHg. 4. lower than 140 mmHg and a diastolic pressure greater than 90 mmHg.

3. greater than 140 mmHg and a diastolic pressure lower than 90 mmHg. The likelihood of developing isolated systolic hypertension is greater with age and is confirmed with a systolic pressure greater than 140 mmHg while the diastolic pressure remains less than 90 mmHg.

A client is prescribed an ACE inhibitor for management of hypertension. Which of the following side effects should the nurse instruct the client as being expected with this medication? 1. Tachycardia 2. Constipation 3. Bizarre dreams 4. Persistent dry cough

4. Persistent dry cough One side effect of ACE inhibitors that is expected with this medication is a persistent dry cough. Tachycardia, constipation, and bizarre dreams are not side effects associated with ACE inhibitors.

A client is scheduled for a cardiac catheterization. The nurse realizes that the indications for this diagnostic test would be: 1. hypertension. 2. peripheral edema. 3. cerebral vascular accident. 4. diagnose coronary artery disease

4. diagnose coronary artery disease Clinical implications for cardiac catheterization are to diagnose coronary artery disease and assess for atherosclerotic lesions. Hypertension, peripheral edema, and cerebral vascular accident are not indications for a cardiac catheterization

The nurse is assessing a clients pulse pressure. His blood pressure reading is 130/82 mmHg. Which of the following is the correct pulse pressure? 40 48 130 82

48

A client is diagnosed with a normal ejection fraction. The nurse realizes that the clients ejection fraction is most likely between: 1. 10% to 20%. 2. 30% to 40%. 3. 60% to 70%. 4. 80% to 90%.

60% to 70%. Ejection fraction is the percentage of blood that is emptied from the ventricle during systole. An ejection fraction of 60% to 70% is considered normal. Lower ejection fraction findings indicate damage to the ventricle. Ejection fractions are not usually as high as 80% to 90%.

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) 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.

The nurse is evaluating a client who is experiencing chest pain. Which of the following should be included in this assessment? (Select all that apply.) Grade the pain on a scale of 1 to 10. Precipitating factors. Assess for sleep disturbance. Determine what was used to eliminate the pain. Assess for sweating. Determine if the pain is related to an injury or surgery

Grade the pain on a scale of 1 to 10. Precipitating factors. Determine what was used to eliminate the pain. Assess for sweating. Determine if the pain is related to an injury or surgery

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 Secondary hypertension

Hypertensive emergency 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 ren

The nurse is reviewing a clients white blood cell count. Which of the following would not be affected by the presence of an infection? Basophils Eosinophils Lymphocytes Neutrophils

Lymphocytes

The nurse teaches the client which guidelines regarding lifestyle modifications for hypertension? Reduce smoking to no more than four cigarettes per day Limit aerobic physical activity to 15 minutes, three times per week Stop alcohol intake Maintain adequate dietary intake of fruits and vegetables

Maintain adequate dietary intake of fruits and vegetables

The physician is ordering a test for the hypertensive client that will be able to evaluate whether the client has experienced heart damage. Which diagnostic test would the nurse anticipate to determine heart damage? Blood chemistry Multiple gated acquisition scan (MUGA) Chest radiograph Fluorescein angiography

Multiple gated acquisition scan (MUGA) The nurse realizes that undiagnosed (untreated), long-standing hypertension can cause heart damage. The diagnostic test that best determines heart damage is the multiple gate acquisition scan (MUGA). This test is used to detect how efficiently the heart pumps. A blood chemistry determines electrolyte balance. A chest radiograph (chest x-ray) can provide details of the heart size through shading on the scan. Fluorescein angiography is an ophthalmologic test revealing leaking retinal blood vessels.

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. 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.

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 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.

A 40-year-old man newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the patient and advises that the patient should avoid tobacco use. What is the rationale behind that advice to the patient? Smoking directly causes high blood pressure. Smoking increases the risk of heart disease. Smoking causes obesity, which exacerbates hypertension. Smoking increases cardiac output.

Smoking increases the risk of heart disease. Smoking does not cause high blood pressure, but it does increase the risk for heart disease. A patient with hypertension is already at an increased risk of heart disease. Smoking does not directly cause obesity and it does not increase cardiac output.

Which diuretic medication conserves potassium? Furosemide Spironolactone Chlorothiazide Chlorthalidone

Spironolactone Spironolactone is known as a potassium-sparing diuretic. Furosemide causes loss of potassium from the body. Chlorothiazide and chlorthalidone cause mild hypokalemia.

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. 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.

A client is experiencing chest pain that occurs in the third costochondral joint. The onset was sudden; it radiated to the shoulders; and it becomes worse when taking a deep breath or twisting the torso. The nurse suspects that this client is experiencing: aortic dissection. pulmonary embolus. pneumothorax. musculoskeletal-costochondritis.

musculoskeletal-costochondritis.

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

A client is diagnosed with a low red blood cell count. Which of the following should the nurse assess in this client? urine output bowel sounds respirations consciousness

respirations The function of the erythrocyte or red blood cell is to transport oxygen from the lungs to the cells of the body. With a low red blood cell count, the nurse should assess the clients respiratory status. The urine output, bowel sounds, and consciousness may or may not be affected by the decrease in red blood cells.

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. 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).

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 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.