Hypertension (Med-Surg)

The nurse is teaching the Dietary Approaches to Stop Hypertension (DASH) diet to a client diagnosed with essential hypertension. Which statement indicates that the client understands teaching concerning the DASH diet? 1. "I should eat at least four (4) to five (5) servings of vegetables a day." 2. "I should eat meat that has a lot of white streaks in it." 3. "I should drink no more than two (2) glasses of whole milk a day." 4. "I should decrease my grain intake to no more than twice a week."

1 1. The DASH diet has proved beneficial in lowering blood pressure. It recommends eating a diet high in vegetables and fruits. 2. The DASH diet recommends two (2) or fewer servings of lean meats, which have very few white streaks; the white streaks indicate the meat is high in fat. 3. The DASH diet recommends two (2) to three (3) servings of nonfat or low-fat milk, not whole milk. 4. The DASH diet recommends seven (7) to eight (8) servings of grain a day.

The nurse is teaching the client recently diagnosed with essential hypertension. Which instruction should the nurse provide when discussing heart healthy exercise? 1. Walk at least 30 minutes a day on flat surfaces. 2. Perform light weight lifting three (3) times a week. 3. Recommend high-intensity aerobics daily. 4. Encourage the client to swim laps once a week.

1 1. Walking 30 to 45 minutes a day will help to reduce blood pressure, weight, and stress and will increase a feeling of overall well-being. 2. Isometric exercises (such as weight lifting) should be discouraged because performing them can raise the systolic blood pressure. 3. The client should walk, cycle, jog, or swim daily, but high-level aerobic exercise may increase the client's blood pressure. 4. Swimming laps is recommended, but it should be daily, not once a week. TEST-TAKING HINT: Remember to look at the frequency of interventions; it makes a differ- ence when selecting the correct answers.

The 66-year-old male client has his blood pressure (BP) checked at a health fair. The BP is 168/98. Which action should the nurse implement first? 1. Recommend that the client have his blood pressure checked in one (1) month. 2. Instruct the client to see his health-care provider as soon as possible. 3. Discuss the importance of eating a low-salt, low-fat, low-cholesterol diet. 4. Explain that this BP is within the normal range for an elderly person.

2 1. This BP is elevated, and the client should have his BP checked frequently but not before seek- ing medical treatment. 2. The diastolic blood pressure should be less than 85 mm Hg according to the American Heart Association; therefore, this client should see the health-care provider. 3. Teaching is important, but the nurse must first make sure the client sees the health-care provider for a thorough checkup and antihy- pertensive medication prescription. Diet alone should not be recommended by the nurse. 4. This is not the normal range for an elderly person's blood pressure; the diastolic should be less than 85 mm Hg.

The nurse just received the a.m. shift report. Which client should the nurse assess first? 1. The client diagnosed with coronary artery disease who has a BP of 170/100. 2. The client diagnosed with DVT who is complaining of chest pain. 3. The client diagnosed with pneumonia who has a pulse oximeter reading of 98%. 4. The client diagnosed with ulcerative colitis who has non-bloody diarrhea.

2 1. This blood pressure is elevated, but it is not life threatening. 2. The chest pain could be a pulmonary em- bolus secondary to deep vein thrombosis and requires immediate intervention by the nurse. 3. A pulse oximeter reading of greater than 93% is within normal limits. 4. Nonbloody diarrhea is an expected sign of ulcerative colitis and would not require immediate intervention by the nurse.

The health-care provider prescribes an angiotensin-converting enzyme (ACE) inhibitor for the client diagnosed with essential hypertension. Which statement is the most appropriate rationale for administering this medication? 1. ACE inhibitors prevent beta receptor stimulation in the heart. 2. This medication blocks the alpha receptors in the vascular smooth muscle. 3. ACE inhibitors prevent vasoconstriction and sodium and water retention. 4. ACE inhibitors decrease blood pressure by relaxing vascular smooth muscle.

3 1. Beta-adrenergic blocking agents, not ACE in- hibitors, prevent the beta receptor stimulation in the heart, which decreases heart rate and cardiac output. 2. Alpha-adrenergic blockers, not ACE inhibitors, block alpha receptors in the vascular smooth muscle, which decreases vasomotor tone and vasoconstriction. 3. Angiotensin-converting enzyme (ACE) inhibitors prevent the conversion of angiotensin I to angiotensin II and this, in turn, prevents vasoconstriction and sodium and water retention. 4. Vasodilators, not ACE inhibitors, reduce blood pressure by relaxing vascular smooth muscle, especially in the arterioles.

The client diagnosed with essential hypertension asks the nurse, "Why do I have high blood pressure?" Which response by the nurse would be most appropriate? 1. "You probably have some type of kidney disease that causes the high BP." 2. "More than likely you have had a diet high in salt, fat, and cholesterol." 3. "There is no specific cause for hypertension, but there are many known risk factors." 4. "You are concerned that you have high blood pressure. Let's sit down and talk."

3 1. Kidney disease leads to secondary hyperten- sion; secondary hypertension is elevated blood pressure resulting from an identifiable under- lying process. 2. A high-salt, high-fat, high-cholesterol diet is a risk factor for essential hypertension, but it is not the only cause; therefore, this would be an incorrect answer. 3. There is no known cause for essential hypertension, but many factors—both modifiable (obesity, smoking, diet) and nonmodifiable (family history, age, gender)—are risk factors for essential hypertension. 4. This is a therapeutic reply that is inappropriate because the client needs facts.

The male client diagnosed with essential hypertension has been prescribed an alpha-adrenergic blocker. Which intervention should the nurse discuss with the client? 1. Eat at least one (1) banana a day to help increase the potassium level. 2. Explain that impotence is an expected side effect of the medication. 3. Take the medication on an empty stomach to increase absorption. 4. Change position slowly when going from a lying to sitting position.

4 1. The potassium level is not affected by an alpha-adrenergic blocker. 2. Impotence is a major cause of noncompliance with taking prescribed medications for hyper- tension in male clients. The noncompliance should be reported to the HCP immediately so the medication can be changed. 3. The medication can be taken on an empty or a full stomach, depending on whether the client becomes nauseated after taking the medication. 4. Orthostatic hypotension may occur when the blood pressure is decreasing and may lead to dizziness and light-headedness, so the client should change position slowly.

Which of the following terms describes the force against which the ventricle must expel blood? a) Afterload b) Cardiac output c) Overload d) Preload

ANSWER: A Rationale: Afterload refers to the resistance normally maintained by the aortic and pulmonic valves, the condition and the tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles. Cardiac output is the amount of blood expelled by the heart per minute. Overload refers to an abundance of circulating volume. Preload is the volume of blood in the ventricle at the end of diastole.

A client is receiving captopril (Capoten) for heart failure. The nurse should notify the physician that the medication therapy is ineffective if an assessment reveals: a) Skin rash b) Peripheral edema c) Dry cough d) Postural hypotension

ANSWER: B Rationale: Peripheral edema is a sign of fluid volume excess and worsening heart failure. A skin rash, dry cough, and postural hypotension are adverse reactions to captopril, but they don't indicate that therapy is ineffective.

A client is prescribed lisinopril for treatment of hypertension. He asks the nurse about possible adverse effects. The nurse should teach him about which of the following common adverse effects of this medication? Select all that apply. a) Constipation b) Dizziness c) Headache d) Hyperglycemia e) Hypotension

ANSWER: B, C, E

A 55-year-old black male is found to have a blood pressure of 150/90 mmHg during a work-site health screening. What should the nurse do? a) Consider this to be a normal finding for his age and race b) Recommend he have his blood pressure rechecked in 1 year c) Recommend he have his blood pressure rechecked within 2 weeks d) Recommend he see his physician immediately for further evaluation

ANSWER: C Rationale: Although hypertension is more prevalent in the black population, a blood pressure of 150/90 mmHg isn't considered normal. He should have his blood pressure rechecked within 2 weeks. One year is too long to wait. He need not see his physician yet.

What should the nurse emphasize when teaching a patient who is newly prescribed clonidine (Catapres)? a. The drug should never be stopped abruptly. b. The drug should be taken early in the day to prevent nocturia. c. The first dose should be taken when the patient is in bed for the night. d. Because aspirin will decrease the drug's effectiveness, Tylenol should be used instead.

a. Centrally acting α-adrenergic blockers may cause severe rebound hypertension if the drugs are abruptly discontinued, and patients should be taught about this effect because many are not consistently compliant with drug therapy. Diuretics should be taken early in the day to prevent nocturia. The profound orthostatic hypotension that occurs with first-dose peripheral acting α- adrenergic blockers can be prevented by taking the initial dose at bedtime. Aspirin use may decrease the effectiveness of ACE inhibitors.

A 42-yr-old man has been diagnosed with primary hypertension with an average BP of 162/92 mm Hg on three consecutive clinic visits. What are four priority lifestyle modifications that should be explored in the initial treatment of the patient? a. b. c. d.

a. Dietary modifications to increase fruits, vegetables, fat-free milk, whole grains, fish, poultry, beans, seeds, and nuts; and restrict sodium, cholesterol, and saturated fat; maintain intake of potassium, calcium, vitamin D, and omega-3 fatty acids; and promote weight reduction if overweight b. Daily moderate-intensity physical activity for at least 30 minutes on most days of the week c. Cessation of tobacco use (if a user) d. Moderation or cessation of alcohol intake

What early manifestations is the patient with primary hypertension likely to report? a. No symptoms b. Cardiac palpitations c. Dyspnea on exertion d. Dizziness and vertigo

a. Hypertension is often asymptomatic, especially if it is mild or moderate, and has been called the "silent killer." The absence of symptoms often leads to noncompliance with medical treatment and a lack of concern about the disease in patients. With severe hypertension, symptoms may include fatigue, palpitations, angina, dyspnea, and dizziness.

During treatment of a patient with a BP of 222/148 mm Hg and confusion, nausea, and vomiting, the nurse initially titrates the medications to achieve which goal? a. Decrease the mean arterial pressure (MAP) to 129 mm Hg b. Lower the BP to the patient's normal within the second to third hour c. Decrease the SBP to 160 mm Hg and the DBP to between 100 and 110 mm Hg as quickly as possible d. Reduce the systolic BP (SBP) to 158 mm Hg and the diastolic BP (DBP) to 90 mm Hg within the first 2 hours

a. Initially the treatment goal in hypertensive emergencies is to reduce the mean arterial pressure (MAP) by no more than 20% to 25% in the first hour, with further gradual reduction over the next 24 hours. In this case the MAP is 222 + 2(148)/3 = 172, so decreasing it by 25% equals 129. Lowering the BP too far or too fast may cause a stroke, myocardial infarction (MI), or renal failure. Only when the patient has an aortic dissection, angina, or signs of an ischemic stroke does the SBP have to be lowered to 100 to 120 mm Hg or less as quickly as possible.

Priority Decision: A patient with stage 2 hypertension who is taking chlorothiazide (Diuril) and lisinopril (Zestril) has prazosin (Minipress) added to the medication regimen. What is most important for the nurse to teach the patient to do? a. Weigh every morning to monitor for fluid retention. b. Change position slowly and avoid prolonged standing. c. Use sugarless gum or candy to help relieve dry mouth. d. Take the pulse daily to note any slowing of the heart rate.

b. Chlorothiazide is a thiazide diuretic that causes orthostatic hypotension. Prazosin is an α- adrenergic blocker that causes dilation of arterioles and veins and causes orthostatic hypotension. The patient may feel dizzy, weak, and faint when assuming an upright position after sitting or lying down and should be taught to change positions slowly, avoid standing for long periods, do leg exercises to increase venous return, and lie or sit down when dizziness occurs. Direct-acting vasodilators often cause fluid retention; dry mouth may occur with diuretic use, and centrally acting α- and β-blockers may cause bradycardia.

Most organ damage in hypertension is related to what? a. Increased fluid pressure exerted against organ tissue b. Atherosclerotic changes in vessels that supply the organs c. Erosion and thinning of blood vessels in organs from constant pressure d. Increased hydrostatic pressure causing leakage of plasma into organ interstitial spaces

b. Elevated BP causes endothelial damage, which causes the inner lining of arterioles to become thickened and stiffened and affects coronary circulation, cerebral circulation, peripheral vessels, and renal and retinal blood vessels. The narrowed vessels lead to ischemia and ultimately to damage of these organs.

The patient who is being admitted has had a history of uncontrolled hypertension. High SVR is most likely to cause damage to which organ? a. Brain b. Heart c. Retina d. Kidney

b. The increased systemic vascular resistance (SVR) of hypertension directly increases the workload of the heart, and heart failure occurs when the heart can no longer pump effectively against the increased resistance. The heart may be indirectly damaged by atherosclerotic changes in the blood vessels, as are the brain, retina, and kidney.

What is the primary BP effect of β-adrenergic blockers such as atenolol (Tenormin)? a. Vasodilation of arterioles by blocking movement of calcium into cells b. Decrease Na+ and water reabsorption by blocking the effect of aldosterone c. Decrease CO by decreasing rate and strength of the heart and renin secretion by the kidneys d. Vasodilation caused by inhibiting sympathetic outflow from the central nervous system (CNS)

c. Cardioselective β-adrenergic blockers decrease CO, reduce sympathetic vasoconstrictor tone, and decrease renin secretion by kidneys. Calcium channel blockers reduce BP by causing blocked movement of calcium into cells, which causes vasodilation of arterioles. Spironolactone blocks the effect of aldosterone. Central adrenergic antagonists such as clonidine (Catapres) inhibit sympathetic outflow from the central nervous system (CNS).

Which manifestation is an indication that a patient is having hypertensive emergency? a. Symptoms of a stroke with an elevated BP b. A systolic BP >180 mm Hg and a diastolic BP >110 mm Hg c. A sudden rise in BP accompanied by neurologic impairment d. A severe elevation of BP that occurs over several days or weeks

c. Hypertensive emergency, a type of hypertensive crisis, is a situation in which a patient's BP is severely elevated with evidence of acute target organ disease (e.g., cerebrovascular, cardiovascular, renal, or retinal). The neurologic manifestations are often similar to the presentation of a stroke but do not show the focal or lateralizing symptoms of stroke. Hypertensive crises are defined by the degree of organ damage and how rapidly the BP rises, not by specific BP measurements. A hypertensive urgency is a less severe crisis, in which a patient's BP becomes severely elevated over hours or days but there is no evidence of target organ damage.

Dietary teaching that includes eating dietary sources of potassium is indicated for the hypertensive patient taking which drug? a. Enalapril b. Labetalol c. Spironolactone d. Hydrochlorothiazide

d. Hydrochlorothiazide is a thiazide diuretic that causes sodium and potassium loss through the kidneys. High-potassium foods should be included in the diet, or potassium supplements may be used to prevent hypokalemia. Enalapril and spironolactone may cause hyperkalemia by inhibiting the action of aldosterone, and potassium supplements should not be used by patients taking these drugs. As a combined α/β-blocker, labetalol does not affect potassium levels.

Which drugs are most commonly used to treat hypertensive crises? a. Labetalol and bumetanide (Bumex) b. Esmolol (Brevibloc) and captopril (Captopril) c. Enalaprilat (Vasotec) and minoxidil (Minoxidil) d. Fenoldopam (Corlopam) and sodium nitroprusside (Nitropress)

d. Hypertensive crises are treated with IV administration of antihypertensive drugs, including the vasodilators sodium nitroprusside, fenoldopam, and nicardipine; adrenergic blockers such as labetalol, esmolol, and phentolamine; the ACE inhibitor enalaprilat; the calcium channel blocker clevidipine; nitroglycerin for myocardial ischemia; hydralazine with other medications; and oral captopril. Sodium nitroprusside is the most effective parenteral drug for hypertensive emergencies.

The patient asks the nurse about valsartan (Diovan), the new medication prescribed for blood pressure. What is the best explanation the nurse can use to explain the action of this medication? a. Prevents the conversion of angiotensin I to angiotensin II b. Acts directly on smooth muscle of arterioles to cause vasodilation c. Decreases extracellular fluid volume by increasing Na+ and Cl− excretion with water d. Vasodilation, prevents the action of angiotensin II, and promotes increased salt and water excretion

d. Valsartan (Diovan) is an angiotensin II receptor blocker (ARB). ARBs prevent the action of angiotensin II, produce vasodilation, and increase salt and water excretion. Angiotensin- converting enzyme (ACE) inhibitors prevent the conversion of angiotensin I to angiotensin II. Direct vasodilators act directly on smooth muscle of arterioles to cause vasodilation. Thiazide diuretics decrease extracellular fluid volume by increasing Na+ and Cl− excretion with water.