MED SURG PREP U 31, PrepU Chapter 31, PrepU Med surg assignment 9, review question chapt 31, Chapter 31 POINT, MED SURG PREP U 31, NUR 222 - Ch 13 - PrepU

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. He asks the nurse what his blood pressure should be. The nurse's most appropriate response is:

"Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg." (Page 388)

A client with high blood pressure is receiving an antihypertensive drug. The nurse knows that antihypertensive drugs commonly cause fatigue and dizziness, especially on rising. When developing a client teaching plan to minimize orthostatic hypotension, which instruction should the nurse include? "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." "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." Explanation: Measures that minimize orthostatic hypotension include flexing the calf muscles to boost blood return to the heart, avoiding alcohol and straining at stool, changing positions slowly, eating a high-protein snack at night, wearing elastic stockings, and holding onto a stationary object when rising. Although the client should rest between demanding activities and consume plenty of fluids and fiber (contained in fruits and vegetables) to maintain a balanced diet, these measures don't directly relieve orthostatic hypotension.

A 66-year-old client presents to the emergency room (ER) complaining of a severe headache and mild nausea for the last 6 hours. Upon assessment, the patient's BP is 210/120 mm Hg. The patient has a history of HTN for which he takes 1.0 mg clonidine (Catapres) twice daily. Which of the following questions is most important for the nurse to ask the patient next?

"Have you taken your prescribed Catapres today?"

A client is placed on a low-sodium (500 mg/day) diet. Which client statement indicates that the nurse's nutrition teaching plan has been effective? "I'm glad I can still have chicken bouillon." "I chose a tossed salad with sardines and oil and vinegar dressing for lunch." "I chose broiled chicken with a baked potato for dinner." "I can still eat a ham-and-cheese sandwich with potato chips for lunch."

"I chose broiled chicken with a baked potato for dinner."

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

"Sit quietly for 5 minutes prior to taking blood pressure." Explanation: Instructions for the client regarding measuring the blood pressure at home include the following: (1) Avoid smoking cigarettes or drinking caffiene 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 55-year-old man newly diagnosed with hypertension returns to his physician's office for a routine follow-up appointment after several months of treatment with Lopressor (metoprolol). During the nurse's initial assessment the patient's blood pressure (BP) is recorded as 180/90 mm Hg. The patient states he does not take his medication as prescribed. The best response by the nurse is which of the following

"The medication you were prescribed may cause sexual dysfunction; are you experiencing this side effect?" The nurse needs to understand why the patient is not taking his medication. Lopressor is a beta-blocker. All patients should be informed that beta-blockers might cause sexual dysfunction and that other medications are available if problems with sexual function occur.

A 77-year-old woman presents to the local community center for a blood pressure screening. The women's blood pressure is recorded as 180/90 mm Hg. The woman has a history of hypertension, but she currently is not taking her medications. Which of the following questions is most appropriate for the nurse to ask the patient first

"Why is it that you are not taking your medication?" It is important for the nurse to first ascertain if the reason why the patient is not taking her medications. Adherence to the therapeutic program may be more difficult for older adults. The medication regimen can be difficult to remember, and the expense can be a challenge. Monotherapy (treatment with a single agent), if appropriate, may simplify the medication regimen and make it less expensive.

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 patient diagnosed with hypertension about the DASH diet. How many servings of meat, fish, and poultry should a patient consume per day?

2 or fewer

The nurse is assessing the blood pressure for a patient who has hypertension and the nurse does not hear an auscultatory gap. What outcome may be documented in this circumstance?

A high diastolic or low systolic reading (Page 387)

A community health nurse is screening for hypertension. Which of the following clients would the nurse focus on most intensively? A Hispanic teenager A middle-aged African-American man A 45-year-old Asian woman A postmenopausal Caucasian woman

A middle-aged African-American man

A patient is taking furosemide for management of mild hypertension. The nurse knows to assess laboratory results for a side effect of this diuretic. Select the abnormal laboratory reading that needs to be reported to a health care provider.

A serum potassium level of 2.8 mEq/L

Which of the following causes would not be consistent with masked hypertension?

Active lifestyle (Page 384)

Which ethnic background would the nurse screen for hypertension at an early age?

African population Explanation: The population of African descent is at the highest risk for development of hypertension. The other ethnic backgrounds have a lower risk.

Which of the following findings indicates that hypertension is progressing to target organ damage

An eye examination with an ophthalmoscope is important because retinal blood vessel damage indicates similar damage elsewhere in the vascular system. The patient is questioned about blurred vision, spots in front of the eyes, and diminished visual acuity.

Every shift you work in the hospital unit where you practice nursing, blood pressures are measured as a component of your policy-scheduled assessments. Much information can be gleaned from comparing blood pressure measurements. What does a blood pressure reading indicate?

Arterial ability to stretch and fill with blood (Page 384)

You are teaching a health class at the local YMCA. What body system would you explain regulates arterial blood pressure?

Autonomic nervous system

The patient should avoid smoking cigarettes or drinking caffeine for 30 minutes before

BP is measured.

The nurse is administering the morning mediations to a patient on the cardiac telemetry unit. Atenolol has been prescribed for this patient. Prior to administration, the nurse would tell the patient that the medication is which type of antihypertensive? Vasodilator Diuretic Angiotensin-converting enzyme (ACE) inhibitor Beta blocker

Beta blocker

What can be a result of malignant hypertension, even though it is intensively treated?

Blindness (Page 393)

Diuresis is a desired effect post administration of

Bumex.

The nurse is reviewing a patient's diet. The patient has been diagnosed with hypertension. The nurse recommends reducing or avoiding caffeine for patients with hypertension because:

Caffeine increases the heart rate and causes vasoconstriction.

An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed the client hydrochlorothiazide and enalapril. What will the nurse be sure to include in educating this client?

Change positions (lying or sitting to standing) slowly. Explanation: Antihypertensive medications can cause hypotension, especially postural hypotension that may result in injury. The nurse teaches clients to change positions slowly when moving from a lying or sitting position to a standing position. Rebound hypertension occurs when antihypertensive medications are stopped abruptly. The nurse also counsels elderly clients to use supportive devices such as handrails and walkers to prevent falls that could result from dizziness. Eating salty foods could defeat the purpose of taking the antihypertensive medications.

A nurse is providing education about hypertension to a community group. One client reports that his doctor has diagnosed him with hypertension, but that he feels just fine. He asks, "What would happen if I did not treat my hypertension?" Which of the following are possible consequences of untreated hypertension? Choose all that apply. Stroke Tension pneumothorax Coronary artery disease Pancreatitis Myocardial infarction

Coronary artery disease Myocardial infarction Stroke

A patient with hypertension is waking up several times a night to urinate. The nurse knows that what laboratory studies may indicate pathologic changes in the kidneys due to the hypertension? Select all that apply.

Creatinine, Blood urea nitrogen {BUN} (Page 387)

You are the triage nurse in a walk-in clinic when a diabetic client visits the clinic and asks you to take her blood pressure (BP). The measurements are 150/90 mm Hg. Which of the following would the nurse expect as the treatment to normalize the client's BP? Daily exercise Smoking cessation programs Drug therapy Low-fat diet

Drug therapy

A nurse educator is providing information about hypertension to a small group of clients. A participant asks what she can do to decrease her blood pressure and thus her risk for heart problems. The nurse describes modifiable and nonmodifiable risk factors. Which of the following risk factors can the client modify? Family history of cardiovascular disease Age (older than 55 years for men, 65 years for women) Dyslipidemia Ethnicity

Dyslipidemia

A patient with long-standing hypertension is admitted to the hospital with hypertensive urgency. The physician orders a chest x-ray, which reveals an enlarged heart. What diagnostic test does the nurse anticipate preparing the patient for to determine left ventricular enlargement? Echocardiography Stress test Cardiac catheterization Tilt-table test

Echocardiography

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

Echocardiography Explanation: 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 of the following statements would the nurse include in the education session? Limit alcohol consumption to no more that 3 drinks per day. Maintain a waist circumference of 45 inches (114 cm) (men) and 40 inches (102 cm) (women) or less. Engage in aerobic activity at least 30 minutes/day most days of the week. Maintain a body mass index between 30 and 35.

Engage in aerobic activity at least 30 minutes/day most days of the week.

A nurse on a busy medical unit is aware of the importance of accurate blood pressure (BP) measurement. To ensure accuracy when assessing patients' blood pressures, the nurse should always:

Ensure that the correct cuff size is used for each patient

flow rate of filtered fluid through the kidney, an indicator of renal function

Glomerular filtration rate GFR

It is important for the nurse to encourage the patient diagnosed with hypertension to rise slowly from a sitting or lying position for which of the following reasons

Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. It is important for the nurse to encourage the patient to rise slowly from a sitting or lying position because gradual changes in position provide time for the heart to increase its rate of contraction to resupply oxygen to the brain and not blood pressure or heart rate.

A nurse educator is teaching a small group of clients about hypertension and dietary changes that will assist in lowering blood pressure readings. The nurse is specifically discussing the (Dietary Approaches to Stop Hypertension (DASH) diet and teaches the clients that the food group with the largest number of servings per day is which of the following? Fruits Vegetables Low-fat or fat-free dairy foods Grains and grain products

Grains and grain products

The nurse is performing an assessment on a patient to determine the effects of hypertension on the heart and blood vessels. What specific assessment data will assist in determining this complication? (Select all that apply.)

Heart rate Heart rhythm Character of apical and peripheral pulses Explanation: During the physical examination, the nurse must also pay specific attention to the rate, rhythm, and character of the apical and peripheral pulses to detect the effects of hypertension on the heart and blood vessels.

You are writing a plan of care for your hypertensive client. What is one nursing intervention you should include in the plan of care?

Help client reduce or eliminate caffeine. (Page 388)

a Situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage

Hypertensive emergency

Which of the following would be inconsistent as a component of metabolic syndrome? Elevated triglyceride levels Hypertension Hypotension Abdominal obesity

Hypotension

Which of the following would be inconsistent with a hypertensive urgency?

Intracranial hemorrhage Explanation: Elevated blood pressure in hypertensive urgency is associated with severe headache, epistaxis, and anxiety. An example of a hypertensive emergency is a myocardial infarction, intracranial hemorrhage, or dissecting aortic aneurysm.

The nurse teaches the patient which of the following guidelines regarding lifestyle modifications for hypertension

Maintain adequate dietary intake of fruits and vegetables

The nurse teaches the client which guideline regarding lifestyle modification for hypertension?

Maintain adequate dietary intake of potassium (Page 390)

A client hospitalized for treatment of hypertension is being prepared for discharge. Which teaching topic should the nurse should be sure to cover?

Maintaining a low-sodium diet (Page 390)

A 47-year-old male patient calls the nurse and asks about the risk factors of hypertension. What should the nurse list as risk factors for primary hypertension?

Obesity, high intake of sodium and saturated fat.

An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for?

Postural hypotension and resulting injury Explanation: Antihypertensive medication can cause hypotension, especially postural hypotension that may result in injury. Rebound hypertension occurs when antihypertensive medication is stopped abruptly. Sexual dysfunction may occur, especially with beta blockers, but other medications are available should this problem ensue. This is not immediately a priority concern. Antihypertensive medications do not usually cause postural hypertension.

A patient is taking amiloride (Midamor) and lisinopril (Zestril) for the treatment of hypertension. What laboratory studies should the nurse monitor while the patient is taking these two medications together? Magnesium level Calcium level Potassium level Sodium level

Potassium level

A client is taking amiloride and lisinopril for the treatment of hypertension. What laboratory studies should the nurse monitor while the client is taking these two medications together?

Potassium level Explanation: Amiloride (Midamor) is a potassium-sparing diuretic, meaning that it causes potassium retention. The nurse should monitor for hyperkalemia (elevated potassium level) if given with an ACE inhibitor, such as lisinopril (Zestril) or angiotensin receptor blocker.

Which adrenergic inhibitor acts directly on the blood vessels, producing vasodilation?

Prazosin (Page 392)

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

Pressures should not differ more than 5 mm Hg between Pressures should not differ more than 5 mm Hg between arms. Explanation: 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.

denotes high blood pressure from an unidentified cause; also called essential hypertension

Primary hypertension

Decreasing hypertension is the main focus of the medical cardiology practice where you practice nursing. Different goals apply to different age groups for managing and reducing blood pressures. Angie Dodd, a 54-year-old nurse, is beginning medical management of her recently-diagnosed hypertension. What is considered the most important strategy in her treatment?

Reducing her systolic pressure below 140mmHg (Page 387)

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

Renal dysfunction resulting from atherosclerosis

A client, newly admitted to the nursing unit, has a primary diagnosis of renal failure. When assessing the client, the nurse notes a blood pressure (BP) of 180/100. The nurse knows that this is what kind of hypertension? Malignant Primary Secondary Essential

Secondary

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? Choose all that apply. Diabetes mellitus Frequent upper respiratory infections Physical inactivity Gallbladder disease Smoking

Smoking Diabetes mellitus Physical inactivity Explanation: Risk factors for cardiovascular problems in clients with hypertension include smoking, dyslipidemia, diabetes mellitus, impaired renal function, obesity, physical inactivity, age, and family history.

Which diuretic medication conserves potassium? Chlorothiazide Furosemide Chlorthalidone Spironolactone

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

A nursing class is practicing measurement of blood pressure. One otherwise healthy participant, 46 years old, is 138/90. This man requires follow-up. In which classification of hypertension is he according to the JNC 7 (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood pressure) recommendation?

Stage 1 (Page 384)

The nurse is employed in a physician's office and is caring for a client present for an annual exam. A blood pressure of 124/84 mm Hg is documented. Following revised guidelines for identifying hypertension, which educational pamphlet is help?

Stress reduction to lower prehypertensive state

The nursing student is part of a group of nursing students who are making a presentation on chronic hypertension. What is one subject the nursing student would need to include in the presentation as a possible consequence of untreated chronic hypertension? Right-sided heart failure Pulmonary insufficiency Peripheral edema Stroke

Stroke

What is blood pressure?

The force produced by the volume of blood in arterial walls (Page 384)

The nurse is caring for a patient newly diagnosed with hypertension. Which of the following statements if made by the patient indicates the need for further teaching

The patient needs to understand the disease process and how lifestyle changes and medications can control hypertension. The patient must take his/her medication as directed. A normal BP indicates the medication is producing its desired effect. The other responses do not indicate the need for further teaching.

The nurse observes a certified nursing assistant (CNA) obtaining a blood pressure reading with a cuff that is too small for the patient. The nurse informs the CNA that using a cuff that is too small can affect the reading results in what way?

The results will be falsely elevated. (Page 386)

A patient has come to the clinic for a follow-up assessment that will include a BP reading. To ensure an accurate reading, the nurse should confirm that the patient has done which of the following?

Tried to rest quietly for 5 minutes before the reading is taken

Which statements are true when the nurse is measuring blood pressure (BP)? Select all that apply.

Using a BP cuff that is too small will give a higher BP measurement. The client's arm should be positioned at the level of the heart. The client should sit quietly while BP is being measured. Explanation: These statements are all true when measuring a BP. When using a BP cuff that is too large, the reading will be lower than the actual BP. The client should avoid smoking cigarettes or drinking caffeine for 30 minutes before BP is measured.

Lifestyle modifications are recommended to prevent and manage hypertension. Select the modification that has been found to have the greatest effect in reducing blood pressure measurements.

Weight reduction (Page 390)

Patients taking loop diuretic may experience

a low serum potassium level.

Angiotensin-converting enzyme (ACE) inhibitors can induce

a mild to severe dry cough.

The desired effects of antihypertensives are to maintain

a normal BP.

According to the categories of blood pressure levels established by the Joint National Committee (JNC) VI, stage 1 hypertension is demonstrated by

a systolic pressure of 140 to 159, or a diastolic pressure of 90 to 99. Pressure of 130 systolic and 80 diastolic falls within the normal range for an adult. Pressure of 110 systolic and 60 diastolic falls within the normal range for an adult. Pressure of 120 systolic and 70 diastolic falls within the normal range for an adult.

Guidelines for lifestyle modification in patients with hypertension include

adopting the dietary approaches to stop hypertension (DASH) eating plan: consume a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat, dietary sodium reduction: reduce dietary sodium intake to no more than 100 mmol/day (2.4 g sodium or 6 g sodium chloride),

Patients need to be informed that rebound hypertension can occur if

antihypertensive medications are suddenly stopped.

The heart, nervous system, and kidneys are also carefully

assessed.

Corgard is a

beta-blocker. A desired effect of this medication is to reduce the pulse rate in patients with tachycardia and an elevated blood pressure (BP).

Postural hypotension and sexual dysfunction are side effects of

certain antihypertension medications.

The nurse is administering medications on a medical surgical unit. A patient is ordered to receive 40 mg of oral Corgard (nadolol) for the treatment of HTN. Prior to administering the medication, the nurse should complete which of the following?

checking the patient's heart rate

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

continuous IV infusion Explanation: The medications of choice in hypertensive emergencies are best managed through the continuous IV infusion of a short-acting titratable antihypertensive agent. The nurse avoids the sublingual and IM routes as their absorption and dynamics are unpredictable. The oral route would not have as quick an onset as a continuous IV infusion.

Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress: decreases the production of neurotransmitters that constrict peripheral arterioles. increases the resistance that the heart must overcome to eject blood. increases the production of neurotransmitters that constrict peripheral arterioles. increases blood volume and improves the potential for greater cardiac output.

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

Abnormal blood lipid levels, including high total, low density lipoprotein, and triglyceride levels as well as low high density lipoprotein levels

dyslipidemia

Guidelines for lifestyle modification in patients with hypertension include physical activity such as

engage in regular aerobic physical activity such as brisk walking (at least 30 min/day, most days of the week),

Hyperlipidemia and diabetes are risk factors for development of

hypertension.

Stopping antihypertensives abruptly can precipitate a severe

hypertensive reaction and is not recommended.

a situation in which blood pressure is severely elevated but there is no evidence of target organ damage

hypertensive urgency

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? procedural interventions observation only nonpharmacological interventions pharmacological interventions

nonpharmacological interventions

A BUN level and 60 cc/mL over 2 hours are

normal findings.

A systolic BP of less than 120 mm Hg is

normal.

The nurse is conducting a service project for a local elderly community group on the topic of HTN. The nurse will relay the risk factors and cardiovascular problems related to HTN include which of the following?

obesity, age greater than or equal to 55 in men, smoking

ECG changes associated with an elevated serum potassium levels include

peaked T waves.

The nurse is caring for a patient newly diagnosed with hypertension. Which of the following statements if made by the patient indicates the need for further teaching?

"If I take my blood pressure and it is normal, I don't have to take my BP pills."

The nurse is caring for a client newly diagnosed with hypertension. Which statement by the client indicates the need for further teaching?

"If I take my blood pressure and it is normal, I don't have to take my blood pressure pills." Explanation: The client needs to understand the disease process and how lifestyle changes and medications can control hypertension. The client must take all medications as directed. A normal blood pressure indicates the medication is producing the desired effect. The other responses do not indicate the need for further teaching.

The nurse is caring for a female client who has had 25 mg of oral hydrochlorothiazide added to her medication regimen for the treatment of HTN. Which of the following instructions should the nurse give the patient?

"Increase the amount of fruits and vegetables you eat."

The nurse is developing a nursing care plan for a patient who is being treated for hypertension. What is a measurable patient outcome that the nurse should include?

Patient will reduce Na+ intake to no more than 2.4 g daily.

A patient with secondary hypertension has come into the clinic for a routine check-up. The nurse is aware that the difference between primary hypertension and secondary hypertension is which of the following?

Secondary hypertension has a specific cause.

Guidelines for lifestyle modification in patients with hypertension include Moderate alcohol consumption

limit consumption to no more than two drinks (eg, 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and to no more than 1 drink per day in women and lighter-weight people.

medication therapy with a single medication

monotherapy

Secondary hypertension may be caused by a

tumor of the adrenal gland (eg, pheochromocytoma).

Essential hypertension has no known

underlying cause.

Primary hypertension has no known

underlying cause.

Diuretics cause increased

urination; the patient should not take the medication prior to going to bed.

The public health nurse is presenting a workshop on hypertension for the Parent Teacher Organization of the local elementary school. A parent asks the nurse who is at risk for hypertension. What would be the nurse's best answer?

"People at highest risk for hypertension include those with diabetes." (Page 384)

Officially, hypertension is diagnosed when the client demonstrates a systolic blood pressure greater than ______ mm Hg and a diastolic blood pressure greater than _____ mm Hg over a sustained period. 130, 80 120, 70 110, 60 140, 90

140, 90

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? Being sure to keep follow-up appointments Walking as far as the client is able every day Changing positions slowly related to possible hypotension Eating extra potassium due to loss of potassium related to medications

Changing positions slowly related to possible hypotension

Aging is positively correlated to the incidence of hypertension. This is due to three of the following four structural or functional changes. Which choice is not considered a cause?

Increased ability to exert diastolic pressure (Page 385)

The nurse is developing a teaching plan for a patient diagnosed with hypertension. It would be important to emphasize which of the following as part of the plan of care?

Limiting sodium intake in the diet (Page 390)

The nurse understands that an overall goal of hypertension management includes which of the following

Prolonged blood pressure elevation gradually damages blood vessels throughout the body, particularly in target organs such as the heart, kidneys, brain, and eyes. The overall goal of management is that the patient does not experience target organ damage.

Hypertension that can be attributed to an underlying cause is termed which of the following

Secondary

A patient is being treated for hypertensive emergency. When treating this patient, the priority goal is to lower the mean blood pressure (BP) by which percentage in the first hour? Up to 25% 45% 35% 40%

Up to 25%

a condition most commonly seen in the older adult in which the systolic pressure is greater than 140 mm Hg and the diastolic pressure is within normal limits (less than 90 mm Hg)

isolate systolic hypertension

The nurse is caring for a client who is prescribed diuretic medication for the treatment of hypertension. The nurse recognizes that which of the following medications conserves potassium

spironolactone (Aldactone) Aldactone is known as a potassium-sparing diuretic. Lasix causes loss of potassium from the body. Diuril causes mild hypokalemia. Hygroton causes mild hypokalemia.

A diastolic blood pressure of 90 mm Hg is classified as normal. prehypertension. stage 1 hypertension. stage 2 hypertension.

stage 1 hypertension.

A systolic BP of 140 to 159 mm Hg is

stage I hypertension.

prehypertension for adults

systolic 120-139 and diastolic 80-89

Approximately what percentage of adults in the United States have hypertension?

30 Explanation: About 32.6% of the adults in the United States have hypertension.

When treating hypertensive emergencies, the nurse identifies the most appropriate route of administration for antihypertensive agents as being which of the following? Continuous IV infusion Intramuscular Oral Sublingual

Continuous IV infusion

Which of the following diagnostic tests may reveal an enlarged left ventricle? Computed tomographic scan Echocardiography Positron emission tomography (PET) scan Fluorescein angiography

Echocardiography

During the physical assessment of a client with hypertension, what would you expect to be the most obvious finding? Hypotension in either one or both systolic or diastolic measurements. Client is underweight. Client is anemic. Sustained increase of either one or both systolic or diastolic measurements.

Sustained increase of either one or both systolic or diastolic measurements.

Bumex is a loop diuretic that can cause

fluid and electrolyte imbalances.

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

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

Thiazide diuretics may deplete

potassium; many clients will need potassium supplementation.

Adrenergic inhibitors can cause

sedation and fatigue.

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

Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension? "I should eliminate caffeine from my diet to lower my blood pressure." "A glass of red wine each day will lower my blood pressure." "If I include less fat in my diet, I'll lower my blood pressure." "Limiting my salt intake to 2 grams per day will improve my blood pressure."

"Limiting my salt intake to 2 grams per day will improve my blood pressure." Explanation: To lower blood pressure, a client should limit daily salt intake to 2 g or less. Alcohol intake is associated with a higher incidence of hypertension, poor compliance with treatment, and refractory hypertension. Chronic, moderate caffeine intake and fat intake don't affect blood pressure

According to the DASH diet, how many servings of vegetables should a person consume each day? 7 or 8 2 or 3 4 or 5 2 or fewer

4 or 5 Explanation: Four or five servings of vegetables are recommended in the DASH diet. The diet recommends two or fewer servings of lean meat, fish, and poultry; two or three servings of low-fat or fat-free dairy foods; and seven or eight servings of grains and grain products

A nurse is caring for a client with hypertension. The physician orders furosemide (lasix) 2 mg/kg to be given intravenously. The client weighs 24 kg. The medication comes in a single-use vial that contains 40 mg in 4 mL (10 mg/mL). How much will the nurse draw up for this client's dose? 0.24 mL 2.4 mL 0.48 mL 4.8 mL

4.8 mL

A client, newly prescribed a low-sodium diet due to hypertension, is asking for help with meal choices. The client provides four meal choices, which are favorites. Which selection would be best?

Green pepper stuffed with diced tomatoes and chicken Explanation: Fresh vegetables are low in sodium with diced tomatoes (fresh) and chicken is a good low-sodium, high vegetable and protein selection. Cheese and soup (tomato and creamed) are high in sodium. Processed meats such as a hot dog and condiments such as ketchup are high in sodium.

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? Kidneys and autonomic nervous system Lung and arteries Brain and sympathetic nervous system Heart and blood vessels

Heart and blood vessels Explanation: 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.

A client is taking 50 mg of oral spironolactone twice a day to assist with blood pressure control. While the nurse is performing the morning assessment, the client reports nausea, general muscle cramps, and weakness. The ECG strip shows a peaked, narrow T-wave, which is a change. What electrolyte imbalance does the nurse suspect?

Hyperkalemia Explanation: Potassium-sparing diuretics, such as spironolactone, can cause hyperkalemia, especially if given with an ACE inhibitor. Signs of hyperkalemia are nausea, diarrhea, abdominal cramps, and peaked narrow T-waves.

A nurse is educating about lifestyle modifications for a group of clients with newly diagnosed hypertension. While discussing dietary changes, which of the following points would the nurse emphasize?

It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. (Page 390)

A patient is admitted to the intensive care unit (ICU) with a diagnosis of hypertension emergency/crisis. The patient's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV Nitropress (nitroprusside). Upon assessment, which of the following patient findings requires immediate intervention by the nurse

Left arm numbness and weakness The finding of left arm numbness and weakness may indicate the patient is experiencing neurological symptoms associated with an ischemic stroke because of the severely elevated BP and requires immediate interventions.

The nurse is caring for an 82-year-old male 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? Increase in calcium intake Decrease in cardiac output Decrease in blood volume Loss of arterial elasticity

Loss of arterial elasticity

An 87-year-old client was just recently diagnosed with prehypertension. She is to meet with a dietician and return for follow-up with her cardiologist in six months. As her nurse, what would you expect her treatment to include?

Nonpharmacological interventions

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

Numbness and weakness in the left arm Explanation: Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. The finding of numbness and weakness in left arm may indicate the client is experiencing neurological symptoms associated with an ischemic stroke because of the severely elevated BP; immediate intervention is required. Urine output of 40 mL/h is within normal limits. The other findings are likely caused by the hypertension and require intervention, but they do not require action as urgently as the neurologic changes.

Which term is refers to hypertension in which blood pressure that is controlled with therapy becomes uncontrolled (abnormally high) when the therapy is discontinued? Rebound Essential Secondary Primary

Rebound Explanation: Rebound hypertension may precipitate a hypertensive crisis. Essential or primary hypertension denotes high blood pressure from an unidentified source. Secondary hypertension denotes high blood pressure from an identified cause, such as renal disease.

A patient is flying overseas for 1 week for business and packed antihypertensive medications in a suitcase. After arriving at the intended destination, the patient found that the luggage had been stolen. If the patient cannot take the medication, what condition becomes a concern? Rebound hypertension Isolated systolic hypertension Angina Left ventricular hypertrophy

Rebound hypertension

When caring for a client with essential hypertension what instruction should the nurse provide to the client to normalise blood pressure?

Reduce sodium intake (Page 385)

The nurse is seeing a client for the first time and has just checked the client's blood pressure. For what value would the nurse consider the client prehypertensive?

Systolic BP is between 120 and 139 mm Hg.

Target organ damage from untreated/undertreated hypertension includes which of the following

Target organ systems include cardiac, cerebrovascular, peripheral vascular, renal, and the eye.

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 following? The adrenal gland The thymus The pituitary gland The thyroid gland

The adrenal gland Explanation: 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.

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 incidence and prevalence of hypertension increase with age.

The nurse is teaching a patient diagnosed with hypertension about the DASH diet. How many servings of meat, fish, and poultry should a patient consume per day

Two or fewer servings of meat, fish, and poultry are recommended in the DASH diet.

Hypertension that can be attributed to an underlying is termed which of the following?

delete

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? persistent cough tremor dizziness blurred vision

dizziness Explanation: A common adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. The client and the client's spouse should be alerted to this possibility and provided with some tips for managing dizziness.

a side effect of Catapres is

rebound or withdrawal hypertension.

The nurse is caring for a client newly diagnosed with secondary hypertension. Which of the following conditions contributes to the development of secondary hypertension?

renal disease

Which of the following findings indicates that hypertension is progressing to target organ damage?

retinal blood vessel damage

High blood pressure from an identified cause, such as renal disease

secondary hypertension

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

secondary.

The nurse is caring for a patient prescribed Bumex (bumetanide) for the treatment of stage 2 hypertension. Which of the following indicates the patient is experiencing an adverse effect of the medication?

serum potassium value of 3.0 mEq/L

Guidelines for lifestyle modification in patients with hypertension include Tobacco

should be avoided because anyone with high blood pressure is already at increased risk for heart disease, and smoking amplifies this risk.

Target organ damage from untreated/undertreated hypertension includes which of the following?

stroke, retinal damage, heart failure

stage 1 hypertension for adults

systolic 140-159 diastolic 90-99

A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. For a client without diabetes mellitus, the target blood pressure is 140/90 or lower. Because this client has diabetes mellitus, the target blood pressure will be which of the following? 130/80 or lower 145/95 or lower 150/95 or lower 125/85 or lower

130/80 or lower Explanation: 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.

During a routine physical examination, the nurse assesses a blood pressure reading of 150/90 mm Hg. The patient's blood work indicates several abnormal results. The health care provider informs the nurse that he suspects that the patient has metabolic syndrome. The nurse knows that this diagnosis is associated with three classic signs/symptoms. Select all that apply.

A blood pressure reading greater than 130/85 mm Hg, Dyslipidemia and/or abdominal obesity, Insulin resistance (Page 385)

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

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

The nurse understands that patient education related to antihypertensive medication should include all of the following instructions except which of the following

If a dosage of medication is missed, double up on the next one to catch up. Doubling doses could cause serious hypotension (HTN) and is not recommended. Medications should be taken as prescribed. Hot baths, strenuous exercise, and excessive alcohol are all vasodilators and should be avoided. Many OTC preparations can precipitate HTN.

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, Decreasing renal absorption of sodium. (Page 384)

A client experiences orthostatic hypotension while receiving furosemide (Lasix) to treat hypertension. How should the nurse intervene? Instruct the client to sit for several minutes before standing. Administer a vasodilator as ordered. Insert an indwelling urinary catheter as ordered. Administer I.V. fluids as ordered.

Instruct the client to sit for several minutes before standing.

The nurse is conducting a service project for a local elderly community group on the topic of hypertension. The nurse will relay that risk factors and cardiovascular problems related to hypertension include which of the following

Major risk factors (in addition to hypotension) include smoking, dyslipidemia (high LDL, low HDL cholesterol), diabetes mellitus, impaired renal function, obesity, physical inactivity, age (older than 55 years for men, 65 years for women), and family history of cardiovascular disease.

The nurse is caring for a client with hypertension who is experiencing complications. What diagnostic test evaluates the efficiency or inefficiency of the heart to pump blood? Echocardiography Multiple gated acquisition (MUGA) scan Chest radiography Computed tomography scan

Multiple gated acquisition (MUGA) scan

Gary Larkins, a 51-year-old salesman, has a 20-pack-year history which directly impacts his newly diagnosed high blood pressure. Why do you, as his nurse, recommend smoking cessation for Gary?

Nicotine raises his heart rate, constricts arterioles, and reduces his heart's ability to eject blood.

The student nurse is doing clinical hours in a walk-in clinic. A patient with primary hypertension, and who has not been adhering to the prescribed dietary regimen, comes in for a follow-up appointment. The student is asked to develop a Nursing Care Plan for this patient. What is one of the measurable patient outcomes the student may include?

Patient will reduce Na intake to no more than 2.4g of sodium.

A nurse is discussing with a group of nursing students how to accurately measure blood pressure. The nurse is sure to include all the following information except:

Position the forearm above the level of the heart.

A 77-year-old client has newly diagnosed stage 2 hypertension. The physician has prescribed a thiazide and an angio-converting enzyme inhibitor. About what is the nurse most concerned? Postural hypertension and resulting injury Postural hypotension and resulting injury Rebound hypertension Sexual dysfunction

Postural hypotension and resulting injury

A patient is brought to the emergency department with complaints 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? Rapidly reduce the blood pressure so the patient will not suffer a stroke. Reduce the blood pressure by 20% to 25% within the first hour of treatment. Reduce the blood pressure by 50% within the first hour of treatment. Reduce the blood pressure to about 140/80 mm Hg.

Reduce the blood pressure by 20% to 25% within the first hour of treatment.

Which term describes high blood pressure from an identified cause, such as renal disease?

Secondary hypertension Explanation: Secondary hypertension is high blood pressure from an identified cause, such as renal disease. Primary hypertension denotes high blood pressure form an unidentified source. Rebound hypertension is pressure that is controlled with therapy and becomes uncontrolled (abnormally high) when that therapy is discontinued. A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage.

The nurse is administering medications on a medical surgical unit. A patient is ordered to receive 40 mg of oral Corgard (nadolol) for the treatment of hypertension. Prior to administering the medication, the nurse should complete which of the following

The nurse should check the patient's heart rate (HR) prior to administering Corgard to ensure that the patient's pulse rate is not below 60 (beats per minute (bpm).

The nurse is caring for a female client who has had 25 mg of oral hydrochlorothiazide added to her medication regimen for the treatment of hypertension (HTN). Which of the following instructions should the nurse give the patient

Thiazide diuretics cause loss of sodium, potassium, and magnesium. The patient should be encouraged to eat fruits and vegetables which are high in potassium.

Direct vasodilators may cause

headache and increased heart rate.

Beta-blockers may induce decreased

heart rate; pulse rate should be assessed before administration.

A blood pressure (BP) of 140/90 mm Hg is considered to be: prehypertension. hypertension. normal. a hypertensive emergency.

hypertension. Explanation: A BP of 140/90 mm Hg or higher is hypertension. A blood pressure less than 120/80 mm Hg is considered normal. A BP of 120 to 139/80 to 89 mm Hg is prehypertension. Hypertensive emergency is a situation in which BP is severely elevated and there is evidence of actual or probable target organ damage.

Secondary hypertension occurs when a cause for the high blood pressure can be

identified. These causes include renal parenchymal disease, narrowing of the renal arteries, hyperaldosteronism (mineralocorticoid hypertension), pheochromocytoma, certain medications (e.g., prednisone, epoietin alfa [Epogen]), and coarctation of the aorta.

The nurse understands that client education related to antihypertensive medication should include which of the following? inform client that recommended lifestyle changes are not necessary inform client to discontinue antihypertensives once blood pressure is normal inform client to avoid over-the-counter cold and sinus medications inform client if a dosage of medication is missed , to double the next scheduled dose

inform client to avoid over-the-counter cold and sinus medications Explanation: Doubling doses could cause serious hypotension (HTN) and is not recommended. Medications should be taken as prescribed. Many over-the-counter preparations can precipitate HTN. Stopping antihypertensives abruptly can precipitate a severe hypertensive reaction and is not recommended. Patients with hypertension must make considerable effort to adhere recommended lifestyle modifications.

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.

High blood pressure can also occur with

pregnancy; women who experience high blood pressure during pregnancy are at increased risk of ischemic heart disease, heart attacks, strokes, kidney disease, diabetes, and death from heart attack.

A systolic blood pressure of 135 mm Hg would be classified as normal. prehypertension. stage 1 hypertension. stage 2 hypertension.

prehypertension.

The nurse is caring for a patient with systolic blood pressure of 135 mm Hg. This finding would be classified as

prehypertension. Explanation: A systolic blood pressure of 135 mm Hg is classified as prehypertension. A systolic BP less than 120 mm Hg is normal. A systolic BP of 140 to 159 mm Hg is stage I hypertension. A systolic BP greater than or equal to 160 is classified as stage II hypertension.

A systolic blood pressure of 135 mm Hg would be classified as

prehypertension. Explanation: A systolic blood pressure of 135 mm Hg is classified as prehypertension. A systolic BP less than 120 mm Hg is normal. A systolic BP of 140 to 159 mm Hg is stage I hypertension. A systolic BP greater than or equal to 160 is classified as stage 2 hypertension.

Blood pressure that is controlled with medication and becomes uncontrolled (abnormally high) with the abrupt discontinuation of medication

rebound hypertension

The nurse is teaching a client about chronic untreated hypertension. What complication will the nurse explain to the client?

stroke Explanation: A stroke occurs if vessels in the brain rupture and bleed. If an aneurysm has developed in the aorta from chronic hypertension, it may burst and cause hemorrhage and shock. Perpheral edema, right-sided heart failure, and pulmonary insufficiency are not usually consequences of untreated chronic hypertension.

Normal Blood pressure range for adults

systolic <120 and diastolic <80

stage 2 hypertension for adults

systolic equal to or greater than 160 and diastolic equal to or greater than 100

The nurse understands that an overall goal of hypertension management includes which of the following?

there is no indication of target organ damage

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

A client diagnosed with kidney disease Explanation: Secondary hypertension is an elevated blood pressure that results from or is secondary to some other disorder such as kidney disease, a tumor of the adrenal medulla, or atherosclerosis. Depression alone is typically not associated with hypertension. Advanced age and alcohol intake are considered factors for essential hypertension.

The nurse is working on a busy cardiac unit caring for four hypertensive clients. Which client description would the nurse assess first because the client is at an increased risk for malignant hypertension?

A client with anorexia and history of no healthcare insurance Explanation: Accelerated and malignant hypertension can occur in individuals who fail to maintain follow-up or comply with medical therapy. Those individuals who have no healthcare insurance often are unable to obtain the medical follow-up or afford the cost of medications to treat the hypertensive state. If the hypertension is untreated, symptoms and complication can rapidly follow. The other choices need further assessment but are not the priority.

A male patient is being prescribed atenolol for hypertension. The nurse should make the patient aware of which potential sexual dysfunction associated with this antihypertensive?

Impotence (p. 392)

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 Explanation: In older clients, systolic BP may be elevated because of loss of arterial elasticity (arteriosclerosis). Systolic BP would not become elevated by a decrease in blood volume, an increase in calcium intake, or a decrease in cardiac output.

A 77-year-old client has newly diagnosed stage 2 hypertension for which the physician has prescribed a thiazide and an angio-converting enzyme inhibitor. The nurse is concerned about the client's risk for postural hypotension because of these medications, as well as for what other reason? Older adults have impaired cardiovascular reflexes. Older adults require large doses of these medications to control their blood pressure. These medications often cause rebound hypertension. Older adults have trouble remembering to measure their blood pressure at home.

Older adults have impaired cardiovascular reflexes.

The nurse is assessing a patient with severe hypertension. When performing a focused assessment of the eyes, what does the nurse understand may be observed related to the hypertension?

Papilledema (Page 387)

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. Explanation: A hypertensive emergency is a situation in which blood pressures are extremely elevated and must be lowered immediately (not necessarily to less than 140/90 mm Hg) to halt or prevent damage to the target organs (Chobanian et al., 2003; Rodriguez et al., 2010). Hypertensive emergencies are acute, life-threatening blood pressure elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. The therapeutic goals are reduction of the mean blood pressure by 20% to 25% within the first hour of treatment, a further reduction to a goal pressure of about 160/100 mm Hg over a period of up to 6 hours, and then a more gradual reduction in pressure over a period of days.

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

Retinal blood vessel damage Explanation: Symptoms suggesting that hypertension is progressing to the extent that target organ damage is occurring must be detected early so that appropriate treatment can be initiated. All body systems must be assessed to detect any evidence of vascular damage. An eye examination with an ophthalmoscope is important because retinal blood vessel damage indicates similar damage elsewhere in the vascular system. The client is questioned about blurred vision, spots in front of the eyes, and diminished visual acuity. The heart, nervous system, and kidneys are also carefully assessed. A BUN concentration of 12 mg/dL and urine output of 60 mL over 2 hours are normal findings. The presence of pneumonia does not indicate target organ damage.

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

Sit on the edge of the chair and rise slowly. Explanation: The nursing instruction emphasized to maintain client safety is to sit on the edge of the chair before rising slowly. By doing so, the client reduces the possibility of falls related to postural hypotension. Using a pillbox to store medications and taking the medication at the same time daily is good medication management instruction. There is no reason when taking antihypertensive medications to restrict driving.

The nurse is administering medications on a medical-surgical unit. A client is ordered to receive 40 mg oral nadolol for the treatment of hypertension. Before administering the medication, the nurse should

check the client's heart rate. Explanation: Nadolol is a beta-blocker. A desired effect of this medication is to reduce the pulse rate in clients with tachycardia and elevated blood pressure (BP). The nurse should check the client's heart rate (HR) before administering nadolol to ensure that the pulse is not less than 60 beats per minute. The other interventions are not indicated before administering a beta-blocker medication.

When measuring blood pressure in each arm of a healthy adult, the nurse recognizes that the pressures

differ no more than 5 mm Hg between arms. Explanation: Normally, in the absence of 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 anatomical variant.

When using a BP cuff that is too large the reading will be

lower than the actual BP.

Choose the statements that correctly match the hypertensive medication with its side effect.

with tiazide diuretics, monitor serum potassium levels, direct vasodilators may cause headache and tachycardia

A nurse is teaching a 38-year-old man with newly diagnosed hypertension who asks if there is any harm in stopping his antihypertensive medication if he decides to discontinue it. The correct reply addresses the consequence of stopping antihypertensive medications abruptly. Which of the following statements from the nurse would be appropriate? "Postural hypotension can occur." "Rebound hypertension can occur." "Postural hypertension can occur." "Rebound hypotension can occur."

"Rebound hypertension can occur."

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

A cuff that is too small will give a false high blood pressure. Explanation: Using a cuff that is too small will give a false high blood pressure measurement, while using a cuff that is too large results in a false low blood pressure measurement.

A female client, aged 82, visits the clinic for a blood pressure (BP) check. Her hypertension is not well controlled, and a new blood pressure medicine is prescribed. What is important for the nurse to teach this client about her blood pressure medicine? Take the medicine on an empty stomach. A possible adverse effect of blood pressure medicine is dizziness when you stand. There are no adverse effects from blood pressure medicine. A severe drop in blood pressure is possible.

A possible adverse effect of blood pressure medicine is dizziness when you stand.

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? Essential (primary) Secondary Pathologic Malignant

Essential (primary) Explanation: Essential or primary hypertension, about 95% of cases, is sustained elevated BP with no known cause. This client does not have secondary, pathologic, or malignant hypertension.

A 35-year-old female patient has been diagnosed with hypertension. The patient is a stock broker, smokes daily, and is also a diabetic. During a follow-up appointment, the patient states that she finds it cumbersome and time consuming to visit the doctor regularly just to check her blood pressure (BP). As the nurse, which of the following aspects of patient teaching would you recommend: Discussing methods for stress reduction Administering glycemic control Purchasing a self-monitoring BP cuff Advising smoking cessation

Purchasing a self-monitoring BP cuff Because this patient finds it time consuming to visit the doctor just for a blood pressure reading, as the nurse, you can suggest the use of an automatic cuff at a local pharmacy, or purchasing a self-monitoring cuff.