NURS 318 Med Surg II: Chapter 33 Hypertension

The nurse is teaching the patient about the Dietary Approaches to Stop Hypertension (DASH) diet. Which statement indicates that the patient understood the teaching?

"I should include four to five servings of fruits and vegetables daily." The DASH diet encourages consumption of fruits and vegetables. Pork and beef are high in fat and therefore have to be restricted according to the DASH diet; poultry and fish have to be consumed instead of red meat. Fat-free or low-fat milk has to be used instead of whole milk according to the DASH recommendations. The DASH diet recommends a few servings of whole grain products daily. Text Reference - p. 715 TEST-TAKING TIP: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks "why," be sure the response you have chosen is a reason. If the question stem is singular, then be sure the option is singular, and the same for plural stems and plural responses. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer.

In reviewing medication instructions with a patient being discharged on antihypertensive medications, which statement would be most appropriate for the nurse to make when discussing guanethidine (Ismelin)?

"Make position changes slowly, especially when rising from lying down to a standing position." Guanethidine is a peripheral-acting α-adrenergic antagonist and can cause marked orthostatic hypotension. For this reason, the patient should be instructed to rise slowly, especially when moving from a recumbent to a standing position. Support stockings also may be helpful. Tachycardia or lung effects are not evident with guanethidine, nor are nausea and vomiting. Text Reference - p. 718 TEST-TAKING TIP: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten.

A patient is diagnosed with primary hypertension and asks the nurse what caused this condition. Which is the best response by the nurse?

"There is no one identifiable reason." There is not one exact cause of primary hypertension; there are several contributing factors. Renal or kidney disease is a cause of secondary hypertension. An increase not decrease in plasma renin levels is a contributing factor in the development of primary hypertension. Hypertension speeds up the process of atherosclerosis in the peripheral blood vessels. Text Reference - p. 712

The patient with hypertension is due for a dose of metoprolol (Lopressor) 37.5 mg. Available are 25-mg tablets. How many tablets should the nurse administer?

1.5 tablets Using ratio and proportion, multiply 25 by x and multiply 37.5 × 1 to yield 25x = 37. Divide 37.5 by 25 to yield 1.5 tablets.

The nurse is checking blood pressure for people at a health fair. Which patient is at higher risk to develop primary hypertension?

4.59-year-old African American with a BMI of 35 who has a high stress job The patient has four risk factors for primary hypertension: advanced age, African-American race, morbid obesity with a BMI of 35, and a high level of stress. All of the other patients have fewer risk factors for primary hypertension: in the 45-year-old smoker, smoking is the only risk factor; in the 60-year-old with cancer, advanced age and pain are the only risk factors; and in the 65-year-old retiree, the only risk factor is advanced age. Text Reference - p. 713

The nurse is creating a plan of care for a patient with a new diagnosis of hypertension. Which is a potential nursing diagnosis for the patient taking antihypertensive medications? Select all that apply.

Anxiety Sexual dysfunction Nursing diagnoses associated with patients taking medications for hypertension include anxiety (related to complexity of management regimen) and sexual dysfunction (related to side effects of antihypertensive drugs). Constipation, impaired memory, and urge urinary incontinence are not side effects of antihypertensive drugs. Text Reference - p. 720

Despite a high dosage, a male patient who is taking nifedipine (Procardia XL) for antihypertensive therapy continues to have blood pressures over 140/90 mmHg. What should the nurse do next?

Assess the patient's adherence to therapy A long-acting calcium-channel blocker, such as nifedipine, causes vascular smooth muscle relaxation, resulting in decreased systemic vascular resistance (SVR) and arterial blood pressure (BP) and related side effects. The nurse needs to assess the patient's adherence to therapy. The patient's blood pressure is elevated still and must be addressed. Asking the patient to make an exercise plan or use the DASH diet is not addressing the blood pressure. It is not necessary to request another medication without assessing if the patient actually is taking the medication prescribed. Text Reference - p. 720

The nurse records normal blood pressure (BP) for a patient with a family history of hypertension and diabetes. What should the nurse teach the patient to specifically address the risks of hypertension? Select all that apply.

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

Which item on the patient's dinner tray should not be taken in large quantities by the patient prescribed furosemide (Lasix) for hypertension?

Chicken noodle soup Furosemide , a diuretic, causes fluid loss to decrease blood pressure. Chicken noodle soup is high in sodium and may cause increased fluid retention, negating the effects of the medication and increasing the blood pressure. Ice cream, grapefruit juice, and coffee will not decrease the effectiveness of furosemide. Text Reference - p. 717

A patient with hypertension has been prescribed an antihypertensive medication. During a follow-up visit, the patient asks if the medication can be stopped because the blood pressure (BP) is now within the normal range. Which nursing response is appropriate?

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

A patient is prescribed lisinopril (Prinivil) for the treatment of hypertension. The patient asks about side effects of this medication. Which side effects should the nurse include? Select all that apply.

Cough, Dizziness, Hypotension Cough, dizziness, and hypotension are side effects of angiotensin-converting enzyme (ACE) inhibitors. Peripheral edema is a side effect of calcium channel blockers. Impotence is a side effect for thiazide diuretics, aldosterone receptor blockers, central-acting alpha-adrenergic antagonists, peripheral-acting alpha-adrenergic antagonists, beta-adrenergic blockers, and mixed alpha 1 and beta 1 blockers. Muscle stiffness is not associated with an ACE inhibitor. Text Reference - p. 724 TEST-TAKING TIP: Avoid spending excessive time on any one question. Most questions can be answered in 1 to 2 minutes.

A patient has been prescribed atenolol (Tenormin). Before administering the drug, the nurse should assess for which condition?

Diabetes mellitus Atenolol reduces blood pressure by blocking β-adrenergic effects. It should be used with caution in patients with diabetes mellitus. It depresses the tachycardia associated with hypoglycemia and may prevent diagnosing hypoglycemia. A history of asthma, dry cough, or depression does not affect administration of the drug. Nonselective blockers should not be used in patients with asthma due to the risk of bronchospasm. Angiotensin-converting enzymes may cause dry cough. Reserpine should not be administered in patients with depression as the condition may worsen.

A nurse is monitoring the blood pressure (BP) of a patient visiting the health care facility. What should the nurse ensure when recording the BP? Select all that apply.

Ensure the patient has not exercised within 30 minutes. Support the patient's arm at heart level. Palpate the radial pulse for auscultatory measurement. The nurse should ensure that the patient has not exercised, smoked, or ingested caffeine within 30 minutes before measurement. The patient's arm should be supported at heart level. The radial pulse is palpated for auscultatory measurement. The nurse should begin measurement only after the patient has rested patiently for 5 minutes after sitting. The cuff should be deflated at a rate of 2-3 mm Hg/sec. Text Reference - p. 723

A patient is scheduled a dose of metoprolol (Lopressor). The nurse should withhold the dose and consult the health care provider after noting which assessment finding?

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

The nurse teaches a patient with hypertension that symptoms of uncontrolled hypertension may include which of the following? Select all that apply.

Fatigue, Dizziness, palpitations Uncontrolled hypertension may result in fatigue, dizziness, and palpitations. Cluster headaches and shortness of breath do not occur with uncontrolled hypertension. TEST-TAKING TIP: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation. Text Reference - p. 713

The nurse assessing a patient records a systolic blood pressure (SBP) as 142 mm Hg and diastolic blood pressure (DBP) as 91 mm Hg. How should the nurse classify the patient's blood pressure (BP)?

Hypertension stage 1 The patient's BP can be classified as hypertension stage I, where SBP ranges between 140-159 mm Hg, and DBP is between 90-99 mm Hg. In normal BP, SBP is less than 120 mm Hg, and DBP is less than 80 mm Hg. In the case of prehypertension, SBP ranges between 120-139 mm Hg, and DBP is between 80-89 mm Hg. In hypertension stage II, SBP is 160 mm Hg or more, and DBP is 100 mm Hg or more. STUDY TIP: Determine whether you are a "lark" or an "owl." Larks, day people, do best getting up early and studying during daylight hours. Owls, night people, are more alert after dark and can remain up late at night studying, catching up on needed sleep during daylight hours. It is better to work with natural biorhythms than to try to conform to an arbitrary schedule. You will absorb material more quickly and retain it better if you use your most alert periods of each day for study. Of course, it is necessary to work around class and clinical schedules. Owls should attempt to register in afternoon or evening lectures and clinical sections; larks do better with morning lectures and day clinical sections. Text Reference - p. 712

A nurse is providing care for a patient who continues to experience hypertension despite taking a calcium channel blocker daily. A diuretic has been prescribed. How does a diuretic help control blood pressure? Select all that apply.

It reduces plasma volume. It promotes sodium and water excretion. It reduces the vascular response to catecholamines. Diuretics are an important component of BP treatment. Diuretics tend to reduce the plasma volume by promoting excretion of sodium and water. The net result is a reduction in the circulating volume, which causes a decrease in the BP. Diuretics also reduce the vascular response to catecholamines. The blood vessels do not constrict in response to catecholamines; as a result, the BP is reduced. Diuretics do not cause vasodilation or prevent the movement of extracellular calcium into the cells; these effects are brought about by calcium channel blockers.

The nurse is teaching a women's group about prevention of hypertension. What information should be included in the teaching for all the women? Select all that apply.

Limit sodium and fat intake Increase fruits and vegetables Exercise 30 minutes most days Primary prevention of hypertension is to make lifestyle modifications that prevent or delay the increase in blood pressure (BP). Along with exercise for 30 minutes on most days, the dietary approaches to stop hypertension (DASH) eating plan is a healthy way to lower BP by limiting sodium and fat intake, increasing fruits and vegetables, and increasing nutrients that are associated with lowering BP. Weight loss may or may not be necessary for the individual. Nuts and seeds and dried beans are used for protein intake. Text Reference - p. 715

The nurse is teaching a patient, recently diagnosed with hypertension (HTN), about diagnostic studies prescribed by a primary health care provider. Which information would the nurse include? Select all that apply.

Lipid profile to provide information about the risk factor for HTN Blood urea nitrogen (BUN) and serum creatinine levels to provide information on renal function Elevated lipid profile is an additional risk factor for hypertension because it leads to development of atherosclerosis. BUN, creatinine, and urinalysis provide information about baseline renal function and help to identify renal damage. Echocardiography evaluates degree of ventricular hypertrophy, while ECG is used to assess baseline cardiac function. Diuretic therapy frequently leads to an increase in uric acid. Text Reference - p. 715

A patient with a history of pheochromocytoma is in the emergency department and has a blood pressure of 246/144 mm Hg. The health care provider prescribes sodium nitroprusside. What nursing interventions are required when administering this medication? Select all that apply.

Measuring hourly urine output. Continuous blood pressure monitoring. Titrate the infusion according to mean arterial pressure or blood pressure (BP) as prescribed. Measure urine output hourly to assess renal perfusion. Patients being treated with IV sodium nitroprusside should have continuous blood pressure monitoring. The drug is titrated according to MAP or BP as prescribed. When a patient is to receive sodium nitroprusside for a hypertensive emergency, the nurse will prepare for an infusion of the medication, as it is not given IV push. The initial goal is to decrease MAP by no more than 20% to 25%, or to decrease MAP to 110 to 115 mm Hg. If the patient is clinically stable, drugs can be titrated to gradually lower BP over the next 24 hours. Lowering the BP too quickly or too much may decrease cerebral, coronary, or renal perfusion. This could precipitate a stroke, myocardial infarction (MI), or renal failure. Text Reference - p. 719 TEST-TAKING TIP: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation.

The nurse is obtaining data from a patient who has been on medication for hypertension and diabetes for four years. The patient has been experiencing blurred vision due to retinal damage caused by hypertension. What are the other manifestations of target organ disease? Select all that apply.

Nocturia, Aneurysm, Transient ischemic attack Hypertension affects the kidneys; the earliest manifestation of renal disease is nocturia. Hypertension speeds up the process of atherosclerosis in the peripheral blood vessels leading to aneurysms. Adequate control of blood pressure (BP) reduces the risk of transient ischemic attack. Pneumonia and anemia are not manifestations of target organ disease. Text Reference - p. 714

When teaching a patient about dietary management of stage 1 hypertension, which instruction is most appropriate?

Restrict sodium intake The patient should decrease intake of sodium . This will help to control hypertension, which can be aggravated by excessive salt intake, which in turn leads to fluid retention. Caffeine and protein intake do not affect hypertension. Calcium supplements are not recommended to lower blood pressure. Text Reference - p. 712

A nurse is preparing discharge teaching for a patient with orthostatic hypotension. Which instructions should be a part of the discharge plan? Select all that apply.

Rise slowly from a supine to sitting position. Lie down or sit if dizziness occurs. Do not stand still for prolonged periods. Perform leg exercises to increase venous return. Orthostatic hypotension is a condition where there is a decrease in blood pressure upon rising to a standing position from a lying down or sitting position. The patient should be instructed to rise slowly from the sitting and lying down position and move only when no dizziness occurs. The patient should sit or lie down if there is dizziness. This prevents the risk of falling. Standing still for prolonged periods may cause venous stasis and worsen hypotension. Doing leg exercises helps to increase venous return to the heart and lowers blood pressure. Sleeping with the head elevated helps to keep the blood flow to the brain uniform and prevents orthostatic hypotension. Text Reference - p. 723

The nurse is preparing a presentation on complications of hypertension. Which information would the nurse include? Select all that apply.

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

When assessing the patient for orthostatic hypotension, after taking the blood pressure (BP) and pulse (P) in the supine position, what should the nurse do next?

Take BP and P with patient sitting When assessing for orthostatic changes in BP after measuring BP in the supine position, the patient then is placed in a sitting position and BP is measured within one to two minutes, and then repositioned to the standing position with BP measured again, within one to two minutes. The results then are recorded with a decrease of 20 mm Hg or more in systolic blood pressure (SBP), a decrease of 10 mm Hg or more in diastolic blood pressure (DBP), or an increase in pulse of greater than or equal to 20 beats/minute from supine to standing, indicating orthostatic hypotension. Text Reference - p. 721

A patient arrives at a medical clinic for a checkup. The patient's blood pressure (BP) is 150/94 mm Hg. All other assessment findings are within normal limits. The nurse reviews the patient's file from previous visits, and there is no history of elevated blood pressure. What could be the reason for a falsely high blood pressure?

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

A nurse helps a patient move from a lying down position to a standing position. The patient suddenly becomes dizzy. What is the probable reason for the dizziness?

The vasomotor center may not have been activated. During any change in position, the vasomotor center is activated and stimulates the sympathetic nervous system (SNS) response. The SNS response ensures that cerebral blood flow is maintained by causing peripheral vasoconstriction and by increasing venous return. If the patient feels dizzy when changing positions, it means that the vasomotor center is not being stimulated. If the peripheral arteries constrict and the venous return to the heart is increased, the blood flow to the heart is maintained and may prevent dizziness in the patient. If the force of contraction is increased, the patient would not experience dizziness as the blood flow to the brain would be maintained. Text Reference - p. 711

A nurse is caring for a patient admitted to the health care facility with acute ischemic stroke. The patient is receiving IV antihypertensive drugs. Which interventions should the nurse perform for this patient? Select all that apply.

Titrate drug according to mean arterial pressure (MAP) or BP as prescribed. Measure hourly urine output. Perform frequent neurologic checks. Drugs should be titrated according to MAP or BP as prescribed. The nurse should measure hourly urine output to assess renal perfusion and should perform frequent neurologic checks. Antihypertensive IV drugs have a rapid onset of action; hence BP and pulse should be assessed every 2 to 3 minutes using a noninvasive BP machine. The patient should be restricted to bed; severe cerebral ischemia or fainting may result if the patient tries to get up. Text Reference - p. 272

The nurse is assessing a patient's blood pressure and reviewing factors that contribute to primary hypertension. Which of these may be contributing factors to the development of primary hypertension? Select all that apply.

Tobacco use Diabetes mellitus Increased sodium intake Greater-than-ideal body weight Contributing factors to primary hypertension include increased sympathetic nervous system (SNS) activity, overproduction (not underproduction) of sodium-retaining hormones and vasoconstricting substances, increased sodium intake, greater-than-ideal body weight, diabetes mellitus, tobacco use, and excessive alcohol consumption. Thyroid disease is related to secondary hypertension. Text Reference - p. 712

The nurse is obtaining a health history from a patient with hypertension. Nonmodifiable risk factors for the development of hypertension include which of these? Select all that apply.

age, ethnicity, family history Nonmodifiable risk factors for hypertension include increasing age, African-American ethnicity , and a family history of hypertension. Consumption of excessive dietary sodium and excessive alcohol consumption are considered modifiable risk factors. Text Reference - p. 713