Prep U Chapter 31
Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension? "Limiting my salt intake to 2 grams per day will improve my blood pressure." "A glass of red wine each day will lower my blood pressure." "I should eliminate caffeine from my diet to lower my blood pressure." "If I include less fat in my diet, I'll lower my blood pressure."
"Limiting my salt intake to 2 grams per day will improve my blood pressure."
Primary or essential hypertension accounts for about 95% of all hypertension diagnoses with an unknown etiology. Secondary hypertension accompanies specific conditions that create hypertension as a result of tissue damage. Which condition contributes to secondary hypertension? arterial vasoconstriction calcium deficit acid-base imbalance hepatic function
arterial vasoconstriction
A systolic blood pressure of 135 mm Hg would be classified as normal. prehypertension. stage 1 hypertension. stage 2 hypertension.
prehypertension.
The nurse is creating a community teaching demonstration focusing on the cause of blood pressure. When completing the visual aid, which body structures represent the mechanism of blood pressure? Lung and arteries Heart and blood vessels Kidneys and autonomic nervous system Brain and sympathetic nervous system
Heart and blood vessels
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.) Character of apical and peripheral pulses Respiratory rate Heart rhythm Lung sounds Heart rate
Character of apical and peripheral pulses Heart rhythm Heart rate
The nurse is completing a cardiac assessment on a patient. The patient has a blood pressure (BP) reading of 126/80. The nurse would identify this blood pressure reading as which of the following? Prehypertension Normal Stage 2 hypertension Stage 1 hypertension
Prehypertension
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 hypertension can occur." "Postural hypotension can occur." "Rebound hypotension can occur." "Rebound hypertension can occur."
"Rebound hypertension can occur."
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 125/85 or lower 150/95 or lower
130/80 or lower
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. 120, 70 110, 60 130, 80 140, 90
140, 90
Approximately what percentage of adults in the United States have hypertension? 20 30 40 50
30
According to the DASH diet, how many servings of vegetables should a person consume each day? 2 or fewer 2 or 3 4 or 5 7 or 8
4 or 5
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? There are no adverse effects from blood pressure medicine. A severe drop in blood pressure is possible. Take the medicine on an empty stomach. A possible adverse effect of blood pressure medicine is dizziness when you stand.
A possible adverse effect of blood pressure medicine is dizziness when you stand.
A patient has severe coronary artery disease (CAD) and hypertension. Which medication order should the nurse consult with the physician about that is contraindicated for a patient with severe CAD? Bumetanide (Bumex) Amiloride (Midamor) Clonidine (Catapres) Methyldopa (Aldomet)
Clonidine (Catapres)
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) Malignant Secondary Pathologic
Essential (primary)
Which of the following would be inconsistent as a component of metabolic syndrome? Hypertension Hypotension Elevated triglyceride levels Abdominal obesity
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 arterial resistance to left ventricular ejection Decreased elasticity of the major blood vessels Atherosclerosis Increased ability to exert diastolic pressure
Increased ability to exert diastolic pressure
A client experiences orthostatic hypotension while receiving frusemide (Lasix) to treat hypertension. How should the nurse intervene? Administer I.V. fluids as ordered. Administer a vasodilator as ordered. Insert an indwelling urinary catheter as ordered. Instruct the client to sit for several minutes before standing.
Instruct the client to sit for several minutes before standing.
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? Decrease in blood volume Increase in calcium intake Decrease in cardiac output Loss of arterial elasticity
Loss of arterial elasticity
The nurse is planning the care of a patient admitted to the hospital with hypertension. What objective will help to meet the needs of this patient? Making sure that the patient adheres to the therapeutic medication regimen Scheduling the patient for all follow-up visits and making phone calls to the home to ensure adherence Instructing the patient to enter a weight loss program and begin an exercise regimen Lowering and controlling the blood pressure without adverse effects and without undue cost
Lowering and controlling the blood pressure without adverse effects and without undue cost
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? Nausea and severe headache Numbness and weakness in the left arm Chest pain score of 3 (on a scale of 1 to 10) Urine output of 40 mL over the past hour
Numbness and weakness in the left arm
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? Reduce the blood pressure by 50% within the first hour of treatment. Rapidly reduce the blood pressure so the patient will not suffer a stroke. Reduce the blood pressure to about 140/80 mm Hg. Reduce the blood pressure by 20% to 25% within the first hour of treatment.
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? Primary hypertension Rebound hypertension Hypertensive emergency Secondary hypertension
Secondary hypertension
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.
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 thyroid gland The thymus The pituitary gland
The adrenal gland
Which statements are true when the nurse is measuring blood pressure (BP)? Select all that apply. The client should sit quietly while BP is being measured. The client's BP should be measured 1 hour before consuming alcohol. The client's arm should be positioned at the level of the heart. Using a BP cuff that is too small will give a higher BP measurement. Using a BP cuff that is too large will give a higher BP measurement.
The client should sit quietly while BP is being measured. The client's arm should be positioned at the level of the heart. Using a BP cuff that is too small will give a higher BP measurement.
The nurse is caring for a client with essential hypertension. The nurse reviews labwork and assesses kidney function. Which action of the kidney would the nurse evaluate as the body's attempt to regulate high blood pressure? The kidney retains water and excretes sodium. The kidney excretes sodium and water. The kidney retains sodium and water. The kidney retains sodium and excretes water.
The kidney excretes sodium and water.
A client comes to the emergency department complaining of visual changes and a severe headache. The nurse measures the client's blood pressure at 210/120 mm Hg. However, the client denies having hypertension or any other disorder. After diagnosing malignant hypertension (hypertensive emergency), a life-threatening disorder, the physician initiates emergency intervention. What is the most common cause of malignant hypertension (hypertensive emergency)? Pheochromocytoma Untreated hypertension Dissecting aortic aneurysm Pyelonephritis
Untreated hypertension
Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress increases the production of neurotransmitters that constrict peripheral arterioles. increases blood volume and improves the potential for greater cardiac output. increases the resistance that the heart must overcome to eject blood. decreases the production of neurotransmitters that constrict peripheral arterioles.
decreases the production of neurotransmitters that constrict peripheral arterioles.
When measuring blood pressure in each arm of a healthy adult, the nurse recognizes that the pressures must be equal in both arms. differ no more than 5 mm Hg between arms. may vary 10 mm Hg or more between arms. may vary, with the higher pressure found in the left arm.
differ no more than 5 mm Hg between arms.
A client with a history of hypertension is receiving client education about structures that regulate arterial pressure. Which structure is a component of that process? kidneys parasympathetic nervous system limbic system lungs
kidneys
Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through: ophthalmic examination. an MRI. using a sphygmomanometer. laboratory tests.
ophthalmic examination.
It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position provide time for the heart to reduce the rate of contraction to resupply oxygen to the brain. help reduce the work required by the heart to resupply oxygen to the brain. provide time for the heart to increase the rate of contraction to resupply oxygen to the brain. help reduce the blood pressure to resupply oxygen to the brain.
provide time for the heart to increase the rate of contraction to resupply oxygen to the brain.
Hypertension that can be attributed to an underlying cause is termed isolated systolic hypertension. essential hypertension. secondary hypertension. primary hypertension.
secondary hypertension.
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? "Do you have a dry mouth or nasal congestion?" "Are you having chest pain or shortness of breath?" "Did you take any medication for your headache?" "Have you taken your prescribed clonidine today?"
"Have you taken your prescribed clonidine today?"
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: "The lower the better. Blood pressure of 120/80 mm Hg is best for everyone." "Your blood pressure is fine. Just keep doing what you're doing." "The current recommendation is for everyone to have blood pressure of 140/90 mm Hg or lower." "Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg."
"Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg."
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? Pathologic Essential (primary) Secondary Malignant
Essential (primary)
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? Angina Rebound hypertension Left ventricular hypertrophy Isolated systolic hypertension
Rebound hypertension
Which finding indicates that hypertension is progressing to target organ 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
Retinal blood vessel damage
The nurse is caring for a client prescribed bumetanide for the treatment of stage 2 hypertension. Which finding indicates the client is experiencing an adverse effect of the medication? Urine output of 90 mL 1 hour after medication administration Blood glucose value of 160 mg/dL Serum potassium value of 3.0 mEq/L Electrocardiogram (EGG) tracing demonstrating peaked T waves
Serum potassium value of 3.0 mEq/L
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? Stroke Right-sided heart failure Pulmonary insufficiency Peripheral edema
Stroke
The nurse is caring for a client who is prescribed medication for the treatment of hypertension. The nurse recognizes that which medication conserves potassium? Spironolactone Chlorthalidone Chlorothiazide Furosemide
Spironolactone
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? "Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night." "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." "Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising."
"Flex your calf muscles, avoid alcohol, and change positions slowly."
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? "Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising." "Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night." "Rest between demanding activities, eat plenty of fruits and vegetables, and drink 6 to 8 cups of fluid daily." "Flex your calf muscles, avoid alcohol, and change positions slowly."
"Flex your calf muscles, avoid alcohol, and change positions slowly."
While in nursing school, you discover the prevalence of high blood pressure in the United States and are amazed at its frequency of occurrence. Which of the following is closest to approximately how many people have high blood pressure? 1 in 4 adults 1 in 10 adults 1 in 5 adults 1 in 7 adults
1 in 4 adults
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? 4.8 mL 0.48 mL 2.4 mL 0.24 mL
4.8 mL
The nurse is caring for a patient with an intracranial hemorrhage. The patient is having a hypertensive emergency. Which of the following nursing intervention would take priority in this patient? Maintaining the BP at a significantly higher than normal level to prevent orthostatic hypotension. Avoid lowering the blood pressure (BP) too quickly Reduction of the BP to 160/100 mm Hg within the half hour of treatment Reduction of the mean BP by up to 50% within the first hour of treatment
Avoid lowering the blood pressure (BP) too quickly
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? Drug therapy Smoking cessation programs Daily exercise Low-fat diet
Drug therapy
Which of the following diagnostic tests may reveal an enlarged left ventricle? Fluorescein angiography Echocardiography Computed tomographic scan Positron emission tomography (PET) scan
Echocardiography
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 Hyponatremia Hypokalemia Hypernatremia
Hyperkalemia
When administering an angiotensin-converting enzyme (ACE) inhibitor with spironolactone, the nurse should be aware that which electrolyte imbalance may occur? Hypokalemia Hypercalcemia Hypocalcemia Hyperkalemia
Hyperkalemia
A patient arrives at the clinic for a follow-up visit for treatment of hypertension. The nurse obtains a blood pressure reading of 180/110 but finds no evidence of impending or progressive organ damage when performing the assessment on the patient. What situation does the nurse understand this patient is experiencing? Hypertensive urgency Hypertensive emergency Primary hypertension Secondary hypertension
Hypertensive urgency
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. A person with hypertension should never consume alcohol. There is usually no need to change alcohol consumption for clients with hypertension. The taste buds never adapt to decreased salt intake.
It takes 2 to 3 months for the taste buds to adapt to decreased salt intake.
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? 35% Up to 25% 40% 45%
Up to 25%
The nurse understands that client education related to antihypertensive medication should include which of the following? inform client if a dosage of medication is missed , to double the next scheduled dose inform client to discontinue antihypertensives once blood pressure is normal inform client that recommended lifestyle changes are not necessary inform client to avoid over-the-counter cold and sinus medications
inform client to avoid over-the-counter cold and sinus medications
A nurse is educating a client about monitoring blood pressure readings at home. Which of the following will the nurse be sure to emphasize? "Avoid smoking cigarettes for 8 hours prior to taking blood pressure." "Be sure the forearm is well supported above heart level while 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."
A patient is being seen at the clinic on a monthly basis for assessment of blood pressure. The patient has been checking her blood pressure at home as well and has reported a systolic pressure of 158 and a diastolic pressure of 64. What does the nurse suspect this patient is experiencing? Isolated systolic hypertension Hypertensive urgency Primary hypertension Secondary hypertension
Isolated systolic hypertension
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? Angiotensin-converting enzyme (ACE) inhibitor Diuretic Beta blocker Vasodilator
Beta blocker
The nurse teaches the client which guidelines regarding lifestyle modifications for hypertension? Maintain adequate dietary intake of fruits and vegetables Stop alcohol intake Reduce smoking to no more than four cigarettes per day Limit aerobic physical activity to 15 minutes, three times per week
Maintain adequate dietary intake of fruits and vegetables
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? Maintain a waist circumference of 45 inches (114 cm) (men) and 40 inches (102 cm) (women) or less. Limit alcohol consumption to no more that 3 drinks per day. Maintain a body mass index between 30 and 35. Engage in aerobic activity at least 30 minutes/day most days of the we
Engage in aerobic activity at least 30 minutes/day most days of the week
A client is admitted to the intensive care unit (ICU) with a diagnosis of hypertension emergency/crisis. The client's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV nitroprusside. Upon assessment, which finding requires immediate intervention by the nurse? Numbness and weakness in the left arm Urine output of 40 mL over the past hour Chest pain score of 3 (on a scale of 1 to 10) Nausea and severe headache
Numbness and weakness in the left arm
A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. Which of the following are risk factors for cardiovascular problems in clients with hypertension? Choose all that apply. Gallbladder disease Physical inactivity Smoking Diabetes mellitus Frequent upper respiratory infections
Physical inactivity Smoking Diabetes mellitus
