Deck 33: Nursing Management: Hypertension

Question 1

The RN is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside (Nipride). Which of the following nursing actions can the nurse delegate to an experienced LPN/LVN?

A) Titrate nitroprusside to maintain BP at 160/100 mm Hg.
B) Evaluate effectiveness of nitroprusside therapy on BP.
C) Set up the automatic blood pressure machine to take BP every 15 minutes.
D) Assess the patient's environment for adverse stimuli that might increase BP.

Answer 1

Set up the automatic blood pressure machine to take BP every 15 minutes.

Question 2

Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new patient?

A) Obtain a BP reading in each arm and average the results.
B) Deflate the BP cuff at a rate of 5 to 10 mm Hg per second.
C) Have the patient sit in a chair with the feet flat on the floor.
D) Assist the patient to the supine position for BP measurements.

Answer 2

Have the patient sit in a chair with the feet flat on the floor.

Question 3

The nurse obtains this information from a patient with prehypertension. Which finding is most important to address with the patient?

A) Low dietary fiber intake
B) No regular aerobic exercise
C) Weight 5 pounds above ideal weight
D) Drinks wine with dinner once a week

Answer 3

No regular aerobic exercise

Question 4

Which information should the nurse include when teaching a patient with newly diagnosed hypertension?

A) Dietary sodium restriction will control BP for most patients.
B) Most patients are able to control BP through lifestyle changes.
C) Hypertension is usually asymptomatic until significant organ damage occurs.
D) Annual BP checks are needed to monitor treatment effectiveness.

Question 5

Which action will be included in the plan of care when the nurse is caring for a patient who is receiving sodium nitroprusside (Nipride) to treat a hypertensive emergency?

A) Organize nursing activities so that the patient has undisturbed sleep for 6 to 8 hours at night.
B) Assist the patient up in the chair for meals to avoid complications associated with immobility.
C) Use an automated noninvasive blood pressure machine to obtain frequent BP measurements.
D) Place the patient on NPO status to prevent aspiration caused by nausea and the associated vomiting.

Question 6

Which BP finding by the nurse indicates that no changes in therapy are needed for a patient with stage 1 hypertension who has a history of heart failure?

A) 108/64 mm Hg
B) 128/76 mm Hg
C) 140/90 mm Hg
D) 136/ 82 mm Hg

Question 7

The nurse has just finished teaching a hypertensive patient about the newly prescribed quinapril (Accupril). Which patient statement indicates that more teaching is needed?

A) "The medication may not work as well if I take any aspirin."
B) "The doctor may order a blood potassium level occasionally."
C) "I will call the doctor if I notice that I have a frequent cough."
D) "I won't worry if I have a little swelling around my lips and face."

Question 8

The nurse in the emergency department received change-of-shift report on four patients with hypertension. Which patient should the nurse assess first?

A) 52-year-old with a BP of 212/90 who has intermittent claudication
B) 43-year-old with a BP of 190/102 who is complaining of chest pain
C) 50-year-old with a BP of 210/110 who has a creatinine of 1.5 mg/dL
D) 48-year-old with a BP of 200/98 whose urine shows microalbuminuria

Question 9

After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented, which diet choice indicates that the teaching has been effective?

A) The patient avoids eating nuts or nut butters.
B) The patient restricts intake of dietary protein.
C) The patient has only one cup of coffee in the morning.
D) The patient has a glass of low-fat milk with each meal.

Question 10

A patient is diagnosed with hypertension and nadolol ( Corgard ) is prescribed. The nurse should consult with the health care provider before giving this medication upon finding a history of

A) asthma.
B) peptic ulcer disease.
C) alcohol dependency.
D) myocardial infarction ( MI ).

Question 11

The nurse is reviewing the laboratory tests for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider?

A) Serum creatinine of 2.6 mg/dL
B) Serum potassium of 3.8 mEq/L
C) Serum hemoglobin of 14.7 g/dL
D) Blood glucose level of 98 mg/dL

Question 12

The charge nurse observes a new RN doing discharge teaching for a hypertensive patient who has a new prescription for enalapril ( Vasotec ). The charge nurse will need to intervene if the new RN tells the patient to

A) check the BP with a home BP monitor every day.
B) move slowly when moving from lying to standing.
C) increase the dietary intake of high-potassium foods.
D) make an appointment with the dietitian for teaching.

Question 13

When a patient with hypertension who has a new prescription for atenolol (Tenormin) returns to the health clinic after 2 weeks for a follow-up visit, the BP is unchanged from the previous visit. Which action should the nurse take first?

A) Provide information about the use of multiple drugs to treat hypertension.
B) Teach the patient about the reasons for a possible change in drug therapy.
C) Remind the patient that lifestyle changes also are important in BP control.
D) Question the patient about whether the medication is actually being taken.

Question 14

During change-of-shift report, the nurse obtains this information about a hypertensive patient who received the first dose of propranolol (Inderal) during the previous shift. Which information indicates that the patient needs immediate intervention?

A) The patient's most recent BP reading is 156/94 mm Hg.
B) The patient's pulse has dropped from 64 to 58 beats/minute.
C) The patient has developed wheezes throughout the lung fields.
D) The patient complains that the fingers and toes feel quite cold.

Question 15

A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and has a BP of 240/118 mm Hg. Which question should the nurse ask first?

A) Did you take any acetaminophen (Tylenol) today?
B) Do you have any recent stressful events in your life?
C) Have you been consistently taking your medications?
D) Have you recently taken any antihistamine medications?

Question 16

The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a hypertensive emergency. Which finding is most important to report to the health care provider?

A) Urine output over 8 hours is 200 mL less than the fluid intake.
B) The patient is unable to move the left arm and leg when asked to do so.
C) Tremors are noted in the fingers when the patient extends the arms.
D) The patient complains of a severe headache with pain at level 8/10 (0 to 10 scale).

Question 17

After giving a patient the initial dose of oral labetalol (Normodyne) for treatment of hypertension, which action should the nurse take?

A) Encourage oral fluids to prevent dry mouth or dehydration.
B) Instruct the patient to ask for help if heart palpitations occur.
C) Ask the patient to request assistance when getting out of bed.
D) Teach the patient that headaches may occur with this medication.

Question 18

A patient has been diagnosed with possible white coat hypertension. Which action will the nurse plan to take next?

A) Schedule the patient for frequent BP checks in the clinic.
B) Instruct the patient about the need to decrease stress levels.
C) Tell the patient how to self-monitor and record BPs at home.
D) Teach the patient about ambulatory blood pressure monitoring.

Question 19

A 52-year-old patient who has no previous history of hypertension or other health problems suddenly develops a BP of 188/106 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that

A) a BP recheck should be scheduled in a few weeks.
B) the dietary sodium and fat content should be decreased.
C) there is an immediate danger of a stroke and hospitalization will be required.
D) more diagnostic testing may be needed to determine the cause of the hypertension.

Question 20

A patient has just been diagnosed with hypertension and has a new prescription for captopril (Capoten). Which information is important to include when teaching the patient?

A) Check BP daily before taking the medication.
B) Increase fluid intake if dryness of the mouth is a problem.
C) Include high-potassium foods such as bananas in the diet.
D) Change position slowly to help prevent dizziness and falls.

Question 21

Which assessment finding for a patient who is receiving furosemide (Lasix) to treat stage 2 hypertension is most important to report to the health care provider?

A) Blood glucose level of 180 mg/dL
B) Blood potassium level of 3.0 mEq/L
C) Early morning BP reading of 164/96 mm Hg
D) Orthostatic systolic BP decrease of 12 mm Hg

Question 22

Which nursing action should the nurse take first in order to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes?

A) Have the patient record dietary intake for 3 days.
B) Give the patient a detailed list of low-sodium foods.
C) Teach the patient about foods that are high in sodium.
D) Help the patient make an appointment with a dietitian.

Question 23

The nurse obtains a blood pressure of 180/75 mm Hg for a patient. What is the patient's mean arterial pressure (MAP)? ____________________