Deck 31: Assessment and Management of Patients With Hypertension

Question 1

An older adult is newly diagnosed with primary hypertension and has just been started on a beta-blocker. The nurses health education should include which of the following?

A) Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the betablocker
B) Maintaining a diet high in dairy to increase protein necessary to prevent organ damage
C) Use of strategies to prevent falls stemming from postural hypotension
D) Limiting exercise to avoid injury that can be caused by increased intracranial pressure

Answer 1

Use of strategies to prevent falls stemming from postural hypotension

Question 2

A patient with primary hypertension comes to the clinic complaining of a gradual onset of blurry vision and decreased visual acuity over the past several weeks. The nurse is aware that these symptoms could be indicative of what?

A) Retinal blood vessel damage
B) Glaucoma
C) Cranial nerve damage
D) Hypertensive emergency

Answer 2

Retinal blood vessel damage

Question 3

A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective assessment data from a patient with hypertension, the nurse learns that the patient has a family history of hypertension and she herself has high cholesterol and lipid levels. The patient says she smokes one pack of cigarettes daily and drinks about a pack of beer every day. The nurse notes what nonmodifiable risk factor for hypertension?

A) Hyperlipidemia
B) Excessive alcohol intake
C) A family history of hypertension
D) Closer adherence to medical regimen

Answer 3

A family history of hypertension

Question 4

The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in what way?

A) The BP is always higher in a hypertensive emergency.
B) Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies.
C) Hypertensive urgency is treated with rest and benzodiazepines to lower BP.
D) Hypertensive emergencies are associated with evidence of target organ damage.

Question 5

A group of student nurses are practicing taking blood pressure. A 56-year-old male student has a blood pressure reading of 146/96 $\mathrm{mm} \mathrm{Hg}$ . Upon hearing the reading, he exclaims, My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it? Which of the following responses by the nursing instructor would be best?

A) Yes. Hypertension is prevalent among men; it is fortunate we caught this during your routine examination.
B) We will need to reevaluate your blood pressure because your age places you at high risk for hypertension.
C) A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made.
D) You have no need to worry. Your pressure is probably elevated because you are being tested.

Question 6

A 40-year-old male newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the patient and advises that the patient should avoid tobacco use. What is the primary rationale behind that advice to the patient?

A) Quitting smoking will cause the patients hypertension to resolve.
B) Tobacco use increases the patients concurrent risk of heart disease.
C) Tobacco use is associated with a sedentary lifestyle.
D) Tobacco use causes ventricular hypertrophy.

Question 7

A patient has been prescribed antihypertensives. After assessment and analysis, the nurse has identified a nursing diagnosis of risk for ineffective health maintenance related to nonadherence to therapeutic
Regimen. When planning this patients care, what desired outcome should the nurse identify?

A) Patient takes medication as prescribed and reports any adverse effects.
B) Patients BP remains consistently below 140/90 mm Hg.
C) Patient denies signs and symptoms of hypertensive urgency.
D) Patient is able to describe modifiable risk factors for hypertension.

Question 8

The nurse is providing care for a patient with a new diagnosis of hypertension. How can the nurse best promote the patients adherence to the prescribed therapeutic regimen?

A) Screen the patient for visual disturbances regularly.
B) Have the patient participate in monitoring his or her own BP.
C) Emphasize the dire health outcomes associated with inadequate BP control.
D) Encourage the patient to lose weight and exercise regularly.

Question 9

A patient newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a patient with prolonged, uncontrolled hypertension is at risk for developing what health problem?

A) Renal failure
B) Right ventricular hypertrophy
C) Glaucoma
D) Anemia

Question 10

A patient with primary hypertension complains of dizziness with ambulation. The patient is currently on an alpha-adrenergic blocker and the nurse assesses characteristic signs and symptoms of postural hypotension. When teaching this patient about risks associated with postural hypotension, what should the nurse emphasize?

A) Rising slowly from a lying or sitting position
B) Increasing fluids to maintain $\mathrm{BP}$
C) Stopping medication if dizziness persists
D) Taking medication first thing in the morning

Question 11

The nurse is planning the care of a patient who has been diagnosed with hypertension, but who otherwise enjoys good health. When assessing the response to an antihypertensive drug regimen, what blood pressure would be the goal of treatment?

A) $\quad 156 / 96 \mathrm{~mm} \mathrm{Hg}$ or lower
B) $\quad 140 / 90 \mathrm{~mm} \mathrm{Hg}$ or lower
C) Average of $2 \mathrm{BP}$ readings of $150 / 80 \mathrm{~mm} \mathrm{Hg}$
D) $\quad 120 / 80 \mathrm{~mm} \mathrm{Hg}$ or lower

Question 12

A patient in a hypertensive emergency is admitted to the ICU. The nurse anticipates that the patient will be treated with IV vasodilators, and that the primary goal of treatment is what?

A) Lower the BP to reduce onset of neurologic symptoms, such as headache and vision changes.
B) Decrease the BP to a normal level based on the patients age.
C) Decrease the mean arterial pressure between $20 \%$ and $25 \%$ in the first hour of treatment.
D) Reduce the BP to $120 / 75 \mathrm{~mm} \mathrm{Hg}$ as quickly as possible.

Question 13

The nursing lab instructor is teaching student nurses how to take blood pressure. To ensure accurate measurement, the lab instructor would teach the students to avoid which of the following actions?

A) Measuring the BP after the patient has been seated quietly for more than 5 minutes
B) Taking the BP at least 10 minutes after nicotine or coffee ingestion
C) Using a cuff with a bladder that encircles at least $80 \%$ of the limb
D) Using a bare forearm supported at heart level on a firm surface

Question 14

A nurse is teaching an adult female patient about the risk factors for hypertension. What should the nurse explain as risk factors for primary hypertension?

A) Obesity and high intake of sodium and saturated fat
B) Diabetes and use of oral contraceptives
C) Metabolic syndrome and smoking
D) Renal disease and coarctation of the aorta

Question 15

The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. Which of the following should the nurse integrate into the management of this clients hypertension?

A) Ensure that the patient receives a larger initial dose of antihypertensive medication due to impaired absorption.
B) Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion.
C) Recognize that an older adult is less likely to adhere to his or her medication regimen than a younger patient.
D) Carefully assess for weight loss because of impaired kidney function resulting from normal aging.

Question 16

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?

A) Secondary hypertension has a specific cause.
B) Secondary hypertension has a more gradual onset than primary hypertension.
C) Secondary hypertension does not cause target organ damage.
D) Secondary hypertension does not normally respond to antihypertensive drug therapy.

Question 17

The nurse is assessing a patient new to the clinic. Records brought to the clinic with the patient show the patient has hypertension and that her current BP readings approximate the readings from when she was first diagnosed. What contributing factor should the nurse first explore in an effort to identify the cause of the clients inadequate BP control?

A) Progressive target organ damage
B) Possibility of medication interactions
C) Lack of adherence to prescribed drug therapy
D) Possible heavy alcohol use or use of recreational drugs

Question 18

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?

A) Tried to rest quietly for 5 minutes before the reading is taken
B) Refrained from smoking for at least 8 hours
C) Drunk adequate fluids during the day prior
D) Avoided drinking coffee for 12 hours before the visit

Question 19

The nurse is providing care for a patient with a diagnosis of hypertension. The nurse should consequently assess the patient for signs and symptoms of which other health problem?

A) Migraines
B) Atrial-septal defect
C) Atherosclerosis
D) Thrombocytopenia

Question 20

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?

A) Patient will reduce $\mathrm{Na}^{+}$ intake to no more than $2.4 \mathrm{~g}$ daily.
B) Patient will have a stable BUN and serum creatinine levels.
C) Patient will abstain from fat intake and reduce calorie intake.
D) Patient will maintain a normal body weight.

Question 21

A patient with newly diagnosed hypertension has come to the clinic for a follow-up visit. The patient asks the nurse why she has to come in so often. What would be the nurses best response?

A) We do this so you dont suffer a stroke.
B) We do this to determine how your blood pressure changes throughout the day.
C) We do this to see how often you should change your medication dose.
D) We do this to make sure your health is stable. Well then monitor it at routinely scheduled intervals.

Question 22

The hospital nurse cares for many patients who have hypertension. What nursing diagnosis is most common among patients who are being treated for this health problem?

A) Deficient knowledge regarding the lifestyle modifications for management of hypertension
B) Noncompliance with therapeutic regimen related to adverse effects of prescribed therapy
C) Deficient knowledge regarding BP monitoring
D) Noncompliance with treatment regimen related to medication costs

Question 23

The nurse is teaching a patient about some of the health consequences of uncontrolled hypertension. What health problems should the nurse describe? Select all that apply.

A) Transient ischemic attacks
B) Cerebrovascular accident
C) Retinal hemorrhage
D) Venous insufficiency
E) Right ventricular hypertrophy

Question 24

The nurse is collaborating with the dietitian and a patient with hypertension to plan dietary modifications. These modifications should include which of the following?

A) Reduced intake of protein and carbohydrates
B) Increased intake of calcium and vitamin $\mathrm{D}$
C) Reduced intake of fat and sodium
D) Increased intake of potassium, vitamin $\mathrm{B}_{12}$ and vitamin $\mathrm{D}$

Question 25

The critical care nurse is caring for a patient just admitted in a hypertensive emergency. The nurse should anticipate the administration of what medication?

A) Warfarin (Coumadin)
B) Furosemide (Lasix)
C) Sodium nitroprusside (Nitropress)
D) Ramipril (Altace)

Question 26

A patient in hypertensive emergency is being cared for in the ICU. The patient has become hypovolemic secondary to natriuresis. What is the nurses most appropriate action?

A) Add sodium to the patients IV fluid, as ordered.
B) Administer a vasoconstrictor, as ordered.
C) Promptly cease antihypertensive therapy.
D) Administer normal saline IV, as ordered.

Question 27

During an adult patients last two office visits, the nurse obtained BP readings of $122 / 84 \mathrm{~mm} \mathrm{Hg}$ and $130 / 88 \mathrm{~mm} \mathrm{Hg}$ , respectively. How would this patients BP be categorized?

A) Normal
B) Prehypertensive
C) Stage 1 hypertensive
D) Stage 2 hypertensive

Question 28

A patient comes to the walk-in clinic complaining of frequent headaches. While assessing the patients vital signs, the nurse notes the BP is $161 / 101 \mathrm{~mm} \mathrm{Hg}$ . According to JNC 7, how would this patients BP be defined if a similar reading were obtained at a subsequent office visit?

A) High normal
B) Normal
C) Stage 1 hypertensive
D) Stage 2 hypertensive

Question 29

A patient has been diagnosed as being prehypertensive. What should the nurse encourage this patient to do to aid in preventing a progression to a hypertensive state?

A) Avoid excessive potassium intake.
B) Exercise on a regular basis.
C) Eat less protein and more vegetables.
D) Limit morning activity.

Question 30

The nurse is screening a number of adults for hypertension. What range of blood pressure is considered normal?

A) Less than 140/90 mm Hg
B) Less than 130/90 mm Hg
C) Less than $129 / 89 \mathrm{~mm} \mathrm{Hg}$
D) Less than $120 / 80 \mathrm{~mm} \mathrm{Hg}$

Question 31

A community health nurse teaching a group of adults about preventing and treating hypertension. The nurse should encourage these participants to collaborate with their primary care providers and regularly monitor which of the following?

A) Heart rate
B) Sodium levels
C) Potassium levels
D) Blood lipid levels

Question 32

A community health nurse is planning an educational campaign addressing hypertension. The nurse should anticipate that the incidence and prevalence of hypertension are likely to be highest among members of what ethnic group?

A) Pacific Islanders
B) African Americans
C) Asian-Americans
D) Hispanics

Question 33

The home health nurse is caring for a patient who has a comorbidity of hypertension. What assessment question most directly addresses the possibility of worsening hypertension?

A) Are you eating less salt in your diet?
B) How is your energy level these days?
C) Do you ever get chest pain when you exercise?
D) Do you ever see spots in front of your eyes?

Question 34

A student nurse is taking care of an elderly patient with hypertension during a clinical experience. The instructor asks the student about the relationships between BP and age. What would be the best answer by the student?

A) Because of reduced smooth muscle tone in blood vessels, blood pressure tends to go down with age, not up.
B) Decreases in the strength of arteries and the presence of venous insufficiency cause hypertension in the elderly.
C) Structural and functional changes in the cardiovascular system that occur with age contribute to increases in blood pressure.
D) The neurologic system of older adults is less efficient at monitoring and regulating blood pressure.

Question 35

A 55-year-old patient comes to the clinic for a routine check-up. The patients BP is $159 / 100 \mathrm{~mm} \mathrm{Hg}$ and the physician diagnoses hypertension after referring to previous readings. The patient asks why it is important to treat hypertension. What would be the nurses best response?

A) Hypertension can cause you to develop dangerous blood clots in your legs that can migrate to your lungs.
B) Hypertension puts you at increased risk of type 1 diabetes and cancer in your age group.
C) Hypertension is the leading cause of death in people your age.
D) Hypertension greatly increases your risk of stroke and heart disease.

Question 36

The nurse is reviewing the medication administration record of a patient who takes a variety of medications for the treatment of hypertension. What potential therapeutic benefits of antihypertensives should the nurse identify? Select all that apply.

A) Increased venous return
B) Decreased peripheral resistance
C) Decreased blood volume
D) Decreased strength and rate of myocardial contractions
E) Decreased blood viscosity

Question 37

A newly diagnosed patient with hypertension is prescribed Diuril, a thiazide diuretic. What patient education should the nurse provide to this patient?

A) Eat a banana every day because Diuril causes moderate hyperkalemia.
B) Take over-the-counter potassium pills because Diuril causes your kidneys to lose potassium.
C) Diuril can cause low blood pressure and dizziness, especially when you get up suddenly.
D) Diuril increases sodium levels in your blood, so cut down on your salt.

Question 38

A patient in hypertensive urgency is admitted to the hospital. The nurse should be aware of what goal of treatment for a patient in hypertensive urgency?

A) Normalizing BP within 2 hours
B) Obtaining a BP of less than 110/70 $\mathrm{mm} \mathrm{Hg}$ within 36 hours
C) Obtaining a BP of less than $120 / 80 \mathrm{~mm} \mathrm{Hg}$ within 36 hours
D) Normalizing BP within 24 to 48 hours

Question 39

A patients medication regimen for the treatment of hypertension includes hydrochlorothiazide. Following administration of this medication, the nurse should anticipate what effect?

A) Drowsiness or lethargy
B) Increased urine output
C) Decreased heart rate
D) Mild agitation

Question 40

A patients recently elevated BP has prompted the primary care provider to prescribe furosemide (Lasix). The nurse should closely monitor which of the following?

A) The clients oxygen saturation level
B) The patients red blood cells, hematocrit, and hemoglobin
C) The patients level of consciousness
D) The patients potassium level