Question 1

A 62-year-old patient who has just arrived in the emergency department complaining of a sudden-onset severe headache and nausea has a BP of 240/118 mm Hg. The patient gives a history of taking clonidine (Catapres) and hydrochlorothiazide (HydroDIURIL) for 10 years for hypertension. The most appropriate question by the nurse at this time is

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

Accepted Answer

Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do not increase BP. Stressful events will increase BP, but not usually to the level in this patient.

Question 2

A patient with stage 1 hypertension who received a new prescription for atenolol (Tenormin) returns to the health clinic after 2 weeks for a follow-up visit. BP is unchanged from the previous clinic visit. The nurse's first action will be to

A) ask the patient about whether the medication is actually being taken.
B) teach the patient about the reasons for an increase in the medication dose.
C) provide information about the use of multiple drugs to treat hypertension.
D) remind the patient that lifestyle changes are also important in BP control.

Accepted Answer

b-adrenergic blockers cause adverse effects (such as erectile dysfunction, fatigue, and depression) in some patients, leading to noncompliance. It is important to determine whether the patient has stopped taking the medication before initiating any changes in therapy, such as increasing the atenolol dose or adding a second medication. Whereas reinforcement of the continued need for lifestyle changes is appropriate, a decrease in BP would be expected after initiation of medication therapy even if lifestyle changes had not occurred.

Question 3

While caring for a patient admitted with a hypertensive emergency and receiving sodium nitroprusside (Nipride), it will be essential for the nurse to&#10;A) insert an arterial line to obtain BP to ensure accurate BP measurements.&#10;B) assist the patient up in the chair for meals to avoid complications associated with immobility.&#10;C) titrate the rate of IV nitroprusside to avoid too-rapid reduction of BP to normal levels.&#10;D) place the patient on NPO status to prevent aspiration caused by nausea and the associated vomiting.

Accepted Answer

When initiating treatment with rapidly acting medications such as sodium nitroprusside, the BP should not be decreased more than 25 % in the first 2 hours to prevent a sudden drop in cerebral perfusion. Frequent BP monitoring is required when treating hypertensive emergencies, an arterial line is often used; however, BP can also be monitored by using an automatic noninvasive BP device. Additionally, only a health care provider or an advanced practice nurse would insert an arterial line. When patients are receiving IV vasodilators, the BP is unable to adjust to changes in position, so the patients should remain on bed rest. There is no indication that this patient is nauseated or at risk for aspiration, so an NPO status is not appropriate.

Question 4

During assessment of a patient with newly diagnosed stage 1 hypertension, the nurse finds that the patient uses a lot of salt on foods and is 30 pounds overweight. The patient states, "I thought high blood pressure was caused by stress, but I do not feel stressed at all." An appropriate nursing diagnosis for this patient is

A) noncompliance related to lack of motivation and poor coping skills.
B) situational low self-esteem related to new diagnosis of hypertension.
C) ineffective health maintenance related to lack of knowledge about risk factors for hypertension
D) ineffective denial related to complexity of management regimen and the associated lifestyle changes.

Accepted Answer

This patient's subjective and objective assessment data indicate that lack of knowledge about hypertension will need to be addressed to allow the patient to improve the BP. There is no evidence for noncompliance, lack of motivation, or poor coping skills. The patient's statements do not indicate low self-esteem or denial.

Question 5

A patient with hypertension asks the nurse why lifestyle changes are needed when the patient has no symptoms from the high BP. The response by the nurse that is most likely to improve patient compliance with therapy is that hypertension

A) damages the blood vessels leading to risk for heart attack, stroke, and kidney failure.
B) increases blood flow to the kidneys leading to increased workload for the renal system.
C) may not cause any problems for some people but does cause symptoms in many others.
D) is probably causing symptoms but the patient does not recognize that they are occurring.

Accepted Answer

Teaching the patient that hypertension can damage blood vessels and eventually cause severe health problems is most likely to improve patient compliance with needed lifestyle changes. The increased renal blood flow caused by hypertension does not damage the kidneys. Teaching the patient that hypertension may cause symptoms in some people or that the patient has unrecognized symptoms is unlikely to provide the motivation for behavior changes.

Question 6

The nurse is evaluating the response to treatment for a patient has recently started taking furosemide (Lasix) to treat stage 2 hypertension. The information that will require the nurse to act most rapidly is a(n)

A) blood potassium level of 3.0 mEq/L.
B) blood glucose level of 180 mg/dl.
C) BP reading of 164/96.
D) orthostatic decrease of 12 mm Hg.

Accepted Answer

Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening dysrhythmias. The health care provider should be notified of the potassium level immediately and administration of potassium supplements initiated. The elevated blood glucose and BP also indicate a need for collaborative interventions but will not require action as urgently as the hypokalemia. An orthostatic drop of 12 mm Hg is common and will require intervention only if the patient is symptomatic.

Question 7

A new patient is seen at an outpatient clinic for a routine health examination. To determine the patient's baseline blood pressure (BP) accurately, the nurse will&#10;A) have the patient sit with the arm supported at the level of the heart and measure the BP in each arm.&#10;B) obtain the BP readings in both arms and average the results.&#10;C) measure the BP in both the supine and upright positions.&#10;D) take additional measurements if there is a 10 mm Hg difference between BP readings taken 5 minutes apart.

Accepted Answer

To obtain the baseline BP, the patient's arm should be at the level of the heart. The BP is obtained in both arms; if there is a difference, the arm with the higher pressure should be used to monitor BP. The BP can be obtained with the patient in the supine position, but the arm should be positioned at heart level. A 10 mm Hg difference between BP taken 5 minutes apart is within the range of normal and would not require additional measurements.

Question 8

When reading the medical history on a patient's chart, the nurse notes that the patient has pseudohypertension. When assessing the patient, the nurse will anticipate&#10;A) an elevated SBP with a normal DBP.&#10;B) an increase in BP when the patient is stressed.&#10;C) that the patient may also be diabetic or have insulin resistance.&#10;D) that the patient may have few symptoms of target-organ damage.

Accepted Answer

Pseudohypertension is caused by sclerosis of the larger arteries, resulting in BP readings that are falsely elevated. One indication of pseudohypertension is a high BP without any of the target-organ damage that would be expected. An elevated SBP with a normal DBP is common in older adults but does not define pseudohypertension. A BP increase with stress or associated with diabetes or insulin resistance may occur but is not defined as pseudohypertension.

Question 9

The nurse is planning patient teaching for a patient who 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) To increase fluid intake if dryness of the mouth is a problem
B) To check BP daily before taking the medication
C) To include high-potassium foods such as citrus fruits in the diet
D) To change position slowly to help prevent dizziness and falls

Accepted Answer

The ACE inhibitors frequently cause orthostatic hypotension, and patients should be taught to change position slowly to allow the vascular system time to compensate for the position change. Increasing fluid intake may counteract the effect of the medication, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP does not need to be checked at home by the patient before taking the medication. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.

Question 10

A patient with no history of health problems and a BP of 210/142 is admitted to the ICU with a diagnosis of hypertensive crisis. The clinical manifestation that will require the most immediate action by the nurse is that

A) the patient complains of a severe headache with pain at level 9/10 (0-10 scale).
B) tremors are present in the fingers when the arms are extended.
C) the urine output is 90 ml over the first 2 hours after the patient is admitted.
D) the patient is unable to move the left leg when asked to do so.

Accepted Answer

The patient's inability to more the left leg indicates that a hemorrhagic stroke may be occurring and will require immediate action to prevent further neurologic damage. The other clinical manifestations also are likely caused by the hypertension and will require rapid nursing actions, but they do not require action as urgently as the neurologic changes.

Question 11

The nurse obtains the following information about hypertension risk factors from a patient with prehypertension. The risk factor that will be most important to address with the patient is that the patient

A) gets no regular aerobic exercise.
B) is 5 pounds over the ideal weight.
C) has a low dietary fiber intake.
D) drinks wine with dinner once a week.

Accepted Answer

The answer of The nurse obtains the following information about...

Question 12

The nurse teaches a patient who is taking labetalol (Normodyne) for treatment of hypertension to change position slowly because this drug&#10;A) blocks the renin-angiotensin-aldosterone system (RAAS).&#10;B) paralyzes the smooth muscle of blood vessels.&#10;C) decreases sympathetic nervous system activity.&#10;D) prevents the movement of calcium into the cardiac cells.

Accepted Answer

The answer of The nurse teaches a patient who is...

Question 13

The nurse measures the BP of a 78-year-old patient and finds it to be 168/86 mm Hg in both arms. The nurse will plan to teach the patient that&#10;A) increased BP is a normal finding in older adults.&#10;B) prehypertension indicates the need for lifestyle changes.&#10;C) it is important to address the increased BP.&#10;D) there is a high probability of kidney and heart disease.

Accepted Answer

The answer of The nurse measures the BP of a...

Question 14

Laboratory testing is ordered for a patient during a clinic visit for routine assessment of hypertension. When monitoring for target organ damage, the nurse will be most concerned about&#10;A) blood urea nitrogen (BUN) of 15 mg/dl (5.4 mmol/L).&#10;B) serum hemoglobin of 14.7 g/dl (135 g/L).&#10;C) serum creatinine of 2.6 mg/dl (230 mmol/L).&#10;D) serum potassium of 3.8 mEq/L (3.2 mmol/L).

Accepted Answer

The answer of Laboratory testing is ordered for a patient...

Question 15

A 52-year-old patient has no history of hypertension and no risk factors related to hypertension. During an annual physical examination, the BP is 188/106. After reconfirming the BP, it is appropriate for the nurse to tell the patient that

A) a BP recheck should be scheduled in 2 months.
B) there is an imminent danger of a stroke and immediate hospitalization is indicated.
C) the dietary sodium and fat content should be decreased.
D) more diagnostic testing may be needed to determine the cause of the hypertension

Accepted Answer

The answer of A 52-year-old patient has no history of...

Question 16

An 86-year-old patient lives alone and is on a fixed income. The patient is taking once-daily doses of metoprolol (Lopressor) and furosemide (Lasix) to control BP. The patient is able to tell the nurse the names of the medications and when they are to be taken but does not always take the medications regularly, so BP is not well controlled. The most appropriate action by the nurse will be to

A) discuss the patient's possible confusion with a family member.
B) ask the patient about whether the cost of the medications is too high.
C) offer the patient teaching about long-term effects of hypertension.
D) assist the patient with an easier dosing schedule to improve compliance.

Accepted Answer

The answer of An 86-year-old patient lives alone and is...

Question 17

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

Accepted Answer

The answer of The charge nurse observes a new RN...

Question 18

The nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented to manage BP. Which diet choice indicates that the teaching has been effective?&#10;A) The patient has a glass of low-fat milk with each meal.&#10;B) The patient has only one cup of coffee in the morning.&#10;C) The patient restricts intake of dietary protein.&#10;D) The patient has tomato juice and bacon for breakfast.

Accepted Answer

The answer of The nurse teaches the patient with stage...

Question 19

A patient is diagnosed with hypertension, and first-line drug therapy with a b-adrenergic blocking agent is planned. After reviewing the patient's history, the nurse consults with the health care provider about the use of this drug upon finding a history of

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

Accepted Answer

The answer of A patient is diagnosed with hypertension, and...

Question 20

During assessment of a patient who has stage 2 hypertension, the nurse recognizes that it is common for the patient to experience&#10;A) frequent nose bleeds.&#10;B) blurred vision.&#10;C) dyspnea on exertion.&#10;D) no symptoms.

Accepted Answer

The answer of During assessment of a patient who has...

Question 21

The nurse is has just finished medication teaching for a hypertensive patient who has a new prescription for quinapril (Accupril). The patient statement that indicates that more teaching is needed is&#10;A) &#34;I will call the doctor if I notice that I have a frequent cough.&#34;&#10;B) &#34;The medication may not work as well if I take any aspirin.&#34;&#10;C) &#34;I won't worry if I have a little swelling around my lips and face.&#34;&#10;D) &#34;The doctor may order a blood potassium level occasionally.&#34;

Accepted Answer

The answer of The nurse is has just finished medication...

Question 22

During change-of-shift report, the nurse obtains all of this information about a hypertensive patient who received the first dose of nadolol (Corgard) during the previous shift. The information that will be of most concern to the nurse is that

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

Accepted Answer

The answer of During change-of-shift report, the nurse obtains all...

Question 23

The RN has developed a care plan for a patient with a hypertensive crisis who is receiving sodium nitroprusside (Nipride). Which of the following nursing actions should not be delegated to an LPN/LVN who is working in the ICU?

A) Reposition the patient every 2 hours.
B) Titrate nitroprusside to maintain BP 160/100 mm Hg.
C) Check and document urine output hourly.
D) Monitor oxygen saturation every 2 hours.

Accepted Answer

The answer of The RN has developed a care plan...

Deck 33: Nursing Management: Hypertension