Deck 35: Nursing Management: Hypertension

Question 1

The nurse assesses the risk factors for hypertension in a patient with high normal BP.Which risk factor would the nurse identify from the health history and advise the patient to change,in order to prevent hypertension?

A) Little or no regular exercise
B) No use of relaxation techniques
C) High dietary intake of simple sugars
D) Drinking wine with dinner once a week

Answer 1

Little or no regular exercise

Question 2

When teaching a patient about nutritional therapy related to hypertension,the nurse tells the patient to consume how many servings per day of whole grains?

A) Two to three
B) Four to five
C) Six to eight
D) Avoid intake of whole grains.

Answer 2

Six to eight

Question 3

A 52-year-old woman has no history of hypertension and no risk factors related to hypertension.During an annual physical examination,her blood pressure is 188/106 mm Hg.After reconfirming her BP,it is appropriate for the nurse to tell the patient which of the following?

A) She should have her BP rechecked in 2 months.
B) She is in imminent danger of a stroke and should be hospitalized immediately.
C) She needs to reduce the sodium and fat content in her diet and exercise more vigorously.
D) Her increased BP might be due to a specific disease and may require further diagnostic testing.

Answer 3

Her increased BP might be due to a specific disease and may require further diagnostic testing.

Question 4

An 86-year-old widow is a retired homemaker who lives alone and is on a fixed income.She tells the nurse the names of her medications and when she takes them.She has labelled and filled an egg carton with her medications to keep on schedule.Over time,however,it is apparent that her BP is not well controlled,and she does not always take her medication regularly.What is a possible cause of the lack of responsiveness to therapy that the nurse should explore with the patient?

A) A lack of teaching about hypertension
B) A lack of money to purchase the medication
C) A complex and inconvenient dosing schedule
D) The development of confusion and memory deficit

Question 5

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?

A) The patient has a glass of low-fat milk with each meal.
B) The patient has only one cup of coffee in the morning.
C) The patient restricts intake of dietary protein.
D) The patient has tomato juice and bacon for breakfast.

Question 6

A new patient is seen at an outpatient clinic for a routine health examination.During the patient's initial visit,which technique would the nurse use to assess the patient's blood pressure (BP)?

A) Have the patient sit with the arm supported at heart level,and measure the BP in each arm first.
B) Average all the BP readings obtained in both arms to establish a baseline BP for the patient.
C) Measure the first BP with the patient lying supine,and repeat the measurement in 5 minutes in the opposite arm.
D) Take additional measurements if there is a difference of more than 10 mm Hg between the first and second BP readings.

Question 7

During assessment of a 50-year-old patient who has newly diagnosed stage 1 hypertension,the patient admits he uses a lot of salt on his foods and has not been able to lose the 13.6 kg he has gained in the last 10 years.He does not understand why he has hypertension because he is not an anxious person.What is an appropriate nursing diagnosis for the nurse to document for the patient?

A) Noncompliance related to lack of motivation
B) Disturbed self-esteem related to diagnosis of hypertension
C) Ineffective health maintenance related to lack of knowledge of disease process and management
D) Anxiety related to complexity of management regimen and lifestyle changes associated with hypertension

Question 8

Why should the nurse teach a patient who is taking labetalol (Normodyne)for treatment of hypertension to change position slowly?

A) The medication blocks the vasoconstrictive and sodium-retaining properties initiated by the presence of angiotensin.
B) The medication paralyzes the smooth muscle of blood vessels,and they cannot constrict in response to sympathetic stimulation.
C) The medication blocks the normal sympathetic nervous system response to position changes in vasoconstriction and increased heart rate.
D) The medication blocks the movement of calcium into the cardiac cells,and cardiac output cannot increase in response to decreased BP.

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 of the following information is important to include when teaching the patient?

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

Question 10

During assessment of a patient who has stage 2 hypertension,the nurse recognizes that it is common for the patient to experience which of the following?

A) Nosebleeds
B) No symptoms
C) Blurred vision
D) Dyspnea on exertion

Question 11

Which of the following amounts of exercise recommended by the Canadian Hypertension Education Program (CHEP)to reduce the possibility of a person becoming hypertensive?

A) 30 minutes of light exercise daily
B) 60 minutes of moderate exercise,twice a day,three times per week
C) 30 to 60 minutes of moderate exercise,four to seven times per week
D) 30 to 45 minutes of heavy exercise,three times per week

Question 12

The nurse measures the BP of a 78-year-old patient and finds it to be 168/86 mm Hg in both arms.What will the nurse include in the teaching plan for this patient?

A) Increased BP is a normal finding in older adults.
B) Prehypertension indicates the need for lifestyle changes.
C) It is important to address the increased BP.
D) A high probability of kidney and heart disease exists.

Question 13

The charge nurse observes a new registered nurse (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 do which of the following?

A) Increase the dietary intake of high-potassium foods.
B) Move slowly when moving from a lying to a standing position.
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.

Question 14

A patient with stage 1 hypertension who received a new prescription for methyldopa returns to the health clinic after 2 weeks for a follow-up visit.BP is unchanged from the previous clinic visit.What is the nurse's first action?

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.

Question 15

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

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

Question 16

Which diuretic would the nurse anticipate that the patient with renal insufficiency would be prescribed?

A) Metolazone (Zaroxolyn)
B) Indapamide (Lozide)
C) Bumetanide (Burinex)
D) Chlorthalidone hydrochlorothiazide

Question 17

Laboratory testing is ordered for a patient during a clinic visit for routine assessment of hypertension.When the results of the testing are available,the nurse recognizes that target organ damage is indicated by which of the following results?

A) Blood urea nitrogen (BUN)of 5.4 mmol/L (15 mg/dL)
B) Serum uric acid of 464 ?mol/L (7.8 mg/dL)
C) Serum creatinine of 230 ?mol/L (2.6 mg/dL)
D) Serum potassium of 3.2 mmol/L (3.2 mEq/L)

Question 18

A 62-year-old patient is admitted to the hospital with a BP of 240/118 mm Hg.The patient has been taking clonidine hydrochloride (Catapres)and hydrochlorothiazide (HydroDIURIL)for 10 years for hypertension.What is the most appropriate question the nurse can ask at this time?

A) "Have you recently taken any antihistamine medications?"
B) "Have you been taking the clonidine and hydrochlorothiazide lately?"
C) "Did you have any recent stressful events in your life?"
D) "Did you take any acetaminophen yet today?"

Question 19

Which of the following is a correct mechanism action of aldosterone?

A) Increased sodium reabsorption
B) Decreased water reabsorption
C) Decreased blood volume
D) Increased potassium excretion

Question 20

A 69-year-old woman is diagnosed with hypertension and placed on acebutolol (Sectral).After reviewing the patient's history,the nurse consults with the physician about the use of this medication upon finding which of the following conditions?

A) Asthma
B) Peptic ulcer disease
C) Alcohol dependency
D) Myocardial infarction

Question 21

During the change-of-shift report,the nurse obtains all of this information about a hypertensive patient who received the first dose of nadolol pindolol (Visken)during the previous shift.Which of the following information will be of most concern to the nurse?

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.

Question 22

A patient with hypertension has just developed an abrupt elevation in BP.Which of the following would indicate that the patient is in a hypertensive crisis?

A) Widening pulse pressure
B) Systolic above 110 mm Hg
C) Diastolic above 120 mm Hg
D) Mean arterial pressure of 82 mm Hg