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

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

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

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

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

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)

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

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

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?

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

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

Accepted Answer

The recommendations for preventing hypertension include exercising aerobically for 30 minutes most days of the week. A weight that is 5 pounds over the ideal body weight is not a risk factor for hypertension. The DASH diet is high in fiber, but increasing fiber alone will not prevent hypertension from developing. The dietary recommendation for alcohol is for no more than one drink a day for women and small adults or two drinks a day for men.

Question 12

The nurse teaches a patient who is taking labetalol (Normodyne) for treatment of hypertension to change position slowly because this drug

Accepted Answer

Labetalol decreases sympathetic nervous system activity by blocking both a- and b-receptors, leading to vasodilation and a decrease in heart rate, which lower BP. The angiotensin-converting enzyme (ACE)-inhibitors and angiotensin II blocking medications block the RAAS. Direct vasodilator medications inhibit the ability of vascular smooth muscle to contract and cause vasoconstriction. Calcium-channel blockers block the movement of calcium into cardiac muscle cells and lead to a decrease in heart rate and contractility, which will result in lower cardiac output.

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

Accepted Answer

Although an increase in systolic BP (SBP) is a common finding in older adults, the recommendations for treating elevated BP are unchanged. An SBP of >140 mm Hg is a more important cardiovascular risk factor than diastolic BP (DBP) in individuals older than 50. The diagnosis of prehypertension indicates a systolic BP between 120 and 139 and a DBP between 80 and 89. Kidney and heart disease are common complications of hypertension, but there are no data to support these as diagnoses for this patient.

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

Accepted Answer

BUN and creatinine are useful in determining whether renal failure is developing as a result of hypertension. The BUN level is normal. The serum creatinine is elevated and will require further investigation. The serum potassium level and hemoglobin level are normal.

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

Accepted Answer

A sudden increase in BP in a patient with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem. The BP will require more frequent monitoring than every 2 months. If the patient has no other risk factors, a stroke in the immediate future is unlikely. There is no indication that dietary salt or fat intake have contributed to this sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this BP to an acceptable level.

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

Accepted Answer

The cost of medications is a common cause of lack of medication compliance in older patients with fixed incomes. The patient is well-oriented and well-informed about the medications, and there is no indication that further education about the possible effects of chronic hypertension is needed. The once-daily dosing schedule is already in place and is optimal for assuring compliance with the medications.

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

Accepted Answer

The ACE inhibitors cause retention of potassium by the kidney, so hyperkalemia is a possible adverse effect. The other teaching by the new RN is appropriate for a patient with newly diagnosed hypertension who has just started therapy with enalapril.

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?

Accepted Answer

The DASH recommendations for prevention of hypertension include increasing the intake of calcium-rich foods. Caffeine restriction and decreased protein intake are not included in the recommendations. Tomato juice is very high in sodium and bacon is very high in sodium and fat, both of which should be restricted in patients with hypertension.

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

Accepted Answer

Cardioselective b-adrenergic blocking agents block b₁-adrenergic receptors. Nonselective agents block b₁- and b₂-adrenergic receptors. Nonselective agents may cause bronchospasm, especially in patients with a history of asthma. b-blockers will have no effect on the patient's peptic ulcer disease or alcohol dependency. The use of a b-blocker for a hypertensive patient who has had an MI is appropriate because b-blocker therapy is recommended after MI.

Question 20

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

Accepted Answer

Hypertension is largely asymptomatic until damage to target organs has occurred. Frequent nosebleeds are not a common symptom of hypertension. Blurred vision and dyspnea on exertion indicate complications associated with damage to the retina and heart failure caused by chronic hypertension, but they are not common symptoms of hypertension.

Quiz 33: Nursing Management: Hypertension