CH 36: Hypertensive Crisis Flashcards
A 52-year-old male with a history of uncontrolled hypertension arrives at the emergency department with a BP of 224/136 mm Hg. He reports a severe headache, blurred vision, and confusion. Physical examination reveals papilledema and bilateral lower extremity edema.
Which of the following findings indicate that the patient is experiencing a hypertensive emergency rather than a hypertensive urgency?
A. Systolic BP greater than 180 mm Hg
B. Presence of target organ damage
C. Lack of medication adherence
D. Complaint of headache
B. Presence of target organ damage
Rationale: The key distinction between a hypertensive emergency and hypertensive urgency is target organ damage. This patient exhibits signs of encephalopathy (confusion), retinopathy (papilledema), and possible heart failure (lower extremity edema), confirming hypertensive emergency.
Which of the following complications can result from an untreated hypertensive emergency? (SATA)
A. Stroke
B. Myocardial infarction
C. Chronic stable angina
D. Aortic dissection
E. Nephropathy
A. Stroke
B. Myocardial infarction
D. Aortic dissection
E. Nephropathy
Rationale: Hypertensive emergencies can lead to acute life-threatening complications such as stroke, MI, aortic dissection, and kidney damage. Chronic stable angina (C) is more likely associated with hypertensive urgency, not emergency.
A 65-year-old woman is admitted to the ICU with a BP of 210/130 mm Hg. She is diagnosed with a hypertensive emergency and started on IV nitroprusside.
What is the primary goal of IV antihypertensive therapy in this patient?
A. Lower BP as quickly as possible to prevent further organ damage
B. Reduce BP to normal levels within 30 minutes
C. Maintain BP at 220/140 mm Hg for cerebral perfusion
D. Gradually lower BP by no more than 20-25% in the first hour
D. Gradually lower BP by no more than 20-25% in the first hour
Rationale: Rapidly lowering BP can lead to ischemia of vital organs due to inadequate perfusion. The goal is to reduce BP in a controlled manner, typically by 20-25% in the first hour, then gradually normalize it over the next 24-48 hours.
Which of the following is the preferred route of medication administration for a hypertensive emergency?
A. Intravenous
B. Oral
C. Subcutaneous
D. Transdermal
A. Intravenous
Rationale: IV administration allows for rapid titration and immediate BP control, which is essential in hypertensive emergencies.
A nurse is monitoring a patient receiving IV sodium nitroprusside for hypertensive crisis. Which assessments should the nurse prioritize? (SATA)
A. Continuous BP monitoring
B. Signs of cyanide toxicity
C. Neurologic status
D. Urine output
E. Bowel sounds
A. Continuous BP monitoring
B. Signs of cyanide toxicity
C. Neurologic status
D. Urine output
Rationale: Nitroprusside can cause rapid BP drops (A) and cyanide toxicity (B) with prolonged use. Neurologic changes (C) may indicate worsening encephalopathy or stroke, while urine output (D) reflects renal function and perfusion.
A 30-year-old male is brought to the ED with a BP of 230/142 mm Hg. He has a history of recreational drug use. His pupils are dilated, and he is agitated and tachycardic.
Which drug is most likely responsible for this hypertensive crisis?
A. Heroin
B. Benzodiazepines
C. Cocaine
D. Marijuana
C. Cocaine
Rationale: Cocaine, along with amphetamines and PCP, is a common cause of drug-induced hypertensive crisis. It leads to severe vasoconstriction, which can result in stroke, MI, or encephalopathy.
Which interventions should be included in the care plan for a patient experiencing a hypertensive crisis due to cocaine use? (SATA)
A. Administer benzodiazepines
B. Use beta-blockers as first-line treatment
C. Provide IV antihypertensives such as nicardipine
D. Avoid rapid BP reduction
E. Initiate seizure precautions
A. Administer benzodiazepines
C. Provide IV antihypertensives such as nicardipine
D. Avoid rapid BP reduction
E. Initiate seizure precautions
Rationale: Benzodiazepines (A) help manage agitation and sympathetic overactivity. Nicardipine (C) is preferred over beta-blockers (B) due to concerns about unopposed alpha-stimulation worsening hypertension. Seizure precautions (E) are necessary due to increased risk.
A patient with hypertensive urgency is prescribed oral clonidine. What is the nurse’s priority teaching point?
A. “Take this medication on an empty stomach.”
B. “Do not stop taking this medication suddenly.”
C. “Monitor your pulse for bradycardia.”
D. “Expect a dry cough as a side effect.”
B. “Do not stop taking this medication suddenly.”
Rationale: Clonidine should not be abruptly discontinued as it can lead to rebound hypertension, which may precipitate a hypertensive crisis.
Which patient is at highest risk for developing a hypertensive crisis?
A. A 45-year-old with controlled hypertension taking lisinopril daily
B. A 60-year-old with newly diagnosed hypertension and no medication history
C. A 50-year-old who stopped taking his antihypertensive medication last week
D. A 35-year-old with gestational hypertension at 30 weeks gestation
C. A 50-year-old who stopped taking his antihypertensive medication last week
Rationale: Nonadherence or abrupt discontinuation of antihypertensive medications is a major cause of hypertensive crisis.
A patient in hypertensive crisis develops sudden-onset severe chest pain radiating to the back. What is the nurse’s priority action?
A. Administer IV beta-blockers
B. Perform a 12-lead ECG
C. Obtain a CT scan of the chest
D. Notify the provider immediately
D. Notify the provider immediately
Rationale: Sudden severe chest pain with radiation suggests an aortic dissection, a life-threatening complication requiring immediate intervention.
Which factors increase a patient’s risk for hypertensive crisis? (SATA)
A. Poor medication adherence
B. High sodium diet
C. Chronic alcohol use
D. Hypokalemia
E. History of diabetes
A. Poor medication adherence
B. High sodium diet
C. Chronic alcohol use
E. History of diabetes
Rationale: Medication nonadherence (A), excessive sodium intake (B), chronic alcohol use (C), and diabetes (E) all contribute to poor BP control.
Which symptom in a hypertensive crisis patient suggests impending encephalopathy?
A. Sudden weakness in one limb
B. Severe, persistent headache
C. Nausea and vomiting
D. Altered mental status
D. Altered mental status
Rationale: Encephalopathy manifests as confusion, restlessness, or decreased LOC due to cerebral edema from severe hypertension.
Which symptom in a hypertensive crisis patient suggests impending encephalopathy?
A. Sudden weakness in one limb
B. Severe, persistent headache
C. Nausea and vomiting
D. Altered mental status
D. Altered mental status
Rationale: Encephalopathy manifests as confusion, restlessness, or decreased LOC due to cerebral edema from severe hypertension.
Which lab finding would be most concerning in a patient with hypertensive emergency?
A. Elevated creatinine
B. Hyperkalemia
C. Hyponatremia
D. Increased hemoglobin
A. Elevated creatinine
Rationale: Elevated creatinine indicates renal involvement, a sign of target organ damage in hypertensive emergencies.
A 50-year-old male with a history of untreated hypertension presents with a BP of 240/150 mm Hg. He is experiencing severe headache, nausea, vomiting, and confusion. Which of the following is the most likely cause of his symptoms?
A. Hypertensive encephalopathy
B. Acute myocardial infarction
C. Pulmonary edema
D. Aortic dissection
A. Hypertensive encephalopathy
Rationale: Hypertensive encephalopathy is the most likely cause of these symptoms in the context of severely elevated blood pressure. It is characterized by cerebral edema resulting from increased blood pressure, which disrupts cerebral function and leads to symptoms such as severe headache, nausea, vomiting, and confusion. These manifestations occur due to increased capillary permeability in the brain. The other conditions listed would present with different symptoms, such as chest pain or shortness of breath, not confusion and vomiting.
A patient with hypertensive crisis is admitted to the ICU. The nurse is assessing for complications of hypertensive encephalopathy. Which of the following signs would indicate potential cerebral edema? (SATA)
A. Nausea and vomiting
B. Seizures
C. Papilledema
D. Severe chest pain
E. Decreased level of consciousness
A. Nausea and vomiting
B. Seizures
C. Papilledema
E. Decreased level of consciousness
Rationale: Nausea and vomiting (A), seizures (B), papilledema (C), and decreased level of consciousness (E) are all signs of cerebral edema in hypertensive encephalopathy. Cerebral edema occurs due to increased blood pressure and the resulting disruption of the blood-brain barrier, leading to fluid accumulation in the brain. These signs are direct consequences of this edema and increased intracranial pressure. Severe chest pain (D) is not a typical symptom of cerebral edema but would be more indicative of cardiac involvement such as a myocardial infarction or aortic dissection.
A patient with hypertensive crisis develops sudden chest and back pain, accompanied by a decrease in peripheral pulses. What is the nurse’s most immediate concern?
A. Pulmonary edema
B. Myocardial infarction
C. Aortic dissection
D. Renal failure
C. Aortic dissection
Rationale: Aortic dissection is a life-threatening complication of hypertensive crisis that can cause sudden, severe chest and back pain. It results from a tear in the inner layer of the aorta, which can disrupt blood flow and lead to decreased pulses in the extremities. Prompt diagnosis and intervention are critical to prevent further complications, such as rupture or organ failure. The other options are not as strongly associated with the combination of chest/back pain and absent pulses.
A patient with hypertensive crisis exhibits exudates, hemorrhages, and papilledema on retinal examination. These findings suggest damage to which organ system?
A. Cardiovascular system
B. Renal system
C. Nervous system
D. Ocular system
D. Ocular system
Rationale: Retinal findings such as exudates, hemorrhages, and papilledema indicate damage to the ocular system, specifically the retina, as a result of elevated blood pressure. Hypertensive crisis can cause changes in the retinal vasculature, including these manifestations, due to the increased pressure affecting the blood vessels in the eyes. These findings are not typically seen in the cardiovascular, renal, or nervous systems, even though hypertensive crisis can affect these organ systems.
A 60-year-old female with poorly controlled hypertension presents with elevated BP (220/140 mm Hg) and complaints of fatigue, nausea, and oliguria. The nurse suspects acute kidney injury (AKI) due to hypertensive crisis. Which of the following laboratory findings would confirm the diagnosis of AKI?
A. Decreased creatinine clearance
B. Elevated blood urea nitrogen (BUN) and creatinine
C. Elevated sodium levels
D. Decreased urine osmolality
B. Elevated blood urea nitrogen (BUN) and creatinine
Rationale: Elevated BUN and creatinine are classic signs of acute kidney injury (AKI), confirming that the kidneys are not effectively filtering waste products from the blood. In the case of hypertensive crisis, this could be due to damage to the renal vasculature, leading to reduced kidney function. Decreased creatinine clearance (A) could also be seen with renal impairment, but BUN and creatinine are more directly elevated in AKI. Elevated sodium levels (C) and decreased urine osmolality (D) are not specific indicators of AKI.
A patient with a history of hypertensive crisis is receiving IV antihypertensive medication. The nurse is concerned about the potential for rapid BP reduction. What is the most serious consequence of lowering BP too quickly in a hypertensive crisis?
A. Renal failure
B. Myocardial infarction
C. Stroke
D. Pulmonary edema
C. Stroke
Rationale: Rapid reduction in blood pressure can lead to a decrease in cerebral perfusion, which may precipitate ischemic stroke, especially in patients with pre-existing vascular disease. This is the most serious consequence of lowering BP too quickly in a hypertensive crisis. While renal failure, MI, and pulmonary edema are serious complications, they are more commonly associated with prolonged, uncontrolled hypertension rather than rapid BP reduction.
A 45-year-old male is admitted with hypertensive emergency (BP 230/150 mm Hg). He is experiencing chest pain and shortness of breath. Which of the following interventions should the nurse implement first?
A. Administer IV morphine
B. Initiate IV antihypertensive therapy
C. Administer oxygen via nasal cannula
D. Obtain an ECG
C. Administer oxygen via nasal cannula
Rationale: The first priority is to ensure adequate oxygenation, especially since the patient is experiencing chest pain and shortness of breath. Oxygen via nasal cannula should be administered to prevent hypoxia and reduce the workload on the heart. After ensuring oxygenation, IV antihypertensive therapy (B) can be initiated to control BP. Morphine (A) may be indicated later for pain relief, but oxygenation should always be prioritized. Obtaining an ECG (D) is important, but it can be done after addressing immediate airway and oxygenation needs.
A patient with hypertensive crisis presents with confusion, headache, and blurred vision. What diagnostic test is most appropriate to assess for possible cerebral involvement?
A. MRI of the brain
B. Serum potassium level
C. Chest X-ray
D. Renal ultrasound
A. MRI of the brain
Rationale: MRI of the brain is the most appropriate diagnostic test to assess for cerebral involvement, such as hypertensive encephalopathy or potential stroke, in a patient with symptoms like confusion, headache, and blurred vision. These symptoms suggest increased intracranial pressure or vascular changes in the brain. A chest X-ray (C) and renal ultrasound (D) would be used to assess cardiac and renal function, but they do not provide information on cerebral complications. Serum potassium level (B) is unrelated to cerebral involvement in this case.
A patient with a hypertensive emergency has been admitted to the ICU. Which action should the nurse prioritize in the initial management of this patient?
A. Administering IV antihypertensive agents
B. Lowering blood pressure by 50% immediately
C. Preparing for an immediate surgical intervention
D. Increasing fluid intake to prevent dehydration
A. Administering IV antihypertensive agents
Rationale: Hypertensive emergencies require hospitalization and IV administration of antihypertensive drugs to control the blood pressure rapidly while monitoring for organ damage. Lowering BP too quickly or too much could cause ischemia and endanger the patient’s life. Surgical intervention is not the first priority unless complications such as aortic dissection arise. Fluid intake is not a priority in hypertensive emergencies unless dehydration is also present.
When managing a hypertensive crisis, which factor primarily determines the treatment approach?
A. The patient’s age
B. The level of systolic BP only
C. The presence of new or progressive target organ damage
D. The patient’s blood pressure prior to admission
C. The presence of new or progressive target organ damage
Rationale: The decision to treat a hypertensive crisis is based on the presence of target organ damage, not just the BP level. The BP is a significant factor, but it’s the organ damage (e.g., encephalopathy, MI, renal failure) that dictates the urgency of the situation and the need for immediate intervention.
