Chapter 27 - Hypertension Flashcards
An older adult is newly diagnosed with primary hypertension and has just been started on a beta-blocker. Which topic should the nurse include in health education?
A. Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the beta-blocker
B. Maintaining a diet high in dairy to increase protein necessary to prevent organ damage
C. Use of strategies to prevent falls stemming from orthostatic hypotension
D. Limiting exercise to avoid injury that can be caused by increased intracranial pressure
C. Use of strategies to prevent falls stemming from orthostatic hypotension
Rationale: Older adults have impaired cardiovascular reflexes and are more sensitive to orthostatic hypotension. The nurse teaches clients to change positions slowly when moving from lying or sitting positions to a standing position and counsels older clients to use supportive devices as necessary to prevent falls that could result from dizziness. Lifestyle changes, such as regular physical activity/exercise, and a diet rich in fruits, vegetables, and low-fat dairy products, are strongly recommended. Increasing fluids in older clients may be contraindicated due to cardiovascular disease. Increased intracranial pressure is not a risk, and activity should not normally be limited
A client with primary hypertension comes to the clinic reporting 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 which condition? A. Retinal blood vessel damage B. Glaucoma C. Cranial nerve damage D. Hypertensive emergency
A. Retinal blood vessel damage
Rationale: Blurred vision, spots in front of the eyes, and diminished visual acuity can mean retinal blood vessel damage indicative of damage elsewhere in the vascular system as a result of hypertension. Glaucoma and cranial nerve damage do not normally cause these symptoms. A hypertensive emergency would have a more rapid onset
At a blood pressure screening, the nurse learns that a client has a family history of hypertension, high cholesterol, and elevated lipid levels. The client says reports smoking one pack of cigarettes daily and drinking "about a pack of beer" every day. The nurse notes which nonmodifiable risk factor for hypertension? A. Hyperlipidemia B. Excessive alcohol intake C. A family history of hypertension D. Closer adherence to medical regimen
C. A family history of hypertension
Rationale: Unlike cholesterol levels, alcohol intake, and adherence to treatment, family history is not modifiable.
The staff educator is teaching emergency department nurses about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in which way?
A. The blood pressure (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.
D. Hypertensive emergencies are associated with evidence of target organ damage.
Rationale: Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that they cause. Blood pressures are extremely elevated in both urgency and emergencies, but there is no evidence of target organ damage in hypertensive urgency. Extremely close hemodynamic monitoring of the client’s BP is required in both situations. The medications of choice in hypertensive emergencies are those with an immediate effect, such as intravenous vasodilators. Oral doses of fast-acting agents, such as beta-adrenergic blocking agents, angiotensin-converting enzyme inhibitors, or alpha-agonists, are recommended for the treatment of hypertensive urgencies
A 56-year-old client at a screening event has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, the client states, “My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it?” What is the nurse’s best response?
A. “Yes. 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. Diagnosis requires multiple elevated readings.”
D. “You have no need to worry. Your pressure is probably elevated because you are being tested.”
C. “A single elevated blood pressure does not confirm hypertension. Diagnosis requires multiple elevated readings.”
Rationale: Hypertension is confirmed by two or more readings with systolic pressure of at least 140 mm Hg and diastolic pressure of at least 90 mm Hg. An age of 56 does not constitute a risk factor in and of itself. The nurse should not tell the client that there is no need to worry.
A client newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the client and advises that the client should avoid tobacco use. What is the PRIMARY rationale behind that advice to the client?
A. Quitting smoking will cause the client’s hypertension to resolve.
B. Tobacco use increases the client’s concurrent risk of heart disease.
C. Tobacco use is associated with a sedentary lifestyle.
D. Tobacco use causes ventricular hypertrophy.
B. Tobacco use increases the client’s concurrent risk of heart disease
Rationale: Smoking increases the risk for heart disease, for which a client with hypertension is already at an increased risk. Quitting will not necessarily cause hypertension to resolve and smoking does not directly cause ventricular hypertrophy. The association with a sedentary lifestyle is true, but this is not the main rationale for the nurse’s advice; the association with heart disease is more salient.
The nurse identifies a nursing diagnosis of Ineffective Health Maintenance related to nonadherence to therapeutic regimen in a client with hypertension who has not been taking their medication as prescribed. When planning this client’s care, which outcome would be appropriate?
A. Client takes medication as prescribed and reports any adverse effects.
B. Client’s BP remains consistently below 140/90 mm Hg.
C. Client denies signs and symptoms of hypertensive urgency.
D. Client is able to describe modifiable risk factors for hypertension
A. Client takes medication as prescribed and reports any adverse effects
Rationale: The most appropriate expected outcome for a client who is given the nursing diagnosis of risk for ineffective health maintenance is that the client takes the medication as prescribed. The other listed goals are valid aspects of care, but none directly relates to the client’s role in the treatment regimen.
The nurse is providing education to a client newly diagnosed with hypertension. Which outcome would be most appropriate for this client?
A. Client will have no visual disturbances.
B. Client will return demonstrate measuring a blood pressure.
C. Client will state two side effects of not taking antihypertensives.
D. Client will lose two pounds within two weeks.
B. Client will return demonstrate measuring a blood pressure.
Rationale: The primary outcome for this client is making sure that blood pressure remains under control. This is best done by measurement of blood pressure (BP) reading. Visual disturbances can happen with uncontrolled hypertension, but it is not the primary client outcome. Stating two detrimental effects of hypertension is important but not as important as measurement of BP. Losing weight is also important in controlling BP, but the question is not addressing obesity
A client newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a client with prolonged, uncontrolled hypertension is at risk for developing which health problem? A. Chronic kidney disease B. Right ventricular hypertrophy C. Glaucoma D. Anemia
A. Chronic kidney disease
Rationale: When uncontrolled hypertension is prolonged, it can result in chronic kidney disease, myocardial infarction, stroke, impaired vision, left ventricular hypertrophy, and cardiac failure. Glaucoma and anemia are not directly associated with hypertension.
A client with primary hypertension reports dizziness with ambulation when taking the prescribed alpha-adrenergic blocker. When teaching this client, what should the nurse emphasize?
A. Rising slowly from a lying or sitting position
B. Increasing fluids to maintain BP
C. Stopping medication if dizziness persists
D. Taking medication first thing in the morning
A. Rising slowly from a lying or sitting position
Rationale: Clients who experience postural hypotension should be taught to rise slowly from a lying or sitting position and use a cane or walker if necessary for safety. It is not necessary to teach these clients about increasing fluids or taking medication in the morning (this would increase the effects of dizziness). Clients should not be taught to stop the medication if dizziness persists because this is unsafe and beyond the nurse’s scope of practice.
The nurse is planning the care of a client who has been diagnosed with hypertension, but who otherwise enjoys good health When assessing the response to an antihypertensive drug regimen, which blood pressure would be the goal of treatment?
A. 160/90 mm Hg or lower
B. 100/80 mm Hg or lower
C. Average of two BP readings of 150/80 mm Hg
D. 130/80 mm Hg or lower
D. 130/80 mm Hg or lower
Rationale: A pressure of 130/80 mm Hg or less is the goal for clients. All other readings are out of range or not appropriate.
The nurse is caring for a client in the emergency department who was admitted for a hypertensive emergency. The nurse knows the goal of intravenous vasodilator therapy for a hypertensive emergency would be which outcome?
A. Lower the blood pressure to reduce the onset of neurological changes
B. Decrease the blood pressure to a normal level based on the client’s age
C. Decrease the systolic blood pressure by no more than 25% within the first hour
D. Decrease the blood pressure to less than or equal to 120/80 as quickly as possible
C. Decrease the systolic blood pressure by no more than 25% within the first hour
Rationale: The initial treatment for hypertensive crisis is to decrease the systolic blood pressure by no more than 25% within the first hour of treatment. Lowering the blood pressure too fast may cause hypotension in a client whose body has adjusted to hypertension and could cause a stroke, myocardial infarction, or visual changes. Neurologic symptoms should be addressed, but this is not the primary focus of treatment planning
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 action?
A. Measuring the BP after the client has been seated quietly for more than 5 minutes
B. Taking the BP 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
B. Taking the BP 10 minutes after nicotine or coffee ingestion
Rationale: Blood pressures should be taken with the client seated with arm bare, supported, and at heart level. The client should not have smoked tobacco or taken caffeine in the 30 minutes preceding the measurement. The client should rest quietly for 5 minutes before the reading is taken. The cuff bladder should encircle at least 80% of the limb being measured and have a width of at least 40% of limb circumference. Using a cuff that is too large results in a lower BP and a cuff that is too small will give a higher BP measurement.
A nurse is teaching an client about the risk factors for hypertension. Which factors 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
A. Obesity and high intake of sodium and saturated fat
Rationale: Obesity, stress, high intake of sodium or saturated fat, and family history are all risk factors for primary hypertension. Diabetes and oral contraceptives are risk factors for secondary hypertension. Metabolic syndrome, smoking, renal disease, and coarctation of the aorta are causes of secondary hypertension
The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. Which item should the nurse integrate into the management of this client’s hypertension?
A. Ensure that the client 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 the medication regimen than a younger client.
D. Carefully assess for weight loss because of impaired kidney function resulting from normal aging.
B. Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion
Rationale: Older adults have impaired cardiovascular reflexes and thus are more sensitive to extracellular volume depletion caused by diuretics. The nurse needs to assess hydration status, low BP, and postural hypotension carefully. Older adults may have impaired absorption, but they do not need a higher initial dose of an antihypertensive than a younger person. Adherence to treatment is not necessarily linked to age. Kidney function and absorption decline with age; less, rather than more, antihypertensive medication is prescribed. Weight gain is not necessarily indicative of kidney function decline.
