Chapter 32 - Hypetension Flashcards
A 52 yr old pt who has no previous hx of HTN or other problems suddenly develops a BP of 188/106. After reconfirming the BP, the nurse should tell the pt:
A. a BP recheck should be scheduled in a few weeks
B. the dietary sodium and fat content should be decreased
C. there is an immediate danger of a stroke
D. more diagnostic testing may be needed to determine the cause of the HTN
D. more diagnostic testing may be needed to determine the cause of the HTN
-a sudden increase in BP in a pt over age of 50 with no previous HTN hx or risk factors indicates that the HTN may be secondary to some other problem.
Which action will be included in the plan of care when the nurse is caring for a pt who os receiving sodium nitroprusside (Nipride) to treat a hypertensive emergency?
A. Organize nursing activities so that the pt has undistrubed sleep for 6-8 hrs at night
B. Assist the pt up in the chair for meals to avoid complications associated with immobility
C. Use an automated noninvasive BP machine to obtain frequent BP
D. Place the pt on NPO status to prevent aspiration caused by nausea and the associated vomiting
C. Use an automated noninvasive BP machine to obtain frequent BP
-Frequent monitoring of BP is needed when the pt is receiving rapid-acting IV antihypertensive meds
The nurse has just finished teaching a hypertensive pt about the newly prescribed quinapril (Accupril). Which pt statement indicates that more teaching is needed?
A. This medication may not work as well if i take any aspirin
B. The Dr may order a blood potassium level occasionally
C. I will call the Dr if I notice I have a frequent cough
D. I won’t worry if I have little swelling around my lips and face
D. I wont worry if I have little swelling around my lips and face
-Angioedema occurring with ACE inhibitor therapy is an indication that the ACE inhibitor should be discontinued
During change-of-shift report, the nurse obtains this info about a hypertensive pt who received the first dose of propranolol (Inderal) during the previous shift. Which info indicates that the pt needs immediate intervention?
A. The pts most recent BP reading is 156/94
B. The pts pulse has dropped from 64 to 58
C. The pt has developed wheezes throughout the lung fields
D. The pt complains that the fingers and toes feel quite cold
C. The pt has developed wheezes throughout the lung fields
-The most urgent concern for this pt is the wheezes, which indicate that bronchospasm is occurring
A pt has been dx with possible white coat HTN. Which action will the nurse plan to take next?
A. Schedule the pt for frequent BP checks in the clinic
B. Instruct the pt about the need to decrease stress levels
C. Tell the pt how to self-monitor and record BPs at home
D. Teach the pt about ambulatory blood pressure monitoring
C. Tell the pt how to self-monitor and record BPs at home
-Having the pt self-monitor BPs at home will provide a reliable indication about whether the pt has HTN
Which BP finding by the nurse indicates that no changes in the therapy are needed for a pt with stage 1 hypertension who has a hx of heart failure? A. 104/64 B. 128/76 C. 140/90 D. 136/82
B. 128/76
-The goal for antihypertensive therapy for a pt with HTN and heart failure is a BP of 130/80
Which info should the nurse include when teaching a pt with newly dx HTN?
A. Dietary sodium restriction will control BP for most pts
B. Most pts are able to control BP through lifestyle changes
C. HTN is usually asymptomatic until significant organ damage occurs
D. Annual BP checks are needed to monitor treatment effectiveness
C. HTN is usually asymptomatic until significant organ damage occurs
-HTN is usually asymptomatic until target organ damage has occurred
The nurse in the ED received change-of-shift report on 4 pts with HTN. Which pt should the nurse assess first?
A. 52 yr old with a BO of 212/90 who has intermittent claudication
B. 43 yr old with a BP of 190/102 who is complaining of chest pain
C. 50 yr old with a BP of 210/110 who has a creatinine of 1.5 md/dL
D. 48 yr old with a BP of 200/98 whose urine shows microalbuminuria
B. 43 yr old with a BP of 190/102 who is complaining of chest pain
-The pt with chest pain may be experiencing acute MI and rapid assessment and intervention is needed
The nurse is reviewing the lab test for a pt who has recently been dx with HTN. Which result is most important to communicate to the health care provider? A. Creatinine 2.6 B. Potassium 3.8 C. HGB 14.7 D. blood glucose of 98
A. Creatinine 2.6
-A elevated creatinine indicated renal damage cause by HTN
A pt with a history of HTN treated with a diuretic and an ACE inhibitor arrives in the ED complaining of a severe headache and has a BP of 240/118. Which question would you ask first?
A. Did you take Tylenol today?
B. Do you have any recent stressful events in your life?
C. Have you been consistently taking your meds?
D. Have you recently taken any antihistamines?
C. Have you been consistently taking your meds?
-Sudden withdrawal of antihypertensive meds can cause rebound HTN and hypertensive status
The nurse is assessing a pt who has been admitted to the ICU with a hypertensive emergency. Which finding is most important to report to the health care provider?
A. Urine output over 8 hrs is 200 mL less than the fluid intake
B. The pt is unable to move the left arm and leg when asked to do so
C. Tremors are noted in the fingers when the pt extends the arms
D. The pt complains of a severe headache with pain level 8/10
B. The patient is unable to move the left arm and leg when asked to do so
-This indicates that a hemorrhagic stroke may be occurring and will require immediate action to prevent further neurological damage
When a pt with HTN who has a new rx for atenolol (Tebormin) returns to the health clinic after 2 wks for a f/u visit, the BP is unchanged from the previous visit. Which action should the nurse take first?
A. Provide info about the use of multiple drugs to treat HTN
B. Teach the pt about the reasons for a possible change in drug therapy
C. Remind the pt that lifestyle changes also are important in BP control
D. Question the pt about whether the med is actually being taken
D. Question the pt about whether the med is actually being taken
The RN is caring for a pt with hypertensive crisis who is recieveing sodium nitroprusside (Nipride). Which of the following nursing actions can the nurse delegate to an experienced LPN/LVN?
A. Titration nitroprusside to maintain BP at 160/100 mm Hg
B. Evaluate effectiveness of nitroprusside therapy on BP
C. Set up the automatic BP machine to take BP every 15 mins
D. Assess the pts environment for adverse stimuli that might increase BP
C. Set the automatic BP machine to take BP every 15 mins
The charge nurse observes a new RN doing discharge teaching for a hypertensive pt who has a new RX for enalapril (Vasotec). The charge nurse will need to intervene if the new RN tells the pt to:
a. check the BP at home everyday
b. move slowly when moving from lung to standing
c. increase the dietary intake of high-potassium foods
d. make an appt with a dietician for teaching
c. increase thee dietary intake of high-potassium foods
- ACE inhibitors cause retention of potassium by the kidney, so hyperkalemia is a possible adverse effect
Which assessment finding for a pt who is receiving furosemide (Lasix) to treat stage 2 hypertension is most important to report to the health care provider?
A. Blood glucose level of 180 mg/dL
B. Blood potassium level of 3.0
C. Early morning BP reading of 164/96
D. Orthostatic systolic BP decrease of 12
B. Blood potassium
-Hypokalemia is frequent adverse effect of the loop diuretics and can cause life-threatening dysrhythmias
