Chapter 36 Hypertension (NCLEX) Flashcards
NCLEX Questions (11th and 12th edition)
*** Which action would the nurse in the hypertension clinic take to obtain an accurate baseline blood pressure (BP) for a new patient?
A. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second.
B. Have the patient sit in a chair with the feet flat on the floor.
C. Assist the patient to the supine position for BP measurement.
D. Obtain two BP readings in the dominant arm and average the results.
Answer: B
B. Have the patient sit in a chair with the feet flat on the floor
Rationale:
The patient should be seated with the feet flat on the floor. The BP is obtained in both arms, and the results of the two arms are not averaged. The patient does not need to be in the supine position. The cuff should be deflated at 2 to 3 mm Hg per second.
Which information about a patient newly diagnosed with elevated blood pressure is most important for the nurse to address with the patient?
A. Low dietary fiber intake
B. No regular physical exercise
C. Drinks a beer with dinner every night
D. Weight is 5 pounds above ideal weight
Answer: B
B. No regular physical exercise
Rationale:
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 Dietary Approaches to Stop Hypertension (DASH) diet is high in fiber but increasing fiber alone will not prevent hypertension from developing. The patient‘s alcohol intake is within guidelines and does not increase the hypertension risk.
Which action would the nurse take when giving the first dose of oral labetalol to a patient hospitalized with hypertension?
A. Encourage the use of hard candy to prevent dry mouth.
B. Teach the patient that headaches often occur with this drug.
C. Instruct the patient to call for help if heart palpitations occur.
D. Ask the patient to request assistance before getting out of bed.
Answer: D
D. Ask the patient to request assistance before getting out of bed.
Rationale:
Labetalol decreases sympathetic nervous system activity by blocking both A- and B-adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause
severe orthostatic hypotension. Heart palpitations, dry mouth, dehydration, and headaches are possible side effects of other antihypertensives.
After the nurse teaches the patient with stage 1 hypertension about diet modifications, which diet choice indicates that the teaching has been effective?
A. The patient avoids eating nuts or nut butters.
B. The patient restricts intake of chicken and fish.
C. The patient drinks low-fat milk with each meal.
D. The patient has two cups of coffee in the morning.
Answer: C
C. The patient drinks low-fat milk with each meal.
Rationale:
Increased levels of dietary potassium and calcium are associated with lower BP. People with hypertension should receive adequate intake of these from food sources such as low-fat milk. Plant based and Mediterranean diets with increased fruit, nut, vegetable, legumes, and lean proteins from fish and vegetables decreases BP and mortality rates from cardiovascular
disease. Caffeine intake or restriction and decreased protein intake are not recommendations.
*** Which information would the nurse teach the patient who has been prescribed captopril?
A. Include high-potassium foods such as bananas in the diet.
B. Increase fluid intake if dryness of the mouth is a problem.
C. Change position slowly to help prevent dizziness and falls.
D. Check the blood pressure in both arms before taking the drug.
Answer: C
C. Change position slowly to help prevent dizziness and falls.
Rationale:
The angiotensin-converting enzyme (ACE) inhibitors often 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
drug. The patient is taught to use gum or hard candy to relieve dry mouth. The BP should be taken in the nondominant arm by newly diagnosed patients in the morning, before taking the drug, and in the evening. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.
*** Propranolol (Inderal) is newly prescribed for a patient diagnosed with hypertension. Which information in the patient‘s history would prompt the nurse to consult with the health care provider before giving this drug?
A. Asthma
B. Daily alcohol use
C. Peptic ulcer disease
D. Myocardial infarction (MI)
Answer: A
A. Asthma
Rationale:
Non-cardioselective -blockers block B1- and B2-adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma. -Blockers will have no effect on the patient‘s peptic ulcer disease or alcohol use. -Blocker therapy is recommended after
MI.
*** A 62-yr-old patient who has no history of hypertension has a blood pressure (BP) of 198/110 mm Hg during a routine wellness check. After reconfirming the BP, which information would the nurse provide to the patient?
A. A BP recheck should be scheduled in a few weeks.
B. Dietary sodium and fat content should be decreased.
C. Diagnosis, treatment, and monitoring will be needed.
D. There is danger of a stroke, requiring hospitalization.
Answer: C
C. Diagnosis, treatment, and monitoring will be needed.
Rationale:
A sudden increase in BP in a patient older than age 50 years with no hypertension history or risk factors indicates that the hypertension may be secondary to some other problem. The BP will need treatment and ongoing monitoring. If the patient has no other risk factors, a stroke in the immediate future is unlikely and the BP may be managed as an outpatient. There is no indication that dietary salt or fat intake have contributed to this sudden increase in BP. Reducing intake of salt and fat alone will not be adequate to reduce this BP to an acceptable
level.
Which action will be included in the plan of care for a patient who is receiving intravenous nicardipine to treat a hypertensive emergency?
A. Keep the patient NPO to prevent aspiration caused by nausea and possible vomiting.
B. Organize nursing activities so that the patient has 8 hours of undisturbed sleep at night.
C. Refer patient to physical therapy to avoid complications associated with immobility.
D. Use an automated noninvasive blood pressure machine to obtain frequent measurements.
Answer: D
D. Use an automated noninvasive blood pressure machine to obtain frequent measurements.
Rationale:
Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV
antihypertensive medications. This can be most easily accomplished with an automated BP
machine or arterial line. The patient will require frequent assessments, so allowing 8 hours of
undisturbed sleep is not reasonable. When patients are receiving IV vasodilators, bed rest is
maintained to prevent decreased cerebral perfusion and fainting, but prolonged immobility is
not expected. There is no indication that this patient is nauseated or at risk for aspiration, so an
NPO status is unnecessary.
The nurse has just finished teaching a hypertensive patient about a newly prescribed drug, ramipril (Altace). Which patient statement indicates that more teaching is needed?
A. “The medication may not work well if I take aspirin.”
B. “I can expect some swelling around my lips and face.”
C. “The doctor may order a blood potassium level occasionally.”
D. “I will call the doctor if I notice that I have a frequent cough.”
Answer: B
B. “I can expect some swelling around my lips and face.”
Rationale:
Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an indication that the ACE inhibitor would be discontinued. The patient would be taught that if any swelling of the face or oral mucosa occurs, the health care provider would be immediately
notified because this could be life threatening. The other patient statements indicate that the patient has an accurate understanding of ACE inhibitor therapy.
*** A patient with hypertension received the first dose of nadolol (Corgard) during the previous shift. Which information indicates that the patient needs immediate intervention?
A. The patient‘s pulse has dropped from 68 to 57 beats/min.
B. The patient reports that the fingers and toes feel quite cold.
C. The patient has developed wheezes throughout the lung fields.
D. The patient‘s blood pressure (BP) reading is now 158/92 mm Hg.
Answer: C
C. The patient has developed wheezes throughout the lung fields.
Rationale:
The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the non-cardioselective -blockers) is occurring. The nurse would immediately obtain an O2 saturation measurement, apply supplemental O2, and notify the
health care provider. The mild decrease in heart rate and cold fingers and toes are associated with B-receptor blockade but do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated. However, this is not as urgently needed as addressing the bronchospasm.
*** An older patient has been diagnosed with possible white coat hypertension. Which planned action by the nurse addresses that suspected cause of the hypertension?
A. Schedule the patient for regular BP checks in the clinic.
B. Instruct the patient about the need to decrease stress levels.
C. Teach the patient how to self-monitor and record BPs at home.
D. Tell the patient and caregiver that major dietary changes are needed.
Answer C
C. Teach the patient how to self-monitor and record BPs at home.
Rationale
In the phenomenon of “white coat” hypertension, patients have elevated BP readings in a clinical setting and normal readings when BP is measured elsewhere. Having the patient self-monitor BPs at home will provide a reliable indication about whether the patient has hypertension. Regular BP checks in the clinic are likely to be high in a patient with white coat hypertension. There is no evidence that this patient has elevated stress levels or a poor diet,
and those factors do not cause white coat hypertension.
