Chapter 36 Hypertension (Review Questions) Flashcards
Basic questions from the book and lectures
The nurse determines that the patient has stage 2 hypertension when the patient’s average blood pressure is: (Select all that apply.)
A. 150/96 mm Hg
B. 155/88 mm Hg
C. 172/92 mm Hg
D. 160/110 mm Hg
E. 182/106 mm Hg
Answers: A,B,C,D,E
A. 150/96 mm Hg
B. 155/88 mm Hg
C. 172/92 mm Hg
D. 160/110 mm Hg
E. 182/106 mm Hg
While performing blood pressure screening at a health fair, the nurse counsels which person as having the greatest risk for developing hypertension?
A. A 56-year-old man whose father died at age 62 from a stroke
B. A 30-year-old female advertising agent who is unmarried and lives alone
C. A 68-year-old man who uses herbal remedies to treat his enlarged prostate gland
D. A 43-year-old man who travels extensively with his job and exercises only on weekends
Answer: A
A. A 56-year-old man whose father died at age 62 from a stroke
The nurse takes blood pressures at a health fair. The nurse identifies which person as most at risk for developing hypertension?
A. A 52-year-old male who smokes and has a parent with hypertension
B. A 30-year-old female advertising agent who is unmarried and lives alone
C. 68-year-old male who uses herbal remedies to treat an enlarged prostate gland
D. A 43-year-old female who travels extensively for work and exercises only on weekends
ANS: A
A. A 52-year-old male who smokes and has a parent with hypertension
The nurse determines that which blood pressure would meet the criteria for a diagnosis of stage 1 hypertension? (Select all that apply.)
A. 134/84 mm Hg
B. 138/88 mm Hg
C. 144/92 mm Hg
D. 156/96 mm Hg
E. 182/100 mm Hg
Answers: A, B
A. 134/84 mm Hg
B. 138/88 mm Hg
A patient’s blood pressure has not responded to the prescribed drugs for hypertension. Which of the following should the nurse assess first?
A. Potential for drug interactions
B. Progressive target organ damage
C. Possible use of recreational drugs
D. Patient’s adherence to drug therapy
Answer: D
D. Patient’s adherence to drug therapy
A defect in which BP-regulating mechanisms can result in the development of hypertension? (Select all that apply)
A. Release of norepinephrine
B. Secretion of prostaglandins
C. Stimulation of the sympathetic nervous system
D. Stimulation of the parasympathetic nervous system
E. Activation of the renin-angiotensin-aldosterone system
Answer: A, C, E
A. Release of norepinephrine
C. Stimulation of the sympathetic nervous system
E. Activation of the renin-angiotensin-aldosterone system
Which item in a patient history would the nurse recognize as a modifiable risk factor for the development of hypertension?
A. Low-calcium diet
B. Excess alcohol use
C. Family history of hypertension
D. Consumption of a high-protein diet
Answer: B
B. Excess alcohol use
Which information would the nurse apply to a teaching plan for a patient with hypertension?
A. All patients with elevated BP need drug therapy
B. Obese persons must achieve normal weight to lower BP
C. It is not necessary to lower salt in the diet if taking diuretic
D. Lifestyle modifications are needed for persons with elevated BP
Answer: D
D. Lifestyle modifications are needed for persons with elevated BP
Which consideration would the nurse include in the management of the older adult with hypertension?
A. Preventing primary hypertension from converting to secondary hypertension
B. Recognizing that the older adult is less likely to adhere to the drug therapy regimen than a younger adult
C. Ensuring that the patient receives larger initial doses of antihypertensive drugs because of impaired absorption
D. Using a precise technique in assessing the BP of the patient because of the possible presence of orthostatic hypertension
Answer: D
D. Using a precise technique in assessing the BP of the patient because of the possible presence of orthostatic hypertension
A patient with newly discovered high BP has an average reading of 158/98 mm Hg after 3 months exercise and diet modifications. Which management strategy would the nurse expect?
A. Drug therapy will be needed because the BP has not reached the goal
B. BP monitoring should continue for 3 months to confirm a diagnosis of hypertension
C. Lifestyle changes are less important since they were not effective, and drugs will be started
D. More changes in the patient’s lifestyle are needed for longer time before starting drug therapy
Answer: A
A. Drug therapy will be needed because the BP has not reached the goal
A patient is admitted to the hospital in a hypertensive emergency (BP 244/142 mm Hg). Sodium nitroprusside is started to treat elevated BP. Which management strategies would the nurse anticipate? (Select all that apply)
A. Measuring hourly urine output
B. Continuous BP monitoring with an arterial line
C. Decreasing the MAP by 50% within the first hour
D. Maintaining bed rest and giving tranquilizers to lower the BP
E. Assessing the patient for signs of heart failure and changes in mental status
Answer: A, B, E
A. Measuring hourly urine output
B. Continuous BP monitoring with an arterial line
E. Assessing the patient for signs of heart failure and changes in mental status
Which information would the nurse consider when planning care for older adult patients with hypertension? (Select all that apply.)
A. Systolic blood pressure increases with aging.
B. White coat syndrome is prevalent in older patients.
C. Volume depletion contributes to orthostatic hypotension.
D. Blood pressures should be maintained near 120/80 mm Hg.
E. Blood pressure drops 1 hour after eating in many older patients.
F. Older patients require higher doses of antihypertensive medications.
Answer: A, B, C, D, E
A. Systolic blood pressure increases with aging.
B. White coat syndrome is prevalent in older patients.
C. Volume depletion contributes to orthostatic hypotension.
D. Blood pressures should be maintained near 120/80 mm Hg.
E. Blood pressure drops 1 hour after eating in many older patients.
Rationale:
Systolic blood pressure increases with age and patients older than age 60 years should be maintained below 150/90 mm Hg. Older adults are more likely to have elevated blood pressure when taken by health care providers (white coat syndrome). Older patients have orthostatic hypotension related to dehydration, reduced compensatory mechanisms, and medications. One hour after eating, many older patients have a drop in blood pressure. Lower doses of medications may be needed to control blood pressures in older adults related to decreased absorption rates and excretion ability.
In caring for a patient with poorly controlled hypertension, which laboratory test result would the nurse recognize as indicating target organ damage?
A. Serum uric acid of 3.8 mg/dL
B. Serum creatinine of 2.6 mg/dL
C. Serum potassium of 3.5 mEq/L
D. Blood urea nitrogen of 15 mg/dL
Answer: B
B. Serum creatinine of 2.6 mg/dL
Rationale:
The normal serum creatinine level is 0.6 to 1.3 mg/dL. This elevated level indicates target organ damage to the kidneys. The other laboratory results are within normal limits.
When teaching how lisinopril helps lower the patient’s blood pressure, which mechanism of action would the nurse explain?
A. Blocks β-adrenergic effects.
B. Relaxes arterial and venous smooth muscle.
C. Inhibits conversion of angiotensin I to angiotensin II.
D. Reduces sympathetic outflow from central nervous system.
Answer: C
C. Inhibits conversion of angiotensin I to angiotensin II.
Rationale:
Lisinopril is an angiotensin-converting enzyme inhibitor that inhibits the conversion of angiotensin I to angiotensin II, which reduces angiotensin II–mediated vasoconstriction and sodium and water retention. β-Blockers result in vasodilation and decreased heart rate. Direct vasodilators relax arterial and venous smooth muscle. Central-acting α-adrenergic antagonists reduce sympathetic outflow from the central nervous system to produce vasodilation and decreased systemic vascular resistance and blood pressure.
The nurse is teaching a women’s group about ways to prevent hypertension. Which information would the nurse include? (Select all that apply.)
A. Lose weight.
B. Limit beef consumption.
C. Limit sodium and fat intake.
D. Increase fruits and vegetables.
E. Exercise 30 minutes most days.
Answer: B, C, D, E
B. Limit beef consumption.
C. Limit sodium and fat intake.
D. Increase fruits and vegetables.
E. Exercise 30 minutes most days.
Rationale:
Primary prevention of hypertension is to make lifestyle modifications that prevent or delay the increase in BP. Along with exercise for 30 minutes on most days, the DASH eating plan is a healthy way to lower BP by limiting sodium and fat intake, increasing fruits and vegetables, and increasing nutrients that are associated with lowering BP. Beef includes saturated fats, which should be limited. Weight loss may or may not be needed, depending on the person.
A patient who is taking nifedipine (Procardia XL) for antihypertensive therapy continues to have blood pressures over 140/90 mm Hg. Which action would the nurse take next?
A. Ask the patient to make an exercise plan.
B. Assess the patient’s adherence to therapy.
C. Teach the patient to follow the DASH diet.
D. Request a prescription for a thiazide diuretic.
Answer: B
Rationale:
A long-acting calcium-channel blocker such as nifedipine causes vascular smooth muscle relaxation, resulting in decreased systemic vascular resistance and arterial blood pressure and related side effects. The patient data the nurse has about this patient is very limited, so the nurse needs to begin by assessing adherence to therapy.
The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD), angina, and hypertension. The health care provider adds a new prescription for Atenolol 100 mg PO. For which adverse effect is the patient at risk?
A. Hypocapnia
B. Tachycardia
C. Bronchospasm
D. Nausea and vomiting
Answer: C
C. Bronchospasm
Rationale:
Atenolol is a cardioselective β1-adrenergic blocker that reduces blood pressure and could affect the β2-receptors in the lungs with larger doses or with drug accumulation. Although the risk of bronchospasm is less with cardioselective β-blockers than nonselective β-blockers, atenolol should be used cautiously in patients with COPD.
A middle aged patient is diagnosed with hypertension and receives a prescription for benazepril. After providing teaching, which statement by the patient indicates correct understanding?
A. “If I take this medication, I will not need to follow a special diet.”
B. “It is normal to have some swelling in my face while taking this medication.”
C. “I will need to eat foods such as bananas and potatoes that are high in potassium.”
D. “If I develop a dry cough while taking this medication, I should notify my doctor.”
Answer: D
D. “If I develop a dry cough while taking this medication, I should notify my doctor.”
Rationale:
Benazepril is an angiotensin-converting enzyme inhibitor. The medication inhibits breakdown of bradykinin, which may cause a dry, hacking cough. Other adverse effects include hyperkalemia. Swelling in the face could indicate angioedema and should be reported immediately to the prescriber. Patients taking drug therapy for hypertension should also attempt lifestyle modifications to lower blood pressure such as a reduced sodium diet.
The nurse teaches a young adult patient newly diagnosed with hypertension about lifestyle modifications to reduce blood pressure. Which patient statement demonstrates further teaching is required?
A. “I will avoid adding salt to my food during or after cooking.”
B. “If I lose weight, I might not need to continue taking medications.”
C. “I can lower my blood pressure by switching to smokeless tobacco.”
D. “Diet changes can be as effective as taking blood pressure medications.”
Answer: C
C. “I can lower my blood pressure by switching to smokeless tobacco.”
Rationale:
Nicotine contained in tobacco products (smoking and chew) cause vasoconstriction and increase blood pressure. Persons with hypertension should restrict sodium to 1500 mg/day by avoiding foods high in sodium and not adding salt in preparation of food or at meals. Weight loss can decrease blood pressure between 5 to 20 mm Hg. Following dietary recommendations (e.g., the DASH diet) lowers blood pressure, and these decreases compare with those achieved with blood pressure–lowering medication.
The nurse is caring for a patient with hypertension who is scheduled to receive a dose of metoprolol tartrate. Which data collected just before administration indicates that the nurse should consult the prescribing provider before administering the dose?
A. O2 saturation 93%
B. Pulse 48 beats/min
C. Respirations 24 breaths/min
D. Blood pressure 118/74 mm Hg
Answer: B
B. Pulse 48 beats/min
Rationale:
Because metoprolol is a β1-adrenergic blocking agent, it can cause hypotension and bradycardia as adverse effects. The nurse should withhold the dose and consult with the health care provider for parameters regarding pulse rate limits.
A patient with a history of chronic hypertension is being evaluated in the emergency department for a blood pressure of 200/140 mm Hg. Which patient assessment question is the priority?
A. Is the patient pregnant?
B. Does the patient need to urinate?
C. Does the patient have a headache or confusion?
D. Is the patient taking antiseizure medications as prescribed?
Answer: C
C. Does the patient have a headache or confusion?
Rationale:
The nurse’s priority assessments include neurologic deficits, retinal damage, heart failure, pulmonary edema, and renal failure. The headache or confusion could be seen with hypertensive encephalopathy from increased cerebral capillary permeability leading to cerebral edema. In addition, headache or confusion could represent signs and symptoms of a hemorrhagic stroke. Pregnancy can lead to secondary hypertension. Needing to urinate and taking antiseizure medication do not support a hypertensive emergency.
The assistive personnel (AP) is taking orthostatic vital signs. In the supine position, the patient’s blood pressure (BP) is 130/80 mm Hg, and the heart rate (HR) is 80 beats/min. In the sitting position, the BP is 140/80, and the HR is 90 beats/min. Which action would the nurse instruct the AP to take next?
A. Repeat BP and HR in this position.
B. Record the BP and HR measurements.
C. Take BP and HR with patient standing.
D. Return the patient to the supine position.
Answer: C
Rationale:
The vital signs taken do not reflect orthostatic changes, so the AP will continue with the measurements while the patient is standing. There is no need to repeat or delay the readings. The patient does not need to return to the supine position. When assessing for orthostatic changes, the AP will take the BP and pulse in the supine position, then place the patient in a sitting position for 1 to 2 minutes and repeat the readings, and then reposition to the standing position for 1 to 2 minutes and repeat the readings. Results consistent with orthostatic changes would have a decrease of 20 mm Hg or more in systolic BP, a decrease of 10 mm Hg or more in diastolic BP, and/or an increase in HR of greater than or equal to 20 beats/min with position changes.
Which instruction would the nurse give when teaching a patient about stage 1 hypertension?
A. Increase water intake.
B. Restrict sodium intake.
C. Increase protein intake.
D. Use calcium supplements.
Answer: B
B. Restrict sodium intake.
Rationale:
The patient should decrease intake of sodium. This will help to control hypertension, which can be aggravated by excessive salt intake, which in turn leads to fluid retention. Protein intake does not affect hypertension. Calcium supplements are not recommended to lower blood pressure.
When teaching to a patient with hypertension, which protein source would the nurse recommend restricting?
A. Broiled fish
B. Roasted duck
C. Roasted turkey
D. Baked chicken breast
Answer: B
B. Roasted duck
Rationale:
Roasted duck is high in fat, which should be avoided by the patient with hypertension. Weight loss may slow the progress of atherosclerosis and overall cardiovascular disease risk. The other meats are lower in fat and are therefore acceptable in the diet.
Which information would the nurse teach to a patient about the primary mechanism by which uncontrolled hypertension causes organ damage?
A. Hypertension promotes atherosclerosis and damage to the walls of the arteries.
B. Hypertension causes direct pressure on organs, resulting in necrosis and scar tissue.
C. Hypertension causes thickening of the capillary membranes, leading to hypoxia of organ systems.
D. Hypertension increases blood viscosity, intravascular coagulation and tissue necrosis distal to occlusions.
Answer: A
A. Hypertension promotes atherosclerosis and damage to the walls of the arteries.
Rationale:
Hypertension is a major risk factor for the development of atherosclerosis by mechanisms not yet fully known. Atherosclerosis damages the walls of arteries and reduces circulation to target organs and tissues.
The nurse supervises assistant personnel (AP) taking the blood pressure of a patient admitted with heart failure who is obese. Which action by the AP will require the nurse to intervene?
A. Deflating the blood pressure cuff at a rate of 8 to 10 mm Hg/sec
B. Waiting 2 minutes after position changes to take orthostatic pressures
C. Taking the blood pressure with the patient’s arm at the level of the heart
D. Taking a forearm blood pressure if the largest cuff will not fit the patient’s upper arm
Answer: A
A. Deflating the blood pressure cuff at a rate of 8 to 10 mm Hg/sec
Rationale:
The cuff should be deflated at a rate of 2 to 3 mm Hg/sec. The arm should be supported at the level of the heart for accurate blood pressure measurements. Using a cuff that is too small causes a falsely high reading and too large causes a falsely low reading. If the maximum size blood pressure cuff does not fit the upper arm, the forearm may be used. Orthostatic blood pressures should be taken within 1 to 2 minutes of repositioning the patient.
The nurse is caring for a patient who has taken hydrochlorothiazide for 10 years to treat hypertension. Which parameter indicates effectiveness of this drug therapy?
A. BP 128/78 mm Hg
B. Weight loss of 2 lb
C. Absence of ankle edema
D. Output of 600 mL per 8 hours
Answer: A
A. BP 128/78 mm Hg
Rationale:
Hydrochlorothiazide may be used alone as monotherapy to manage hypertension or in combination with other medications if not effective alone. After the first few weeks of therapy, the diuretic effect diminishes, but the antihypertensive effect remains. Because the patient has been taking this medication for 10 years, the most direct measurement of its intended effect would be the blood pressure.
The nurse reviews the medication record of a patient with hypertension. Which medication would the nurse recognize as increasing the patient’s risk for hypokalemia?
A. Clonidine (Catapres)
B. Bumetanide (Bumex)
C. Amiloride (Midamor)
D. Spironolactone (Aldactone)
Answer: B
B. Bumetanide (Bumex)
Rationale:
Bumetanide is a loop diuretic. Hypokalemia is a common adverse effect of this medication. Amiloride is a potassium-sparing diuretic. Spironolactone is an aldosterone-receptor blocker. Hyperkalemia is an adverse effect of both amiloride and spironolactone. Clonidine is a central-acting α-adrenergic antagonist and does not cause electrolyte abnormalities.
An older adult with hypertension admitted to the emergency department with a blood pressure of 234/148 mm Hg is started on nitroprusside. After 1 hour of treatment, the mean arterial blood pressure (MAP) is 55 mm Hg. Which nursing action is a priority?
A. Start an infusion of 0.9% normal saline at 100 mL/hr.
B. Maintain the current administration rate of the nitroprusside.
C. Request insertion of an arterial line for accurate blood pressure monitoring.
D. Stop the nitroprusside infusion and assess the patient for potential complications.
Answer: D
D. Stop the nitroprusside infusion and assess the patient for potential complications.
Rationale:
Nitroprusside is a potent vasodilator medication. A blood pressure of 234/118 mm Hg would have a calculated MAP of 177 mm Hg. Subtracting 25% (or 44 mm Hg) = 133 mm Hg. The initial treatment goal is to decrease MAP by no more than 20%-25% within minutes to 1 hour. For this patient, the goal MAP would be around 133 mm Hg. Minimal MAP required to perfuse organs is around 60 to 65 mm Hg. Lowering the blood pressure too rapidly may decrease cerebral, coronary, or renal perfusion and could precipitate a stroke, myocardial infarction, or renal failure. The priority is to stop the nitroprusside infusion and then use fluids only if necessary to support restoration of MAP.
