htn Flashcards
The nurse is teaching an older patient with hypertension about developing an exercise program. Which instructions would the nurse include?
1
Perform weightlifting on a daily basis.
2
Perform flexibility and balance exercises daily.
3
Perform muscle-strengthening activities twice a week.
4
Perform high-intensity activity for 30 minutes on most days.
3
Perform muscle-strengthening activities twice a week.
All adults should perform muscle-strengthening activities using the major muscles of the body at least twice a week. Weightlifting is not recommended for a patient with hypertension because it may increase BP. Flexibility and balance exercises are recommended at least twice a week for older adults, especially those at risk for falls. It is recommended to perform moderate-intensity aerobic physical activity for at least 30 minutes on most days (i.e., more than five days a week).
The nurse provides discharge teaching to a female patient who was newly diagnosed with primary hypertension. Which instruction would be included?
1
Decrease the intake of omega-3 fatty acids.
2
Restrict sodium to less than or equal to 2300 mg/day.
3
Limit the intake of alcohol to no more than one drink per day.
4
Begin taking a calcium supplement to help lower BP.
3
Limit the intake of alcohol to no more than one drink per day.
Excessive alcohol intake is strongly associated with hypertension. Women and lighter-weight men should limit their intake to no more than one drink per day. Calcium supplements are not recommended to lower BP. Increased levels of dietary omega-3 fatty acids are associated with lower BP. People with hypertension should restrict sodium to less than or equal to 1500 mg/day.
A patient receives instructions about monitoring BP levels at home. Which information would the nurse teach the patient about measuring the BP in a supine position?
1
Take the reading immediately after lying down.
2
Support the arm with a pillow during measurement.
3
Take at least two consecutive readings one after another.
4
Use the arm with the lower BP for all future measurements.
2
Support the arm with a pillow during measurement.
When measuring BP in a supine position, the patient should support the arm with a small pillow to raise the position of the hand to the level of the heart. Record the average pressure by taking two consecutive readings at least one minute apart; this allows the blood to drain from the arm and prevents inaccurate readings. The first reading should be taken after two to three minutes of rest in a supine position. If bilateral BP measurements are not equal, the patient should use the arm with the highest BP for all future measurements.
Which systolic BP (SBP) measurement correlates with stage 1 hypertension? 1 118 mm Hg 2 129 mm Hg 3 132 mm Hg 4 142 mm Hg
3
132 mm Hg
Stage 1 hypertension is defined as an SBP of 130 to 139 or a diastolic BP (DBP) of 80 to 89 mm Hg. Normal BP is defined as an SBP of less than 120 mm Hg and a DBP of less than 80 mm Hg. Elevated BP is defined as an SBP between 120 and 129 mm Hg and a DBP of less than 80 mm Hg. Hypertension (stage 1) is defined as an SBP between 130 and 139 mm Hg and a DBP between 80 and 89 mm Hg. Hypertension (stage 2) is defined as an SBP of greater than 140 mm Hg and a DBP of greater than 90 mm Hg. If either the SBP or DBP is outside of a range, the higher measurement determines the classification.
Which laboratory test result indicates the presence of target organ damage in a patient with hypertension? 1 Serum uric acid of 3.8 mg/dL 2 Serum creatinine of 2.6 mg/dL 3 Serum potassium of 3.5 mEq/L 4 Blood urea nitrogen (BUN) of 15 mg/dL
2
Serum creatinine of 2.6 mg/dL
The normal serum creatinine level is 0.6 to 1.3 mg/dL. This elevated level of 2.6 mg/dL indicates target organ damage to the kidneys. BUN of 15 mg/dL, serum uric acid of 3.8 mg/dL, and serum potassium of 3.5 mEq/L are within normal limits.
A patient has not reached goal BP despite taking full doses of an appropriate three-drug therapy regimen, including a diuretic. Which finding in the patient history is the likely cause of resistant hypertension? 1 Increasing obesity 2 Excess pepper intake 3 Consumes peppermints 4 Erectile dysfunction (ED) medication
1
Increasing obesity
An increase in obesity is one of the causes of resistant hypertension. Licorice (rather than peppermint), excess salt (rather than pepper) intake, and oral contraceptives (rather than ED medications) are also possible causes of resistant hypertension.
Which mechanism of hypertension causes target organ damage?
1
Promotion of atherosclerosis and damage to the walls of the arteries
2
Thickening of the capillary membranes, leading to hypoxia of organs
3
Direct pressure on organs that results in necrosis and replacement of cells with scar tissue
4
Increased blood viscosity that contributes to intravascular coagulation and tissue necrosis
1
Promotion of atherosclerosis and damage to the walls of the arteries
Hypertension is a major risk factor for the development of atherosclerosis by mechanisms not yet fully known. However, once atherosclerosis develops, it damages the walls of arteries and reduces circulation to target organs and tissues. Hypertension does not thicken capillary membranes, cause direct pressure on organs, or increase blood viscosity.
A patient with hypertension receives a prescription for lisinopril. Which mechanism of action would the nurse expect from this medication?
1
Blocks α-adrenergic effects
2
Relaxes arterial and venous smooth muscle
3
Inhibits conversion of angiotensin I to angiotensin II
4
Reduces sympathetic outflow from the central nervous system (CNS)
3
Inhibits conversion of angiotensin I to angiotensin II
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that inhibits the conversion of angiotensin I to angiotensin II, which reduces angiotensin II–mediated vasoconstriction and sodium and water retention. β-adrenergic receptor blockers (β-blockers) result in vasodilation and a decreased heart rate. Direct vasodilators relax arterial and venous smooth muscle. Central-acting α-adrenergic antagonists reduce sympathetic outflow from the CNS to produce vasodilation and decreased systemic vascular resistance (SVR) and BP.
Which medication should be used with caution in patients with diabetes because the drug may depress the tachycardia associated with hypoglycemia? 1 Diltiazem 2 Metoprolol 3 Prednisone 4 Hydromorphone
2
Metoprolol
Metoprolol, a β-adrenergic receptor blocker (β-blocker), slows the heart rate. Tachycardia is a classic symptom of hypoglycemia; therefore patients must be made aware of the failure of the heart rate to respond to decreasing glucose levels and should be instructed to look for other signs of hypoglycemia. Diltiazem and hydromorphone will not affect blood sugars or signs/symptoms of hypoglycemia. Prednisone will increase, not decrease, blood sugar levels.
Which changes in vital signs indicate that a patient who has just stood up is experiencing postural hypotension?
1
Increased systolic BP and/or decreased heart rate (HR)
2
Increased diastolic BP and/or decreased HR
3
Decreased systolic BP, decreased diastolic BP, and/or increased HR
4
Decreased systolic BP, increased diastolic BP, and no change in HR
3
Decreased systolic BP, decreased diastolic BP, and/or increased HR
A decrease in both systolic and diastolic BP and an increase in HR would be seen in a patient with postural hypotension. BP drops as the volume of circulating blood decreases when a patient abruptly stands from a lying or sitting position. The HR increases as the heart attempts to compensate by increasing the amount of circulating blood by increasing cardiac output. Increased systolic BP and decreased HR; increased diastolic BP and increased HR; and decreased systolic BP, increased diastolic BP, and no change in HR are all incorrect.
A patient with hypertension has been prescribed an antihypertensive medication. During a follow-up visit, the patient asks if the medication can be stopped because the BP is now within the normal range. Which response would the nurse provide?
1
“You may stop the medication now because your BP is normal.”
2
“Begin taking half-doses of the medication because the BP has decreased.”
3
“You may stop taking the medication only if you maintain a healthy lifestyle.”
4
“Continue the medication unless your health care provider advises discontinuing it.”
4
“Continue the medication unless your health care provider advises discontinuing it.”
Antihypertensive medications are effective at reducing BP; however, the medications should not be stopped abruptly because this can cause a severe hypertensive reaction. The medications should be discontinued only after consulting with the health care provider. The medication should not be stopped even if the BP measurements show normal readings. Medications should be taken regularly for sustained therapeutic effects. A reduction of the dosage may reduce the efficacy of the drug. Lifestyle modifications are necessary to reduce cardiovascular risks; however, antihypertensive medications should also be used for effective reduction of BP.
The nurse is preparing to measure the BP of a patient who is lying down on a bed. Which technique should the nurse use?
1
Place the BP cuff on the forearm when measuring the BP.
2
Measure the BP in both arms and record the lowest reading.
3
Rest the patient’s arm on a pillow during the BP measurement.
4
Measure the BP twice in quick succession and average the readings.
3
Rest the patient’s arm on a pillow during the BP measurement.
For measurements taken in a supine position, raise and support (e.g., with a small pillow) the arm at the heart level. If the arm is resting on the bed, it will be below the heart level. This allows the blood to drain from the arm and prevents inaccurate readings. If the patient is in a lying-down position, the arm should be placed on a pillow so that it is at the heart level. The upper arm, not the forearm, is the preferred site of BP cuff placement because of its accuracy of recordings. Atherosclerosis in the subclavian artery may result in a falsely low BP in the affected side; therefore the arm that has the highest recording of the BP should be used for further measurements. BP measurements should be taken at least one minute apart.
