Hypertension

Question 1

A nurse is discussing with a group of students how to accurately measure blood pressure. The nurse is sure to include all of the following information except:

a.) Routinely calibrate the sphygmomanometer
b.) Center the cuff bladder directly over the brachial artery
c.) Initiallyt take the blood pressure in both arms
d.) Position the forearm above the level of the heart

Answer 1

d.) Position the forearm above the level of the heart

The patient’s forearm must be positioned at heart level.

Question 2

Officially, hypertension is diagnosed when the patient demonstrates a systolic blood pressure greater than ______ mmHg and a diastolic blood pressure greater than ______ mmHg over a sustained period of two or more visits.

a.) 130 / 80 mmHg
b.) 140 / 90 mmHg
c.) 120/70 mmHg
d.) 110/60 mmHg

Answer 2

b.) 140/90 mmHg

Systolic > 140 mmHg
Diastolic > 90 mmHg

Question 3

What are the target organs that are impacted by hypertension?

KNOW THIS!!!!!!

Answer 3

• Brain
• Eyes
• Heart
• Peripheral Vascular Disease
• Kidneys

Question 4

What is peripheral vascular disease (PVD)?

Answer 4

plaque build up causing narrowing of blood vessles = ↓ blood flow to limbs

Question 5

You are doing the final checklist before sending home a 63-year-old female patient who has been newly diagnosed with hypertension. She is going to be started on her first antihypertensive medication. What is one of the main things you should tell her and her husband to watch out for?

a.) Tremor
b.) Blurred vision
c.) Persistent cough
d.) Dizziness

Answer 5

d.) Dizziness

A common adverse side effect of all HTN medications is postural / orthostatic hypotension which can lead to falls. Therefore, you should alert both the patient & her hsuband about the possibility of dizziness and provide them with tips for how to manage dizziness.

Question 6

A nurse is educating a patient about monitoring blood pressure readings at home. WHich of the following will the nurse be sure to emphasize?

a.) Sit with your legs crossed when taking your blood pressure.
b.) Sit quietly for 5 minutes prior to taking your blood pressure.
c.) Be sure the forearm is well supported above the level of the heart when taking your blood pressure.
d.) Avoid smoking cigarettes for 8 hours prior to taking your blood pressure

Answer 6

b.) Sit quietly for 5 minutes prior to taking your blood pressure

INSTRUCTIONS FOR TAKING BP AT HOME:
1.) avoid smoking cigarettes or drinking caffeine for 30 minutes before taking your BP
2.) Sit quietly for 5 minutes before taking your BP
3.) Have forearm supported at heart level, with both feed on the ground while taking your BP

Question 7

Hypertension is defined as “sustained elevations in systolic or diastolic blood pressure that exceed pre-hypertension levels”. What are some of the consequences of hypertension that make it such a health menace in the United States?

a.) Renal disease
b.) Cerebrovascular accident
c.) Cardiac failure
d.) Heart disease
e.) All of the above

Answer 7

e.) All of the above

Healthcare professionals have revised guidelines for identifying HTN because HTN puts people at risk for heart disease, heart failure, stroke, & kidney disease

Question 8

The nurse understands that patient education to antihypertensive medicaiton should include all of the following instructions except for what?

a.) Avoid hot baths, exercise, & alcohol within 3 hours of taking vasodilators.
b.) If a dosage of medication is missed, double up on the next one to catch up.
c.) Do not stop antihypertensive medication abruptly.
d.) Avoid OTC cold, weight reduction, & sinus medications

Answer 8

b.) If a dosage of medication was missed, double up on the next one to catch up.

do NOT double a dose to make up for a missed dose

Question 9

Decreasing hypertension is the main focus of the medical cardiology practice where you are a nurse. Different goals apply to different age groups for managing & reducing blood pressure. Angie Dodd, a 54-year-old nurse is being medically managed for her recent hypertension diagnosis. What is considered the most important strategy in her treatment?

a.) Reducing her systolic pressure below 140 mmHg
b.) Reducing her systolic pressure below 130 mmHg
c.) Reducing her diastolic pressure below 90 mmHg
d.) Reducing her diastolic pressure below 80 mmHg

Answer 9

a.) Reducing her systolic pressure below 140 mmHg

Question 10

The nurse is administering morning medications to a patient on a cardiac telemetry unit. Atenolol has been prescribed for this patient. Prior to administration, the nurse would tell the patient that Atenolol is what type of antihypertensive medication?

a.) Angiotensin-converting enzyme (ACE) inhibitor
b.) Beta-blocker
c.) Calcium channel blocker
d.) Diuretic

Answer 10

b.) Beta Blocker

Beta blockers block receptors in the sympathetic nervous system causing vasodilation, ↓ cardiac output, ↓ HR & ↓ BP.

Question 11

It is appropriate for the nurse to recommend smoking cessation for patients with hypertension because nicotine…

a.) decreases circulating blood volume.
b.) increases the heart rate, constricts arterioles, & increases the heart’s ability to eject blood.
c.) increases the heart rate, constricts arterioles, & reduces the heart’s ability to eject blood.
d.) decreases the heart rate, constricts arterioles, & reduces the heart’s ability to eject blood.

Answer 11

c.) increases the heart rate, constricts arterioles, & reduces the heart’s ability to eject blood.

Question 12

The nurse is caring for a patient with long-standing hypertension. As a patient advocate, which instruction is most helpful in preventing further complications?

a.) Obtain a regular appointment with an ophthamologist.
b.) Focus on exercise at least twice a week.
c.) Avoid the consumption of caffeinated beverages.
d.) Maintain a healthy diet of fruits and vegetables.

Answer 12

a.) Obtain a regular appointment with an ophthamologist.

Question 13

A patient is admitted to the ICU with a diagnosis of a hypertensive emergency / crisis. The patient’s blood pressure is 200/130 mmHg. The nurse is preparing to administer IV Nitropress (nitroprusside). Upon assessment, which of the following patient findings requires immediate intervention by the nurse?

a.) Urine output of 40 cc/mL over the last hour.
b.) Left arm numbness & weakness
c.) Nausea & severe headache
d.) Chest pain score of 3 out of 10.

Answer 13

b.) Left arm numbness & weakness

Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an ICU because of the serious target organ damage that may occur. The finding of L arm numbness & weakness may indicate that the patient is experiencing neurological symptoms associated with an ischemic stroke because of the severely hgih BP requiring immediate intervention

Urine output of 40 mL/hr is normal limits.

Question 16

The nurse is explaining the DASH diet to a patient diagnosed with hypertension. The patient asks about how many servings of fruit per day can be consumed on the diet. THe nurse would be correct in stating which of the following?

a.) 2 or fewer
b.) 2 or 3
c.) 4 or 5
d.) 7 or 8

Answer 16

d.) 4 or 5 servings

DASH DIET
* 2 or fewer servings of meat, fish,or poultry
* 2 or 3 servings of low-fat or fat-free dairy
* 4 or 5 servings of fruit
* 7 or 8 servings of grains or grain products

Question 17

You are part of a group of nursing students making a presentation about chronic hypertension. What is one subject you would need to include in your presentation as a possible consequence of untreated hypertension?

a.) Stroke
b.) Peripheral edema
c.) Pulmonary insufficiency
d.) Right-sided heart failure

Answer 17

a.) Stroke

Question 18

Which of the following would be inconsistent as a component of metabolic syndrome?

a.) Elevated triglyceride levels
b.) Hypotension
c.) Abdominal obesity
d.) Hypertension

Answer 18

b.) Hypotension

**Metabolic Syndrome = ** diabetes, obesity, dyslipidemia, hypertension, & ↑ triglycerides

Question 19

Which of the following statements are true when the nurse is measuring a patient’s blood pressure? (Select all that apply)

a.) The patient’s arm should be positioned at the level of the heart.
b.) Ask the patient to sit quietly while the BP is being measured.
c.) Using a BP cuff that is too large will give a higher BP measurement.
d.) Using a BP cuff that is too small will give a higher BP measurement.
e.) Blood pressure should be taken 1 hour after alcohol consumption.

Answer 19

a.) The patient’s arm should be positioned at the level of the heart.

b.) Ask the patient to sit quietly while the BP is being measured

d.) Using a BP cuff that is too small will give a higher BP measurement.

Question 20

The nurse is caring for a patient with a systolic blood pressure of 135 mmHg. THis finding would be classified as which of the following?

a.) Normal blood pressure
b.) Pre-hypertension
c.) Stage 1 hypertension
d.) Stage 2 hypertension

Answer 20

b.) Pre-hypertension

Systolic BP Ranges

Normal < 130 mmHg
Pre-Hypertension = 121 - 139 mmHg
Stage 1 Hypertension = 140 - 159 mmHg
Stage 2 Hypertension > 160 mmHg

Question 21

What are the systolic blood pressure ranges for each of the following stages?

1.) Normal BP
2.) Pre-Hypertension
3.) Stage 1 Hypertension
4.) Stage 2 Hypertension

Answer 21

1.) Normal BP = < 120 mmHg
2.) Pre-Hypertension = 121 - 139 mmHg
3.) Stage 1 Hypertension = 140 - 159 mmHg
4.) Stage 2 Hypertension = 160+ mmHg

Question 22

A community health nurse is screening for hypertension. Which of the following patients would the nurse focus on most intesively?

a.) A post-menopausal Caucasian female
b.) A 45-year-old Asian female
c.) A middle-aged African-American male
d.) A Hispanic teenaged male

Answer 22

c.) A middle-aged African-American male

Question 23

The nurse teaches the patient which of the following guidelines regarding lifestyle modifications for hypertension?

a.) Stop alcohol intake.
b.) Maintain adequate dietary intake of fruits & vegetables.
c.) Limit aerobic physical acitviyt to 15 minutes, three times per week.
d.) Reduce smoking to no more than 4 cigarettes per day.

Answer 23

b.) Maintain adequate dietary intake of fruits and vegetables

• follow DASH diet (2 or less meat; 2 or 3 servings of low-fat or no-fat dairy; 4 or 5 servings of fruit; 7 or 8 servings of grains)
• Limit EtOH to no more than 2 drinks per day in men & no more than 1 drink per day for women
• Avoid tobacco

Question 25

The nurse is administering medications on a medical surgical unit. A patient is ordered to receive 40 mg of oral nadolol (Corgard) for the treatment of hypertension. Prior to administering the medication, the nurse should check which of the following?

a.) urine output
b.) heart rate
c.) serum potassium level
d.) weight

Answer 25

b.) heart rate

nadolol = beta blocker
* ↓ HR
* ↓ BP

Question 26

A 77-year-old patient has newly diagnosed stage 2 hypertension. The physician prescribed a thiazide & an angio-converting enzyme inhibitor. What is the nurse most concerned about?

a.) Postural hypotension & resulting injury
b.) Postural hypertension & resulting injury
c.) Rebound hypertension
d.) Sexual dysfunction

Answer 26

a.) Postural hypotension (orthostatic hypotension) & resulting injury

• Rebound HTN = when antihypertensives are stopped abruptly
• Sexual dysfunction may occur with other meds like Beta blockers.

Question 27

A nurse is teaching a patient who is newly diagnosed with hypertension & diabetes. For a patient with hypertension but without diabetes , the target blood pressure is 140/90 or lower. Because the patient has diabetes, which of the following is the target blood pressure?

a.) 125/85 mmHg or lower
b.) 130/80 mmHg or lower
c.) 145/95 mmHg or lower
d.) 150/95 mmHg or lower

Answer 27

b.) 130/80 mmHg or lower

Question 28

A nurse is educating a group of clients with newly diagnosed hypertension about lifestyle modifications. While discussing dietary changes, which of the following pointns should the nurse emphasize?

a.) The taste buds never adapt to decreased salt intake.
b.) There is usually no need to change alcohol consumption for patients with hypertension.
c.) It takes 2-3 months for the taste buds to adapt to decreased salt intake.
d.) A person with hypertension should never consume alcohol.

Answer 28

c.) It takes 2-3 months for the taste buds to adapt to decreased salt intake.

Question 29

An 82-year-old female client visits the clinic for a blood pressure check. Her hypertension is not well controlled, and a new blood pressure medication is prescribed. What is important for the nurse to teach this client about her blood pressure medication?

a.) Take the medication on an empty stomach.
b.) A severe drop in blood pressure is possible.
c.) A possible adverse effects of blood pressure medication is dizziness when you stand up.
d.) There are no adverse effects from the blood pressure medication.

Answer 29

c.) A possible adverse effect of blood pressure medication is dizziness when you stand up.

Question 30

Which of the following patient scenarios would be correct for the nurse to identify a patient with secondary hypertension?

a.) A patient of advanced age.
b.) A patient diagnosed with kidney disease.
c.) A patient experiencing depression.
d.) A patient with excessive EtOH intake.

Answer 30

b.) A patient diagnosed with kidney disease

Secondary Hypertension: ↑ BP resulting from (secondary to) other disorders / diseases like kidney disease, a tumor of the adrenal medulla, or atherosclerosis.

Question 31

The nurse is caring for a patient with an intracranial hemorrhage. The patient is having a hypertensive emergency/crisis. Which of the following nursing interventions would take priority in this patient?

a.) Reduce the blood pressure to 160/100 mmHg within 30 minutes of treatment.
b.) Maintain the blood pressure at a significantly higher than normal level to prevent orthostatic hypotension.
c.) Avoid lowering the blood pressure too quickly.
d.) Reduce the mean blood pressure by up to 50% within 1 hour of the treatment.

Answer 31

c.) Avoid lowering the blood pressure too quickly

Question 32

Explain how ACE (angiotensin-converting enzyme) inhibitors work.

KNOW THIS!!!

Answer 32

Convert angiotensin I to angiotensin II to decrease BP

Question 33

How do diuretics work for hypertension?

KNOW THIS!!!

Answer 33

↓ fluid onboard to ↓ stroke volume

Question 34

Which medicaiton class is the first line therapy for hypertension?

KNOW THIS!!!

Answer 34

Thiazide Diuretics