Hypertension Flashcards
The nurse is instructing a student on the proper technique for measuring blood pressure (BP). Which student action indicates a need for further teaching?
a. Palpates the systolic pressure before auscultating blood pressure
b. Wraps the blood pressure cuff firmly around the arm
c. Positions the arm at waist level
d. Centers the blood pressure cuff bladder directly over the brachial artery
c
Positioning the arm above the heart level will give a falsely low reading. Placing the arm below the heart will falsely elevate the reading. All other options are correct steps in achieving an accurate blood pressure.
A client in a clinic setting has just been diagnosed with hypertension. When the client asks what the end goal is for treatment, what is the nurse’s best response?
a. To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less
b. To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less
c. To lose weight, achieve a body mass index of 24 or less, and to eat a diet rich in fruits and vegetables
d. To stop smoking and increase physical activity to 30 minutes/day most days of the week
a
The end goal of hypertension treatment is to prevent complications and death by achieving and maintaining arterial blood pressure at 140/90 or lower for most people. To achieve this end goal, the client is taught to make the following lifestyle changes (these are not end goals; they are ways to reach the end goal listed above): (1) maintaining a normal body mass index (about 24; greater than 25 is considered overweight); maintaining a waist circumference of less than 40 inches for males and 35 inches for females; limiting alcohol intake to no more than 2 drinks for males and 1 drink for females per day; engaging in aerobic activity at least 30 minutes per day most days of the week.
A client is being seen at the clinic on a monthly basis for assessment of blood pressure. The client has been checking blood pressure at home as well and has reported a systolic pressure of 158 and a diastolic pressure of 64. What does the nurse suspect this client is experiencing?
a. Isolated systolic hypertension
b. Primary hypertension
c. Hypertensive urgency
d. Secondary hypertension
a
As a result of changes that occur with aging, the aorta and large arteries are less able to accommodate the volume of blood pumped out by the heart (stroke volume), and the energy that would have stretched the vessels instead elevates the systolic blood pressure, resulting in an elevated systolic pressure without a change in diastolic pressure. This condition, known as isolated systolic hypertension, is more common in older adults and is associated with significant cardiovascular and cerebrovascular morbidity and mortality (Chobanian et al., 2003).
The nurse is caring for an older adult client who has come to the clinic for a yearly physical. When assessing the client, the nurse notes the blood pressure (BP) is 140/93. The nurse knows that in older clients what happens that may elevate the systolic BP?
a. Decrease in cardiac output
b. Loss of arterial elasticity
c. Decrease in blood volume
d. Increase in calcium intake
b
In older clients, systolic BP may be elevated because of loss of arterial elasticity (arteriosclerosis). Systolic BP would not become elevated by a decrease in blood volume, an increase in calcium intake, or a decrease in cardiac output.
Which statements are true when the nurse is measuring blood pressure (BP)? Select all that apply.
a. Using a BP cuff that is too small will give a higher BP measurement.
b. The client should sit quietly while BP is being measured.
c. The client’s BP should be measured 1 hour before consuming alcohol.
d. The client’s arm should be positioned at the level of the heart.
e. Using a BP cuff that is too large will give a higher BP measurement.
a, b, d
These statements are all true when measuring a BP. When using a BP cuff that is too large, the reading will be lower than the actual BP. The client should avoid smoking cigarettes or drinking caffeine for 30 minutes before BP is measured.
A 35-year-old client has been diagnosed with hypertension. The client is a stock broker, smokes daily, and has diabetes. During a follow-up appointment, the client states that regular visits to the health care provider just to check blood pressure (BP) are cumbersome and time consuming. Which aspect of client teaching would the nurse recommend?
a. Administering glycemic control
b. Advising smoking cessation
c. Discussing methods for stress reduction
d. Purchasing a self-monitoring BP cuff
d
Because this client finds visiting the health care provider time-consuming just for a BP reading, the nurse can suggest the use of an automatic cuff at a local pharmacy, or purchasing a self-monitoring cuff. Discussing methods to reduce stress, advising smoking cessation, and achieving glycemic control would constitute client education in managing hypertension.
The nurse is explaining the DASH diet to a client diagnosed with hypertension. The client inquires about how many servings of fruit per day can be consumed on the diet. What is the nurse’s best response?
a. 2 or fewer servings per day
b. 4 or 5 servings per day
c. 2 or 3 servings per day
d. 7 or 8 servings per day
b
The client can consume 4 or 5 servings of fruit per day on the DASH diet. The servings for grains and grain product is 7 or 8. Two or 3 servings of low-fat or fat-free dairy foods can be consumed per day. Meat, fish, and poultry servings are 2 or fewer per day.
According to the classification of hypertension diagnosed in older adults, hypertension that can be attributed to an underlying cause is termed:
a. secondary.
b. primary.
c. isolated systolic.
d. essential.
a
Secondary hypertension may be caused by a tumor of the adrenal gland (e.g., pheochromocytoma). Primary, or essential, hypertension has no known underlying cause. Isolated systolic hypertension is demonstrated by readings in which the systolic pressure exceeds 140 mm Hg and the diastolic measurement is normal or near normal (less than 90 mm Hg).
The nurse is discussing aging and the incidence of hypertension with an older adult. What lifestyle change will lower blood pressure for the older adult?
a. Sleep four hours each night.
b. Add salt to foods for taste.
c. Keep weight stable.
d. Exercise once a week.
c
Obesity can contribute to hypertension, so keeping weight stable is healthy. Salt can add to hypertension. The American Heart Association recommends exercising more than once a week for the older adult. Sleeping for four hours is not enough for rest.
The nurse is evaluating the types of medications prescribed for a client’s hypertension. Which of the following medication classifications establishes an action on vasoconstrictive hormones in the blood stream?
a. Calcium channel blocker
b. ACE inhibitor
c. Loop diuretic
d. Beta-blocker
b
The angiotensin-converting enzyme (ACE) inhibitor’s primary action is to prevent the conversion of angiotensin I to angiotensin II, a potent vasoconstricting hormone in the blood. A beta-blocker blocks the beta-adrenergic receptors decreasing sympathetic nervous system stimulation. Loop diuretics excrete water from the loop of Henle, reducing circulating blood volume. Calcium channel blockers dilate coronary and peripheral arteries.
Which condition(s) indicates target organ damage from untreated/undertreated hypertension? Select all that apply.
a. Diabetes
b. Retinal damage
c. Stroke
d. Heart failure
e. Hyperlipidemia
b, c, d
Target organs include the heart, kidney, brain, and eyes. Hyperlipidemia and diabetes are risk factors for development of hypertension.
Which finding indicates that hypertension is progressing to target organ damage?
a. Retinal blood vessel damage
b. Chest x-ray showing pneumonia
c. Urine output of 60 mL over 2 hours
d. Blood urea nitrogen concentration of 12 mg/dL
a
Symptoms suggesting that hypertension is progressing to the extent that target organ damage is occurring must be detected early so that appropriate treatment can be initiated. All body systems must be assessed to detect any evidence of vascular damage. An eye examination with an ophthalmoscope is important because retinal blood vessel damage indicates similar damage elsewhere in the vascular system. The client is questioned about blurred vision, spots in front of the eyes, and diminished visual acuity. The heart, nervous system, and kidneys are also carefully assessed. A BUN concentration of 12 mg/dL and urine output of 60 mL over 2 hours are normal findings. The presence of pneumonia does not indicate target organ damage.
The nurse is caring for a client prescribed bumetanide for the treatment of stage 2 hypertension. Which finding indicates the client is experiencing an adverse effect of the medication?
a. Urine output of 90 mL 1 hour after medication administration
b. Blood glucose value of 160 mg/dL
c. Electrocardiogram (EGG) tracing demonstrating peaked T waves
d Serum potassium value of 3.0 mEq/L
d
Bumetanide is a loop diuretic that can cause fluid and electrolyte imbalances. Clients taking these medications may experience a low serum potassium concentration. ECG changes associated with an elevated serum potassium concentration include peaked T waves. Diuresis is a desired effect postadministration of bumetanide. The serum glucose concentration is elevated and requires intervention; however, this elevation is not associated with the administration of bumetanide.
The nurse teaches the client which guidelines regarding lifestyle modifications for hypertension?
a. Limit aerobic physical activity to 15 minutes, three times per week
b. Maintain adequate dietary intake of fruits and vegetables
c. Reduce smoking to no more than four cigarettes per day
d. Stop alcohol intake
b
Guidelines include adopting the Dietary Approaches to Stop Hypertension (DASH) eating plan: consume a diet rich in fruits, vegetables, and low-fat dairy products and reduced amounts of saturated and total fat; reduce dietary sodium intake to no more than 100 mmol/day (2.4 g sodium or 6 g sodium chloride); engage in regular aerobic physical activity such as brisk walking (at least 30 min/day, most days of the week); moderate alcohol consumption, limiting consumption to no more than two drinks (e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most males and to no more than one drink per day in females and lighter-weight people. Tobacco should be avoided because anyone with high blood pressure is already at increased risk for heart disease, and smoking amplifies this risk.
The nurse is instructing a client who is newly prescribed an antihypertensive medication. Which nursing instruction is emphasized to maintain client safety?
a. Take the medication at the same time daily.
b. Sit on the edge of the chair and rise slowly.
c. Do not operate a motor vehicle.
d. Use a pillbox to store daily medication.
b
The nursing instruction emphasized to maintain client safety is to sit on the edge of the chair before rising slowly. By doing so, the client reduces the possibility of falls related to postural hypotension. Using a pillbox to store medications and taking the medication at the same time daily is good medication management instruction, but not necessarily related to safety. When taking antihypertensive medications, there is no reason to restrict driving.
