Lewis- CH 36 Hypertension

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.

B. Have the patient sit in a chair with the feet flat on the floor.

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

B. No regular physical exercise

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.

D. Ask the patient to request assistance before getting out of bed.

Labetalol decreases sympathetic nervous system activity by blocking both - and -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.

C. The patient drinks low-fat milk with each meal.

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.

C. .Change position slowly to help prevent dizziness and falls

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)

A. Asthma

Non-cardioselective -blockers block 1- and 2-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.

C. Diagnosis, treatment, and monitoring will be needed.

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.

D. Use an automated noninvasive blood pressure machine to obtain frequent measurements.

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."

B. "I can expect some swelling around my lips and face."

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.

C. The patient has developed wheezes throughout the lung fields.

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 -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.

C. Teach the patient how to self-monitor and record BPs at home.

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.

Which blood pressure (BP) finding by the nurse indicates that no changes in therapy are needed for a 48-yr-old patient with newly diagnosed hypertension?

a. 98/56 mm Hg

b. 128/76 mm Hg

c. 128/92 mm Hg

d. 142/78 mm Hg

B. 128/76 mm Hg

The 8th Joint National Committee's recommended goal for antihypertensive therapy for a 30- to 59-yr-old patient with hypertension is a BP below 130/80 mm Hg. The BP of 98/56 mm Hg may indicate overtreatment of the hypertension and an increased risk for adverse drug effects. The other two blood pressures indicate a need for modifications in the patient's treatment.

Which information is important for the nurse to include when teaching a patient newly diagnosed with hypertension?

a. Most people can control hypertension through dietary changes.

b. Annual BP checks are needed to monitor treatment effectiveness.

c. Hypertension is usually asymptomatic until organ damage occurs.

d. Increasing physical activity controls hypertension for most people.

C. Hypertension is usually asymptomatic until organ damage occurs.

Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle changes (e.g., physical activity, dietary changes) are used to help manage BP, but drugs are needed for most patients. Home BP monitoring would be taught to the patient and findings checked by the health care provider frequently when starting treatment for hypertension and then every 3 months when stable.

The nurse on the intermediate care unit received change-of-shift report on four patients with hypertension. Which patient would the nurse assess first?

a. 48-yr-old with a BP of 160/92 mm Hg who reports chest pain

b. 50-yr-old with a BP of 190/104 mm Hg whose creatinine is 1.7 mg/dL

c. 52-yr-old with a BP of 198/90 mm Hg who has intermittent claudication

d. 43-yr-old with a BP of 172/98 mm Hg whose urine shows microalbuminuria

A. 48-yr-old with a BP of 160/92 mm Hg who reports chest pain

The patient with chest pain may be experiencing acute myocardial infarction and rapid assessment and intervention are needed. Intermittent claudication, elevated creatinine, and microalbuminuria show chronic target organ damage but do not indicate acute processes.

The nurse is reviewing the laboratory test results for a patient who has recently been diagnosed with hypertension. Which result is important to communicate to the health care provider?

a. Serum creatinine of 2.8 mg/dL

b. Serum potassium of 4.5 mEq/L

c. Serum hemoglobin of 14.7 g/dL

d. Blood glucose level of 96 mg/dL

A. Serum creatinine of 2.8 mg/dL

The elevated serum creatinine indicates renal damage caused by the hypertension. The other laboratory results are normal.

A patient who has a history of hypertension treated with a diuretic and clonidine (Catapres) arrives in the emergency department. The patient reports a severe headache and nausea and has a blood pressure (BP) of 238/118 mm Hg. Which question would the nurse ask to follow up on these findings?

a. "Have you recently taken any antihistamines?"

b. "Have you consistently taken your medications?"

c. "Did you take any acetaminophen (Tylenol) today?"

d. "Have there been recent stressful ev

B. "Have you consistently taken your medications?"

Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do not increase BP. Stressful events will increase BP but not usually to the level seen in this patient.

The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a hypertensive emergency. Which finding is most urgent to report to the health care provider?

a. Urine output over 8 hours is 250 mL less than the fluid intake.

b. The patient cannot move the left arm and leg when asked to do so.

c. Tremors are noted in the fingers when the patient extends the arms.

d. The patient reports a headache with pain at level 7 of 10 (0 to 10 scale).

B. The patient cannot move the left arm and leg when asked to do so.

The patient's inability to move the left arm and leg indicates that a stroke may be occurring and will require immediate action to prevent further neurologic damage. The other clinical manifestations are also likely caused by the hypertension and will require rapid nursing actions, but they do not require action as urgently as the neurologic changes.

A patient with hypertension who was prescribed atenolol (Tenormin) 2 weeks ago returns to the health clinic for a follow-up visit. The blood pressure (BP) is unchanged from the previous visit. Which action would the nurse take first?

a. Tell the patient why a change in drug dosage is needed.

b. Ask the patient if the medication is being taken as prescribed.

c. Review with the patient any lifestyle changes made to help control BP.

d. Teach the patient that multiple drugs are often needed to treat

B. Ask the patient if the medication is being taken as prescribed.

Because nonadherence with antihypertensive therapy is common, the nurse's initial action would be to determine whether the patient is taking the atenolol as prescribed. The patient may not have been able to obtain the medication. The other actions also may be implemented, but these would be done after assessing patient adherence with the prescribed therapy.

The registered nurse (RN) is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside. Which nursing action can the nurse delegate to an experienced licensed practical/vocational nurse (LPN/VN)?

a. Evaluate effectiveness of nitroprusside therapy on blood pressure (BP).

b. Assess the patient's environment for adverse stimuli that might increase BP.

c. Titrate nitroprusside to decrease mean arterial pressure (MAP) to 115 mm Hg.

d. Set up the automatic noninvasive BP

D. Set up the automatic noninvasive BP

LPN/VN education and scope of practice include the correct use of common equipment such as automatic noninvasive blood pressure machines. Assessment, evaluation, and medication titration require advanced nursing judgment and education, and would be done by RNs.

The charge nurse observes a new registered nurse (RN) doing discharge teaching for a patient with hypertension who has a prescription for enalapril (Vasotec). Which statement by the new nurse to the patient requires the charge nurse's intervention?

a. "Make an appointment with the dietitian for teaching."

b. "Increase your dietary intake of high-potassium foods."

c. "Check your blood pressure at home at least once a day."

d. "Move slowly when moving from lying to sitting to stand

B. "Increase your dietary intake of high-potassium foods."

ACE inhibitors cause retention of potassium by the kidney, so hyperkalemia is a possible adverse effect. The other teaching by the new RN is appropriate for a patient with newly diagnosed hypertension who has just started therapy with enalapril.

A patient is receiving IV furosemide to treat stage 2 hypertension. Which assessment finding is most important to report to the health care provider?

a. Blood glucose level of 175 mg/dL

b. Serum potassium level of 3.0 mEq/L

c. Orthostatic systolic BP decrease of 12 mm Hg

d. Current blood pressure (BP) reading of 168/94 mm Hg

B. Serum potassium level of 3.0 mEq/L

Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening dysrhythmias. The health care provider would be notified of the potassium level immediately and administration of potassium supplements initiated. The elevated blood glucose and BP also need collaborative intervention but will not require action as urgently as the hypokalemia. An orthostatic drop of 12 mm Hg will require intervention only if the patient is symptomatic.

Which action would the nurse take first to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes?

a. Collect a detailed diet history.

b. Provide a list of low-sodium foods.

c. Help the patient make an appointment with a dietitian.

d. Teach the patient about foods that are high in potassium.

A. Collect a detailed diet history.

The initial nursing action would be assessment of the patient's baseline dietary intake through a thorough diet history. The other actions may be appropriate, but assessment of the patient's baseline would occur first.

The nurse is caring for a 70-yr-old patient who takes hydrochlorothiazide and enalapril (Norvasc). The patient's blood pressure (BP) continues to be high. Which patient information may indicate a need for a change?

a. Patient takes a daily multivitamin tablet.

b. Patient uses ibuprofen to treat osteoarthritis.

c. Patient checks BP daily just after getting up.

d. Patient drinks wine three to four times a week.

B. Patient uses ibuprofen to treat osteoarthritis.

Because use of nonsteroidal antiinflammatory drugs (NSAIDs) can prevent adequate BP control, the patient may need to avoid the use of ibuprofen. A multivitamin tablet will help supply vitamin D, which may help lower BP. BP decreases while sleeping, so self-monitoring early in the morning will result in obtaining pressures that are at their lowest. The patient's alcohol intake is not excessive.

The nurse measures a patient's blood pressure as 172/82 mm Hg. What is the patient's mean arterial pressure (MAP)? ___________

112 mm Hg

MAP=(SBP+2DBP)/3