NURS Clinical Science Exam Prep - Hypertension

What is systolic pressure?

ventricles contract and pump blood into arterial circulation

What is diastolic pressure?

heart is filling

What is the total peripheral resistance (TPR)?

the value you hear/obtained in the peripheral vascular beds

What is the desired BP for people over 60?

below 150/90

What is the desired BP for people younger than 60?

below 140/90

What control systems play a major role in maintaining blood pressure?

the arterial baroreceptor system, regulation of body fluid volume, the renin-angiotensin-aldosterone system, vascular autoregulation

What is the most common type of hypertension?

primary hypertension

What does primary hypertension result in?

damage to vital organs

What does primary hypertension cause?

medial hyperplase (thickening) of arterioles

What are common risk factors of primary hypertension?

obesity, smoking, stress, family history

What is secondary hypertension?

caused by specific disease states or drugs

What specific disease states or drug cause secodary hypertension?

Cushing’s syndrome, hyperthyroidism, chronic renal disease, certain drugs

What is a hypertensive crisis?

medical emergency; elevated BP that can progress rapidly with readings of 180/120 mm Hg or greater

What are symptoms of a hypertensive crisis?

morning headaches, blurred vision, dyspnea, uremia

What is the etiology and genetic risk of primary hypertension?

race, hyperlipidemia, smoking, older than 60 years old, obesity; physical inactivity

What is the etiology and genetic risk of secondary hypertension?

kidney disease

What is the incidence and prevalence of hypertension?

worldwide epidemic; 121.5 million adults older than 20 years old have hypertension

What are target organs affected by untreated hypertension?

heart, brain, kidneys, retina, blood vessels

What is health promotion and maintenace of hypertension?

weight reduction, DASH diet, reduce intake of dietary sodium, increase physical activity, limit/stop alcohol intake, reduce saturated fat and cholesterol, discontinue tobacco use, reduce stress

What are labs taken for hypertension?

urinarylis for protein, RBC, BUN, creatinine

What are diagnositc assessments for hypertension?

chest x-ray (cardiomegaly), ECG shows degree of cardiac involvement

What is the pharmacologic management of hypertension for those with comorbid conditions (ex., diabetes, cardiovascular disease, or CKD)?

antihypertensive medication at the elevated stage

What is the pharmacologic management for those with elevate blood pressure?

nonpharmacologic therapy

What is the pharmacologic therapy for those with stage 1 hypertension?

combination of nonpharmacologic therapy and an antihypertensive medication

What is the pharmacological therapy for those with stage 2 hypertension?

nonpharmacologic therapy and two antihypertensive medications

What is the result of prescribing two antihypertensives from different drug classes?

additive or synergistic blood pressure reduction (common practice in managing HTN)

What is the reason for prescirbing two anthypertensives from different drug classes?

patient has not responded to the initial medication, has a compelling condition, or has very high, sustained blood pressure

What is normal blood pressure?

< 120/80 mmHg

What is elevated blood pressure?

120-129/ <80 mmHg

What is prehypertension?

120-139/80-89 mmHg

What is hypternsion stage 1?

130-139/80-89 mmHg

What is hypertension stage 2?

>140 mmHg/>90 mmHg

What are the benefits of once-a-day drug therapy

increased the likelihood that the treatment regimen will be followed, especially for older adults

What are the first-line antihypertensive drugs?

diuretics (thiazide, thiazide-like, potassium-sparing diuretics), angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs)

What is a kind of potassium-sparing diuretic?

spironolactone

What is a loop-diuretic?

furosemide; bumetanide

What is a thiazide diuretic?

hydrochlorothiazide, cholorthiazide

What are diuretics?

increased urinary excretion of water and electrolytes, therby reducing blood volume

When should diuretics be taken?

morning (prevents nocturia)

What is used for mild to moderate hypertension?

diuretics

What are thiazide (low-ceiling) diuretics?

hydrochlorothiazide

What is hydrochlorothiazide?

inhibit sodium, chloride, and water reabsorption in the distal tubule

What does hydrochlorothiazide promote excretion of?

potassium, bicarbonate, magnesium

What does hydrochlorthiazide decrease?

calcium excretion, helps prevent kidney stones and bone loss

What are the benefits of thiazides?

low cost and highly effective; can be prescribed alone or with other classes of drugs

What is the interaction of NSAIDs with thiazide diuretics?

counteract the antihyeprtensive efficacy of the medication

What is the interaction of lithium with thiazide diuretics?

hyponatremia and accumulate into toxicity

What is the memory device for thiazides?

“flush the salt and water away” but can also “flush the potassium away”

What are loop (high-ceiling) diuretics?

inhibit sodium, chloride, and water reabsorption in the ascending loop of hele

What do loop diuretics promote?

potassium excretion

What are kinds of loop diuretics?

furosemide/lasix, torsemide

What has greater diuresis than thiazides?

loop diuretics

What diuretic is not routinley used for HTN?

loop diuretics

What is the memory device for loop diuretics?

“loop the henle, flush the fluid, lose potassium, don’t forget it”

What is patient teaching for client’s on loop and thiazide agents?

eat foods high in K+ and to undergo follow-up lab tests to monitor electrolytes levels (these agents cause K+ and Mg2+ excretion)

What must be used cautiously in patients with diabetes?

loop and thiazide agents

What must be used cautiously in patients with gout?

loop and thiazide agents (hyperuricemia can occur)

What is spironolactone?

potassium-sparing diuretic

What are the effects of spironolactone?

has a limited effect on BP

What does sprionolactone conserve?

potassium; commonly prescribe with loop or thiazide diuretics to offset potassium loss

What is an associated risk with spironolactone?

hyperkalemia

What is a memory device for spironolactone?

“potassium-sparing protects potassium”

What is the most frequent side effect of thiazide and loop diuretics?

hypokalemia

What must be monitored when administering diuretics?

serum potassium levels

What must be assessed for diuretics?

irregular pulse, dysrhythmias, muscle weakness, orthostatic HTN, I & O/daily weights

What are side effects of diuretics?

hypovolemia and dehydration; assess for weakness, dizziness, or onset of confusion

How can diuretics affect BP?

orthostatic hypotension associated with diuresis (teach older adults to rise slowly)

What are potassium-high foods?

bananas, potatoes, orange juice, potassium suppement

What are potassium-sparing diurectis?

increase diuresis (urination) without the loss of potassium

What is education for potassium-sparing diuretics?

decrease intake of foods that are high in potassium and to undergo follow-up laboratory tests for electrolyte levels (these agents cause retention of K+ in the body)

What can indicate hyperkalemia?

report of weakness and irregular pulse

What are potassium-sparing diuretics commonly prescribed with?

loop or thiazide diuretics; offset potassium loss

What is an associated risk with potassium-sparing diuretics?

hyperkalemia

What should not be used routinely with spironolacton/aldactone?

ACE, angiotensin 2 receptors

What is given in addition to thiazide diuretics?

spironlactone

When should hyperkalemia be assessed?

taking potassium-sparing diuretics such as spironolactone

What can an increased potassium level cause?

weakness, irregular pulse, cardiac dysrhythmias

What are common examples of beta blockers?

atenolol, metoprolol

What are common examples of calcium channel blockers?

verapamil, amlodipine, diltiazem

What must be assessed when taking beta blockers?

heart rate and blood pressure before administation

When should beta blockers not be administered?

HR is <50-60 beats/min

What should be monitored when taking beta blockers?

orthostatic hypotension

When should beta blockers be used with caution?

patients with diabetes; glucose production may be affected

What are adverse effects of beta blockers?

fatigue, depression, and sexual dysfunction

What is the effect of beta blockers?

decrease heart rate and contractility; inhibit the secretion of renin, reduce cardiac output and lower systemic BP

What medication should never abruptly be stopped due to increased BP?

beta blockers

What are calcium channel blockers?

treat hypertension and ohter cardiovascular diseases

What is the result of calcium channel blockers?

vasodilation, decrease BP

What are adverse effects of calcium channel blockers?

dizziness, headache, flushing

What should be monitored when taking calcium channel blockers?

pulse and BP; slows SA and AV conduction, decreases HR and vasodilation and causes decreased BP

What should be avoided when taking calcium channel blockers?

grapefruit juice and grapefruit

What are types of ACE inhibitors?

lisonpril, enalapril, captopril

What are nursig implication for ace inhibitors?

report persistent, dry cough

What must be monitored when taking ACE inhibitors?

BP; especially orthostatic pressures, these agents result in vasodilation and decreased BP

What must be checked before administering ACE inhibitors?

systolic BP is below 100

What does ACE inhibitors reduce?

excretion of potassium

A 58-year-old client is seeing the primary health care provider for an annual examination. His family history includes hypertension and type 2 diabetes. He is 30 pounds overweight and reports smoking a pack of cigarretes daily. He works as a car salesman in a very competitive mark. What risk factors for hypertension does the nurse identify for this client?

age, family hisotry, smoking, being overweight, job-related stress

The nurse obtains these vital signs:

• BP - 142/90 mm Hg

• HR - 80/min

• R - 18/min

• T - 97.8 F

Based on these readings, does the client have hypertension?

May have hypertension. However, blood pressure should be checked in both arms and two or more readings should be taken at each visit

The client is diagnosed with hypertension. He asks what he can do to improve his health. Which teaching points will the nurse include when providing information about reducing the impact, and successfully managing, hypertension?

lifestyle changes, exercising, weight loss, alternative therapies. Teach the patient to monitor his BP on a daily basis, smoking and caffeine intake should be avoided

At the end of the visit, the primary health care provider prescribes hydrochlorothiazide 25 mg PO each morning. Which teaching will the nurse provide?

Eat foods rich in potassium, such as bananas and orange juice