27
Chapter 27: Hypertension
NCLEX-Style Flashcards — One Complete Set
Blood Pressure Physiology
Flashcard 1
Q: What formula determines blood pressure?
A: Blood pressure = Cardiac output × Peripheral resistance
Flashcard 2
Q: What is cardiac output?
A: The amount of blood pumped by the heart.
Flashcard 3
Q: What is peripheral resistance?
A: The resistance created by the blood vessels against blood flow.
Flashcard 4
Q: How does the sympathetic nervous system affect blood pressure?
A: It causes vasoconstriction, which increases peripheral resistance and raises blood pressure.
Flashcard 5
Q: How does the parasympathetic nervous system affect blood pressure?
A: It causes vasodilation, which lowers blood pressure.
Flashcard 6
Q: What do baroreceptors and chemoreceptors detect?
A: Changes in blood pressure, oxygen, carbon dioxide, and pH.
Flashcard 7
Q: What three systems regulate arterial pressure?
A:
Autonomic nervous system
Kidneys
Endocrine glands
Flashcard 8
Q: What does systolic blood pressure represent?
A: The pressure produced when the ventricles contract and eject blood.
Flashcard 9
Q: What does diastolic blood pressure represent?
A: Arterial pressure during ventricular relaxation.
Flashcard 10
Q: Why does systolic blood pressure commonly increase in older adults?
A: Loss of arterial elasticity increases resistance to blood flow.
Flashcard 11
Q: What happens to blood pressure when blood vessels narrow?
A: Peripheral resistance increases, causing blood pressure to rise.
Flashcard 12
Q: What is central aortic systolic pressure?
A: The pressure at the root of the aorta as blood is pumped from the left ventricle.
Flashcard 13
Q: How may central aortic systolic pressure compare with brachial systolic pressure?
A: It may be as much as 30 mm Hg lower than the brachial arm pressure.
RAAS and Hormonal Regulation
Flashcard 14
Q: When is renin released?
A: The kidneys release renin when renal perfusion or blood pressure decreases.
Flashcard 15
Q: What is the correct RAAS sequence?
A:
Renin → Angiotensin I → Angiotensin II → Aldosterone
Flashcard 16
Q: What does renin do to angiotensinogen?
A: Renin converts angiotensinogen into angiotensin I.
Flashcard 17
Q: Where is angiotensinogen produced?
A: The liver.
Flashcard 18
Q: What does angiotensin-converting enzyme do?
A: It converts angiotensin I into angiotensin II.
Flashcard 19
Q: Where is angiotensin-converting enzyme primarily found?
A: In the lungs.
Flashcard 20
Q: What are the major effects of angiotensin II?
A:
Powerful vasoconstriction
Increased peripheral resistance
Increased blood pressure
Stimulation of aldosterone release
Flashcard 21
Q: What does aldosterone cause?
A: Sodium and water retention, increasing blood volume and blood pressure.
Flashcard 22
Q: How do natriuretic peptides lower blood pressure?
A: They cause vasodilation and promote sodium and water excretion.
Flashcard 23
Q: What may happen when natriuretic factor is deficient?
A: Sodium and water retention increase, causing blood pressure to rise.
Flashcard 24
Q: How does hypernatremia contribute to hypertension?
A: Sodium retention increases blood volume, which raises blood pressure.
Flashcard 25
Q: How may low potassium contribute to hypertension?
A: The kidneys may retain sodium to maintain electrolyte balance, increasing blood volume and blood pressure.
Hypertension Types and Risk Factors
Flashcard 26
Q: What is essential hypertension?
A: Sustained high blood pressure with no identifiable cause.
Flashcard 27
Q: Approximately what percentage of hypertension cases are essential hypertension?
A: Approximately 95%.
Flashcard 28
Q: What is secondary hypertension?
A: High blood pressure caused by another disorder, medication, or substance.
Flashcard 29
Q: What conditions can cause secondary hypertension?
A:
Kidney disease
Pheochromocytoma
Hyperaldosteronism
Atherosclerosis
Cocaine or stimulant use
Oral contraceptives
Flashcard 30
Q: What is pheochromocytoma?
A: A benign tumor of the adrenal medulla that releases excessive catecholamines, causing vasoconstriction, increased heart rate, and hypertension.
Flashcard 31
Q: Which test may identify pheochromocytoma?
A: A 24-hour urine collection showing elevated catecholamines.
Flashcard 32
Q: What lifestyle factors increase hypertension risk?
A:
Obesity
Physical inactivity
Smoking
Excessive alcohol intake
Poor stress management
Flashcard 33
Q: Which groups have a high risk for hypertension?
A:
Older adults
African Americans
Clients with diabetes mellitus
Flashcard 34
Q: What is white coat hypertension?
A: Blood pressure that is elevated in a healthcare setting because of anxiety but normal outside the healthcare setting.
Flashcard 35
Q: What causes white coat hypertension?
A: Anxiety increases epinephrine and norepinephrine, causing vasoconstriction and elevated blood pressure.
Flashcard 36
Q: What is masked hypertension?
A: Blood pressure is normal in the healthcare setting but elevated at home or during ambulatory monitoring.
Flashcard 37
Q: Which is more easily missed: white coat or masked hypertension?
A: Masked hypertension, because office readings appear normal.
Flashcard 38
Q: Which monitoring methods help distinguish white coat and masked hypertension?
A:
Home blood pressure monitoring
Ambulatory blood pressure monitoring
Effects and Complications
Flashcard 39
Q: Why is hypertension called the “silent killer”?
A: Clients may have no symptoms for years until serious organ damage occurs.
Flashcard 40
Q: What are the four major target organs damaged by hypertension?
A: Think E-B-H-K:
Eyes
Brain
Heart
Kidneys
Flashcard 41
Q: How can hypertension lead to heart failure?
A:
High blood pressure → increased resistance → increased cardiac workload → left ventricular hypertrophy → heart failure.
Flashcard 42
Q: How can hypertension cause angina?
A: Cardiac hypertrophy increases oxygen demand, leading to myocardial ischemia and angina.
Flashcard 43
Q: What eye complications may result from hypertension?
A:
Retinal vascular damage
Retinal hemorrhage
Blurred vision
Papilledema
Blindness
Flashcard 44
Q: What brain complications may result from hypertension?
A:
Stroke
Intracranial hemorrhage
Cognitive decline
Flashcard 45
Q: What cardiac complications may result from hypertension?
A:
Angina
Myocardial infarction
Left ventricular hypertrophy
Heart failure
Pulmonary edema
Flashcard 46
Q: What renal complication may result from long-term hypertension?
A: Reduced renal blood flow can cause kidney disease and renal failure.
Assessment Findings
Flashcard 47
Q: What is the most obvious assessment finding in hypertension?
A: Sustained elevation of systolic, diastolic, or both blood pressure measurements.
Flashcard 48
Q: What symptoms may occur as blood pressure rises?
A:
Headache
Dizziness
Fatigue
Insomnia
Nervousness
Nosebleeds
Blurred vision
Flashcard 49
Q: What may angina or dyspnea indicate in a client with hypertension?
A: Development of hypertensive heart disease.
Flashcard 50
Q: What pulse characteristic may be present in hypertension?
A: A full, bounding pulse.
Flashcard 51
Q: What may peripheral edema indicate in a hypertensive client?
A: Fluid retention or cardiovascular dysfunction.
Flashcard 52
Q: What is papilledema?
A: Swelling of the optic disc associated with severe or malignant hypertension.
Diagnostic Tests
Flashcard 53
Q: What can an electrocardiogram detect in hypertension?
A:
Cardiac enlargement
Cardiac strain
Dysrhythmias
Flashcard 54
Q: What does echocardiography evaluate in a hypertensive client?
A:
Left ventricular hypertrophy
Heart enlargement
Heart function
Flashcard 55
Q: What may a chest radiograph show in long-standing hypertension?
A: An enlarged left ventricle.
Flashcard 56
Q: What does a MUGA scan evaluate?
A: How efficiently the heart pumps and whether hypertension has caused heart failure.
Flashcard 57
Q: Which laboratory values may indicate kidney damage from hypertension?
A:
Elevated blood urea nitrogen
Elevated serum creatinine
Flashcard 58
Q: What may fluorescein angiography reveal?
A: Leaking retinal blood vessels caused by hypertensive damage.
Flashcard 59
Q: What may renal arteriography identify?
A: Narrowing of a renal artery.
Flashcard 60
Q: Why are lipid studies obtained in hypertension?
A: Elevated cholesterol and triglycerides may indicate atherosclerosis.
Blood Pressure Measurement
Flashcard 61
Q: What should the client do before blood pressure measurement?
A: Sit quietly for at least 5 minutes.
Flashcard 62
Q: What substances should be avoided for 30 minutes before measuring blood pressure?
A:
Cigarettes or nicotine
Coffee or caffeine
Flashcard 63
Q: How should blood pressure initially be measured?
A: Measure it in both arms and assess the client supine, sitting, and standing.
Flashcard 64
Q: What should the nurse do after identifying the arm used for follow-up readings?
A: Use the same arm and the same position for future measurements.
Flashcard 65
Q: What effect does a blood pressure cuff that is too small have?
A: It produces a falsely elevated reading.
Flashcard 66
Q: What effect does a cuff that is too large have?
A: It may produce a falsely low reading.
Flashcard 67
Q: What factors can falsely elevate a blood pressure reading?
A:
Anxiety
Caffeine
Smoking
Talking
Failure to rest
Improper cuff size
Arm not at heart level
Lifestyle and Nutrition
Flashcard 68
Q: What is the primary goal of hypertension treatment?
A: Lower blood pressure and prevent stroke, myocardial infarction, heart failure, and kidney failure.
Flashcard 69
Q: What does DASH stand for?
A: Dietary Approaches to Stop Hypertension.
Flashcard 70
Q: Which foods are emphasized in the DASH diet?
A:
Fruits
Vegetables
Whole grains
Poultry
Fish
Nuts
Low-fat dairy products
Flashcard 71
Q: Which foods are limited in the DASH diet?
A:
Red meat
Fat
Sweets
Sugar-containing beverages
Flashcard 72
Q: What nutrients are high in the DASH diet?
A:
Potassium
Magnesium
Calcium
Fiber
Protein
Flashcard 73
Q: What is the general daily sodium limit?
A: Less than 2,300 mg per day.
Flashcard 74
Q: What is the daily sodium limit for high-risk clients?
A: Less than 1,500 mg per day.
Flashcard 75
Q: Which clients are considered high risk for stricter sodium restriction?
A:
Age 51 or older
African American
Hypertension
Diabetes
Chronic kidney disease
Flashcard 76
Q: Approximately how much sodium is contained in one teaspoon of table salt?
A: Approximately 2,300 mg.
Flashcard 77
Q: What foods should a client with hypertension limit?
A:
Processed meats
Canned soups
Packaged mixes
Pickles
Olives
Sauerkraut
Sauces
Salted snacks
Flashcard 78
Q: How should canned vegetables be prepared to reduce sodium?
A: Drain and rinse them before eating.
Flashcard 79
Q: How much weight loss may significantly improve blood pressure?
A: Approximately 10% of body weight.
Flashcard 80
Q: What is the ideal body mass index mentioned for hypertension prevention?
A: Less than 25 kg/m².
Medication Flashcards
Flashcard 81
Q: How do diuretics lower blood pressure?
A: They promote sodium and water excretion, reducing blood volume and cardiac workload.
Flashcard 82
Q: What should the nurse monitor in a client taking a loop or thiazide diuretic?
A:
Potassium level
Hydration status
Intake and output
Daily weight
Orthostatic hypotension
Flashcard 83
Q: What are common adverse effects of diuretics?
A:
Dehydration
Hypokalemia
Polyuria
Nocturia
Dizziness
Orthostatic hypotension
Flashcard 84
Q: What drugs are examples of diuretics?
A:
Furosemide
Chlorothiazide
Flashcard 85
Q: How do ACE inhibitors lower blood pressure?
A: They block conversion of angiotensin I into angiotensin II, decreasing vasoconstriction and aldosterone release.
Flashcard 86
Q: What are the major adverse effects of ACE inhibitors?
A:
Persistent dry cough
Hyperkalemia
First-dose hypotension
Dizziness
Renal impairment
Flashcard 87
Q: What is the major black-box warning for ACE inhibitors?
A: They are contraindicated during pregnancy because they can cause fetal injury or death.
Flashcard 88
Q: What ending helps identify ACE inhibitors?
A: “-pril”
Examples: lisinopril, captopril and enalapril.
Flashcard 89
Q: A client taking lisinopril develops a persistent dry cough. What should the nurse recognize?
A: The cough is a common ACE inhibitor adverse effect and should be reported to the provider.
Flashcard 90
Q: How do angiotensin receptor blockers differ from ACE inhibitors?
A: ARBs block angiotensin II receptors and usually do not cause the dry cough associated with ACE inhibitors.
Flashcard 91
Q: What ending identifies most angiotensin receptor blockers?
A: “-sartan”
Examples: losartan and valsartan.
Flashcard 92
Q: What pregnancy teaching applies to ARBs?
A: Women who may become pregnant should use effective contraception.
Flashcard 93
Q: How do calcium channel blockers lower blood pressure?
A: They block calcium movement into cardiac and vascular smooth muscle, causing vasodilation.
Flashcard 94
Q: What should the nurse monitor when administering a calcium channel blocker?
A:
Blood pressure
Heart rate
Bradycardia
Hypotension
ECG with intravenous administration
Flashcard 95
Q: What food interaction applies to calcium channel blockers?
A: Avoid grapefruit juice and grapefruit products because they may increase medication levels and toxicity.
Flashcard 96
Q: What ending identifies many calcium channel blockers?
A: “-dipine”
Examples: amlodipine and nifedipine.
Flashcard 97
Q: How do beta blockers lower blood pressure?
A: They decrease heart rate, cardiac contractility, and myocardial oxygen demand.
Flashcard 98
Q: What assessment is required before administering a beta blocker?
A: Check the apical pulse and blood pressure.
Flashcard 99
Q: When is a beta blocker commonly held?
A: When the heart rate is below the provider’s parameter, commonly below 60 beats/minute.
Flashcard 100
Q: Why must beta blockers not be stopped abruptly?
A: Sudden withdrawal can cause rebound hypertension, angina, or myocardial infarction.
Flashcard 101
Q: What important effect can beta blockers have in diabetic clients?
A: They may mask symptoms of hypoglycemia.
Flashcard 102
Q: Why are beta blockers used cautiously in asthma or COPD?
A: They may affect beta receptors involved in airway function.
Flashcard 103
Q: What ending identifies most beta blockers?
A: “-lol”
Examples: metoprolol, atenolol and propranolol.
Flashcard 104
Q: What is the major safety concern with alpha blockers such as prazosin?
A: First-dose syncope and severe orthostatic hypotension.
Flashcard 105
Q: What teaching is important for a client taking prazosin?
A: Change positions slowly and use fall precautions.
Flashcard 106
Q: What are common adverse effects of clonidine?
A:
Dry mouth
Sedation
Dizziness
Headache
Flashcard 107
Q: Why should clonidine not be stopped abruptly?
A: Abrupt discontinuation can cause rebound hypertension.
Flashcard 108
Q: Which alpha/beta blocker is commonly used in hypertensive emergencies?
A: Labetalol.
Flashcard 109
Q: What should be monitored before giving carvedilol or labetalol?
A: Blood pressure and pulse.
Flashcard 110
Q: What is the main adverse effect of eplerenone?
A: Hyperkalemia.
Flashcard 111
Q: What should the nurse monitor in a client taking eplerenone?
A:
Serum potassium
Renal function
ECG changes associated with hyperkalemia
Flashcard 112
Q: What is aliskiren?
A: A direct renin inhibitor that acts early in the RAAS pathway.
Compelling Indications
Flashcard 113
Q: Which antihypertensive classes are preferred for heart failure?
A:
Diuretic
Beta blocker
ACE inhibitor
ARB
Aldosterone antagonist
Flashcard 114
Q: Which antihypertensive classes are recommended after myocardial infarction?
A:
Beta blocker
ACE inhibitor
Aldosterone antagonist
Flashcard 115
Q: Which antihypertensive medications are commonly preferred for diabetes?
A: ACE inhibitors or ARBs because they help protect the kidneys.
Flashcard 116
Q: Which antihypertensive classes may slow chronic kidney disease progression?
A: ACE inhibitors and ARBs.
Nursing Process and Safety
Flashcard 117
Q: What is a priority nursing diagnosis for hypertension with prolonged vascular resistance?
A: Risk for Decreased Cardiac Output.
Flashcard 118
Q: What assessment findings indicate adequate cardiac output?
A:
Blood pressure at goal
Heart rate 60–100 beats/minute
Clear lung sounds
Effortless breathing
Alert mental status
Adequate urine output
Flashcard 119
Q: Why should a client with hypertension avoid the Valsalva maneuver?
A: Bearing down against a closed glottis temporarily increases blood pressure.
Flashcard 120
Q: What activities may involve the Valsalva maneuver?
A:
Straining during bowel movements
Heavy lifting while holding the breath
Flashcard 121
Q: Why should nicotine be avoided?
A: Nicotine raises heart rate and causes vasoconstriction.
Flashcard 122
Q: What is the major injury risk associated with antihypertensive medications?
A: Falls caused by dizziness, syncope, and orthostatic hypotension.
Flashcard 123
Q: How should the nurse assess for orthostatic hypotension?
A: Measure blood pressure while the client is lying, sitting, and standing.
Flashcard 124
Q: What safety teaching should be provided for orthostatic hypotension?
A:
Rise slowly
Sit at the side of the bed before standing
Use support when standing
Sit or lie down immediately if dizziness occurs
Call for assistance before getting up
Flashcard 125
Q: What should the client understand about antihypertensive medication adherence?
A: Medication must be taken even when the client feels well because hypertension is often asymptomatic.
Flashcard 126
Q: What should clients record when monitoring blood pressure at home?
A: Keep a log of readings and bring it to follow-up appointments.
Flashcard 127
Q: What should clients do before using over-the-counter medications or herbal products?
A: Obtain approval from the healthcare provider.
Accelerated and Malignant Hypertension
Flashcard 128
Q: What finding is associated with accelerated hypertension?
A: Markedly elevated blood pressure with retinal hemorrhages and retinal exudates.
Flashcard 129
Q: What is the classic finding of malignant hypertension?
A: Papilledema.
Flashcard 130
Q: Why is malignant hypertension a medical emergency?
A: Blood pressure rises rapidly and causes acute target-organ damage.
Flashcard 131
Q: Which clients are most likely to develop accelerated or malignant hypertension?
A: Clients who:
Have undiagnosed hypertension
Do not maintain follow-up care
Do not follow the treatment regimen
Flashcard 132
Q: What neurologic findings indicate a hypertensive emergency?
A:
Confusion
Severe headache
Visual disturbances
Seizures
Coma
Flashcard 133
Q: What cardiopulmonary findings may occur during malignant hypertension?
A:
Chest pain
Dyspnea
Moist lung sounds
Heart failure
Pulmonary edema
Flashcard 134
Q: What urine output suggests renal failure during a hypertensive emergency?
A: Less than 30 mL/hour.
Flashcard 135
Q: What does sudden severe back pain with hypotension suggest?
A: A dissecting or ruptured aortic aneurysm.
Flashcard 136
Q: What retinal findings are associated with malignant hypertension?
A:
Flame-shaped hemorrhages
Fluffy white exudates
Papilledema
Flashcard 137
Q: What is the treatment goal during a true hypertensive emergency?
A: Lower blood pressure safely within 1–2 hours.
Flashcard 138
Q: Which intravenous medications may be used during a hypertensive emergency?
A:
Diazoxide
Nitroprusside
Nitroglycerin
Labetalol
Flashcard 139
Q: What is the nurse’s priority when administering IV antihypertensive medication?
A: Use an infusion pump, titrate according to orders and client response, and monitor blood pressure continuously or every few minutes.
Flashcard 140
Q: What equipment should remain available for a client with malignant hypertension?
A: Emergency equipment because the client may deteriorate rapidly.
NCLEX-Style Application Cards
Flashcard 141
Q: The nurse obtains a blood pressure of 168/96 mm Hg using a regular adult cuff on an obese client. What should the nurse do first?
A: Repeat the blood pressure using an appropriately sized larger cuff.
Flashcard 142
Q: A client says, “I stopped taking my blood pressure medication because I feel fine.” What is the best response?
A: “Hypertension often causes no symptoms, but it can still damage your heart, brain, eyes, and kidneys.”
Flashcard 143
Q: A client taking lisinopril reports a persistent dry cough. What should the nurse do?
A: Recognize it as a common ACE inhibitor effect and notify the provider.
Flashcard 144
Q: A client taking metoprolol has a heart rate of 54 beats/minute. What should the nurse do first?
A: Hold the medication according to parameters and notify the provider.
Flashcard 145
Q: A client taking antihypertensive medication becomes dizzy when standing. What is the priority nursing action?
A: Assist the client to sit or lie down immediately to prevent a fall.
Flashcard 146
Q: Which statement by a client taking a beta blocker requires correction?
A: “I can stop taking it as soon as my blood pressure becomes normal.”
Beta blockers should not be discontinued abruptly.
Flashcard 147
Q: Which food should a client taking a calcium channel blocker avoid?
A: Grapefruit and grapefruit juice.
Flashcard 148
Q: Which laboratory value is most important for a client taking eplerenone?
A: Serum potassium.
Flashcard 149
Q: A client has severe hypertension, confusion, visual changes, and papilledema. What condition should the nurse suspect?
A: Malignant hypertension.
Flashcard 150
Q: A client in a hypertensive emergency develops urine output of 20 mL/hour. What does this suggest?
A: Decreased renal perfusion and possible acute renal failure.
Flashcard 151
Q: Which client should receive immediate hypertension education?
A: An older African American adult because both age and ethnicity increase hypertension risk.
Flashcard 152
Q: Which meal selection best supports hypertension management?
A: Fresh poultry or fish with fresh vegetables and whole grains, prepared without added salt.
Flashcard 153
Q: Which client statement demonstrates correct understanding of home blood pressure monitoring?
A: “I will keep a written record and bring it to my follow-up appointments.”
Flashcard 154
Q: A client’s blood pressure is elevated in the clinic but normal at home and during ambulatory monitoring. What is the likely diagnosis?
A: White coat hypertension.
Flashcard 155
Q: A client’s clinic blood pressure is normal, but home and ambulatory readings are elevated. What is the likely diagnosis?
A: Masked hypertension.
Flashcard 156
Q: Which assessment finding requires the most immediate intervention?
A: Severe hypertension with confusion, seizure activity, chest pain, papilledema, or decreased urine output.
Final Must-Memorize Points
BP = Cardiac output × Peripheral resistance
Essential hypertension = 95% of cases; no known cause
Secondary hypertension = caused by another condition
Hypertension is the “silent killer”
Major target organs: Eyes, Brain, Heart, Kidneys
RAAS raises blood pressure
Natriuretic factor lowers blood pressure
Too-small cuff = falsely high reading
ACE inhibitors end in “-pril” and can cause cough and hyperkalemia
ARBs end in “-sartan”
Beta blockers often end in “-lol”; check the pulse
Do not abruptly stop beta blockers or clonidine
Calcium channel blockers: avoid grapefruit
Diuretics: monitor potassium, hydration and orthostatic hypotension
Accelerated hypertension = retinal hemorrhages and exudates
Malignant hypertension = papilledema
Urine output below 30 mL/hour suggests renal impairment
Hypertensive emergency requires rapid IV treatment and frequent BP monitoring