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A nurse is caring for a client with hypertension. The physician orders furosemide (lasix) 2 mg/kg to be given intravenously. The client weighs 24 kg. The medication comes in a single-use vial that contains 40 mg in 4 mL (10 mg/mL). How much will the nurse draw up for this client’s dose? a) 4.8 mL |
4.8 mL The formula is as follows: 24Kg X 2 mg = 48 mg total dose 48 mg / 10mg/mL = 4.8 mL amount to be drawn up |
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A client, newly prescribed a low-sodium diet due to hypertension, is asking for help with meal choices. The client provides four meal choices, which are favorites. Which selection would be best? a) Hot dog with ketchup and relish on whole wheat bun |
Green pepper stuffed with diced tomatoes and chicken Fresh vegetables are low in sodium with diced tomatoes (fresh) and chicken is a good low-sodium, high vegetable and protein selection. Cheese and soup (tomato and creamed) are high in sodium. Processed meats such as a hot dog and condiments such as ketchup are high in sodium |
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A client diagnosed with hypertension begins drug therapy using an antihypertensive agent. The nurse instructs the client’s spouse to remove any objects in the home that can lead to falls. The nurse knows that the teaching has been successful when the client restates which of the following? a) "Insomnia is a common side effect of antihypertensive medications." |
"Antihypertensive drugs can lead to falls." One of the side effects of all antihypertensive drugs is hypotension, which can lead to falls. A major concern regarding side effects of all antihypertensive drugs is hypotension, which can lead to falls |
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A client experiences orthostatic hypotension while receiving frusemide (Lasix) to treat hypertension. How should the nurse intervene? a) Administer I.V. fluids as ordered. |
Instruct the client to sit for several minutes before standing. To minimize the effects of orthostatic hypotension, the nurse should instruct the client to rise slowly, such as by sitting for several minutes before standing. Administering I.V. fluids would be inappropriate (unless the client were dehydrated) because doing so would counteract the effects of furosemide and could cause fluid imbalance. Administering a vasodilator would further reduce the client’s blood pressure, worsening orthostatic hypotension. Inserting an indwelling urinary catheter would make it easier to monitor urine output but wouldn’t minimize the effects of orthostatic hypotension. |
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A 77-year-old client has newly diagnosed stage 2 hypertension. The physician has prescribed a thiazide and an angio-converting enzyme inhibitor. About what is the nurse most concerned? a) Postural hypertension and resulting injury |
Postural hypotension and resulting injury Antihypertensive medication can cause hypotension, especially postural hypotension that may result in injury. Rebound hypertension occurs when antihypertensive medication is stopped abruptly. Sexual dysfunction may occur, especially with beta blockers, but other medications are available should this problem ensue. This is not immediately a priority concern. Antihypertensive medications do not usually cause postural hypertension. |
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Hypertension that can be attributed to an underlying cause is termed which of the following? a) Isolated systolic |
Secondary Secondary hypertension may be caused by a tumor of the adrenal gland (eg, pheochromocytoma). Primary hypertension has no known underlying cause. 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). |
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Which of the following diagnostic tests may reveal an enlarged left ventricle? a) Echocardiography |
Echocardiography Echocardiography reveals an enlarged left ventricle. Fluorescein angiography reveals leaking retinal blood vessels, and a PET scan is used to reveal abnormalities in blood pressure. A CT scan reveals structural abnormalities |
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The nurse is caring for an 82-year-old male 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 blood volume |
Loss of arterial elasticity 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. |
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Which of the following is the nurse most correct to recognize as a direct effect of client hypertension? a) Renal dysfunction resulting from atherosclerosis |
Renal dysfunction resulting from atherosclerosis The nurse is most correct to realize high blood pressure damages the arterial vascular system and accelerates atherosclerosis. The effect of the atherosclerosis impairs circulation to the kidney, resulting in renal failure. Neither anemia, hyperglycemia, nor emphysema occurs as a direct effect of hypertension |
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A recommended follow-up for a person initially diagnosed with prehypertension is for a blood pressure (BP) recheck within which timeframe? a) 2 year |
1 year A patient with an initial BP in the prehypertension range should have her BP rechecked in 1 year. A normal BP should be rechecked in 2 years. Grade 1 hypertension should be confirmed and followed-up within 2 months. Grade 2 hypertension should be evaluated or referred to a source of care within 1 month. |
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A blood pressure of 140/90 mm Hg is considered to be a) prehypertension. |
hypertension. A BP of 140/90 mm Hg or higher is hypertension. A blood pressure of less than 120/80 mm Hg is considered normal. A BP of 120 to 129/80 to 89 mm Hg is prehypertension. Hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage. |
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When treating hypertensive emergencies, the nurse identifies the most appropriate route of administration for antihypertensive agents as being which of the following? a) Continuous IV infusion |
Continuous IV infusion The medications of choice in hypertensive emergencies are best managed through the continuous IV infusion of a short-acting titratable antihypertensive agent. The nurse avoids the sublingual and IM routes as their absorption and dynamics are unpredictable. The oral route would not have as quick an onset as a continuous IV infusion. |
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A nurse is discussing with a nursing student how to accurately measure blood pressure. Which of the following points does the nurse emphasize? a) The size of the cuff does not matter as long as it fits snugly around the arm. |
A cuff that is too small will give a false high blood pressure. Using a cuff that is too small will give a false high blood pressure measurement, while using a cuff that is too large results in a false low blood pressure measurement. |
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It is appropriate for the nurse to recommend smoking cessation for patients with hypertension because nicotine a) decreases the heart rate, constricts arterioles, and reduces the heart’s ability to eject blood. |
increases the heart rate, constricts arterioles, and reduces the heart’s ability to eject blood. The nurse recommends smoking cessation for patients with hypertension because nicotine raises the heart rate, constricts arterioles, and reduces the heart’s ability to eject blood. Reduced oral fluids decrease the circulating blood volume. |
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An 87-year-old client was just recently diagnosed with prehypertension. She is to meet with a dietitian and return for a follow-up with her cardiologist in 6 months. As her nurse, what would you expect her treatment to include? a) Procedural interventions |
Nonpharmacological interventions Nonpharmacologic interventions are used for clients with prehypertension. |
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A nurse is teaching about lifestyle modifications to a group of clients with known hypertension. Which of the following statements would the nurse include in the education session? a) Engage in aerobic activity at least 30 minutes/day most days of the week. |
Engage in aerobic activity at least 30 minutes/day most days of the week. Recommmended lifestye modifications to prevent and manage hypertension include maintaining a normal body mass index (about 24; greater than 25 is considered overweight), maintaining a waist circumference of less than 40 inches for men and 35 inches for women, limiting alcohol intake to no more than 2 drinks for men and 1 drink for women per day, and engaging in aerobic activity at least 30 minutes per day most days of the week. |
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You are part of a group of nursing students who are making a presentation on chronic hypertension. What is one subject you would need to include in your presentation as a possible consequence of untreated chronic hypertension? a) Pulmonary insufficiency |
Stroke A stroke occurs if vessels in the brain rupture and bleed. If an aneurysm has developed in the aorta from chronic hypertension, it may burst and cause hemorrhage and shock. Options A, B, and D are not usually consequences of untreated chronic hypertension |
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A nurse providing education to a community group about hypertension is reviewing appropriate lifestyle modifications. Which of the following are among changes that can help prevent and control hypertension? Choose all that apply. a) Weight reduction |
• Weight reduction • Increased physical activity • Substitution of low-fat for whole dairy products in diet Lifestyle modifications to prevent and manage hypertension include weight reduction, adopting the Dietary Approaches to Stop Hypertension (DASH) diet, dietary sodium reduction, physical activity, and moderation of alcohol consumption. |
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The nurse is caring for an elderly client with a diagnosis of hypertension, who is taking several antihypertensive medications. Which saftey precaution is the nurse most likely to reinforce? a) Eating extra potassium due to loss of potassium related to medications |
Changing positions slowly related to possible hypotension The elderly have impaired cardiovascular reflexes and thus are more sensitive to the extracellular volume depletion caused by diuretics and to the sympathetic inhibition caused by adrenergic antagonists. The nurse teaches clients to change positions slowly when moving from a lying or sitting position to a standing position. This will help prevent falls. Eating extra potassium is not a good idea if taking a potassium-sparing diuretic. The other choices are good teaching points, but not necessarily safety precautions. |
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A nurse working in the clinic is seeing a client who has just been prescribed a new medication for hypertension. The client asks why hypertension is sometimes called the "silent killer." The nurse’s correct response is which of the following? a) "Hypertension often causes no pain." |
"Hypertension often causes no symptoms." Hypertension is sometimes called the "silent killer" because people with it are often symptom free. Physical examination may reveal no abnormalities other than elevated blood pressure. People with hypertension may remain asymptomatic for many years. The usual consequences of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, renal failure, strokes, and impaired vision. Pain is not usually an issue, but that is not why hypertension is called the "silent killer." Hypertension is easily diagnosed by taking a series of blood pressure readings. |
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You are doing the final checklist before sending home a 63-year-old female who has been newly diagnosed with hypertension. She is going to be starting her first antihypertensive medicine. What is one of the main things you should tell her and her husband to watch for? a) Tremor |
Dizziness A common adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. Therefore, you should both alert the patient and her husband to this possibility and provide them with some tips for managing dizziness. |
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The nurse is administering medications on a medical surgical unit. A patient is ordered to receive 40 mg of oral Corgard (nadolol) for the treatment of hypertension. Prior to administering the medication, the nurse should complete which of the following? a) Checking the patient’s urine output |
Checking the patient’s heart rate Corgard is a beta-blocker. A desired effect of this medication is to reduce the pulse rate in patients with tachycardia and an elevated blood pressure (BP). The nurse should check the patient’s heart rate (HR) prior to administering Corgard to ensure that the patient’s pulse rate is not below 60 (beats per minute (bpm). The other interventions are not indicated prior to administering a beta-blocker medication. |
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A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. Which of the following are risk factors for cardiovascular problems in clients with hypertension? Choose all that apply. a) Gallbladder disease |
• Physical inactivity • Smoking • Diabetes mellitus Risk factors for cardiovascular problems in clients with hypertension include smoking, dyslipidemia, diabetes mellitus, impaired renal function, obesity, physical inactivity, age, and family history. |
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A nurse is educating about lifestyle modifications for a group of clients with newly diagnosed hypertension. While discussing dietary changes, which of the following points would the nurse emphasize? a) It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. |
It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. It takes 2 to 3 months for the taste buds to adapt to changes in salt intake. Knowing this may help the client adjust to reduced salt intake. The client should be advised to limit alcohol intake |
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The nurse understands that patient education related to antihypertensive medication should include all of the following instructions except which of the following? a) Avoid over the counter (OTC) cold, weight reduction, and sinus medications. |
If a dosage of medication is missed, double up on the next one to catch up. Doubling doses could cause serious hypotension (HTN) and is not recommended. Medications should be taken as prescribed. Hot baths, strenuous exercise, and excessive alcohol are all vasodilators and should be avoided. Many OTC preparations can precipitate HTN. Stopping antihypertensives abruptly can precipitate a severe hypertensive reaction and is not recommended. |
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The nurse is administering the morning mediations to a patient on the cardiac telemetry unit. Atenolol has been prescribed for this patient. Prior to administration, the nurse would tell the patient that the medication is which type of antihypertensive? a) Vasodilator |
Beta blocker Atenolol is classified as a beta blocker. Beta blockers block beta adrenergic receptors of the sympathetic nervous system, causing vasodilation and decreased cardiac output and heart rate. Atenolol is not classified as a diuretic, ACE inhibitor, or vasodilator. |
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The nurse is caring for a patient newly diagnosed with hypertension. Which of the following statements if made by the patient indicates the need for further teaching? a) "When getting up from bed, I will sit for a short period prior to standing up." |
"If I take my blood pressure and it is normal, I don’t have to take my BP pills." The patient needs to understand the disease process and how lifestyle changes and medications can control hypertension. The patient must take his/her medication as directed. A normal BP indicates the medication is producing its desired effect. The other responses do not indicate the need for further teaching. |
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A client is being seen at the clinic for a routine physical when the nurse notes the client’s blood pressure is 150/97. The client is considered to be a healthy, well-nourished young adult. What type of hypertension does this client have? a) Secondary |
Essential (primary) Essential or primary hypertension, about 95% of cases, is sustained elevated BP with no known cause. This client does not have secondary, pathologic, or malignant hypertension. |
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The nurse is caring for a patient with systolic blood pressure of 135 mm Hg. This finding would be classified as which of the following? a) Prehypertension |
Prehypertension A systolic blood pressure of 135 mm Hg is classified as prehypertension. A systolic BP of less than 120 mm Hg is normal. A systolic BP of 140 to 159 mm Hg is stage I hypertension. A systolic BP of greater than or equal to 160 is classified as stage II hypertension. |
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The nurse is caring for a client who is prescribed diuretic medication for the treatment of hypertension. The nurse recognizes that which of the following medications conserves potassium? |
Spironolactone (Aldactone) Aldactone is known as a potassium-sparing diuretic. Lasix causes loss of potassium from the body. Diuril causes mild hypokalemia. Hygroton causes mild hypokalemia. |
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When measuring the blood pressure in each of the patient’s arms, the nurse recognizes that in the healthy adult, which of the following is true? a) Pressures may vary 10 mm Hg or more between arms. |
Pressures should not differ more than 5 mm Hg between arms. Normally, in the absence of disease of the vasculature, there is a difference of no more than 5 mm Hg between arm pressures. The pressures in each arm do not have to be equal in order to be considered normal. Pressures that vary more than 10 mm Hg between arms indicate an abnormal finding. The left arm pressure is not anticipated to be higher than the right as a normal anatomic variant. |
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The nurse is instructing a client who is newly prescribed an antihypertensive medication. Which nursing instruction is emphasized to maintain client safety? a) Do not operate a motor vehicle. |
Sit on the edge of the chair and rise slowly. 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. There is no reason when taking antihypertensive medications to restrict driving. |
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Which of the following would be inconsistent as a component of metabolic syndrome? a) Hypotension |
Hypotension Diabetes, obesity, dyslipidemia, hypertension, and elevated triglycerides are components of metabolic syndrome. Hypotension is not a component of metabolic syndrome. |
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A nurse is teaching the Dietary Approaches To Stop Hypertension (DASH) diet to clients who have been newly diagnosed with hypertension. Which of the following information will the nurse include? a) Three to four regular dairy foods per day |
Seven to eight whole grain products per day The DASH diet is based on 2,000 calories per day and includes: 7 to 8 whole servings of whole-grain products per day 4 to 5 servings of vegetables per day 4 to 5 servings of fruits per day 2 to 3 servings of low-fat or fat-free dairy foods per day 2 or fewer servings of meat, fish, or poultry per day 4 to 5 servings of nuts, seeds, and dry beans per week |
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Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension? a) "I should eliminate caffeine from my diet to lower my blood pressure." |
"Limiting my salt intake to 2 grams per day will improve my blood pressure." To lower blood pressure, a client should limit daily salt intake to 2 g or less. Alcohol intake is associated with a higher incidence of hypertension, poor compliance with treatment, and refractory hypertension. Chronic, moderate caffeine intake and fat intake don’t affect blood pressure |
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A systolic blood pressure of 135 mm Hg would be classified as which of the following? a) Normal |
Prehypertension A systolic blood pressure of 135 mm Hg is classified as prehypertension. A systolic BP of less than 120 mm Hg is normal. A systolic BP of 140 to 159 mm Hg is stage I hypertension. A systolic BP of greater than or equal to 160 is classified as stage 2 hypertension. |
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A client, newly admitted to the nursing unit, has a primary diagnosis of renal failure. When assessing the client, the nurse notes a blood pressure (BP) of 180/100. The nurse knows that this is what kind of hypertension? a) Essential |
Secondary Secondary hypertension is elevated BP that results from or is secondary to some other disorder. This type of hypertension is not primary, essential, or malignant. |
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Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through: a) Laboratory tests |
Ophthalmic examination Papilledema is an edema of the optic nerves, and thus needs an ophthalmic examination for detection. |
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The nurse is caring for a client with hypertension. The nurse is correct to realize that a 24-hour urine is ordered to determine if the cause of hypertension is related to the dysfunction of which of the following? a) The thymus |
The adrenal gland The 24-hour urine collection specimen is ordered to determine dysfunction of the adrenal gland. The 24-hour urine detects elevated catecholamines. The other options are not evaluated by a 24-hour urine. |
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The public health nurse is presenting a workshop on hypertension for the Parent Teacher Organization of the local elementary school. A parent asks the nurse who is at risk for hypertension. What would be the nurse’s best answer? a) "People at highest risk for hypertension include clients younger than 18 years." |
"People at highest risk for hypertension include those with diabetes." Screening of BP is an important method for identifying people at risk for heart failure, renal failure, and stroke. Those at highest risk are older adults, African Americans, and clients with diabetes mellitus. Therefore options A, C, and D are incorrect. |
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Which of the following describes a situation in which the blood pressure is severely elevated and there is evidence of actual or probable target organ damage? a) Hypertensive emergency |
Hypertensive emergency A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage. Hypertensive urgency is a situation in which blood pressure is severely elevated but there is no evidence of actual or probable target organ damage. Secondary hypertension is high blood pressure from an identified cause, such as renal disease. Primary hypertension denotes high blood pressure from an unidentified source. |
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Why is it important for the nurse to implement measures to relieve emotional stress for patients with hypertension? a) The reduction of stress increases the production of neurotransmitters that constrict peripheral arterioles. |
The reduction of stress decreases the production of neurotransmitters that constrict peripheral arterioles. Reduced stress decreases the production of neurotransmitters that constrict peripheral arterioles. Reduced stress may assist in reducing blood volume and resistance to the heart. |
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A client with high blood pressure is receiving an antihypertensive drug. The nurse knows that antihypertensive drugs commonly cause fatigue and dizziness, especially on rising. When developing a client teaching plan to minimize orthostatic hypotension, which instruction should the nurse include? a) "Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night." |
"Flex your calf muscles, avoid alcohol, and change positions slowly." Measures that minimize orthostatic hypotension include flexing the calf muscles to boost blood return to the heart, avoiding alcohol and straining at stool, changing positions slowly, eating a high-protein snack at night, wearing elastic stockings, and holding onto a stationary object when rising. Although the client should rest between demanding activities and consume plenty of fluids and fiber (contained in fruits and vegetables) to maintain a balanced diet, these measures don’t directly relieve orthostatic hypotension. |
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Which of the following adrenergic inhibitors acts directly on the blood vessels, producing vasodilation? a) Reserpine (Serpasil) |
Prazosin hydrochloride (Minipress) Minipress is peripheral vasodilator acting directly on the blood vessel. It is not used in angina and coronary artery disease, however, because it induces tachycardia if not preceded by administration of propranolol and a diuretic. Serpasil impairs synthesis and reuptake of norepinephrine. Inderal blocks the beta-adrenergic receptors of the sympathetic nervous system, especially the sympathetics to the heart, producing a slower heart rate and lowered blood pressure. Catapres acts through the central nervous system, apparently through centrally mediated alpha-adrenergic stimulation in the brain, producing blood pressure reduction |
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The nurse understands that an overall goal of hypertension management includes which of the following? a) The patient maintains a normal blood pressure reading. |
There is no indication of target organ damage. Prolonged blood pressure elevation gradually damages blood vessels throughout the body, particularly in target organs such as the heart, kidneys, brain, and eyes. The overall goal of management is that the patient does not experience target organ damage. The desired effects of antihypertensives are to maintain a normal BP. Postural hypotension and sexual dysfunction are side effects of certain antihypertension medications. |
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Which diagnostic is the recommended method of determining whether left ventricular hypertrophy has occurred? a) Echocardiogram |
Echocardiogram An echocardiogram is recommended method of determining whether hypertrophy has occurred. ECG and blood chemistry are part of the routine work up. Renal damage may be suggested by elevations in BUN and creatinine levels. |
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A nursing class is practicing measurement of blood pressure. One otherwise healthy participant, 46 years old, is 138/90. This man requires follow-up. In which classification of hypertension is he according to the JNC 7 (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood pressure) recommendation? a) Stage 1 with compelling indications |
Stage 1 Stage 1 hypertension is a blood pressure of 140 to 159 systolic or 90 to 99 diastolic. Stage 2 hypertension is a blood pressure greater than 160 systolic or greater than 100 diastolic. Compelling indications include heart failure, post-myocardial infarction, high cardiovascular disease risk, diabetes, chronic kidney disease, and previous stroke. |
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A nurse is educating a client about monitoring blood pressure readings at home. Which of the following will the nurse be sure to emphasise? a) "Sit quietly for 5 minutes prior to taking blood pressure." |
"Sit quietly for 5 minutes prior to taking blood pressure." Instructions for the client regarding measuring the blood pressure at home include the following: (1) Avoid smoking cigarettes or drinking caffiene for 30 minutes before measuring blood pressure. (2) Sit quietly for 5 minutes before the measurement. (3) Have the forearm supported at heart level, with both feet on the ground during the measurement of the blood pressure. |
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Which of the following findings indicates that hypertension is progressing to target organ damage? a) Retinal blood vessel damage |
Retinal blood vessel damage 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 patient 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 level and 60 cc/mL over 2 hours are normal findings. The presence of pneumonia does not indicate target organ damage. |
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A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. For a client without diabetes mellitus, the target blood pressure is 140/90 or lower. Because this client has diabetes mellitus, the target blood pressure will be which of the following? a) 150/95 or lower |
130/80 or lower The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) specifies a lower goal pressure of 130/80 for people with diabetes mellitus. |
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A client comes to the emergency department complaining of visual changes and a severe headache. The nurse measures the client’s blood pressure at 210/120 mm Hg. However, the client denies having hypertension or any other disorder. After diagnosing malignant hypertension, a life-threatening disorder, the physician initiates emergency intervention. What is the most common cause of malignant hypertension? a) Dissecting aortic aneurysm |
Untreated hypertension Untreated hypertension is the most common cause of malignant hypertension. Pyelonephritis, dissecting aortic aneurysm, and excessive catecholamine release (an effect of pheochromocytoma) are less common causes. Rarely, malignant hypertension results from eclampsia, ingestion of or exposure to drugs or toxic substances, and food and drug interactions (such as those that occur with monoamine oxidase inhibitors and aged cheeses) |
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A 35-year-old female patient has been diagnosed with hypertension. The patient is a stock broker, smokes daily, and is also a diabetic. During a follow-up appointment, the patient states that she finds it cumbersome and time consuming to visit the doctor regularly just to check her blood pressure (BP). As the nurse, which of the following aspects of patient teaching would you recommend? a) Advising a smoking cessation |
Purchasing a self-monitoring BP cuff Because this patient finds it time consuming to visit the doctor just for a blood pressure reading, as the nurse, you can suggest the use of an automatic cuff at a local pharmacy, or purchasing a self-monitoring cuff. Discussing methods for stress reduction, advising a smoking cessation, and administering glycemic control would constitute patient education in managing hypertension. |
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According to the DASH diet, how many servings of vegetables should a person consume per day? a) 7 or 8 |
4 or 5 Four or five servings of vegetables are recommended in the DASH diet. |
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The nurse is explaining the DASH diet to a patient diagnosed with hypertension. The patients inquires 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 3 |
4 or 5 The patient 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. |
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It is important for the nurse to encourage the patient to rise slowly from a sitting or lying position because: a) Gradual changes in position help reduce the blood pressure to resupply oxygen to the brain. |
Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. It is important for the nurse to encourage the patient to rise slowly from a sitting or lying position because gradual changes in position provide time for the heart to increase its rate of contraction to resupply oxygen to the brain and not blood pressure or heart rate. |
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A client with newly diagnosed hypertension asks what she can do to decrease the risk for related cardiovascular problems. Which of the following risk factors is not modifiable by the client? a) Age |
Age Age and family history for cardiovascular disease are risk factors that cannot be changed. Obesity, inactivity, and disylipidemia are risk factors that can be improved by the client through dietary changes, exercise, and other healthy lifestyle choices. |
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A client has just been diagnosed with prehypertension. What would the nurse instruct this client to do to restore his blood pressure below hypertensive levels? a) Increase iodine intake |
Decrease sodium intake The nurse should instruct clients with prehypertension to avoid or decrease sodium and iodine intake. Increasing fluid intake raises circulating blood volume and systemic vascular resistance. Over-the-counter decongestants decrease pulmonary congestion and not hypertension. |
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A client is taking 50 mg of oral spironolactone twice a day to assist with blood pressure control. While the nurse is performing the morning assessment, the client reports nausea, general muscle cramps, and weakness. The ECG strip shows a peaked, narrow T-wave, which is a change. What electrolyte imbalance does the nurse suspect? a) Hypernatremia |
Hyperkalemia Potassium-sparing diuretics, such as spironolactone, can cause hyperkalemia, especially if given with an ACE inhibitor. Signs of hyperkalemia are nausea, diarrhea, abdominal cramps, and peaked narrow T-waves. |
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A client experiences orthostatic hypotension while receiving frusemide (Lasix) to treat hypertension. How should the nurse intervene? a) Administer a vasodilator as ordered. |
Instruct the client to sit for several minutes before standing. To minimize the effects of orthostatic hypotension, the nurse should instruct the client to rise slowly, such as by sitting for several minutes before standing. Administering I.V. fluids would be inappropriate (unless the client were dehydrated) because doing so would counteract the effects of furosemide and could cause fluid imbalance. Administering a vasodilator would further reduce the client’s blood pressure, worsening orthostatic hypotension. Inserting an indwelling urinary catheter would make it easier to monitor urine output but wouldn’t minimize the effects of orthostatic hypotension |
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A nurse is caring for a client who has hypertension and diabetes mellitus. The client’s blood pressure this morning was 150/92 mm Hg. He asks the nurse what his blood pressure should be. The nurse’s most appropriate response is: a) "Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg." |
"Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg." An individual with diabetes mellitus should strive for blood pressure of 130/80 mm Hg or less. An individual without diabetes should strive for blood pressure of 140/90 mm Hg or less. |
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The nurse is caring for a client with accelerated hypertension. Which body system would the nurse assess to identify early signs of blood pressure progression? a) Musculoskeletal system |
Eyes Accelerated hypertension is defined as a markedly elevated blood pressure with symptoms of hemorrhages and exudates in the eyes. If the hypertension is untreated, accelerated hypertension progresses to malignant hypertension with symptoms of papilledema. Long-standing hypertension can produce changes in the kidney, heart, and musculoskeletal system. |
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Which of the following statements are true when the nurse is measuring blood pressure (BP)? Select all that apply. a) Using a BP cuff that is too large will give a higher BP measurement. |
• Ask the patient to sit quietly while the BP is being measured. • The patient’s arm should be positioned at the level of the heart. • Using a BP cuff that is too small will give a higher BP measurement. 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 patient should avoid smoking cigarettes or drinking caffeine for 30 minutes before BP is measured. |
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It is important for the nurse to encourage the patient to rise slowly from a sitting or lying position because a) gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. |
gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. It is important for the nurse to encourage the patient to rise slowly from a sitting or lying position because gradual changes in position provide time for the heart to increase its rate of contraction to resupply oxygen to the brain and not blood pressure or heart rate. |
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The nurse is caring for an elderly client with a diagnosis of hypertension, who is taking several antihypertensive medications. Which saftey precaution is the nurse most likely to reinforce? a) Changing positions slowly related to possible hypotension |
Changing positions slowly related to possible hypotension The elderly have impaired cardiovascular reflexes and thus are more sensitive to the extracellular volume depletion caused by diuretics and to the sympathetic inhibition caused by adrenergic antagonists. The nurse teaches clients to change positions slowly when moving from a lying or sitting position to a standing position. This will help prevent falls. Eating extra potassium is not a good idea if taking a potassium-sparing diuretic. The other choices are good teaching points, but not necessarily safety precautions. |
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The nurse is caring for a patient with an intracranial hemorrhage. The patient is having a hypertensive emergency. Which of the following nursing intervention would take priority in this patient? a) Reduction of the mean BP by up to 50% within the first hour of treatment |
Avoid lowering the blood pressure (BP) too quickly It is important not to become over eager and lower the BP too quickly, thus reducing tissue perfusion and causing a myocardial infarction (MI) or cerebrovascular accident. Among the therapeutic goals are a reduction of the mean BP by up to 25% within the first hour of treatment, and a further reduction of a goal pressure to about 160/110 mm Hg over a period of 2 to 6 hours. Maintaining the BP at a significantly higher than normal level can precipitate a stroke or MI. |
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A nurse is discussing with students how to accurately measure blood pressures. Which of the following information is the nurse certain to emphasize? a) Center the cuff bladder directly over the radial artery. |
Routinely calibrate the sphygmomanometer. The nurse must routinely calibrate the sphygmomanometer to ensure accuracy of readings. Using a cuff that is too small will give a false high blood pressure measurement, and using a cuff that is too large results in a false low blood pressure measurement. The cuff bladder must be centered over the brachial artery, and the client’s forearm must be positioned at heart level. |
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When measuring the blood pressure in each of the patient’s arms, the nurse recognizes that in the normal adult, the pressures a) differ no more than 5 mm Hg between arm pressures. |
differ no more than 5 mm Hg between arm pressures. Normally, in the absence of disease of the vasculature, there is a difference of no more than 5 mm Hg between arm pressures. The pressures in each arm do not have to be equal in order to be considered normal. Pressures that vary more than 10 mm Hg between arms indicate an abnormal finding. The left arm pressure is not anticipated to be higher than the right as a normal anatomical variant. |
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Decreasing hypertension is the main focus of the medical cardiology practice where you practice nursing. Different goals apply to different age groups for managing and reducing blood pressures. Angie Dodd, a 54-year-old nurse, is beginning medical management of her recently diagnosed hypertension. What is considered the most important strategy in her treatment? a) Reducing her diastolic pressure below 90 mmHg |
Reducing her systolic pressure below 140 mmHg Currently, it is believed that in persons older than 50 years of age, reducing the systolic pressure below 140 mm Hg is more important than decreasing the diastolic blood pressure. |
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When treating hypertensive emergencies, the nurse identifies the most appropriate route of administration for antihypertensive agents as being which of the following? a) Oral |
Continuous IV infusion The medications of choice in hypertensive emergencies are best managed through the continuous IV infusion of a short-acting titratable antihypertensive agent. The nurse avoids the sublingual and IM routes as their absorption and dynamics are unpredictable. The oral route would not have as quick an onset as a continuous IV infusion |
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The nurse is instructing a student on the proper technique for measuring blood pressure (BP). Which of the following would indicate a need for further teaching? a) Centers the blood pressure cuff bladder directly over the brachial artery |
Positions the arm at waist level 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. |
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The nurse is completing a cardiac assessment on a patient. The patient has a blood pressure (BP) reading of 126/80. The nurse would identify this blood pressure reading as which of the following? a) Stage 2 hypertension |
Prehypertension A systolic BP of 128 mm Hg is classified as prehypertension. A systolic BP of less than 120 mm Hg is normal. A systolic BP of 140 to 159 mm Hg is Stage I hypertension. A systolic BP of greater than or equal to 160 is classified as Stage 2 hypertension |
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A client is being seen at the clinic for a routine physical when the nurse notes the client’s blood pressure is 150/97. The client is considered to be a healthy, well-nourished young adult. What type of hypertension does this client have? a) Malignant |
Essential (primary) Essential or primary hypertension, about 95% of cases, is sustained elevated BP with no known cause. This client does not have secondary, pathologic, or malignant hypertension. |
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The nurse is developing a teaching plan for a patient diagnosed with hypertension. It would be important to emphasise which of the following as part of the plan of care? a) Limiting activity to prevent over exertion |
Limiting sodium intake in the diet Research findings indicate that smoking cessation, weight loss, reduced alcohol and sodium intake, and regular physical activity are effective lifestyle adaptations to reduce blood pressure. Limiting one’s daily alcohol to 24 ounces of beer for men is recommended. Table salt should be limited to 1 teaspoon daily. |
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A diastolic blood pressure of 90 mm Hg is classified as which of the following? a) Normal |
Grade 1 hypertension A diastolic BP of less than 80 mm Hg is normal. A diastolic BP of 80 to 80 mm Hg is classified as prehypertension. A diastolic BP of 90 to 99 mm Hg is grade I hypertension. A diastolic BP of 100 mm Hg or above is classified as grade 2 hypertension. |
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A nurse is providing education about lifestyle modifications to a group of clients who have been newly diagnosed with hypertension. The nurse would include all the following statesments except: a) Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women. |
Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women. Recommmended lifestye modifications to prevent and manage hypertension include maintaining a normal body mass index (about 24; greater than 25 is considered overweight), maintaining a waist circumference of less than 40 inches for men and 35 inches for women, limiting alcohol intake per day to no more than 2 drinks for men and 1 drink for women, and engaging in aerobic activity at least 30 minutes per day most days of the week. |
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Which of the following conditions contributes to secondary hypertension? a) Arterial vasoconstriction |
Arterial vasoconstriction Secondary hypertension may accompany any primary condition that affects fluid volume or renal function or causes arterial vasoconstriction. Calcium deficiency or acid-based imbalance does not contribute to hypertension. |
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A client in a clinic setting has just been diagnosed with hypertension. She asks what the end goal is for treatment. The correct reply from the nurse is which of the following? a) To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less |
To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less 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 men and 35 inches for women; limiting alcohol intake to no more than 2 drinks for men and 1 drink for women per day; engaging in aerobic activity at least 30 minuetes per day most days of the week. |
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When administering an angiotensin-converting enzyme (ACE) inhibitor with spironolactone, the nurse should be aware that which electrolyte imbalance may occur? a) Hypokalemia |
Hyperkalemia ACE inhibitors and angiotensin receptor blocker (ARBs) block aldosterone and may cause hyperkalemia when used with a potassium sparing diuretic such as spironolactone. Hypercalcemia and hypocalcemia would not occur as an imbalance. |
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The nurse is conducting a service project for a local elderly community group on the topic of hypertension. The nurse will relay that risk factors and cardiovascular problems related to hypertension include which of the following? Select all that apply. a) Age ≥55 in men |
• Age ≥55 in men • Obesity (BMI ≥ 30 kg/m2) • Smoking Major risk factors (in addition to hypertension) include smoking, dyslipidaemia (high LDL, low HDL cholesterol), diabetes mellitus, impaired renal function, obesity, physical inactivity, age (older than 55 years for men, 65 years for women), and family history of cardiovascular disease. |
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A 44-year-old client has a history of hypertension. As her nurse, you engage her in client education to make her aware of structures that regulate arterial pressure. Which of the following structures is a component of that process? a) Kidneys |
Kidneys The autonomic nervous system, the kidneys, and various endocrine glands regulate arterial pressure. |
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A client with severe hypertension states, "I feel fine; I’m not really sick at all." The nurse will teach the client that the system/organs particularly targeted for damage by severe hypertension include which of the following? a) Integumentary |
Sensory Prolonged elevated blood pressure eventually damages blood vessels throughout the body, particularly in target organs such as the heart, kidneys, brain, and eyes. The usual consequences of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, renal failure, strokes, and impaired vision. |
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Which of the following describes a situation in which blood pressure is very elevated but there is no evidence of impending or progressive target organ damage? a) Primary hypertension |
Hypertensive urgency Hypertensive urgency is a situation in which blood pressure is severely elevated but there is no evidence of actual or probable target organ damage. Secondary hypertension is high blood pressure from an identified cause, such as renal disease. Primary hypertension denotes high blood pressure from an unidentified source. A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage. |
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A nurse is discussing with a group of nursing students how to accurately measure blood pressure. The nurse is sure to include all the following information except: a) Position the forearm above the level of the heart. |
Position the forearm above the level of the heart. The cuff bladder must be centered over the brachial artery, and the client’s forearm must be positioned at heart level. The nurse must routinely calibrate the sphygmomanometer. Initially, the nurse should record the blood pressure results in both arms and take subsequent measurements from the arm with the higher reading. |
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When caring for a client with essential hypertension what instruction should the nurse provide to the client to normalise blood pressure? a) Increase intake of fluids. |
Reduce sodium intake. The nurse advises the client with essential hypertension to reduce sodium intake. The nurse also advises the client to reduce oral fluid to decrease circulating blood volume and systemic vascular resistance and adhere to a low-fat diet. |
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A 66-year-old client presents to the emergency room (ER) complaining of a severe headache and mild nausea for the last 6 hours. Upon assessment, the patient’s BP is 210/120 mm Hg. The patient has a history of HTN for which he takes 1.0 mg clonidine (Catapres) twice daily for. Which of the following questions is most important for the nurse to ask the patient next? a) "Are you having chest pain or shortness of breath?" |
"Have you taken your prescribed Catapres today?" The nurse must ask if the patient has taken his prescribed Catapres. Patients need to be informed that rebound hypertension can occur if antihypertensive medications are suddenly stopped. Specifically, a side effect of Catapres is rebound or withdrawal hypertension. Although the other questions may be asked, it is most important to inquire if the patient has taken his prescribed HTN medication given the patient’s severely elevated BP. |
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When measuring the blood pressure in each of the patient’s arms, the nurse recognizes that in the normal adult, the pressures a) may vary, with the higher pressure found in the left arm. |
differ no more than 5 mm Hg between arm pressures. Normally, in the absence of disease of the vasculature, there is a difference of no more than 5 mm Hg between arm pressures. The pressures in each arm do not have to be equal in order to be considered normal. Pressures that vary more than 10 mm Hg between arms indicate an abnormal finding. The left arm pressure is not anticipated to be higher than the right as a normal anatomical variant. |
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When monitoring a patient who has hypertension and chronic kidney disease, the target pressure for this individual should be less than which blood pressure reading? a) 140/90 mm Hg |
130/80 mm Hg For individuals with diabetes or chronic kidney disease, JNC 7 specifies a target pressure of less than 130/80 mm Hg. |
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