Hypertension: Practice Questions

Hypertension: Practice Questions

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NCLEX style questions: Hypertensio...

20 terms hannahk0729Preview Heart F 16 terms Dom Which action will the nurse in the hypertension clinic take to obtain an accurate baseline blood pressure (BP) for a new patient?

• Deflate the BP cuff at a rate of 5 to 10 mm Hg per

second.

• Have the patient sit in a chair with the feet flat on the

floor.

• Assist the patient to the supine position for BP

measurements.

• Obtain two BP readings in the dominant arm and

average the results.

• 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.The nurse obtains the following information from a patient newly diagnosed with prehypertension. Which finding is *most* important to address with the patient?

• Low dietary fiber intake
• No regular physical exercise
• Drinks a beer with dinner every night
• Weight is 5 pounds above ideal weight
• 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 will not increase the hypertension risk.

Which action should the nurse take when giving the initial dose of oral labetalol to a patient with hypertension?

• Encourage the use of hard candy to prevent dry mouth.
• Teach the patient that headaches often occur with this

drug.

• Instruct the patient to call for help if heart palpitations

occur.

• Ask the patient to request assistance before getting

out of bed.

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

Labetalol decreases sympathetic nervous system activity by blocking both a and b 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 that should be implemented, which diet choice indicates that the teaching has been *most* effective?

• The patient avoids eating nuts or nut butters.
• The patient restricts intake of chicken and fish.
• The patient drinks low-fat milk with each meal.
• The patient has two cups of coffee in the morning.
• The patient drinks low-fat milk with each meal.

For the prevention of hypertension, the Dietary Approaches to Stop Hypertension (DASH) recommendations include increasing the intake of calcium-rich foods.Caffeine restriction and decreased protein intake are not included in the recommendations. Nuts are high in beneficial nutrients and 4 to 5 servings weekly are recommended in the DASH diet.A patient has just been diagnosed with hypertension and has been started on captopril . Which information is *most* important to include when teaching the patient about this drug?

• Include high-potassium foods such as bananas in the

diet.

• Increase fluid intake if dryness of the mouth is a

problem.

• Change position slowly to help prevent dizziness and

falls.

• Check blood pressure (BP) in both arms before taking

the drug.

• Change position slowly to help prevent dizziness and falls.

The angiotensin-converting enzyme (ACE) inhibitors frequently 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, and 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 prescribed for a patient diagnosed with hypertension. The nurse should consult with the health care provider before giving this drug when the patient reveals a history of

• daily alcohol use.
• peptic ulcer disease.
• reactive airway disease.
• myocardial infarction (MI).
• reactive airway disease.

Nonselective b-blockers block b1- and b2-adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma. b-Blockers will have no effect on the patient's peptic ulcer disease or alcohol use. b-Blocker therapy is recommended after MI.

A 56-yr-old patient who has no previous history of hypertension or other health problems suddenly develops a blood pressure (BP) of 198/110 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that

• a BP recheck should be scheduled in a few weeks.
• dietary sodium and fat content should be decreased.
• diagnosis, treatment, and ongoing monitoring will be

needed.

• there is an immediate danger of a stroke, requiring

hospitalization.

• diagnosis, treatment, and ongoing monitoring will be needed.

A sudden increase in BP in a patient older than age 50 years with no previous 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. There is no indication that dietary salt or fat intake have contributed to this sudden increase in BP, and 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 when the nurse is caring for a patient who is receiving nicardipine (Cardene) to treat a hypertensive emergency?

• Organize nursing activities so that the patient has

undisturbed sleep for 8 hours at night.

• Keep the patient NPO to prevent aspiration caused by

nausea and possible vomiting.

• Assist the patient up in the chair for meals to avoid

complications associated with immobility.

• Use an automated noninvasive blood pressure

machine to obtain frequent measurements.

• 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. There is no indication that this patient is nauseated or at risk for aspiration, so an NPO status is unnecessary.An older patient has been diagnosed with possible white coat hypertension. Which planned action by the nurse *best* addresses the suspected cause of the hypertension?

• Instruct the patient about the need to decrease stress

levels.

• Teach the patient how to self-monitor and record BPs

at home.

• Schedule the patient for regular blood pressure (BP)

checks in the clinic.

• Inform the patient and caregiver that major dietary

changes will be needed.

• 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?

• 98/56 mm Hg
• 128/76 mm Hg
• 128/92 mm Hg
• 142/78 mm Hg
• 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 140/90 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 *most* important for the nurse to include when teaching a patient with newly diagnosed hypertension?

• Most people are able to control BP through dietary

changes.

• Annual BP checks are needed to monitor treatment

effectiveness.

• Hypertension is usually asymptomatic until target

organ damage occurs.

• Increasing physical activity alone controls blood

pressure (BP) for most people.

• Hypertension is usually asymptomatic until target 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 should 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 should the nurse assess *first*?

• 48-yr-old with a blood pressure of 160/92 mm Hg who

reports chest pain

• 52-yr-old with a blood pressure of 198/90 mm Hg who

has intermittent claudication

• 50-yr-old with a blood pressure of 190/104 mm Hg

who has a creatinine of 1.7 mg/dL

• 43-yr-old with a blood pressure of 172/98 mm Hg

whose urine shows microalbuminuria

• 48-yr-old with a blood pressure 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. The symptoms of the other patients also show target organ damage but are not indicative of acute processes.The nurse is reviewing the laboratory test results for a patient who has recently been diagnosed with hypertension. Which result is *most* important to communicate to the health care provider?

• Serum creatinine of 2.8 mg/dL
• Serum hemoglobin of 14.7 g/dL
• Serum potassium of 4.5 mEq/L
• Blood glucose level of 96 mg/dL
• 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 with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and nausea and has a blood pressure (BP) of 238/118 mm Hg. Which question should the nurse ask to follow up on these findings?

• "Have you recently taken any antihistamines?"
• "Have you consistently taken your medications?"
• "Did you take any acetaminophen (Tylenol) today?"
• "Have there been recent stressful events in your life?"
• "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.