Nursing Management: Hypertension Lewis Chapter 33

The nurse teaches a 28-year-old man newly diagnosed with hypertension about lifestyle modifications to reduce his blood pressure. Which statement by the patient requires an intervention by the nurse?
A "I will avoid adding salt to my food during or after

C "I can lower my blood pressure by switching to smokeless tobacco."
Nicotine contained in tobacco products (smoking and chew) cause vasoconstriction and increase blood pressure. Persons with hypertension should restrict sodium to 1500 mg/day by avoiding

The nurse supervises an unlicensed assistant personnel (UAP) who is taking the blood pressure of 58-year-old female patient admitted with heart failure. The patient is obese. The nurse should intervene if what is observed?
A The UAP waits 2 minutes after

B The UAP deflates the blood pressure cuff at a rate of 8 to 10 mm Hg per second.
The cuff should be deflated at a rate of 2 to 3 mm Hg per second. The arm should be supported at the level of the heart for accurate blood pressure measurements. If the maxi

A 44-year-old man is diagnosed with hypertension and receives a prescription for benazepril (Lotensin). After the nurse teaches him about the medication, which statement by the patient indicates his correct understanding?
A "If I take this medication, I w

D "If I develop a dry cough while taking this medication, I should notify my doctor."
Benazepril is an angiotensin-converting enzyme inhibitor. The medication inhibits breakdown of bradykinin, which may cause a dry, hacking cough. Other adverse effects in

A 67-year-old woman with a history of coronary artery disease and prior myocardial infarction is admitted to the emergency department with a blood pressure of 234/148 mm Hg and started on IV nitroprusside (Nitropress). What should the nurse determine as a

C Mean arterial pressure no lower than 133 mm Hg
The initial treatment goal is to decrease mean arterial pressure by no more than 25% within minutes to 1 hour. If the patient is stable, the goal for BP is 160/100 to 110 mm Hg over the next 2 to 6 hours. L

The nurse admits a 73-year-old male patient with dementia for treatment of uncontrolled hypertension. The nurse will closely monitor for hypokalemia if the patient receives which medication?
A Clonidine (Catapres)
B Bumetanide (Bumex)
C Amiloride (Midamor

B Bumetanide (Bumex)
Bumetanide is a loop diuretic. Hypokalemia is a common adverse effect of this medication. Amiloride is a potassium-sparing diuretic. Spironolactone is an aldosterone-receptor blocker. Hyperkalemia is an adverse effect of both amilorid

The nurse teaches a patient with hypertension that uncontrolled hypertension may damage organs in the body primarily by which mechanism?
A Hypertension promotes atherosclerosis and damage to the walls of the arteries.
Hypertension causes direct pressure o

A Hypertension promotes atherosclerosis and damage to the walls of the arteries.
Hypertension is a major risk factor for the development of atherosclerosis by mechanisms not yet fully known. However, once atherosclerosis develops, it damages the walls of

When teaching a patient about dietary management of stage 1 hypertension, which instruction is most appropriate?
A Restrict all caffeine.
B Restrict sodium intake.
C Increase protein intake.
D Use calcium supplements.

B Restrict sodium intake.
The patient should decrease intake of sodium. This will help to control hypertension, which can be aggravated by excessive salt intake, which in turn leads to fluid retention. Caffeine and protein intake do not affect hypertensio

In caring for a patient admitted with poorly controlled hypertension, which laboratory test result should the nurse understand as indicating the presence of target organ damage?
A BUN of 15 mg/dL
B Serum uric acid of 3.8 mg/dL
C Serum creatinine of 2.6 mg

C Serum creatinine of 2.6 mg/dL
The normal serum creatinine level is 0.6-1.3 mg/dL. This elevated level indicates target organ damage to the kidneys. The other lab results are within normal limits.

When providing dietary instruction to a patient with hypertension, the nurse would advise the patient to restrict intake of which meat?
A Broiled fish
B Roasted duck
C Roasted turkey
D Baked chicken breast

B Roasted duck
Roasted duck is high in fat, which should be avoided by the patient with hypertension. Weight loss may slow the progress of atherosclerosis and overall CVD risk. The other meats are lower in fat and are therefore acceptable in the diet.

The nurse is caring for a patient admitted with a history of hypertension. The patient's medication history includes hydrochlorothiazide (Hydrodiuril) daily for the past 10 years. Which parameter would indicate the optimal intended effect of this drug the

B Blood pressure 128/86
Hydrochlorothiazide may be used alone as monotherapy to manage hypertension or in combination with other medications if not effective alone. After the first few weeks of therapy, the diuretic effect diminishes, but the antihyperten

In reviewing medication instructions with a patient being discharged on antihypertensive medications, which statement would be most appropriate for the nurse to make when discussing guanethidine (Ismelin)?
A "A fast heart rate is a side effect to watch fo

D "Make position changes slowly, especially when rising from lying down to a standing position."
Guanethidine is a peripheral-acting ?-adrenergic antagonist and can cause marked orthostatic hypotension. For this reason, the patient should be instructed to

The nurse is caring for a patient admitted with chronic obstructive pulmonary disease (COPD), angina, and hypertension. Before administering the prescribed daily dose of atenolol 100 mg PO, the nurse assesses the patient carefully. Which adverse effect is

C Bronchospasm
Atenolol is a cardioselective ?1-adrenergic blocker that reduces blood pressure and could affect the ?2-receptors in the lungs with larger doses or with drug accumulation. Although the risk of bronchospasm is less with cardioselective ?-blo

The nurse is caring for a patient with hypertension who is scheduled to receive a dose of esmolol (Brevibloc). The nurse should withhold the dose and consult the prescribing physician for which vital sign taken just before administration?
A Pulse 48
B Res

A Pulse 48
Because esmolol is a ?1-adrenergic blocking agent, it can cause hypotension and bradycardia as adverse effects. The nurse should withhold the dose and consult with the health care provider for parameters regarding pulse rate limits.

When teaching how lisinopril (Zestril) will help lower the patient's blood pressure, which mechanism of action should the nurse use to explain it?
A Blocks ?-adrenergic effects.
B Relaxes arterial and venous smooth muscle.
C Inhibits conversion of angiote

C Inhibits conversion of angiotensin I to angiotensin II.
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that inhibits the conversion of angiotensin I to angiotensin II, which reduces angiotensin II-mediated vasoconstriction and sodium and

Despite a high dosage, a male patient who is taking nifedipine (Procardia XL) for antihypertensive therapy continues to have blood pressures over 140/90 mmHg. What should the nurse do next?
A Assess his adherence to therapy.
B Ask him to make an exercise

A Assess his adherence to therapy.
A long-acting calcium-channel blocker such as nifedipine causes vascular smooth muscle relaxation resulting in decreased SVR and arterial BP and related side effects. The patient data the nurse has about this patient is

The nurse is teaching a women's group about prevention of hypertension. What information should be included in the teaching for all the women (select all that apply)?
A Lose weight.
B Limit nuts and seeds.
C Limit sodium and fat intake.
D Increase fruits

C Limit sodium and fat intake.
D Increase fruits and vegetables.
E Exercise 30 minutes most days.
Primary prevention of hypertension is to make lifestyle modifications that prevent or delay the increase in BP. Along with exercise for 30 minutes on most da

When assessing the patient for orthostatic hypotension, after taking the blood pressure (BP) and pulse (P) in the supine position, what should the nurse do next?
A Repeat BP and P in this position.
B Take BP and P with patient sitting.
C Record the BP and

B Take BP and P with patient sitting.
When assessing for orthostatic changes in BP after measuring BP in the supine position, the patient is placed in a sitting position and BP is measured within 1 to 2 minutes and then repositioned to the standing positi

The patient has chronic hypertension. Today she has gone to the ED, and her blood pressure has risen to 200/140. What is the priority assessment for the nurse to make?
A Is the patient pregnant?
B Does the patient need to urinate?
C Does the patient have

C Does the patient have a headache or confusion?
The nurse's priority assessments include neurologic deficits, retinal damage, heart failure, pulmonary edema, and renal failure. The headache or confusion could be seen with hypertensive encephalopathy from