Chapter 32- Assessment and Management of Patients With Hypertension

1. Mr. Jones, an 80-year-old male with newly diagnosed primary hypertension, has just been started on a beta-blocker. In addition to teaching Mr. Jones about his medication, ie, side effects, purpose, and schedule, the nurse should also focus her teaching on: A) Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the beta-blocker B) Maintaining a diet high in dairy to increase protein necessary to prevent organ damage C) Use of supportive devices such as handrails and walkers to prevent falls stemming from postural hypotension D) Limiting exercise to avoid injury that can be caused by postural hypotension Ans: C Difficulty: Moderate 2. A patient with primary hypertension who returns for follow-up care reveals that he has been experiencing a change in vision, ie, blurring and decreased visual acuity. The nurse is aware that these symptoms could be indicative of: A) Retinal blood vessel damage C) Impending stroke B) Chronic kidney disease D) Hypertensive emergency Ans: A Difficulty: Moderate 3. The nurse doing patient education with a 55-year-old male recently diagnosed with primary hypertension who has no signs or symptoms of the disease is aware that an estimated 50% of patients discontinue their antihypertensive medications within one year of beginning them. Keeping this in mind, the nurse recommends which of the following to this patient: A) Self-monitoring of blood pressure B) Monthly visits to the physician to monitor blood pressure C) Adherence to the treatment plan regardless of symptoms D) Monitoring of symptoms of complications of hypertension and taking medications if symptoms are present Ans: A Difficulty: Moderate 4. A nurse is performing blood pressure screenings. While obtaining subjective assessment data from a patient with hypertension, the nurse notes that a modifiable risk factor is: A) Hyperlipidemia B) Excessive alcohol intake C) Family history of hypertension D) Stricter compliance with medical regime Ans: B Difficulty: Easy 5. A patient is admitted to the emergency room in hypertensive crisis. The nurse is aware that hypertensive urgency differs from hypertensive emergency in that:
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A) B) C) D)

The BP is always higher in a hypertensive emergency. Extremely close hemodynamic monitoring is required during treatment of hypertensive emergencies. Hypertensive urgency is treated with rest and tranquilizers to lower BP. Hypertensive emergencies are associated with evidence of target organ damage. Ans: D Difficulty: Moderate

6. A nurse is caring for an elderly adult with hypertension who is being treated with a diuretic and beta-blocker. The nurse is aware that a major consideration in managing hypertension in the elderly is to: A) Ensure that the patient receive a larger initial dose of antihypertensive medication due to impaired absorption B) Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion C) Recognize that an older adult is less likely to comply with his medication regime than a younger patient D) Carefully assess for weight gain because of impaired kidney function resulting from normal aging Ans: B Difficulty: Moderate 7. The nurse is counseling a 52-year-old male about the risk factors of hypertension. Which of the following should the nurse list as risk factors for primary hypertension? A) Obesity, high intake of sodium, and saturated fat B) Diabetes mellitus and oral contraceptives C) Metabolic syndrome and smoking D) Renal disease and coarctation of the aorta Ans: A Difficulty: Easy 8. The nurse is taking the blood pressure of a patient diagnosed with primary hypertension. To ensure accurate measurement, the nurse would avoid which of the following: A) Measuring the BP after the patient has been seated quietly for 5 minutes B) Taking the BP 10 minutes after nicotine or coffee ingestion C) Using a cuff with a bladder that encircles at least 80% of the limb D) Using a bare forearm supported at heart level on a firm surface Ans: B Difficulty: Easy 9. A nurse is caring for a patient with a hypertensive emergency. During treatment with IV vasodilators, the primary goal of treatment is to: A) Lower the BP to reduce onset of neurological symptoms such as headache, nosebleeds, and vision changes B) Decrease the BP to a normal level based on the patient's age

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C) D)

Decrease the mean arterial pressure 25% in the first hour of treatment Reduce the systolic and diastolic BP as quickly as possible Ans: C Difficulty: Moderate

10. The nurse is assessing a patient with primary hypertension that has been well controlled for the past year. Today, the patient has an abnormally high BP. After interviewing the patient, the nurse realizes that the patient is experiencing rebound hypertension due to: A) Discontinuation of drug therapy B) A change in exercise routine C) A weight gain of 10 lbs. over the past year D) Atherosclerotic changes in vessels that supply vital organs Ans: A Difficulty: Moderate 11. A patient with primary hypertension is being seen in the physician's office for followup care. The nurse assessing response to antihypertensive drug therapy is aware that the goal of hypertensive treatment is to prevent complications and death by achieving and maintaining arterial BP at: A) 156/96 mm Hg or lower B) 140/90 mm Hg or lower C) Average of 2 BP readings of 150/80 mm Hg D) 120/80 mm Hg or lower Ans: B Difficulty: Easy 12. The nurse assessing a patient with secondary hypertension is aware that the difference between primary hypertension and secondary hypertension is that secondary hypertension: A) Has specific causes B) Has a more gradual onset than primary hypertension C) Does not cause target organ damage D) Does not respond to antihypertensive drug therapy Ans: A Difficulty: Easy 13. The nurse is developing a nursing care plan for a patient with primary hypertension who has not been adhering to the prescribed dietary regimen. One of the measurable patient outcomes may include: A) Reduction of sodium intake to no more than 2.4g B) Stable BUN and serum creatine levels C) Abstinence from fat intake and reduction of calories D) Maintenance of a normal body weight Ans: A Difficulty: Moderate

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14. The nurse assesses that a patient with hypertension has blood pressure readings that have not responded to the prescribed antihypertensive medications. Which of the following should the nurse explore to try to identify the cause of poor control? A) Progressive target organ damage C) Noncompliance with drug therapy B) Possibility of medication D) Possible use of recreational drugs interactions Ans: C Difficulty: Moderate 15. A patient with primary hypertension is currently on an alpha-adrenergic blocker. He complains of dizziness with ambulation. The nurse assesses postural hypotension. When teaching this patient about risks associated with postural hypotension, emphasis should be placed on: A) Rising slowly from a lying or sitting position B) Increasing fluids to maintain blood volume C) Stopping medication if dizziness persists D) Taking medication at night to decrease its effect on ambulation Ans: A Difficulty: Easy 16. The nurse is aware that the patient with which of the following conditions is at the greatest risk for hypertension? A) Hyperproteinemia B) Gallstones C) Atherosclerosis D) Asthma Ans: C Difficulty: Easy 17. When educating a patient about risk factors for hypertension, the nurse recognizes the patient has comprehended the teaching when he states: A) I will need to incorporate physical activity into my daily activities. B) My family history has no impact on risk factors for hypertension. C) My weight does not affect my chances of developing hypertension. D) As I get older, my chances of developing hypertension lessen. Ans: A Difficulty: Moderate 18. During an initial assessment by the nurse, a patient's blood pressure measures 160/90. When should the patient be instructed to have a follow-up assessment of his or her blood pressure? A) In 2 years B) In 1 year C) Within 1 month D) Immediately Ans: C Difficulty: Moderate 19. When uncontrolled hypertension is prolonged, the nurse is aware that the patient is at risk for developing which of the following complications? A) Renal failure B) Right ventricular hypertrophy C) Glaucoma D) Anemia

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Ans: A Difficulty: Moderate 20. A patient with uncomplicated hypertension is prescribed furosemide (Lasix). The nurse is aware that this medication is a: A) Loop diuretic for volume depletion B) Potassium-sparing diuretic to inhibit aldosterone C) Thiazide diuretic that affects the vascular smooth muscles D) Peripheral agent to impair synthesis and reuptake of norepinephrine Ans: A Difficulty: Easy 21. The nurse assessing the patient with a new diagnosis of hypertension questions him about decreased visual acuity, which may indicate: A) Retinopathy C) Nephropathy B) Peripheral arterial disease D) Left ventricular hypertrophy Ans: A Difficulty: Difficult 22. A patient is prescribed propranolol hydrochloride to control hypertension and is anxious about the side effects of the medication. An appropriate expected outcome for this patient given a nursing diagnosis of risk for noncompliance with therapeutic regimen related to side effects of prescribed therapy would be that the patient: A) Takes medication as prescribed and reports any side effects B) Reports no visual disturbances C) Reports absence of angina D) Has palpable peripheral pulses Ans: A Difficulty: Difficult 23. Chlorothiazide has been prescribed as part of the treatment regimen for a patient with hypertension. The nurse should explain that alcohol use may potentiate the side effect of: A) Depression B) Hyperkalemia C) Postural hypotension D) Nasal stuffiness Ans: C Difficulty: Moderate 24. When discussing lifestyle changes with an adult patient diagnosed with hypertension, the nurse advises that the patient should avoid tobacco use because smoking: A) Causes high blood pressure C) Causes obesity B) Increases the risk of heart disease D) Increases cardiac output Ans: B Difficulty: Moderate 25. The nurse is preparing to take a patient's blood pressure during a follow-up assessment. Before taking the blood pressure, the nurse should determine if the patient has:

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A) B) C) D)

Tried to rest quietly for 5 minutes before the reading is taken Refrained from smoking for at least 8 hours Been NPO for at least 8 hours Avoided drinking coffee for 12 hours Ans: A Difficulty: Moderate

26. A 56-year-old male has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, he exclaims, "My pressure has never been this high. Will I need to take medication to reduce it?" Which of the following responses by the nurse would be best? A) "Yes, hypertension is prevalent among males; it's fortunate we caught this during your routine examination." B) "We'll need to reevaluate your blood pressure because your age places you at high risk for hypertension." C) "A single elevated blood pressure doesn't confirm hypertension. You'll need to have your blood pressure reassessed several times before a diagnosis can be made." D) "You have no need to worry. Your pressure is probably elevated because you're in the doctor's office." Ans: C Difficulty: Moderate 27. The nurse is caring for a patient receiving spironolactone to treat hypertension. Which instruction should the nurse give the patient? A) Choose foods high in potassium. B) Take potassium supplements each day. C) Discontinue sodium restrictions. D) Avoid salt substitutes. Ans: D Difficulty: Moderate

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