Nokea
A 40-year-old male newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the patient and advises that the patient should avoid tobacco use. What is the primary rationale behind that advice to the patient?
- A. Quitting smoking will cause the patients hypertension to resolve
- B. Tobacco use increases the patients concurrent risk of heart disease
- C. Tobacco use is associated with a sedentary lifestyle
- D. Tobacco use causes ventricular hypertrophy
Correct Answer: B
Rationale: Smoking increases the risk for heart disease, for which a patient with hypertension is already at an increased risk. Quitting will not necessarily cause hypertension to resolve and smoking does not directly cause ventricular hypertrophy. The association with a sedentary lifestyle is true, but this is not the main rationale for the nurses advice; the association with heart disease is more salient.
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A 55-year-old patient comes to the clinic for a routine check-up. The patients BP is 159/100 mm Hg and the physician diagnoses hypertension after referring to previous readings. The patient asks why it is important to treat hypertension. What would be the nurses best response?
- A. Hypertension can cause you to develop dangerous blood clots in your legs that can migrate to your lungs
- B. Hypertension puts you at increased risk of type 1 diabetes and cancer in your age group
- C. Hypertension is the leading cause of death in people your age
- D. Hypertension greatly increases your risk of stroke and heart disease
Correct Answer: D
Rationale: Hypertension, particularly elevated systolic BP, increases the risk of death, stroke, and heart failure in people older than 50 years. Hypertension is not a direct precursor to pulmonary emboli, and it does not put older adults at increased risk of type 1 diabetes or cancer. It is not the leading cause of death in people 55 years of age.
The nurse is planning the care of a patient who has been diagnosed with hypertension, but who otherwise enjoys good health. When assessing the response to an antihypertensive drug regimen, what blood pressure would be the goal of treatment?
- 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
Correct Answer: B
Rationale: The goal of antihypertensive drug therapy is a BP of 140/90 mm Hg or lower. A pressure of 130/80 mm Hg is the goal for patients with diabetes or chronic kidney disease.
The critical care nurse is caring for a patient just admitted in a hypertensive emergency. The nurse should anticipate the administration of what medication?
- A. Warfarin (Coumadin)
- B. Furosemide (Lasix)
- C. Sodium nitroprusside (Nitropress)
- D. Ramipril (Altace)
Correct Answer: C
Rationale: The medications of choice in hypertensive emergencies are those that have an immediate effect. IV vasodilators, including sodium nitroprusside (Nitropress), nicardipine hydrochloride (Cardene), clevidipine (Cleviprex), fenoldopam mesylate (Corlopam), enalaprilat, and nitroglycerin, have immediate actions that are short lived (minutes to 4 hours), and they are therefore used for initial treatment. Ramipril is administered orally and would not meet the patients immediate need for BP management. Diuretics, such as Lasix, are not used as initial treatments and there is no indication for anticoagulants such as Coumadin.
The nurse is collaborating with the dietitian and a patient with hypertension to plan dietary modifications. These modifications should include which of the following?
- A. Reduced intake of protein and carbohydrates
- B. Increased intake of calcium and vitamin D
- C. Reduced intake of fat and sodium
- D. Increased intake of potassium, vitamin B12 and vitamin D
Correct Answer: C
Rationale: Lifestyle modifications usually include restricting sodium and fat intake, increasing intake of fruits and vegetables, and implementing regular physical activity. There is no need to increase calcium, potassium, and vitamin intake. Calorie restriction may be required for some patients, but a specific reduction in protein and carbohydrates is not normally indicated.
A community health nurse is planning an educational campaign addressing hypertension. The nurse should anticipate that the incidence and prevalence of hypertension are likely to be highest among members of what ethnic group?
- A. Pacific Islanders
- B. African Americans
- C. Asian-Americans
- D. Hispanics
Correct Answer: D
Rationale: The prevalence of uncontrolled hypertension varies by ethnicity, with Hispanics and African Americans having the highest prevalence at approximately 63% and 57%, respectively.