Nokea
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.
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A patient has come to the clinic for a follow-up assessment that will include a BP reading. To ensure an accurate reading, the nurse should confirm that the patient has done which of the following?
- A. Tried to rest quietly for 5 minutes before the reading is taken
- B. Refrained from smoking for at least 8 hours
- C. Drunk adequate fluids during the day prior
- D. Avoided drinking coffee for 12 hours before the visit
Correct Answer: A
Rationale: Prior to the nurse assessing the patients BP, the patient should try to rest quietly for 5 minutes. The forearm should be positioned at heart level. Caffeine products and cigarette smoking should be avoided for at least 30 minutes prior to the visit. Recent fluid intake is not normally relevant.
A patient has been prescribed antihypertensives. After assessment and analysis, the nurse has identified a nursing diagnosis of risk for ineffective health maintenance related to nonadherence to therapeutic regimen. When planning this patients care, what desired outcome should the nurse identify?
- A. Patient takes medication as prescribed and reports any adverse effects
- B. Patients BP remains consistently below 140/90 mm Hg
- C. Patient denies signs and symptoms of hypertensive urgency
- D. Patient is able to describe modifiable risk factors for hypertension
Correct Answer: A
Rationale: The most appropriate expected outcome for a patient who is given the nursing diagnosis of risk for ineffective health maintenance is that he or she takes the medication as prescribed. The other listed goals are valid aspects of care, but none directly relates to the patients role in his or her treatment regimen.
The nurse is assessing a patient new to the clinic. Records brought to the clinic with the patient show the patient has hypertension and that her current BP readings approximate the readings from when she was first diagnosed. What contributing factor should the nurse first explore in an effort to identify the cause of the clients inadequate BP control?
- A. Progressive target organ damage
- B. Possibility of medication interactions
- C. Lack of adherence to prescribed drug therapy
- D. Possible heavy alcohol use or use of recreational drugs
Correct Answer: C
Rationale: Deviation from the therapeutic program is a significant problem for people with hypertension and other chronic conditions requiring lifetime management. An estimated 50% of patients discontinue their medications within 1 year of beginning to take them. Consequently, this is a more likely problem than substance use, organ damage, or adverse drug interactions.
A student nurse is taking care of an elderly patient with hypertension during a clinical experience. The instructor asks the student about the relationships between BP and age. What would be the best answer by the student?
- A. Because of reduced smooth muscle tone in blood vessels, blood pressure tends to go down with age, not up
- B. Decreases in the strength of arteries and the presence of venous insufficiency cause hypertension in the elderly
- C. Structural and functional changes in the cardiovascular system that occur with age contribute to increases in blood pressure
- D. The neurologic system of older adults is less efficient at monitoring and regulating blood pressure
Correct Answer: C
Rationale: Structural and functional changes in the heart and blood vessels contribute to increases in BP that occur with aging. Venous insufficiency does not cause hypertension, however. Increased BP is not primarily a result of neurologic changes.
A patient with newly diagnosed hypertension has come to the clinic for a follow-up visit. The patient asks the nurse why she has to come in so often. What would be the nurses best response?
- A. We do this so you dont suffer a stroke
- B. We do this to determine how your blood pressure changes throughout the day
- C. We do this to see how often you should change your medication dose
- D. We do this to make sure your health is stable. Well then monitor it at routinely scheduled intervals
Correct Answer: D
Rationale: When hypertension is initially detected, nursing assessment involves carefully monitoring the BP at frequent intervals and then at routinely scheduled intervals. The reference to stroke is frightening and does not capture the overall rationale for the monitoring regimen. Changes throughout the day are not a clinical priority for most patients. The patient must not change his or her medication doses unilaterally.