Nokea
A client with hypertension comes to the clinic for a follow-up visit. Which of the following would be appropriate for the nurse to do when assisting the client in managing his hypertension? Select all that apply.
- A. Find local resources in the community for taking blood pressure.
- B. Teach client how to properly record weight and blood pressure.
- C. Schedule regular monitoring of weight and blood pressure.
- D. Schedule an appointment to see a cardiologist.
- E. Schedule an appointment to see a nephrologist.
Correct Answer: A,B,C
Rationale: In the ambulatory care setting, the nurse helps plan a schedule of regular monitoring of weight and blood pressure, finds local resources for taking blood pressure in the community, and teaches the client how to record weight and blood pressure readings.
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A client is receiving a diuretic for the treatment of hypertension. Which of the following conditions should the nurse monitor for in clients taking diuretics?
- A. Hyperkalemia
- B. Hyponatremia
- C. Hypomagnesemia
- D. Hypocalcemia
Correct Answer: B
Rationale: The nurse should assess for hyponatremia in clients receiving diuretics. Diuretic usage causes electrolyte disturbances such as hyponatremia and hypokalemia. The nurse should inform the primary health care provider if signs and symptoms of electrolyte imbalance occur. Hyperkalemia, hypomagnesemia, and hypocalcemia do not occur in clients taking diuretics.
A client is prescribed an antihypertensive drug. Which of the following would the nurse include in the teaching plan to promote the best outcome for the client? Select all that apply.
- A. Never discontinue use of the antihypertensive drug except on the advice of the physician.
- B. Avoid the use of nonprescription drugs unless approved by the physician.
- C. Avoid alcohol unless its use has been approved by the physician
- D. Know that unexplained weakness or fatigue is a normal adverse reaction.
- E. Notify the physician if the diastolic pressure suddenly increases to 130 \mathrm{~mm} \mathrm{Hg} or higher.
Correct Answer: A,B,C,E
Rationale: The client should be told to never discontinue the drug unless advised to do so, avoid nonprescription drugs unless approved, avoid alcohol unless it's approved, and notify the physician if the diastolic pressure suddenly increases to 130 \mathrm{~mm} \mathrm{Hg} or higher. The client also should contact the physician if unexplained weakness or fatigue occurs.
A nurse is instructing a client about his prescribed antihypertensive therapy with captopril. Which of the following instructions would the nurse include in the teaching plan? Select all that apply.
- A. Taking the drug with meals to decrease GI upset
- B. Informing the client about the possibility of a cough
- C. Crushing the capsule before taking it
- D. Taking measures to reduce injury from hypotension
- E. Reporting any swelling of the face, throat, or extremities
Correct Answer: B,D
Rationale: The client needs to know that some clients experience a dry cough that does not subside until drug therapy is discontinued and this reaction may need to be tolerated. In addition, these drugs may cause a significant drop in blood pressure after the first dose, so the client needs to take measures to reduce the risk of injury from the drug's effects. The ACE inhibitors, captopril and moexipril, should be taken 1 hour before or 2 hours after meals to enhance absorption. The drugs are sustained-release capsules that should not be crushed, opened, or chewed. ACEIs do not cause angioedema.
The nurse is providing care to a client being treated for a hypertensive emergency. Which of the following would be appropriate for the nurse to do?
- A. Take a blood pressure every 30 minutes.
- B. Alternate the arms for assessing the blood pressure and pulse.
- C. Continuously monitor the client's status.
- D. Measure the pulse rate every hour.
Correct Answer: C
Rationale: When the patient has severe hypertension, does not have the expected response to drug therapy, or is critically ill, continuous monitoring is performed. The blood pressure should be taken in the same arm and same position each time.
A client who is prescribed losartan for hypertension has stopped taking the drug immediately after experiencing adverse reactions. The nurse would be alert for which of the following due to abrupt discontinuation?
- A. Breathing difficulty
- B. Rebound hypertension
- C. Orthostatic hypotension
- D. Anginal attacks
Correct Answer: B
Rationale: Rebound hypertension will occur in clients when antihypertensives are abruptly discontinued. In rebound hypertension, there is a sudden rise in blood pressure when the antihypertensives are withheld. Orthostatic hypotension, anginal attacks, and breathing difficulty are the adverse reactions associated with antihypertensive drug usage and may not occur on stopping the drug.