Nokea
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.
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The nurse is screening a number of adults for hypertension. What range of blood pressure is considered normal?
- A. Less than 140/90 mm Hg
- B. Less than 130/90 mm Hg
- C. Less than 129/89 mm Hg
- D. Less than 120/80 mm Hg
Correct Answer: D
Rationale: JNC 7 defines a blood pressure of less than 120/80 mm Hg as normal, 120 to 129/80 to 89 mm Hg as prehypertension, and 140/90 mm Hg or higher as hypertension.
A patient in hypertensive urgency is admitted to the hospital. The nurse should be aware of what goal of treatment for a patient in hypertensive urgency?
- A. Normalizing BP within 2 hours
- B. Obtaining a BP of less than 110/70 mm Hg within 36 hours
- C. Obtaining a BP of less than 120/80 mm Hg within 36 hours
- D. Normalizing BP within 24 to 48 hours
Correct Answer: D
Rationale: In cases of hypertensive urgency, oral agents can be administered with the goal of normalizing BP within 24 to 48 hours. For patients with this health problem, a BP of 120/80 mm Hg may be unrealistic.
The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in what way?
- A. The BP is always higher in a hypertensive emergency
- B. Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies
- C. Hypertensive urgency is treated with rest and benzodiazepines to lower BP
- D. Hypertensive emergencies are associated with evidence of target organ damage
Correct Answer: D
Rationale: Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. Blood pressures are extremely elevated in both urgency and emergencies, but there is no evidence of target organ damage in hypertensive urgency. Extremely close hemodynamic monitoring of the patients BP is required in both situations. The medications of choice in hypertensive emergencies are those with an immediate effect, such as IV vasodilators. Oral doses of fast-acting agents, such as beta-adrenergic blocking agents, angiotensin-converting enzyme inhibitors, or alpha-agonists, are recommended for the treatment of hypertensive urgencies.
A patient in hypertensive emergency is being cared for in the ICU. The patient has become hypovolemic secondary to natriuresis. What is the nurses most appropriate action?
- A. Add sodium to the patients IV fluid, as ordered
- B. Administer a vasoconstrictor, as ordered
- C. Promptly cease antihypertensive therapy
- D. Administer normal saline IV, as ordered
Correct Answer: D
Rationale: If there is volume depletion secondary to natriuresis caused by the elevated BP, then volume replacement with normal saline can prevent large, sudden drops in BP when antihypertensive medications are administered. Sodium administration, cessation of antihypertensive therapy, and administration of vasoconstrictors are not normally indicated.
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.