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A newly diagnosed patient with hypertension is prescribed Diuril, a thiazide diuretic. What patient education should the nurse provide to this patient?
- A. Eat a banana every day because Diuril causes moderate hyperkalemia
- B. Take over-the-counter potassium pills because Diuril causes your kidneys to lose potassium
- C. Diuril can cause low blood pressure and dizziness, especially when you get up suddenly
- D. Diuril increases sodium levels in your blood, so cut down on your salt
Correct Answer: C
Rationale: Thiazide diuretics can cause postural hypotension, which may be potentiated by alcohol, barbiturates, opioids, or hot weather. Diuril does not cause either moderate hyperkalemia or severe hypokalemia and it does not result in hypernatremia.
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The nurse is developing a nursing care plan for a patient who is being treated for hypertension. What is a measurable patient outcome that the nurse should include?
- A. Patient will reduce Na+ intake to no more than 2.4 g daily
- B. Patient will have a stable BUN and serum creatinine levels
- C. Patient will abstain from fat intake and reduce calorie intake
- D. Patient will maintain a normal body weight
Correct Answer: A
Rationale: Dietary sodium intake of no more than 2.4 g sodium is recommended as a dietary lifestyle modification to prevent and manage hypertension. Giving a specific amount of allowable sodium intake makes this a measurable goal. None of the other listed goals is quantifiable and measurable.
A nurse is teaching an adult female patient about the risk factors for hypertension. What should the nurse explain as risk factors for primary hypertension?
- A. Obesity and high intake of sodium and saturated fat
- B. Diabetes and use of oral contraceptives
- C. Metabolic syndrome and smoking
- D. Renal disease and coarctation of the aorta
Correct Answer: A
Rationale: Obesity, stress, high intake of sodium or saturated fat, and family history are all risk factors for primary hypertension. Diabetes and oral contraceptives are risk factors for secondary hypertension. Metabolic syndrome, renal disease, and coarctation of the aorta are causes of secondary hypertension.
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.
The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. Which of the following should the nurse integrate into the management of this clients hypertension?
- A. Ensure that the patient receives 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 adhere to his or her medication regimen than a younger patient
- D. Carefully assess for weight loss because of impaired kidney function resulting from normal aging
Correct Answer: B
Rationale: Elderly people have impaired cardiovascular reflexes and thus are more sensitive to extracellular volume depletion caused by diuretics. The nurse needs to assess hydration status, low BP, and postural hypotension carefully. Older adults may have impaired absorption, but they do not need a higher initial dose of an antihypertensive than a younger person. Adherence to treatment is not necessarily linked to age. Kidney function and absorption decline with age; less, rather than more antihypertensive medication is prescribed. Weight gain is not necessarily indicative of kidney function decline.
A patient in a hypertensive emergency is admitted to the ICU. The nurse anticipates that the patient will be treated with IV vasodilators, and that the primary goal of treatment is what?
- A. Lower the BP to reduce onset of neurologic symptoms, such as headache and vision changes
- B. Decrease the BP to a normal level based on the patients age
- C. Decrease the mean arterial pressure between 20% and 25% in the first hour of treatment
- D. Reduce the BP to 120/75 mm Hg as quickly as possible
Correct Answer: C
Rationale: Initially, the treatment goal in hypertensive emergencies is to reduce the mean arterial pressure by 25% in the first hour of treatment, with further reduction over the next 24 hours. Lowering the BP too fast may cause hypotension in a patient whose body has adjusted to hypertension and could cause a stroke, MI, or visual changes. Neurologic symptoms should be addressed, but this is not the primary focus of treatment planning.