Nokea
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.
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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.
A patient with secondary hypertension has come into the clinic for a routine check-up. The nurse is aware that the difference between primary hypertension and secondary hypertension is which of the following?
- A. Secondary hypertension has a specific cause
- B. Secondary hypertension has a more gradual onset than primary hypertension
- C. Secondary hypertension does not cause target organ damage
- D. Secondary hypertension does not normally respond to antihypertensive drug therapy
Correct Answer: A
Rationale: Secondary hypertension has a specific identified cause. A cause could include narrowing of the renal arteries, renal parenchymal disease, hyperaldosteronism, certain medications, pregnancy, and coarctation of the aorta. Secondary hypertension does respond to antihypertensive drug therapy and can cause target organ damage if left untreated.
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.
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 patients medication regimen for the treatment of hypertension includes hydrochlorothiazide. Following administration of this medication, the nurse should anticipate what effect?
- A. Drowsiness or lethargy
- B. Increased urine output
- C. Decreased heart rate
- D. Mild agitation
Correct Answer: B
Rationale: Thiazide diuretics lower BP by reducing circulating blood volume; this results in a short-term increase in urine output. These drugs do not cause bradycardia, agitation, or drowsiness.