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A patient has been diagnosed as being prehypertensive. What should the nurse encourage this patient to do to aid in preventing a progression to a hypertensive state?
- A. Avoid excessive potassium intake
- B. Exercise on a regular basis
- C. Eat less protein and more vegetables
- D. Limit morning activity
Correct Answer: B
Rationale: To prevent or delay progression to hypertension and reduce risk, JNC 7 urged health care providers to encourage people with blood pressures in the prehypertension category to begin lifestyle modifications, such as nutritional changes and exercise. There is no need for patients to limit their activity in the morning or to avoid potassium and protein intake.
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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.
The nurse is providing care for a patient with a diagnosis of hypertension. The nurse should consequently assess the patient for signs and symptoms of which other health problem?
- A. Migraines
- B. Atrial-septal defect
- C. Atherosclerosis
- D. Thrombocytopenia
Correct Answer: C
Rationale: Hypertension is both a sign and a risk factor for atherosclerotic heart disease. It is not associated with structural cardiac defects, low platelet levels, or migraines.
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 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 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.