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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.
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The home health nurse is caring for a patient who has a comorbidity of hypertension. What assessment question most directly addresses the possibility of worsening hypertension?
- A. Are you eating less salt in your diet?
- B. How is your energy level these days?
- C. Do you ever get chest pain when you exercise?
- D. Do you ever see spots in front of your eyes?
Correct Answer: D
Rationale: To identify complications or worsening hypertension, the patient is questioned about blurred vision, spots in front of the eyes, and diminished visual acuity. The heart, nervous system, and kidneys are also carefully assessed, but angina pain and decreased energy are not normally suggestive of worsening hypertension. Sodium limitation is a beneficial lifestyle modification, but nonadherence to this is not necessarily a sign of worsening symptoms.
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 new diagnosis of hypertension. How can the nurse best promote the patients adherence to the prescribed therapeutic regimen?
- A. Screen the patient for visual disturbances regularly
- B. Have the patient participate in monitoring his or her own BP
- C. Emphasize the dire health outcomes associated with inadequate BP control
- D. Encourage the patient to lose weight and exercise regularly
Correct Answer: B
Rationale: Adherence to the therapeutic regimen increases when patients actively participate in self-care, including self-monitoring of BP and diet. Dire warnings may motivate some patients, but for many patients this is not an appropriate or effective strategy. Screening for vision changes and promoting healthy lifestyle are appropriate nursing actions, but do not necessarily promote adherence to a therapeutic regimen.
A patient with primary hypertension comes to the clinic complaining of a gradual onset of blurry vision and decreased visual acuity over the past several weeks. The nurse is aware that these symptoms could be indicative of what?
- A. Retinal blood vessel damage
- B. Glaucoma
- C. Cranial nerve damage
- D. Hypertensive emergency
Correct Answer: A
Rationale: Blurred vision, spots in front of the eyes, and diminished visual acuity can mean retinal blood vessel damage indicative of damage elsewhere in the vascular system as a result of hypertension. Glaucoma and cranial nerve damage do not normally cause these symptoms. A hypertensive emergency would have a more rapid onset.
The nurse is reviewing the medication administration record of a patient who takes a variety of medications for the treatment of hypertension. What potential therapeutic benefits of antihypertensives should the nurse identify? Select all that apply.
- A. Increased venous return
- B. Decreased peripheral resistance
- C. Decreased blood volume
- D. Decreased strength and rate of myocardial contractions
- E. Decreased blood viscosity
Correct Answer: B,C,D
Rationale: The medications used for treating hypertension decrease peripheral resistance, blood volume, or the strength and rate of myocardial contraction. Antihypertensive medications do not increase venous return or decrease blood viscosity.