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A patient with primary hypertension complains of dizziness with ambulation. The patient is currently on an alpha-adrenergic blocker and the nurse assesses characteristic signs and symptoms of postural hypotension. When teaching this patient about risks associated with postural hypotension, what should the nurse emphasize?
- A. Rising slowly from a lying or sitting position
- B. Increasing fluids to maintain BP
- C. Stopping medication if dizziness persists
- D. Taking medication first thing in the morning
Correct Answer: A
Rationale: Patients who experience postural hypotension should be taught to rise slowly from a lying or sitting position and use a cane or walker if necessary for safety. It is not necessary to teach these patients about increasing fluids or taking medication in the morning (this would increase the effects of dizziness). Patient should not be taught to stop the medication if dizziness persists because this is unsafe and beyond the nurses scope of practice.
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A patient comes to the walk-in clinic complaining of frequent headaches. While assessing the patients vital signs, the nurse notes the BP is 161/101 mm Hg. According to JNC 7, how would this patients BP be defined if a similar reading were obtained at a subsequent office visit?
- A. High normal
- B. Normal
- C. Stage 1 hypertensive
- D. Stage 2 hypertensive
Correct Answer: D
Rationale: JNC 7 defines stage 2 hypertension as a reading 160/100 mm Hg.
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 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.
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.
The hospital nurse cares for many patients who have hypertension. What nursing diagnosis is most common among patients who are being treated for this health problem?
- A. Deficient knowledge regarding the lifestyle modifications for management of hypertension
- B. Noncompliance with therapeutic regimen related to adverse effects of prescribed therapy
- C. Deficient knowledge regarding BP monitoring
- D. Noncompliance with treatment regimen related to medication costs
Correct Answer: B
Rationale: Deviation from the therapeutic program is a significant problem for people with hypertension and other chronic conditions requiring lifetime management. For many patients, this is related to adverse effects of medications. Medication cost is relevant for many patients, but adverse effects are thought to be a more significant barrier. Many patients are aware of necessary lifestyle modification, but do not adhere to them. Most patients are aware of the need to monitor their BP.