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The charge nurse observes a new RN doing discharge teaching for a patient who is hypertensive and has a new prescription for enalapril. Which of the following actions by the new RN should cause the charge nurse to intervene in the patient's care?
- A. Check the BP with a home BP monitor every day.
- B. Move slowly when moving from lying to standing.
- C. Increase the dietary intake of high-potassium foods.
- D. Make an appointment with the dietitian for teaching.
Correct Answer: C
Rationale: The ACE inhibitors cause retention of potassium by the kidney, so hyperkalemia is a possible adverse effect. The other teaching by the new RN is appropriate for a patient with newly diagnosed hypertension who has just started therapy with enalapril.
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Which of the following information should the nurse include when teaching a patient with newly diagnosed hypertension?
- A. Dietary sodium restriction will control BP for most patients.
- B. Most patients are able to control BP through lifestyle changes.
- C. Hypertension is usually asymptomatic until significant organ damage occurs.
- D. Annual BP checks are needed to monitor treatment effectiveness.
Correct Answer: C
Rationale: Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle changes and sodium restriction are used to help manage blood pressure, but drugs are needed for most patients. BP should be checked by the health care provider every 3-6 months.
The nurse obtains this information from a patient with pre-hypertension. Which of the following findings is most important to address with the patient?
- A. Low dietary fibre intake
- B. No regular aerobic exercise
- C. BMI of 23 kg/m^2
- D. Drinks wine with dinner once a week
Correct Answer: B
Rationale: The recommendations for preventing hypertension include exercising aerobically for 30-60 minutes four to seven days a week. A BMI of 23 kg/m^2 is within the normal BMI range. The Dietary Approaches to Stop Hypertension (DASH) diet is high in fibre, but increasing fibre alone will not prevent hypertension from developing. The patient's alcohol intake will not increase the hypertension risk.
The nurse is assessing a patient who is being investigated for possible white coat hypertension. Which of the following actions should the nurse implement first?
- A. Schedule the patient for frequent BP checks in the clinic.
- B. Instruct the patient about the need to decrease stress levels.
- C. Tell the patient how to self-monitor and record BPs at home.
- D. Teach the patient about ambulatory blood pressure monitoring.
Correct Answer: C
Rationale: Having the patient self-monitor BPs at home will provide a reliable indication about whether the patient has hypertension. Frequent BP checks in the clinic are likely to be high in a patient with white coat hypertension. Ambulatory blood pressure monitoring may be used if the data from self-monitoring is unclear. Although elevated stress levels may contribute to hypertension, instructing the patient about this is unlikely to reduce BP.
The nurse is admitting a patient with a history of hypertension and is being treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor to the emergency department. The patient has symptoms of a severe headache and has a BP of 240/118 mm Hg. Which of the following questions should the nurse ask first?
- A. Did you take any acetaminophen today?
- B. Do you have any recent stressful events in your life?
- C. Have you been consistently taking your medications?
- D. Have you recently taken any antihistamine medications?
Correct Answer: C
Rationale: Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do not increase BP. Stressful events will increase BP but not usually to the level seen in this patient.
The nurse in the emergency department received change-of-shift report on these four patients with hypertension. Which of the following patients should the nurse assess first?
- A. 52-year-old with a BP of 212/90 who has intermittent claudication
- B. 43-year-old with a BP of 190/102 who is complaining of chest pain
- C. 50-year-old with a BP of 210/110 who has a creatinine of 1.33 mcmol/L
- D. 48-year-old with a BP of 200/98 whose urine shows microalbuminuria
Correct Answer: B
Rationale: The patient with chest pain may be experiencing acute myocardial infarction and rapid assessment and intervention is needed. The symptoms of the other patients also show target organ damage, but are not indicative of acute processes.