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The critical care nurse is caring for a patient just admitted in a hypertensive emergency. The nurse should anticipate the administration of what medication?
- A. Warfarin (Coumadin)
- B. Furosemide (Lasix)
- C. Sodium nitroprusside (Nitropress)
- D. Ramipril (Altace)
Correct Answer: C
Rationale: The medications of choice in hypertensive emergencies are those that have an immediate effect. IV vasodilators, including sodium nitroprusside (Nitropress), nicardipine hydrochloride (Cardene), clevidipine (Cleviprex), fenoldopam mesylate (Corlopam), enalaprilat, and nitroglycerin, have immediate actions that are short lived (minutes to 4 hours), and they are therefore used for initial treatment. Ramipril is administered orally and would not meet the patients immediate need for BP management. Diuretics, such as Lasix, are not used as initial treatments and there is no indication for anticoagulants such as Coumadin.
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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 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.
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.
A newly diagnosed patient with hypertension is prescribed Diuril, a thiazide diuretic. What patient education should the nurse provide to this patient?
- A. Eat a banana every day because Diuril causes moderate hyperkalemia
- B. Take over-the-counter potassium pills because Diuril causes your kidneys to lose potassium
- C. Diuril can cause low blood pressure and dizziness, especially when you get up suddenly
- D. Diuril increases sodium levels in your blood, so cut down on your salt
Correct Answer: C
Rationale: Thiazide diuretics can cause postural hypotension, which may be potentiated by alcohol, barbiturates, opioids, or hot weather. Diuril does not cause either moderate hyperkalemia or severe hypokalemia and it does not result in hypernatremia.
A group of student nurses are practicing taking blood pressure. A 56-year-old male student has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, he exclaims, My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it? Which of the following responses by the nursing instructor would be best?
- A. Yes. Hypertension is prevalent among men; it is fortunate we caught this during your routine examination
- B. We will need to reevaluate your blood pressure because your age places you at high risk for hypertension
- C. A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made
- D. You have no need to worry. Your pressure is probably elevated because you are being tested
Correct Answer: C
Rationale: Hypertension is confirmed by two or more readings with systolic pressure of at least 140 mm Hg and diastolic pressure of at least 90 mm Hg. An age of 56 does not constitute a risk factor in and of itself. The nurse should not tell the student that there is no need to worry.