Nokea
The nurse in an oncology clinic notes that the client being treated has hypertension. What tumor is a predisposing condition for secondary hypertension?
- A. Pheochromocytoma
- B. Wilms' tumor
- C. Astrocytoma
- D. Lymphoma
Correct Answer: A
Rationale: Predisposing conditions include kidney disease, pheochromocytoma (a tumor of the adrenal medulla), hyperaldosteronism (increased secretion of mineralocorticoid by the adrenal cortex), atherosclerosis, use of cocaine or other cardiac stimulants (e.g., weight-control drugs, caffeine), and use of oral contraceptives. Wilms' tumors, astrocytomas, and lymphomas are not predisposing conditions for secondary hypertension.
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The nurse is obtaining a health history from a client with a blood pressure of $146 / 88 \mathrm{~mm} \mathrm{Hg}$. The client states that lifestyle changes have not been effective in lowering blood pressure. Which medication classification does the nurse anticipate first?
- A. ACE inhibitors
- B. Beta-blocker
- C. Thiazide diuretic
- D. Calcium channel blocker
Correct Answer: C
Rationale: Clients with hypertension, unable to be lowered by lifestyle changes, usually are placed on a thiazide diuretic initially. However, most people with hypertension will need two or more antihypertensive medications to reduce their blood pressure.
The nurse is volunteering at a community blood pressure screening. A client, never diagnosed with hypertension, presents with a blood pressure of $158 / 90 \mathrm{~mm} \mathrm{Hg}$. Which assessment question(s) is appropriate for the nurse to ask? Select all that apply.
- A. Have you recently drunk a caffeinated beverage?
- B. Did you have a beer after work?
- C. Do you smoke?
- D. Do you have a friend accompanying you?
- E. Are you married and with children?
Correct Answer: A,C
Rationale: At a community blood pressure clinic, the nurse would assess for common factors for a blood pressure to be elevated. Factors that can affect blood pressures readings include smoking or drinking coffee within 30 minutes of the reading. One beer after work should not affect the blood pressure reading, and some individuals may find it relaxing. Social situations are difficult to assess in a community blood pressure clinic.
The nurse is teaching a client about hypertension and the effects on the left ventricle. What diagnostic test will the nurse describe?
- A. echocardiography
- B. computed tomographic (CT) scan
- C. fluorescein angiography
- D. positron emission tomography (PET) scan
Correct Answer: A
Rationale: Echocardiography will reveal an enlarged left ventricle. Fluorescein angiography reveals leaking retinal blood vessels, and a PET scan is used to reveal abnormalities in blood pressure. A CT scan reveals structural abnormalities.
The nurse is working on a busy cardiac unit caring for four hypertensive clients. Which client description would the nurse assess first because the client is at an increased risk for malignant hypertension?
- A. A client with anorexia and history of no health care insurance
- B. A client with liver dysfunction who drinks alcohol daily
- C. A schizophrenic residing at an assisted living facility
- D. A client with chronic asthma who uses a corticosteroid inhaler
Correct Answer: A
Rationale: Accelerated and malignant hypertension can occur in individuals who fail to maintain follow-up or comply with medical therapy. Those individuals who have no health care insurance often are unable to obtain the medical follow-up or afford the cost of medications to treat the hypertensive state. If the hypertension is untreated, symptoms and complication can rapidly follow. The other choices need further assessment but are not the priority.
Which of the following client scenarios would be correct for the nurse to identify as a client with secondary hypertension?
- A. A client experiencing depression
- B. A client diagnosed with kidney disease
- C. A client of advanced age
- D. A client with excessive alcohol intake
Correct Answer: B
Rationale: Secondary hypertension is an elevated blood pressure that results from or is secondary to some other disorder such as kidney disease, a tumor of the adrenal medulla, or atherosclerosis. Depression alone is typically not associated with hypertension. Advanced age and alcohol intake are considered factors for essential hypertension.