Nokea
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.
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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 providing nutritional teaching to a patient with hypertension. Which of the following food groups should the nurse tell the patient that they should have four to five daily servings of?
- A. Whole grains
- B. Vegetables
- C. Meat, fish, and poultry
- D. Fat-free dairy food
- E. Fruit
Correct Answer: B,E
Rationale: Patients should be taught to have four to five daily servings of fruits and vegetables. Whole grains should be seven to eight servings per day. Meat, fish, and poultry are limited to less than 170 g/day. Low-fat dairy foods should be two to three servings per day.
The nurse obtains a blood pressure of 180/75 mm Hg for a patient. What is the patient's mean arterial pressure (MAP)?
- A. 110
- B. 120
- C. 130
- D. 140
Correct Answer: A
Rationale: MAP = (DBP + 1/3 Pulse pressure). For a BP of 180/75 mm Hg, pulse pressure = 180 - 75 = 105 mm Hg. MAP = 75 + (1/3 * 105) = 75 + 35 = 110 mm Hg.
During change-of-shift report, the nurse obtains this information about a patient who is hypertensive and received the first dose of propranolol during the previous shift. Which of the following information indicates that the patient needs immediate intervention?
- A. The patient's most recent BP reading is 156/94 mm Hg.
- B. The patient's pulse has dropped from 64 to 58 beats/minute.
- C. The patient has developed wheezes throughout the lung fields.
- D. The patient complains that the fingers and toes feel quite cold.
Correct Answer: C
Rationale: The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective β-adrenergic blockers) is occurring. The nurse should immediately obtain an oxygen saturation measurement, apply supplemental oxygen, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated; however, this is not as urgently needed as addressing the bronchospasm.
Which of the following assessment findings for a patient who is receiving furosemide to treat stage 2 hypertension is most important to report to the health care provider?
- A. Blood glucose level of 10 mmol/L
- B. Blood potassium level of 3.0 mmol/L
- C. Early morning BP reading of 164/96 mm Hg
- D. Orthostatic systolic BP decrease of 12 mm Hg
Correct Answer: B
Rationale: Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening dysrhythmias. The health care provider should be notified of the potassium level immediately and administration of potassium supplements initiated. The elevated blood glucose and BP also indicate a need for collaborative interventions but will not require action as urgently as the hypokalemia. An orthostatic drop of 12 mm Hg is common and will require intervention only if the patient is symptomatic.