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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.
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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.
When a patient with hypertension who has a new prescription for atenolol returns to the health clinic after 2 weeks for a follow-up visit, the BP is unchanged from the previous visit. Which of the following actions should the nurse take first?
- A. Provide information about the use of multiple drugs to treat hypertension.
- B. Teach the patient about the reasons for a possible change in drug therapy.
- C. Remind the patient that lifestyle changes also are important in BP control.
- D. Ask the patient about whether the medication is actually being taken.
Correct Answer: D
Rationale: Since nonadherence with antihypertensive therapy is common, the nurse's initial action should be to determine whether the patient is taking the atenolol as prescribed. The other actions also may be implemented, but these would be done after assessing patient compliance with the prescribed therapy.
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.
Which of the following actions should the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new patient?
- A. Obtain a BP reading in each arm and average the results.
- B. Deflate the BP cuff at a rate of 5-10 mm Hg/second.
- C. Have the patient sit in a chair.
- D. Assist the patient to the supine position for BP measurements.
Correct Answer: C
Rationale: The patient should be seated to assess the initial BP and pulse. The BP is obtained in both arms, but the results of the two arms are not averaged. The patient does not need to be in the supine position. The cuff should be deflated at 2-3 mm Hg/second.
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.