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The nurse is assessing a patient new to the clinic. Records brought to the clinic with the patient show the patient has hypertension and that her current BP readings approximate the readings from when she was first diagnosed. What contributing factor should the nurse first explore in an effort to identify the cause of the clients inadequate BP control?
- A. Progressive target organ damage
- B. Possibility of medication interactions
- C. Lack of adherence to prescribed drug therapy
- D. Possible heavy alcohol use or use of recreational drugs
Correct Answer: C
Rationale: Deviation from the therapeutic program is a significant problem for people with hypertension and other chronic conditions requiring lifetime management. An estimated 50% of patients discontinue their medications within 1 year of beginning to take them. Consequently, this is a more likely problem than substance use, organ damage, or adverse drug interactions.
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A patients recently elevated BP has prompted the primary care provider to prescribe furosemide (Lasix). The nurse should closely monitor which of the following?
- A. The clients oxygen saturation level
- B. The patients red blood cells, hematocrit, and hemoglobin
- C. The patients level of consciousness
- D. The patients potassium level
Correct Answer: D
Rationale: Loop diuretics can cause potassium depletion. They do not normally affect level of consciousness, erythrocytes, or oxygen saturation.
A patient newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a patient with prolonged, uncontrolled hypertension is at risk for developing what health problem?
- A. Renal failure
- B. Right ventricular hypertrophy
- C. Glaucoma
- D. Anemia
Correct Answer: A
Rationale: When uncontrolled hypertension is prolonged, it can result in renal failure, myocardial infarction, stroke, impaired vision, left ventricular hypertrophy, and cardiac failure. Glaucoma and anemia are not directly associated with hypertension.
The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in what way?
- A. The BP is always higher in a hypertensive emergency
- B. Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies
- C. Hypertensive urgency is treated with rest and benzodiazepines to lower BP
- D. Hypertensive emergencies are associated with evidence of target organ damage
Correct Answer: D
Rationale: Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. Blood pressures are extremely elevated in both urgency and emergencies, but there is no evidence of target organ damage in hypertensive urgency. Extremely close hemodynamic monitoring of the patients BP is required in both situations. The medications of choice in hypertensive emergencies are those with an immediate effect, such as IV vasodilators. Oral doses of fast-acting agents, such as beta-adrenergic blocking agents, angiotensin-converting enzyme inhibitors, or alpha-agonists, are recommended for the treatment of hypertensive urgencies.
A 40-year-old male newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the patient and advises that the patient should avoid tobacco use. What is the primary rationale behind that advice to the patient?
- A. Quitting smoking will cause the patients hypertension to resolve
- B. Tobacco use increases the patients concurrent risk of heart disease
- C. Tobacco use is associated with a sedentary lifestyle
- D. Tobacco use causes ventricular hypertrophy
Correct Answer: B
Rationale: Smoking increases the risk for heart disease, for which a patient with hypertension is already at an increased risk. Quitting will not necessarily cause hypertension to resolve and smoking does not directly cause ventricular hypertrophy. The association with a sedentary lifestyle is true, but this is not the main rationale for the nurses advice; the association with heart disease is more salient.
A 55-year-old patient comes to the clinic for a routine check-up. The patients BP is 159/100 mm Hg and the physician diagnoses hypertension after referring to previous readings. The patient asks why it is important to treat hypertension. What would be the nurses best response?
- A. Hypertension can cause you to develop dangerous blood clots in your legs that can migrate to your lungs
- B. Hypertension puts you at increased risk of type 1 diabetes and cancer in your age group
- C. Hypertension is the leading cause of death in people your age
- D. Hypertension greatly increases your risk of stroke and heart disease
Correct Answer: D
Rationale: Hypertension, particularly elevated systolic BP, increases the risk of death, stroke, and heart failure in people older than 50 years. Hypertension is not a direct precursor to pulmonary emboli, and it does not put older adults at increased risk of type 1 diabetes or cancer. It is not the leading cause of death in people 55 years of age.