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The nurse is caring for a client who is newly diagnosed with hypertension. The client states, 'I do not understand what is causing my blood pressure to continue to rise.' Which information does the nurse recognize as the key structure in regulating arterial blood pressure?
- A. Heart
- B. Lung
- C. Brain
- D. Kidney
Correct Answer: D
Rationale: The body regulates blood pressure throughout the day. The components of the autonomic nervous system, the kidneys, and endocrine glands regulate arterial pressure. The heart is the pump sending blood throughout the system. The lungs exchange oxygen but do not affect blood pressure. The brain recognizes and processes sympathetic nervous system activity to raise blood pressure.
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The nurse is caring for a client with malignant hypertension. What would be an appropriate nursing intervention for this client?
- A. Monitor the client's mental and emotional status every hour.
- B. Monitor the blood pressure (BP) every few minutes by applying an automatic BP recording machine.
- C. Monitor the client's blood sugar every hour.
- D. Monitor the client's temperature every few minutes.
Correct Answer: B
Rationale: The nurse applies an automatic BP recording machine to the arm to measure the BP every few minutes. The nurse also keeps emergency equipment and drugs ready in case complications develop. Monitoring the client's mental and emotional status, blood sugar, or temperature every few minutes will not reflect the sudden rise in BP of a client with malignant hypertension.
The nurse is evaluating the types of medications prescribed for a client's hypertension. Which of the following medication classifications establishes an action on vasoconstrictive hormones in the blood stream?
- A. Beta-blocker
- B. ACE inhibitor
- C. Loop diuretic
- D. Calcium channel blocker
Correct Answer: B
Rationale: The angiotensin-converting enzyme (ACE) inhibitor's primary action is to prevent the conversion of angiotensin I to angiotensin II, a potent vasoconstricting hormone in the blood. A beta-blocker blocks the beta-adrenergic receptors decreasing sympathetic nervous system stimulation. Loop diuretics excrete water from the loop of Henle, reducing circulating blood volume. Calcium channel blockers dilate coronary and peripheral arteries.
Which of the following is the nurse most correct to recognize as a direct effect of client hypertension?
- A. Renal dysfunction resulting from atherosclerosis
- B. Anemia resulting from bone marrow suppression
- C. Hyperglycemia resulting from insulin receptor resistance
- D. Emphysema related to poor gas exchange
Correct Answer: A
Rationale: The nurse is most correct to realize high blood pressure damages the arterial vascular system and accelerates atherosclerosis. The effect of the atherosclerosis impairs circulation to the kidney, resulting in renal failure. Neither anemia, hyperglycemia, nor emphysema occurs as a direct effect of hypertension.
A client, newly prescribed a low-sodium diet due to hypertension, is asking for help with meal choices. The client names four favorite meal choices. Which selection would be best?
- A. Toasted cheese sandwich on whole wheat toast with tomato soup
- B. Creamed chipped beef over toast with mashed potatoes
- C. Hot dog with ketchup and relish on whole wheat bun
- D. Green pepper stuffed with diced tomatoes and chicken
Correct Answer: D
Rationale: Fresh vegetables are low in sodium. A green pepper with (fresh) diced tomatoes and chicken is a good low-sodium, high vegetable and protein selection. Cheese and soup (tomato and creamed) are high in sodium. Processed meats such as a hot dogs and condiments such as ketchup are high in sodium.
The nurse is caring for a client with hypertension. The nurse is correct to realize that a 24-hour urine is ordered to determine if the cause of hypertension is related to the dysfunction of what?
- A. Thyroid gland
- B. Adrenal gland
- C. Pituitary gland
- D. Thymus
Correct Answer: B
Rationale: The 24-hour urine collection specimen is ordered to determine dysfunction of the adrenal gland. The 24-hour urine detects elevated catecholamines. The other options are not evaluated by a 24-hour urine.