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The nurse is caring for a client with accelerated hypertension. Which body system would the nurse assess to identify early signs of blood pressure progression?
- A. Eyes
- B. Kidney
- C. Heart
- D. Musculoskeletal system
Correct Answer: A
Rationale: Accelerated hypertension is defined as a markedly elevated blood pressure with symptoms of hemorrhages and exudates in the eyes. If the hypertension is untreated, accelerated hypertension progresses to malignant hypertension with symptoms of papilledema. Long-standing hypertension can produce changes in the kidney, heart, and musculoskeletal system.
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The nurse is caring for a client with essential hypertension. The nurse reviews lab work and assesses kidney function. Which action of the kidney would the nurse evaluate as the body's attempt to regulate high blood pressure?
- A. The kidney retains sodium and water.
- B. The kidney excretes sodium and water.
- C. The kidney retains sodium and excretes water.
- D. The kidney retains water and excretes sodium.
Correct Answer: B
Rationale: Hypernatremia (elevated serum sodium level) increases blood volume, which raises blood pressure. The kidney's response to the elevation in blood pressure is to excrete sodium and excess water. Any retention of sodium and water would increase blood volume and, thus, blood pressure. Sodium and water move together.
The nurse obtains a blood pressure of $136 / 86 \mathrm{~mm} \mathrm{Hg}$ on a morning assessment of a client with history of hypertension. Which pressure is of most concern when considering ventricular relaxation?
- A. Central aortic pressure
- B. Systolic pressure
- C. Diastolic pressure
- D. Central venous pressure
Correct Answer: C
Rationale: Diastolic blood pressure reflects arterial pressure during ventricular relaxation. It depends on the resistance of the arterioles and the diastolic filing times. Central aortic pressure is the blood pressure pumped from the left ventricle and measured at the root of the aorta. Systolic blood pressure is determined by the force and volume of blood that the left ventricle ejects. Central venous pressure reflects the blood pressure returning to the heart.
The nurse is caring for a client diagnosed with secondary hypertension. What would be a predisposing condition for this diagnosis?
- A. Use of diazepam
- B. Hypoaldosteronism
- C. Pancreatic disease
- D. Use of oral contraceptives
Correct Answer: D
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. Secondary hypertension is not caused by the use of sedatives, hypoaldosteronism, or pancreatic disease.
The nurse and a dietitian are instructing the client on a low-sodium diet needed to lower the blood pressure. Which question is most important for the nurse to ask?
- A. Who eats meals with you?
- B. How do you prepare your food?
- C. Do you eat three meals per day?
- D. Do you snack in the evening?
Correct Answer: B
Rationale: Asking the client how food is prepared gives the nurse and dietitian the ability to judge the sodium content. Typically, canned or prepared food and food from a restaurant will have elevated sodium levels. Sodium content in food prepared from fresh ingredients is usually minimal. Asking about whom the client eats with or the client's eating patterns are not as helpful in determining sodium content.
The nurse is employed in a physician's office and is caring for a client present for an annual exam. A blood pressure of $124 / 84 \mathrm{~mm} \mathrm{Hg}$ is documented. Following revised guidelines for identifying hypertension, which educational pamphlet is helpful?
- A. Increasing fluids for low blood pressure
- B. Stress reduction to lower prehypertensive state
- C. Use of beta-blockers for treatment of hypertension
- D. Diagnostic testing for determining cardiac functioning
Correct Answer: B
Rationale: A blood pressure of $124 / 84 \mathrm{~mm} \mathrm{Hg}$ is now considered to be in the lower range of prehypertension. Knowledge of stress reduction may be helpful in lowering the blood pressure without medication therapy. A blood pressure of $124 / 84 \mathrm{~mm} \mathrm{Hg}$ is not considered a low blood pressure or in need of medication therapy due to hypertension. Diagnostic testing for cardiac functioning is not typical for a client with prehypertension.