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The nurse is caring for a client with long-standing hypertension. As a client advocate, what should the nurse suggest that is most helpful in preventing further complications?
- A. Maintain a healthy diet of fruits and vegetables.
- B. Focus on exercise at least twice a week.
- C. Obtain a regular appointment with eye doctor.
- D. Avoid use of caffeinated beverages.
Correct Answer: C
Rationale: When a client has long-standing hypertension, the high blood pressure damages the arterial vascular system. As a client advocate, the nurse must instruct on not only prevention but also on early identification of complications. Damages may occur to the tiny arteries in the eyes compromising vision. The most helpful instruction is to maintain a regular appointment with an eye doctor. The other options are good instruction for a healthy lifestyle.
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The nurse is teaching a client about hypertension and the effects on the left ventricle. What diagnostic test will the nurse describe?
- A. echocardiography
- B. computed tomographic (CT) scan
- C. fluorescein angiography
- D. positron emission tomography (PET) scan
Correct Answer: A
Rationale: Echocardiography will reveal an enlarged left ventricle. Fluorescein angiography reveals leaking retinal blood vessels, and a PET scan is used to reveal abnormalities in blood pressure. A CT scan reveals structural abnormalities.
The nurse in an oncology clinic notes that the client being treated has hypertension. What tumor is a predisposing condition for secondary hypertension?
- A. Pheochromocytoma
- B. Wilms' tumor
- C. Astrocytoma
- D. Lymphoma
Correct Answer: A
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. Wilms' tumors, astrocytomas, and lymphomas are not predisposing conditions for secondary 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.
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.
The nurse is working on a busy cardiac unit caring for four hypertensive clients. Which client description would the nurse assess first because the client is at an increased risk for malignant hypertension?
- A. A client with anorexia and history of no health care insurance
- B. A client with liver dysfunction who drinks alcohol daily
- C. A schizophrenic residing at an assisted living facility
- D. A client with chronic asthma who uses a corticosteroid inhaler
Correct Answer: A
Rationale: Accelerated and malignant hypertension can occur in individuals who fail to maintain follow-up or comply with medical therapy. Those individuals who have no health care insurance often are unable to obtain the medical follow-up or afford the cost of medications to treat the hypertensive state. If the hypertension is untreated, symptoms and complication can rapidly follow. The other choices need further assessment but are not the priority.