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The nurse is caring for a patient who has just diagnosed with hypertension and has a new prescription for captopril. Which of the following information is important to include when teaching the patient?
- A. Check BP daily before taking the medication.
- B. Increase fluid intake if dryness of the mouth is a problem.
- C. Include high-potassium foods such as bananas in the diet.
- D. Change position slowly to help prevent dizziness and falls.
Correct Answer: D
Rationale: The angiotensin-converting enzyme (ACE) inhibitors frequently cause orthostatic hypotension, and patients should be taught to change position slowly to allow the vascular system time to compensate for the position change. Increasing fluid intake may counteract the effect of the medication, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP does not need to be checked at home by the patient before taking the medication. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.
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Which of the following assessment findings for a patient who is receiving furosemide to treat stage 2 hypertension is most important to report to the health care provider?
- A. Blood glucose level of 10 mmol/L
- B. Blood potassium level of 3.0 mmol/L
- C. Early morning BP reading of 164/96 mm Hg
- D. Orthostatic systolic BP decrease of 12 mm Hg
Correct Answer: B
Rationale: Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening dysrhythmias. The health care provider should be notified of the potassium level immediately and administration of potassium supplements initiated. The elevated blood glucose and BP also indicate a need for collaborative interventions but will not require action as urgently as the hypokalemia. An orthostatic drop of 12 mm Hg is common and will require intervention only if the patient is symptomatic.
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 is teaching a patient with stage I hypertension about diet modifications that should be implemented. Which of the following diet choices indicates that the teaching has been effective?
- A. The patient avoids eating nuts or nut butters.
- B. The patient restricts intake of dietary protein.
- C. The patient has only one cup of coffee in the morning.
- D. The patient has a glass of low-fat milk with each meal.
Correct Answer: D
Rationale: The Dietary Approaches to Stop Hypertension (DASH) recommendations for prevention of hypertension include increasing the intake of calcium-rich foods. Caffeine restriction and decreased protein intake are not included in the recommendations. Nuts are high in beneficial nutrients and 4-5 servings weekly are recommended in the DASH diet.
The nurse is caring for a patient with hypertension and has just administered the initial dose of labetalol. Which of the following actions should the nurse take?
- A. Encourage oral fluids to prevent dry mouth or dehydration.
- B. Instruct the patient to ask for help if heart palpitations occur.
- C. Ask the patient to request assistance when getting out of bed.
- D. Teach the patient that headaches may occur with this medication.
Correct Answer: C
Rationale: Labetalol decreases sympathetic nervous system activity by blocking both ?±- and β-adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension. Heart palpitations, dehydration, and headaches are possible adverse effects of other antihypertensives.
Which of the following actions should the nurse include in the plan of care for a patient who is receiving IV nitroglycerine to treat a hypertensive emergency?
- A. Organize nursing activities so that the patient has undisturbed sleep for 6 to 8 hours at night.
- B. Assist the patient up in the chair for meals to avoid complications associated with immobility.
- C. Use an automated noninvasive blood pressure machine to obtain frequent BP measurements.
- D. Place the patient on NPO status to prevent aspiration caused by nausea and the associated vomiting.
Correct Answer: C
Rationale: Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV antihypertensive medications. This can be most easily accomplished with an automated BP machine or arterial line. The patient will require frequent assessments, so allowing 6 to 8 hours of undisturbed sleep is not appropriate. When patients are receiving IV vasodilators, bed rest is maintained to prevent decreased cerebral perfusion and fainting. There is no indication that this patient is nauseated or at risk for aspiration, so an NPO status is unnecessary.