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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.
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Which of the following nursing actions should the nurse take first in order to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes?
- A. Have the patient record dietary intake for 3 days.
- B. Give the patient a detailed list of low-sodium foods.
- C. Teach the patient about foods that are high in sodium.
- D. Help the patient make an appointment with a dietitian.
Correct Answer: A
Rationale: The initial nursing action should be assessment of the patient's baseline dietary intake through a 3-day diet history. The other actions may be appropriate, but assessment of the patient's baseline should occur first.
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.
Which of the following BP findings by the nurse indicate that no changes in therapy are needed for a patient with stage 1 hypertension who has a history of heart failure?
- A. 108/64 mm Hg
- B. 128/76 mm Hg
- C. 140/90 mm Hg
- D. 136/82 mm Hg
Correct Answer: B
Rationale: The goal for antihypertensive therapy for a patient with hypertension and heart failure is a BP of <130/80 mm Hg. The BP of 108/64 may indicate overtreatment of the hypertension and an increased risk for adverse effects of drugs. The other two blood pressures indicate a need for modifications in the patient's treatment.
The nurse is reviewing the laboratory test results for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider?
- A. Serum creatinine of 230 mcmol/L
- B. Serum potassium of 3.8 mmol/L
- C. Serum hemoglobin of 147 g/L
- D. Blood glucose level of 5.3 mmol/L
Correct Answer: A
Rationale: The elevated creatinine indicates renal damage caused by the hypertension. The other laboratory results are normal.
The nurse is assessing a patient who is being investigated for possible white coat hypertension. Which of the following actions should the nurse implement first?
- A. Schedule the patient for frequent BP checks in the clinic.
- B. Instruct the patient about the need to decrease stress levels.
- C. Tell the patient how to self-monitor and record BPs at home.
- D. Teach the patient about ambulatory blood pressure monitoring.
Correct Answer: C
Rationale: Having the patient self-monitor BPs at home will provide a reliable indication about whether the patient has hypertension. Frequent BP checks in the clinic are likely to be high in a patient with white coat hypertension. Ambulatory blood pressure monitoring may be used if the data from self-monitoring is unclear. Although elevated stress levels may contribute to hypertension, instructing the patient about this is unlikely to reduce BP.