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The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. Which of the following should the nurse integrate into the management of this clients hypertension?
- A. Ensure that the patient receives a larger initial dose of antihypertensive medication due to impaired absorption
- B. Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion
- C. Recognize that an older adult is less likely to adhere to his or her medication regimen than a younger patient
- D. Carefully assess for weight loss because of impaired kidney function resulting from normal aging
Correct Answer: B
Rationale: Elderly people have impaired cardiovascular reflexes and thus are more sensitive to extracellular volume depletion caused by diuretics. The nurse needs to assess hydration status, low BP, and postural hypotension carefully. Older adults may have impaired absorption, but they do not need a higher initial dose of an antihypertensive than a younger person. Adherence to treatment is not necessarily linked to age. Kidney function and absorption decline with age; less, rather than more antihypertensive medication is prescribed. Weight gain is not necessarily indicative of kidney function decline.
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An older adult is newly diagnosed with primary hypertension and has just been started on a beta-blocker. The nurses health education should include which of the following?
- A. Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the beta-blocker
- B. Maintaining a diet high in dairy to increase protein necessary to prevent organ damage
- C. Use of strategies to prevent falls stemming from postural hypotension
- D. Limiting exercise to avoid injury that can be caused by increased intracranial pressure
Correct Answer: C
Rationale: Elderly people have impaired cardiovascular reflexes and are more sensitive to postural hypotension. The nurse teaches patients to change positions slowly when moving from lying or sitting positions to a standing position, and counsels elderly patients to use supportive devices as necessary to prevent falls that could result from dizziness. Lifestyle changes, such as regular physical activity/exercise, and a diet rich in fruits, vegetables, and low-fat dairy products, is strongly recommended. Increasing fluids in elderly patients may be contraindicated due to cardiovascular disease. Increased intracranial pressure is not a risk and activity should not normally be limited.
A student nurse is taking care of an elderly patient with hypertension during a clinical experience. The instructor asks the student about the relationships between BP and age. What would be the best answer by the student?
- A. Because of reduced smooth muscle tone in blood vessels, blood pressure tends to go down with age, not up
- B. Decreases in the strength of arteries and the presence of venous insufficiency cause hypertension in the elderly
- C. Structural and functional changes in the cardiovascular system that occur with age contribute to increases in blood pressure
- D. The neurologic system of older adults is less efficient at monitoring and regulating blood pressure
Correct Answer: C
Rationale: Structural and functional changes in the heart and blood vessels contribute to increases in BP that occur with aging. Venous insufficiency does not cause hypertension, however. Increased BP is not primarily a result of neurologic changes.
A 40-year-old male newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the patient and advises that the patient should avoid tobacco use. What is the primary rationale behind that advice to the patient?
- A. Quitting smoking will cause the patients hypertension to resolve
- B. Tobacco use increases the patients concurrent risk of heart disease
- C. Tobacco use is associated with a sedentary lifestyle
- D. Tobacco use causes ventricular hypertrophy
Correct Answer: B
Rationale: Smoking increases the risk for heart disease, for which a patient with hypertension is already at an increased risk. Quitting will not necessarily cause hypertension to resolve and smoking does not directly cause ventricular hypertrophy. The association with a sedentary lifestyle is true, but this is not the main rationale for the nurses advice; the association with heart disease is more salient.
The nurse is providing care for a patient with a diagnosis of hypertension. The nurse should consequently assess the patient for signs and symptoms of which other health problem?
- A. Migraines
- B. Atrial-septal defect
- C. Atherosclerosis
- D. Thrombocytopenia
Correct Answer: C
Rationale: Hypertension is both a sign and a risk factor for atherosclerotic heart disease. It is not associated with structural cardiac defects, low platelet levels, or migraines.
A patient with primary hypertension comes to the clinic complaining of a gradual onset of blurry vision and decreased visual acuity over the past several weeks. The nurse is aware that these symptoms could be indicative of what?
- A. Retinal blood vessel damage
- B. Glaucoma
- C. Cranial nerve damage
- D. Hypertensive emergency
Correct Answer: A
Rationale: Blurred vision, spots in front of the eyes, and diminished visual acuity can mean retinal blood vessel damage indicative of damage elsewhere in the vascular system as a result of hypertension. Glaucoma and cranial nerve damage do not normally cause these symptoms. A hypertensive emergency would have a more rapid onset.