Nokea
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.
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The nurse is caring for a client who is newly diagnosed with hypertension. The client states, 'I do not understand what is causing my blood pressure to continue to rise.' Which information does the nurse recognize as the key structure in regulating arterial blood pressure?
- A. Heart
- B. Lung
- C. Brain
- D. Kidney
Correct Answer: D
Rationale: The body regulates blood pressure throughout the day. The components of the autonomic nervous system, the kidneys, and endocrine glands regulate arterial pressure. The heart is the pump sending blood throughout the system. The lungs exchange oxygen but do not affect blood pressure. The brain recognizes and processes sympathetic nervous system activity to raise blood pressure.
The nurse would screen a client from which ethnic background for hypertension at an early age?
- A. Asian population
- B. Japanese population
- C. Mexican population
- D. Population of African descent
Correct Answer: D
Rationale: The population of African descent is at the highest risk for development of hypertension. The other ethnic backgrounds have a lower risk.
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 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 is caring for a client with malignant hypertension. What would be an appropriate nursing intervention for this client?
- A. Monitor the client's mental and emotional status every hour.
- B. Monitor the blood pressure (BP) every few minutes by applying an automatic BP recording machine.
- C. Monitor the client's blood sugar every hour.
- D. Monitor the client's temperature every few minutes.
Correct Answer: B
Rationale: The nurse applies an automatic BP recording machine to the arm to measure the BP every few minutes. The nurse also keeps emergency equipment and drugs ready in case complications develop. Monitoring the client's mental and emotional status, blood sugar, or temperature every few minutes will not reflect the sudden rise in BP of a client with malignant hypertension.