Nokea
The nurse is obtaining a health history from a client with a blood pressure of $146 / 88 \mathrm{~mm} \mathrm{Hg}$. The client states that lifestyle changes have not been effective in lowering blood pressure. Which medication classification does the nurse anticipate first?
- A. ACE inhibitors
- B. Beta-blocker
- C. Thiazide diuretic
- D. Calcium channel blocker
Correct Answer: C
Rationale: Clients with hypertension, unable to be lowered by lifestyle changes, usually are placed on a thiazide diuretic initially. However, most people with hypertension will need two or more antihypertensive medications to reduce their blood pressure.
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The nurse is screening a client at a health fair for hypertension. Which assessment data, provided by the client, would prompt the nurse to stress physician involvement? Select all that apply.
- A. Fatigue
- B. Constipation
- C. Headache
- D. Insomnia
- E. Dysuria
- F. Blurred vision
Correct Answer: A,C,D,F
Rationale: When assessing the client for symptoms of hypertension, the nurse should recognize that the client may note fatigue, headache, insomnia, and blurred vision. Other symptoms include dizziness, nervousness, nosebleeds, angina, and dyspnea. Constipation and dysuria are not signs of hypertension.
The nurse and a dietitian are instructing the client on a low-sodium diet needed to lower the blood pressure. Which question is most important for the nurse to ask?
- A. Who eats meals with you?
- B. How do you prepare your food?
- C. Do you eat three meals per day?
- D. Do you snack in the evening?
Correct Answer: B
Rationale: Asking the client how food is prepared gives the nurse and dietitian the ability to judge the sodium content. Typically, canned or prepared food and food from a restaurant will have elevated sodium levels. Sodium content in food prepared from fresh ingredients is usually minimal. Asking about whom the client eats with or the client's eating patterns are not as helpful in determining sodium content.
Which of the following client scenarios would be correct for the nurse to identify as a client with secondary hypertension?
- A. A client experiencing depression
- B. A client diagnosed with kidney disease
- C. A client of advanced age
- D. A client with excessive alcohol intake
Correct Answer: B
Rationale: Secondary hypertension is an elevated blood pressure that results from or is secondary to some other disorder such as kidney disease, a tumor of the adrenal medulla, or atherosclerosis. Depression alone is typically not associated with hypertension. Advanced age and alcohol intake are considered factors for essential hypertension.
Which of the following is the nurse most correct to recognize as a direct effect of client hypertension?
- A. Renal dysfunction resulting from atherosclerosis
- B. Anemia resulting from bone marrow suppression
- C. Hyperglycemia resulting from insulin receptor resistance
- D. Emphysema related to poor gas exchange
Correct Answer: A
Rationale: The nurse is most correct to realize high blood pressure damages the arterial vascular system and accelerates atherosclerosis. The effect of the atherosclerosis impairs circulation to the kidney, resulting in renal failure. Neither anemia, hyperglycemia, nor emphysema occurs as a direct effect of hypertension.
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.