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The nurse is providing care for a patient with a new diagnosis of hypertension. How can the nurse best promote the patients adherence to the prescribed therapeutic regimen?
- A. Screen the patient for visual disturbances regularly
- B. Have the patient participate in monitoring his or her own BP
- C. Emphasize the dire health outcomes associated with inadequate BP control
- D. Encourage the patient to lose weight and exercise regularly
Correct Answer: B
Rationale: Adherence to the therapeutic regimen increases when patients actively participate in self-care, including self-monitoring of BP and diet. Dire warnings may motivate some patients, but for many patients this is not an appropriate or effective strategy. Screening for vision changes and promoting healthy lifestyle are appropriate nursing actions, but do not necessarily promote adherence to a therapeutic regimen.
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A patient has come to the clinic for a follow-up assessment that will include a BP reading. To ensure an accurate reading, the nurse should confirm that the patient has done which of the following?
- A. Tried to rest quietly for 5 minutes before the reading is taken
- B. Refrained from smoking for at least 8 hours
- C. Drunk adequate fluids during the day prior
- D. Avoided drinking coffee for 12 hours before the visit
Correct Answer: A
Rationale: Prior to the nurse assessing the patients BP, the patient should try to rest quietly for 5 minutes. The forearm should be positioned at heart level. Caffeine products and cigarette smoking should be avoided for at least 30 minutes prior to the visit. Recent fluid intake is not normally relevant.
A patient with newly diagnosed hypertension has come to the clinic for a follow-up visit. The patient asks the nurse why she has to come in so often. What would be the nurses best response?
- A. We do this so you dont suffer a stroke
- B. We do this to determine how your blood pressure changes throughout the day
- C. We do this to see how often you should change your medication dose
- D. We do this to make sure your health is stable. Well then monitor it at routinely scheduled intervals
Correct Answer: D
Rationale: When hypertension is initially detected, nursing assessment involves carefully monitoring the BP at frequent intervals and then at routinely scheduled intervals. The reference to stroke is frightening and does not capture the overall rationale for the monitoring regimen. Changes throughout the day are not a clinical priority for most patients. The patient must not change his or her medication doses unilaterally.
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.
The nurse is screening a number of adults for hypertension. What range of blood pressure is considered normal?
- A. Less than 140/90 mm Hg
- B. Less than 130/90 mm Hg
- C. Less than 129/89 mm Hg
- D. Less than 120/80 mm Hg
Correct Answer: D
Rationale: JNC 7 defines a blood pressure of less than 120/80 mm Hg as normal, 120 to 129/80 to 89 mm Hg as prehypertension, and 140/90 mm Hg or higher as hypertension.
A 55-year-old patient comes to the clinic for a routine check-up. The patients BP is 159/100 mm Hg and the physician diagnoses hypertension after referring to previous readings. The patient asks why it is important to treat hypertension. What would be the nurses best response?
- A. Hypertension can cause you to develop dangerous blood clots in your legs that can migrate to your lungs
- B. Hypertension puts you at increased risk of type 1 diabetes and cancer in your age group
- C. Hypertension is the leading cause of death in people your age
- D. Hypertension greatly increases your risk of stroke and heart disease
Correct Answer: D
Rationale: Hypertension, particularly elevated systolic BP, increases the risk of death, stroke, and heart failure in people older than 50 years. Hypertension is not a direct precursor to pulmonary emboli, and it does not put older adults at increased risk of type 1 diabetes or cancer. It is not the leading cause of death in people 55 years of age.