Nokea
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.
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Which of the following information should the nurse include when teaching a patient with newly diagnosed hypertension?
- A. Dietary sodium restriction will control BP for most patients.
- B. Most patients are able to control BP through lifestyle changes.
- C. Hypertension is usually asymptomatic until significant organ damage occurs.
- D. Annual BP checks are needed to monitor treatment effectiveness.
Correct Answer: C
Rationale: Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle changes and sodium restriction are used to help manage blood pressure, but drugs are needed for most patients. BP should be checked by the health care provider every 3-6 months.
The nurse in the emergency department received change-of-shift report on these four patients with hypertension. Which of the following patients should the nurse assess first?
- A. 52-year-old with a BP of 212/90 who has intermittent claudication
- B. 43-year-old with a BP of 190/102 who is complaining of chest pain
- C. 50-year-old with a BP of 210/110 who has a creatinine of 1.33 mcmol/L
- D. 48-year-old with a BP of 200/98 whose urine shows microalbuminuria
Correct Answer: B
Rationale: The patient with chest pain may be experiencing acute myocardial infarction and rapid assessment and intervention is needed. The symptoms of the other patients also show target organ damage, but are not indicative of acute processes.
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.
The nurse obtains a blood pressure of 180/75 mm Hg for a patient. What is the patient's mean arterial pressure (MAP)?
- A. 110
- B. 120
- C. 130
- D. 140
Correct Answer: A
Rationale: MAP = (DBP + 1/3 Pulse pressure). For a BP of 180/75 mm Hg, pulse pressure = 180 - 75 = 105 mm Hg. MAP = 75 + (1/3 * 105) = 75 + 35 = 110 mm Hg.
During change-of-shift report, the nurse obtains this information about a patient who is hypertensive and received the first dose of propranolol during the previous shift. Which of the following information indicates that the patient needs immediate intervention?
- A. The patient's most recent BP reading is 156/94 mm Hg.
- B. The patient's pulse has dropped from 64 to 58 beats/minute.
- C. The patient has developed wheezes throughout the lung fields.
- D. The patient complains that the fingers and toes feel quite cold.
Correct Answer: C
Rationale: The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective β-adrenergic blockers) is occurring. The nurse should immediately obtain an oxygen saturation measurement, apply supplemental oxygen, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated; however, this is not as urgently needed as addressing the bronchospasm.