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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.
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The physician is ordering a test for the hypertensive client that will be able to evaluate whether the client has experienced heart damage. Which diagnostic test would the nurse anticipate to determine heart damage?
- A. Blood chemistry
- B. Multiple gated acquisition scan (MUGA)
- C. Chest radiograph
- D. Fluorescein angiography
Correct Answer: B
Rationale: The nurse realizes that undiagnosed (untreated), long-standing hypertension can cause heart damage. The diagnostic test that best determines heart damage is the multiple gate acquisition scan (MUGA). This test is used to detect how efficiently the heart pumps. A blood chemistry determines electrolyte balance. A chest radiograph (chest $x$-ray) can provide details of the heart size through shading on the scan. Fluorescein angiography is an ophthalmologic test revealing leaking retinal blood vessels.
The nurse is working on a clinical research study, obtaining data evaluating central aortic systolic pressure and brachial arm systolic pressure. The client notes a difference in the readings. Which response by the nurse is most accurate?
- A. The difference is due to machine calibration.
- B. The difference is due to the location of pressure measurement.
- C. The difference is due to the discomfort caused by the measurement procedure.
- D. The difference is due to the constrictive force on the arteries when the measurement is taken.
Correct Answer: B
Rationale: Central aortic systolic pressure results, reflecting pressure at the root of the aorta, can be documented as $30 \mathrm{~mm} \mathrm{Hg}$ lower than when corresponding results obtained at the brachial arm. The differences are not due to machine calibration, discomfort, or constriction of the arteries.
The nurse is caring for a client with hypertension. The nurse is correct to realize that a 24-hour urine is ordered to determine if the cause of hypertension is related to the dysfunction of what?
- A. Thyroid gland
- B. Adrenal gland
- C. Pituitary gland
- D. Thymus
Correct Answer: B
Rationale: The 24-hour urine collection specimen is ordered to determine dysfunction of the adrenal gland. The 24-hour urine detects elevated catecholamines. The other options are not evaluated by a 24-hour urine.
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 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.