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The nurse is working on a busy cardiac unit caring for four hypertensive clients. Which client description would the nurse assess first because the client is at an increased risk for malignant hypertension?
- A. A client with anorexia and history of no health care insurance
- B. A client with liver dysfunction who drinks alcohol daily
- C. A schizophrenic residing at an assisted living facility
- D. A client with chronic asthma who uses a corticosteroid inhaler
Correct Answer: A
Rationale: Accelerated and malignant hypertension can occur in individuals who fail to maintain follow-up or comply with medical therapy. Those individuals who have no health care insurance often are unable to obtain the medical follow-up or afford the cost of medications to treat the hypertensive state. If the hypertension is untreated, symptoms and complication can rapidly follow. The other choices need further assessment but are not the priority.
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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 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 long-standing hypertension. As a client advocate, what should the nurse suggest that is most helpful in preventing further complications?
- A. Maintain a healthy diet of fruits and vegetables.
- B. Focus on exercise at least twice a week.
- C. Obtain a regular appointment with eye doctor.
- D. Avoid use of caffeinated beverages.
Correct Answer: C
Rationale: When a client has long-standing hypertension, the high blood pressure damages the arterial vascular system. As a client advocate, the nurse must instruct on not only prevention but also on early identification of complications. Damages may occur to the tiny arteries in the eyes compromising vision. The most helpful instruction is to maintain a regular appointment with an eye doctor. The other options are good instruction for a healthy lifestyle.
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.
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.