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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.
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The nurse is caring for a patient who is experiencing a hypertensive crisis and is receiving IV labetalol. Which of the following time frequencies should the nurse assess the patients' blood pressure and pulse during the initial administration of this medication?
- A. 2-3 minutes
- B. 5-10 minutes
- C. 15-30 minutes
- D. Hourly
Correct Answer: A
Rationale: Administered intravenously, the drugs have a rapid (within seconds to minutes) onset of action. The patient's BP and pulse should be taken every 2-3 minutes during the initial administration of these drugs.
When a patient with hypertension who has a new prescription for atenolol returns to the health clinic after 2 weeks for a follow-up visit, the BP is unchanged from the previous visit. Which of the following actions should the nurse take first?
- A. Provide information about the use of multiple drugs to treat hypertension.
- B. Teach the patient about the reasons for a possible change in drug therapy.
- C. Remind the patient that lifestyle changes also are important in BP control.
- D. Ask the patient about whether the medication is actually being taken.
Correct Answer: D
Rationale: Since nonadherence with antihypertensive therapy is common, the nurse's initial action should be to determine whether the patient is taking the atenolol as prescribed. The other actions also may be implemented, but these would be done after assessing patient compliance with the prescribed therapy.
The charge nurse observes a new RN doing discharge teaching for a patient who is hypertensive and has a new prescription for enalapril. Which of the following actions by the new RN should cause the charge nurse to intervene in the patient's care?
- A. Check the BP with a home BP monitor every day.
- B. Move slowly when moving from lying to standing.
- C. Increase the dietary intake of high-potassium foods.
- D. Make an appointment with the dietitian for teaching.
Correct Answer: C
Rationale: The ACE inhibitors cause retention of potassium by the kidney, so hyperkalemia is a possible adverse effect. The other teaching by the new RN is appropriate for a patient with newly diagnosed hypertension who has just started therapy with enalapril.
The nurse is caring for a patient with hypertension and has a prescription for propranolol. Which of the following assessment findings should the nurse report to the health care provider before administering this medication?
- A. Asthma
- B. Peptic ulcer disease
- C. Alcohol dependency
- D. Myocardial infarction
Correct Answer: A
Rationale: Nonselective β-adrenergic blockers can cause bronchospasm, putting the patient with a history of asthma at high risk. β-adrenergic blockers will have no effect on the patient's peptic ulcer disease or alcohol dependency. β-adrenergic blocker therapy is recommended after MI.
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.