Nokea
The nurse obtains this information from a patient with pre-hypertension. Which of the following findings is most important to address with the patient?
- A. Low dietary fibre intake
- B. No regular aerobic exercise
- C. BMI of 23 kg/m^2
- D. Drinks wine with dinner once a week
Correct Answer: B
Rationale: The recommendations for preventing hypertension include exercising aerobically for 30-60 minutes four to seven days a week. A BMI of 23 kg/m^2 is within the normal BMI range. The Dietary Approaches to Stop Hypertension (DASH) diet is high in fibre, but increasing fibre alone will not prevent hypertension from developing. The patient's alcohol intake will not increase the hypertension risk.
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Which of the following nursing actions should the nurse take first in order to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes?
- A. Have the patient record dietary intake for 3 days.
- B. Give the patient a detailed list of low-sodium foods.
- C. Teach the patient about foods that are high in sodium.
- D. Help the patient make an appointment with a dietitian.
Correct Answer: A
Rationale: The initial nursing action should be assessment of the patient's baseline dietary intake through a 3-day diet history. The other actions may be appropriate, but assessment of the patient's baseline should occur first.
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 52-year-old patient who has no previous history of hypertension or other health problems and has suddenly developed a BP of 188/106 mm Hg. After reconfirming the BP, which of the following information is best for the nurse to tell the patient?
- A. A BP recheck should be scheduled in a few weeks.
- B. The dietary sodium and fat content should be decreased.
- C. There is an immediate danger of a stroke and hospitalization will be required.
- D. More diagnostic testing may be needed to determine the cause of the hypertension.
Correct Answer: D
Rationale: A sudden increase in BP in a patient over age 50 or under age 20 with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem. The BP will need rapid treatment and ongoing monitoring. If the patient has no other risk factors, a stroke in the immediate future is unlikely. There is no indication that dietary salt or fat intake has contributed to this sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this BP to an acceptable level.
Which of the following BP findings by the nurse indicate that no changes in therapy are needed for a patient with stage 1 hypertension who has a history of heart failure?
- A. 108/64 mm Hg
- B. 128/76 mm Hg
- C. 140/90 mm Hg
- D. 136/82 mm Hg
Correct Answer: B
Rationale: The goal for antihypertensive therapy for a patient with hypertension and heart failure is a BP of <130/80 mm Hg. The BP of 108/64 may indicate overtreatment of the hypertension and an increased risk for adverse effects of drugs. The other two blood pressures indicate a need for modifications in the patient's treatment.
The nurse is assessing a patient who is being investigated for possible white coat hypertension. Which of the following actions should the nurse implement first?
- A. Schedule the patient for frequent BP checks in the clinic.
- B. Instruct the patient about the need to decrease stress levels.
- C. Tell the patient how to self-monitor and record BPs at home.
- D. Teach the patient about ambulatory blood pressure monitoring.
Correct Answer: C
Rationale: Having the patient self-monitor BPs at home will provide a reliable indication about whether the patient has hypertension. Frequent BP checks in the clinic are likely to be high in a patient with white coat hypertension. Ambulatory blood pressure monitoring may be used if the data from self-monitoring is unclear. Although elevated stress levels may contribute to hypertension, instructing the patient about this is unlikely to reduce BP.