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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.
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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.
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.
The nurse is admitting a patient with a history of hypertension and is being treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor to the emergency department. The patient has symptoms of a severe headache and has a BP of 240/118 mm Hg. Which of the following questions should the nurse ask first?
- A. Did you take any acetaminophen today?
- B. Do you have any recent stressful events in your life?
- C. Have you been consistently taking your medications?
- D. Have you recently taken any antihistamine medications?
Correct Answer: C
Rationale: Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do not increase BP. Stressful events will increase BP but not usually to the level seen in this patient.
The nurse is providing nutritional teaching to a patient with hypertension. Which of the following food groups should the nurse tell the patient that they should have four to five daily servings of?
- A. Whole grains
- B. Vegetables
- C. Meat, fish, and poultry
- D. Fat-free dairy food
- E. Fruit
Correct Answer: B,E
Rationale: Patients should be taught to have four to five daily servings of fruits and vegetables. Whole grains should be seven to eight servings per day. Meat, fish, and poultry are limited to less than 170 g/day. Low-fat dairy foods should be two to three servings per day.
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.