Nokea
Which of the following assessment findings for a patient who is receiving furosemide to treat stage 2 hypertension is most important to report to the health care provider?
- A. Blood glucose level of 10 mmol/L
- B. Blood potassium level of 3.0 mmol/L
- C. Early morning BP reading of 164/96 mm Hg
- D. Orthostatic systolic BP decrease of 12 mm Hg
Correct Answer: B
Rationale: Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening dysrhythmias. The health care provider should be notified of the potassium level immediately and administration of potassium supplements initiated. The elevated blood glucose and BP also indicate a need for collaborative interventions but will not require action as urgently as the hypokalemia. An orthostatic drop of 12 mm Hg is common and will require intervention only if the patient is symptomatic.
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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 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.
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.
The nurse is teaching a patient with stage I hypertension about diet modifications that should be implemented. Which of the following diet choices indicates that the teaching has been effective?
- A. The patient avoids eating nuts or nut butters.
- B. The patient restricts intake of dietary protein.
- C. The patient has only one cup of coffee in the morning.
- D. The patient has a glass of low-fat milk with each meal.
Correct Answer: D
Rationale: The Dietary Approaches to Stop Hypertension (DASH) recommendations for prevention of hypertension include increasing the intake of calcium-rich foods. Caffeine restriction and decreased protein intake are not included in the recommendations. Nuts are high in beneficial nutrients and 4-5 servings weekly are recommended in the DASH diet.
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.