Lewis: Medical-Surgical Nursing, 8th Edition

Chapter 33: Nursing Management: Hypertension

1. Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline
blood pressure (BP) for a new patient?

a. Obtain a BP reading in each arm and average the results.
b. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second.
c. Have the patient sit in a chair with the feet flat on the floor.
d. Assist the patient to the supine position for BP measurements.

The patient should be seated with the feet flat on the floor. The BP is obtained in both arms, but the results of
the two arms are not averaged. The patient does not need to be in the supine position. The cuff should be
deflated at 2 to 3 mm Hg per second.
ANS: C

2. The nurse obtains this information from a patient with prehypertension. Which finding is
most important to address with the patient?

a. Low dietary fiber intake
b. No regular aerobic exercise
c. Weight 5 pounds above ideal weight
d. Drinks wine with dinner once a week

The recommendations for preventing hypertension include exercising aerobically for 30 minutes most days of
the week. A weight that is 5 pounds over the ideal body weight is not a risk factor for hypertension. The Dietary
Approaches to Stop Hypertension (DASH) diet is high in fiber, but increasing fiber alone will not prevent
hypertension from developing. The patients alcohol intake will not increase the hypertension risk.
ANS: B

3. After giving a patient the initial dose of oral labetalol (Normodyne) for treatment of hypertension,
which action 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.

Labetalol decreases sympathetic nervous system activity by blocking both - and -adrenergic receptors,
leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension. Heart
palpitations, dehydration, and headaches are possible side effects of other antihypertensives.
ANS: C

4. After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be
implemented, which diet choice 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.
ANS: D

The Dietary Approaches to Stop Hypertension (DASH) recommendations for preventionof 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 to 5 servings weekly are recommended in
the DASH diet.
5. A patient has just been diagnosed with hypertension and has a new prescription for captopril
(Capoten). Which information is important to include when teaching the patient?

a. Check BP daily before taking the medication.
b. Increase fluid intake if dryness of the mouth is a problem.
c. Include high-potassium foods such as bananas in the diet.
d. Change position slowly to help prevent dizziness and falls.

The angiotensin-converting enzyme (ACE) inhibitors frequently cause orthostatic hypotension, and patients
should be taught to change position slowly to allow the vascular system time to compensate for the position
change. Increasing fluid intake may counteract the effect of the medication, and the patient is taught to use
gum or hard candy to relieve dry mouth. The BP does not need to be checked at home by the patient before
taking the medication. Because ACE inhibitors cause potassium retention, increased intake of high-potassium
foods is inappropriate.
ANS: D

6. A patient is diagnosed with hypertension and nadolol (Corgard) is prescribed. The nurse should
consult with the health care provider before giving this medication upon finding a history of

a. asthma.
b. peptic ulcer disease.
c. alcohol dependency.
d. myocardial infarction (MI).
- - -adrenergic receptors and can cause bronchospasm, especially in
-blockers will have no effect on the patients peptic ulcer disease or alcohol
-blocker therapy is
recommended after MI.
ANS: A

7. A 52-year-old patient who has no previous history of hypertension or other health problems
suddenly develops a BP of 188/106 mm Hg. After reconfirming the BP, it is appropriate for the nurse to
tell the patient that

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.

A sudden increase in BP in a patient over age 50 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 have 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.
ANS: D

8. Which action will be included in the plan of care when the nurse is caring for a patient who is
receiving sodium nitroprusside (Nipride) to treat a hypertensive emergency?

a. Organize nursing activities so that the patient has undisturbed sleep for 6 to 8
hours at night.
b. Assist the patient up in the chair for meals to avoid complications associated with
immobility.
c. Use an automated noninvasive blood pressure machine to obtain frequent BP
measurements.
d. Place the patient on NPO status to prevent aspiration caused by nausea and the
associated vomiting.

Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV antihypertensive medications.
This can be most easily accomplished with an automated BP machine or arterial line. The patient will require
frequent assessments, so allowing 6 to 8 hours of undisturbed sleep is not appropriate. When patients are
receiving IV vasodilators, bed rest is maintained to prevent decreased cerebral perfusion and fainting.
There is no indication that this patient is nauseated or at risk for aspiration, so an NPO status is unnecessary.
ANS: C

9. The nurse has just finished teaching a hypertensive patient about the newly prescribed quinapril
(Accupril). Which patient statement indicates that more teaching is needed?

a. The medication may not work as well if I take any aspirin.
b. The doctor may order a blood potassium level occasionally.
c. I will call the doctor if I notice that I have a frequent cough.
d. I wont worry if I have a little swelling around my lips and face.

Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an indication that the
ACE inhibitor should be discontinued. The patient should be taught that if any swelling of the face or oral
mucosa occurs, the health care provider should be immediately notified because this could be life threatening.
The other patient statements indicate that the patient has an accurate understanding of ACE inhibitor therapy.
ANS: D

10. During change-of-shift report, the nurse obtains this information about a hypertensive patient who
received the first dose of propranolol (Inderal) during the previous shift.
Which information indicates that the patient needs immediate intervention?

a. The patients most recent BP reading is 156/94 mm Hg.
b. The patients pulse has dropped from 64 to 58 beats/minute.
c. The patient has developed wheezes throughout the lung fields.
d. The patient complains that the fingers and toes feel quite cold.

The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common
-blockers) is occurring. The nurse should immediately obtain an
oxygen saturation measurement, apply supplemental oxygen, and notify the health care provider. The mild
decrease in -receptor blockade
but do not require any change in therapy. The BP reading may indicate that a change in medication type or
dose may be indicated; however, this is not as urgently needed as addressing the bronchospasm.
ANS: C

11. A patient has been diagnosed with possible white coat hypertension. Which action will the nurse
plan to take next?

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.
ANS: C

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.




12. Which BP finding by the nurse indicates 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

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 drug
effects. The other two blood pressures indicate a need for modifications in the patients treatment.
ANS: B


13. Which 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.

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 to 6 months.
ANS: C

14. The nurse in the emergency department received change-of-shift report on four patients with
hypertension. Which patient should the nurse assess first?

a. 52-year-old with a BP of 212/90 who has intermittent claudication
b. 43-year-old with a BP of 190/102 who is complaining of chest pain
c. 50-year-old with a BP of 210/110 who has a creatinine of 1.5 mg/dL
d. 48-year-old with a BP of 200/98 whose urine shows microalbuminuria

The patient with chest pain may be experiencing acute myocardial infarction and rapid assessment and
intervention is needed. The symptoms of the other patients also show target organ damage, but are not
indicative of acute processes.
ANS: B

15. The nurse is reviewing the laboratory tests 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 2.6 mg/dL
b. Serum potassium of 3.8 mEq/L
c. Serum hemoglobin of 14.7 g/dL
d. Blood glucose level of 98 mg/dL
The elevated creatinine indicates renal damage caused by the hypertension. The other laboratory results are
normal.
ANS: A




16. A patient with a history of hypertension treated with a diuretic and an angiotensinconverting
enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and
has a BP of 240/118 mm Hg. Which question should the nurse ask first?

a. Did you take any acetaminophen (Tylenol) 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?

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.
ANS: C

17. The nurse is assessing a patient who has been admitted to the intensive care unit (ICU)
with a hypertensive emergency. Which finding is most important to report to the health
care provider?

a. Urine output over 8 hours is 200 mL less than the fluid intake.
b. The patient is unable to move the left arm and leg when asked to do so.
c. Tremors are noted in the fingers when the patient extends the arms.
d. The patient complains of a severe headache with pain at level 8/10 (0 to 10 scale).

The patients inability to move the left arm and leg indicates that a hemorrhagic stroke may be occurring and
will require immediate action to prevent further neurologic damage. The other clinical manifestations also likely
are caused by the hypertension and will require rapid nursing actions, but they do not require action as
urgently as the neurologic changes.
ANS: B

18. When a patient with hypertension who has a new prescription for atenolol (Tenormin) returns to the
health clinic after 2 weeks for a follow-up visit, the BP is unchanged from the previous visit. Which
action 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. Question the patient about whether the medication is actually being taken.

Since noncompliance with antihypertensive therapy is common, the nurses 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.
ANS: D

19. The RN is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside
(Nipride). Which of the following nursing actions can the nurse delegate to an experienced LPN/LVN?

a. Titrate nitroprusside to maintain BP at 160/100 mm Hg.
b. Evaluate effectiveness of nitroprusside therapy on BP.
c. Set up the automatic blood pressure machine to take BP every 15 minutes.
d. Assess the patients environment for adverse stimuli that might increase BP.

LPN/LVN education and scope of practice include correct use of common equipment such as automatic blood
pressure machines. The other actions require more nursing judgment and education and should be done by
RNs.
ANS: C

20. The charge nurse observes a new RN doing discharge teaching for a hypertensive patient who has a new
prescription for enalapril (Vasotec). The charge nurse will need to intervene if the new RN tells the patient to

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.

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.
ANS: C

21. Which assessment finding for a patient who is receiving furosemide (Lasix) to treat stage 2
hypertension is most important to report to the health care provider?

a. Blood glucose level of 180 mg/dL
b. Blood potassium level of 3.0 mEq/L
c. Early morning BP reading of 164/96 mm Hg
d. Orthostatic systolic BP decrease of 12 mm Hg
Hypokalemia is a frequent adverse effect of the loop diuretics and can cause lifethreatening 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.
ANS: B


22. Which nursing action 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.

The initial nursing action should be assessment of the patients baseline dietary intake through a 3-day food
diary. The other actions may be appropriate, but assessment of the
patients baseline should occur first.
ANS: A

COMPLETION
1. The nurse obtains a blood pressure of 180/75 mm Hg for a patient. What is the patients mean arterial
pressure (MAP)? ____________________
ANS:
MAP = (SBP + 2 DBP)/3
110