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.
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
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.
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
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.
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)
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.
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.
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 won't worry if I have a little swelling around my lips and
face."
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 patient's most recent BP reading is 156/94 mm Hg.
b. The patient's 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.
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
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
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.
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
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
ANS: A
16. A patient with a history of hypertension treated with a
diuretic and an angiotensin-converting 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?
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).
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.
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 patient's environment for adverse stimuli that
might increase BP.
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.
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
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.
ANS: A
23. Metoprolol (Toprol XL) is added to the pharmacologic
therapy of a diabetic female diagnosed with stage 2
hypertension initially treated with Furosemide (Lasix) and
Ramipril (Altace). An expected therapeutic effect is:
a. Decrease in heart rate.
b. Lessening of fatigue.
c. Improvement in blood sugar levels.
d. Increase in urine output.
ANS: A
24. A client is taking clonidine (Catapres) for treatment of
hypertension. The nurse should teach the client about which
of the following common adverse effects of this drug? Select
all that apply.
a. Dry mouth.
b. Hyperkalemia.
c. Impotence.
d. Pancreatitis.
e. Sleep disturbance.
ANS: A, C, E
25. A client with hypertensive emergency is being treated
with sodium nitroprusside (Nipride). In a dilution of 50 mg/
250 mL, how many micrograms of Nipride are in each
milliliter? ________________________ mcg.
ANS: 200 mcg
26. An industrial health nurse at a large printing plant finds a
male employee's blood pressure to be elevated on two
occasions 1 month apart and refers him to his private
physician. The employee is about 25 lb overweight and has
smoked a pack of cigarettes daily for more than 20 years. The
client's physician prescribes atenolol (Tenormin) for the
hypertension. The nurse should instruct the client to:
a. Avoid sudden discontinuation of the drug.
b. Monitor the blood pressure annually.
c. Follow a 2-g sodium diet.
d. Discontinue the medication if severe headaches develop.
ANS: A
27. The nurse teaches a client, who has recently been
diagnosed with hypertension, about dietary restrictions: a
low-calorie, low-fat, low-sodium diet. Which of the following
menu selections would best meet the client's needs?
a. Mixed green salad with blue cheese dressing, crackers, and
cold cuts.
b. Ham sandwich on rye bread and an orange.
c. Baked chicken, an apple, and a slice of white bread.
d. Hot dogs, baked beans, and celery and carrot sticks.
ANS: C
28. A client's job involves working in a warm, dry room,
frequently bending and crouching to check the underside of a
high-speed press, and wearing eye guards. Given this
information, the nurse should assess the client for which of
the following?
a. Muscle aches.
b. Thirst.
c. Lethargy.
d. Orthostatic hypotension.
ANS: D
29. An exercise program is prescribed for the client with
hypertension. Which intervention would be most likely to
assist the client in maintaining an exercise program?
a. Giving the client a written exercise program.
b. Explaining the exercise program to the client's spouse.
c. Reassuring the client that he or she can do the exercise
program.
d. Tailoring a program to the client's needs and abilities.
ANS: D
30. The client realizes the importance of quitting smoking,
and the nurse develops a plan to help the client achieve this
goal. Which of the following nursing interventions should be
the initial step in this plan?
1. Review the negative effects of smoking on the body.
2. Discuss the effects of passive smoking on environmental
pollution.
3. Establish the client's daily smoking pattern.
4. Explain how smoking worsens high blood pressure.
ANS: C
31. Essential hypertension would be diagnosed in a 40-year-
old male whose blood pressure readings were consistently at
or above which of the following?
1. 120/ 90 mm Hg.
2. 130/ 85 mm Hg.
3. 140/ 90 mm Hg.
4. 160/ 80 mm Hg.
ANS: C
32. When teaching a client about propranolol hydrochloride,
the nurse should base the information on the knowledge that
propranolol:
a. Blocks beta-adrenergic stimulation and thus causes
decreased heart rate, myocardial contractility, and
conduction.
b. Increases norepinephrine secretion and thus decreases
blood pressure and heart rate.
c. Is a potent arterial and venous vasodilator that reduces
peripheral vascular resistance and lowers blood pressure.
d. Is an angiotensin-converting enzyme inhibitor that reduces
blood pressure by blocking the conversion of angiotensin I to
angiotensin II.
ANS: A
33. The most important long-term goal for a client with
hypertension would be to:
a. Learn how to avoid stress.
b. Explore a job change or early retirement.
c. Make a commitment to long-term therapy.
d. Lose weight.
ANS: C

34. The client has had hypertension for 20 years. The nurse a. 0.24 mL
should assess the client for? b. 4.8 mL
c. 2.4 mL
1. Renal insufficiency and failure.
d. 0.48 mL
2. Valvular heart disease.
ANS: B
3. Endocarditis.
40. A patient is being treated for hypertensive emergency.
4. Peptic ulcer disease. When treating this patient, the priority goal is to lower the
mean blood pressure (BP) by which percentage in the first
ANS: A hour?
35. The nurse is developing a care plan with an older adult a. 45%
and is instructing the client that hypertension can be a silent b. 35%
killer. The nurse should instruct the client to be aware of c. 40%
signs and symptoms of other system failures and encourage d. Up to 25%
the client to report signs of which of the following diseases
that are often a result of undeteced high blood pressure? ANS: D

1. Cerebrovascular accidents (CVAs). 41. The nurse is caring for an elderly client with a diagnosis of
hypertension, who is taking several antihypertensive
2. Liver disease. medications. Which saftey precaution is the nurse most likely
to reinforce?
3. Myocardial infarction.
a. Being sure to keep follow-up appointments
4. Pulmonary disease.
b. Walking as far as the client is able every day
ANS: A c. Eating extra potassium due to loss of potassium related to
medications
36. A client treated for hypertension with furosemide (Lasix), d. Changing positions slowly related to possible hypotension
atenolol (Tenormin), and ramipril (Altace) develops a second
degree heart block Mobitz type 1. Which of the following ANS: D
actions should the nurse take?
42. A nurse is teaching about lifestyle modifications to a
1. Administer a 250 mL fluid bolus. group of clients with known hypertension. Which of the
following statements would the nurse include in the
2. Withhold the atenolol. education session?
3. Prepare for cardioversion. a. Limit alcohol consumption to no more that 3 drinks per
4. Set up for an arterial line. day.
b. Maintain a waist circumference of 45 (men) and 40
ANS: B (women) inches or less.
c. Engage in aerobic activity at least 30 minutes/day most
37. A client with newly diagnosed hypertension asks what she
days of the week.
can do to decrease the risk for related cardiovascular
d. Maintain a body mass index between 30 and 35.
problems. Which of the following risk factors is modifiable by
the client? ANS: C
a. Impaired renal function 43. A nurse is providing education about lifestyle
b. Dyslipidemia modifications to a group of clients who have been newly
c. Age diagnosed with hypertension. The nurse would include all the
d. Family history following statesments except:
ANS: B a. Maintain a waist circumference of 40 (men) and 35
(women) inches or less.
38. When treating hypertensive emergencies, the nurse
b. Engage in aerobic activity at least 30 minutes/day most
identifies the most appropriate route of administration for
days of the week.
antihypertensive agents as being which of the following?
c. Maintain a normal body mass index of about 24.
a. Sublingual d. Limit alcohol consumption to no more that 3 drinks per day
b. Continuous IV infusion for men and 2 drinks per day for women.
c. Oral
ANS: D
d. Intramuscular
44. You are part of a group of nursing students who are
ANS: B
making a presentation on chronic hypertension. What is one
39. A nurse is caring for a client with hypertension. The subject you would need to include in your presentation as a
physician orders furosemide (lasix) 2 mg/kg to be given possible consequence of untreated chronic hypertension?
intravenously. The client weighs 24 kg. The medication comes
in a single-use vial that contains 40 mg in 4 mL (10 mg/mL).
How much will the nurse draw up for this client's dose?
a. Right-sided heart failure a. If a dosage of medication is missed, double up on the next
b. Stroke one to catch up.
c. Pulmonary insufficiency b. Avoid over the counter (OTC) cold, weight reduction, and
d. Peripheral edema sinus medications.
c. Avoid hot baths, exercise, and alcohol within 3 hours of
ANS: B
taking vasodilators.
45. Which of the following describes a situation in which the d. Do not stop antihypertensive medication abruptly.
blood pressure is severely elevated and there is evidence of
ANS: A
actual or probable target organ damage?
51. Decreasing hypertension is the main focus of the medical
a. Hypertensive urgency
cardiology practice where you practice nursing. Different
b. Secondary hypertension
goals apply to different age groups for managing and
c. Primary hypertension
reducing blood pressures. Angie Dodd, a 54-year-old nurse, is
d. Hypertensive emergency
beginning medical management of her recently diagnosed
ANS: D hypertension. What is considered the most important
strategy in her treatment?
46. An 87-year-old client was just recently diagnosed with
prehypertension. She is to meet with a dietitian and return a. Reducing her systolic pressure below 140 mmHg
for a follow-up with her cardiologist in 6 months. As her b. Reducing her systolic pressure below 130 mmHg
nurse, what would you expect her treatment to include? c. Reducing her diastolic pressure below 80 mmHg
d. Reducing her diastolic pressure below 90 mmHg
a. Procedural interventions
b. No intervention, just observation ANS: A
c. Nonpharmacological interventions
52. A nurse is discussing with a nursing student how to
d. Pharmacological interventions
accurately measure blood pressure. Which of the following
ANS: C points does the nurse emphasize?

47. A client, newly prescribed a low-sodium diet due to
hypertension, is asking for help with meal choices. The client
provides four meal choices, which are favorites. Which
selection would be best?
a. Hot dog with ketchup and relish on whole wheat bun
b. Green pepper stuffed with diced tomatoes and chicken
c. Creamed chipped beef over toast with mashed potatoes
d. Toasted cheese sandwich on whole wheat toast with
tomato soup
ANS: B
48. Primary or essential hypertension accounts for about 95%
of all hypertension diagnoses—with an unknown etiology.
Secondary hypertension accompanies specific conditions that
create hypertension as a result of tissue damage. Which of
the following conditions contribute to secondary
hypertension?
a. Calcium deficit
b. Hepatic function
c. Arterial vasoconstriction
d. Acid-base imbalance
ANS: C
49. Papilledema is a fairly common symptom of elevated
blood pressure. The best way to detect this condition is
through:
a. An MRI
b. Laboratory tests
c. Ophthalmic examination
d. Using a sphygmomanometer
a. The size of the cuff does not matter as long as it fits snugly
around the arm.
b. A cuff that is too small will give a false low blood pressure.
c. A cuff that is too large will give a false high blood pressure.
d. A cuff that is too small will give a false high blood pressure.
ANS: D
53. You are doing the final checklist before sending home a
63-year-old female who has been newly diagnosed with
hypertension. She is going to be starting her first
antihypertensive medicine. What is one of the main things
you should tell her and her husband to watch for?
a. Tremor
b. Persistent cough
c. Blurred vision
d. Dizziness
ANS: D
54. You're seeing a patient in a low-income clinic for the first
time and have just checked her BP. You're entering her as
prehypertensive because:
a. Her diastolic blood pressure is between 80 and 89 mm Hg.
b. Her systolic BP is above 180 mm Hg.
c. Her diastolic blood pressure is at 100 mm Hg.
d. Her systolic BP is between 120 and 130 mm Hg.
ANS: A

ANS: C

50. The nurse understands that patient education related to

antihypertensive medication should include all of the
following instructions except which of the following?