Chapter 32 Assessment and Management of Patients With Hypertension


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Chapter 32  Assessment and Management of Patients With Hypertension



Complete Chapter Questions And Answers

Sample Questions


Multiple Choice

1. An 80-year-old male, newly diagnosed with primary hypertension, has just been started on a beta-blocker. The nurse knows that in addition to teaching the patient about his medication—ie, side effects, purpose, and schedule—she should also focus her teaching on what?
A) Increasing fluids to avoid extracellular volume depletion from the diurectic effect of the beta-blocker

B) Maintaining a diet high in dairy to increase protein necessary to prevent organ damage C) Use of supportive devices such as hand rails and walkers to prevent falls stemming from postural hypotension
D) Limiting exercise to avoid injury that can be caused by postural hypotension

Ans: C
Chapter: 32
Client Needs: B
Cognitive Level: Application Difficulty: Moderate
Integrated Process: Teaching/Learning Objective: 4
Page and Header: 899, Hypertension

Feedback: Elderly people have impaired cardiovascular reflexes and are more sensitive to

postural hypotension. The nurse teaches patients to change positions slowly when moving from lying or sitting positions to a standing position, and counsels elderly patients to use supportive devices as necessary to prevent falls that could result from dizziness. Lifestyle changes such as regular physical activity/exercise, and a diet rich in fruits, vegetables, and low-fat dairy products, is strongly recommended. Increasing fluids in elderly patients may be contraindicated due to cardiovascular disease.

2. A patient with primary hypertension comes to the clinic complaining of a change in vision— ie, blurring and decreased visual acuity. The nurse is aware that these symptoms could be indicative of what?
A) Retinal blood vessel damage

B) Chronic kidney disease C) Impending stroke
D) Hypertensive emergency

Ans: A
Chapter: 32
Client Needs: A-1
Cognitive Level: Knowledge Difficulty: Moderate
Integrated Process: Nursing Process Objective: 3
Page and Header: 900, Hypertension

Feedback: Blurred vision, spots in front of the eyes, and diminished visual acuity can mean retinal blood vessel damage indicative of damage elsewhere in the vascular system. An eye exam with an ophthalmoscope is particularly important and any significant findings are promptly reported to determine the need for additional diagnostic studies. Blurred vision and a change in visual acuity are not usually indicative of chronic kidney disease, impending stroke, or a hypertensive emergency.

3. A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective assessment data from a patient with hypertension, the patient tells the nurse that she has a family history of hypertension and she herself has high cholesterol and lipids. The patient says she smokes 1 pack of cigarettes daily and drinks “about a pack of beer” every day. The nurse notes that a modifiable risk factor of this patient is what?

A) Hyperlipidemia
B) Excessive alcohol intake
C) A family history of hypertension
D) Stricter compliance with medical regime

Ans: B
Chapter: 32
Client Needs: B
Cognitive Level: Knowledge Difficulty: Easy
Integrated Process: Teaching/Learning Objective: 2
Page and Header: 892, Hypertension

Feedback: Modifiable risk factors are nutritional changes and exercise. Research findings demonstrate that weight loss, reduced alcohol and sodium intake, and regular physical exercise are effective lifestyle adaptations to reduce blood pressure.

4. The staff educator is talking to a group of new emergency department nurses about hypertensive crisis. The nurse educator is aware that hypertensive urgency differs from hypertensive emergency in what way?
A) The BP is always higher in a hypertensive emergency.

B) Extremely close hemodynamic monitoring is required during treatment of hypertensive emergencies.
C) Hypertensive urgency is treated with rest and tranquilizers to lower BP.
D) Hypertensive emergencies are associated with evidence of target organ damage.

Ans: D
Chapter: 32
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning Objective: 6
Page and Header: 901, Hypertensive Crises

Feedback: Hypertensive emergencies are acute, life-threatening blood pressure elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. Blood pressures are extremely elevated in both urgency and emergencies, but there is no evidence of target organ damage in hypertensive urgency. Extremely close hemodynamic monitoring of the patient’s blood pressure is required in both. The medications of choice in hypertensive emergencies are those with an immediate effect such as IV vasodilators. Oral doses of fast-acting agents such as beta-adrenergic blocking agents, angiotensin-converting enzyme inhibitors, or alpha-agonists are recommended for the treatment of hypertensive urgencies.

5. A group of student nurses are practicing taking blood pressure. A 56-year-old male student has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, he exclaims, “My pressure has never been this high. Will I need to take medication to reduce it?” Which of the following responses by the nursing instructor would be best?

A) “Yes. Hypertension is prevalent among males; it’s fortunate we caught this during your routine examination.”
B) “We’ll need to reevaluate your blood pressure because your age places you at high risk for hypertension.”

C) “A single elevated blood pressure doesn’t confirm hypertension. You’ll need to have your blood pressure reassessed several times before a diagnosis can be made.”
D) “You have no need to worry. Your pressure is probably elevated because you’re in the doctor’s office.”

Ans: C
Chapter: 32
Client Needs: D-3
Cognitive Level: Application Difficulty: Moderate
Integrated Process: Teaching/Learning Objective: 1
Page and Header: 890, Introduction

Feedback: Hypertension is confirmed by two or more readings with systolic pressure of at least 140 mm Hg and diastolic pressure of at least 90 mm Hg. Option A is premature. Option B isn’t as specific as option C and also is insensitive to the client’s anxiety. Option D gives false reassurance; the client does need to have his blood pressure reevaluated.

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