Chapter 27 Assessment and Management of Patients With Hypertension
An older adult is newly diagnosed with primary hypertension and has just been started on a beta-blocker.
The nurses health education should include which of the following?
Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the betablocker
B) Maintaining a diet high in dairy to increase protein necessary to prevent organ damage
C) Use of strategies to prevent falls stemming from postural hypotension
D) Limiting exercise to avoid injury that can be caused by increased intracranial pressure
c
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. Increased intracranial
pressure is not a risk and activity should not normally be limited.
2. A patient with primary hypertension comes to the clinic complaining of a gradual onset of bluny vision
and decreased visual acuity over the past several weeks. The nurse is aware that these symptoms could
be indicative of what?
Retinal blood vessel damage
B) Glaucoma
C) Cranial nerve damage
D) Hypertensive emergency
Feedback:
,Test Bank - Brunner & Suddarth's Textbook of Medical-Surqical Nursinq 15e 602
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 as a result of hypertension. Glaucoma
and cranial nerve damage do not normally cause these symptoms. A hypertensive emergency would
have a more rapid onset.
3. A nurse is performing blood pressure screenings at a local health fair. While obtaining subj ective
assessment data from a patient with hypertension, the nurse learns that the patient has a family history
of hypertension and she herself has high cholesterol and lipid levels. The patient says she smokes one
pack of cigarettes daily and drinks about a pack of beer every day. The nurse notes what nonmodifiable
risk factor for hypertension?
Hyperlipidemia
B) Excessive alcohol intake
C) A family history of hypertension
D) Closer adherence to medical regimen c
Feedback:
Unlike cholesterol levels, alcohol intake and adherence to treatment, family history is not modifiable.
4. The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain that
hypertensive urgency differs from hypertensive emergency in what way?
The BP is always higher in a hypertensive emergency.
B) Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies.
C) Hypertensive urgency is treated with rest and benzodiazepines to lower BP.
D) Hypertensive emergencies are associated with evidence of target organ damage.
D
Feedback:
Hypertensive emergencies are acute, life-threatening BP 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 patients BP is required in
both situations. 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.
, Test Bank - Brunner & Suddarth's Textbook of Medical-Surqical Nursinq 15e 603
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. Do you think my doctor will prescribe medication to reduce it? Which of the following
responses by the nursing instructor would be best?
Yes. Hypertension is prevalent among men; it is fortunate we caught this during your routine
examination.
B) We will need to reevaluate your blood pressure because your age places you at high risk for
hypertension.
C) A single elevated blood pressure does not confirm hypertension. You will 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 are being tested.
c
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. An age of 56 does not constitute a risk factor in and of
itself. The nurse should not tell the student that there is no need to worry.
A 40-year-old male newly diagnosed with hypertension is discussing risk factors with the nurse. The
6.
nurse talks about lifestyle changes with the patient and advises that the patient should avoid tobacco use.
What is the primary rationale behind that advice to the patient?
Quitting smoking will cause the patients hypertension to resolve.
B) Tobacco use increases the patients concurrent risk of heart disease.
C) Tobacco use is associated with a sedentary lifestyle.
D) Tobacco use causes ventricular hypertrophy.
Feedback:
Smoking increases the risk for heart disease, for which a patient with hypertension is already at an
increased risk. Quitting will not necessarily cause hypertension to resolve and smoking does not
directly cause ventricular hypertrophy. The association with a sedentary lifestyle is frue, but this is not
the main rationale for the nurses advice; the association with heart disease is more salient.
An older adult is newly diagnosed with primary hypertension and has just been started on a beta-blocker.
The nurses health education should include which of the following?
Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the betablocker
B) Maintaining a diet high in dairy to increase protein necessary to prevent organ damage
C) Use of strategies to prevent falls stemming from postural hypotension
D) Limiting exercise to avoid injury that can be caused by increased intracranial pressure
c
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. Increased intracranial
pressure is not a risk and activity should not normally be limited.
2. A patient with primary hypertension comes to the clinic complaining of a gradual onset of bluny vision
and decreased visual acuity over the past several weeks. The nurse is aware that these symptoms could
be indicative of what?
Retinal blood vessel damage
B) Glaucoma
C) Cranial nerve damage
D) Hypertensive emergency
Feedback:
,Test Bank - Brunner & Suddarth's Textbook of Medical-Surqical Nursinq 15e 602
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 as a result of hypertension. Glaucoma
and cranial nerve damage do not normally cause these symptoms. A hypertensive emergency would
have a more rapid onset.
3. A nurse is performing blood pressure screenings at a local health fair. While obtaining subj ective
assessment data from a patient with hypertension, the nurse learns that the patient has a family history
of hypertension and she herself has high cholesterol and lipid levels. The patient says she smokes one
pack of cigarettes daily and drinks about a pack of beer every day. The nurse notes what nonmodifiable
risk factor for hypertension?
Hyperlipidemia
B) Excessive alcohol intake
C) A family history of hypertension
D) Closer adherence to medical regimen c
Feedback:
Unlike cholesterol levels, alcohol intake and adherence to treatment, family history is not modifiable.
4. The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain that
hypertensive urgency differs from hypertensive emergency in what way?
The BP is always higher in a hypertensive emergency.
B) Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies.
C) Hypertensive urgency is treated with rest and benzodiazepines to lower BP.
D) Hypertensive emergencies are associated with evidence of target organ damage.
D
Feedback:
Hypertensive emergencies are acute, life-threatening BP 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 patients BP is required in
both situations. 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.
, Test Bank - Brunner & Suddarth's Textbook of Medical-Surqical Nursinq 15e 603
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. Do you think my doctor will prescribe medication to reduce it? Which of the following
responses by the nursing instructor would be best?
Yes. Hypertension is prevalent among men; it is fortunate we caught this during your routine
examination.
B) We will need to reevaluate your blood pressure because your age places you at high risk for
hypertension.
C) A single elevated blood pressure does not confirm hypertension. You will 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 are being tested.
c
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. An age of 56 does not constitute a risk factor in and of
itself. The nurse should not tell the student that there is no need to worry.
A 40-year-old male newly diagnosed with hypertension is discussing risk factors with the nurse. The
6.
nurse talks about lifestyle changes with the patient and advises that the patient should avoid tobacco use.
What is the primary rationale behind that advice to the patient?
Quitting smoking will cause the patients hypertension to resolve.
B) Tobacco use increases the patients concurrent risk of heart disease.
C) Tobacco use is associated with a sedentary lifestyle.
D) Tobacco use causes ventricular hypertrophy.
Feedback:
Smoking increases the risk for heart disease, for which a patient with hypertension is already at an
increased risk. Quitting will not necessarily cause hypertension to resolve and smoking does not
directly cause ventricular hypertrophy. The association with a sedentary lifestyle is frue, but this is not
the main rationale for the nurses advice; the association with heart disease is more salient.
