Pharm: A Patient-Centered Nursing
Process Approach CH: 39
A patient is diagnosed with borderline hypertension and states a desire to make
lifestyle changes to avoid needing to take medication. The nurse will recommend which
changes? a. Changing from weight bearing exercise to yoga b. Decreased fluid intake
and increased potassium intake c. Stress reduction and increased protein intake d.
Weight reduction and decreased sodium intake - correct answerANS: D Weight loss
decreases the stress on the heart and the afterload. Decreasing salt intake decreases
the amount of retained fluid. Changing to yoga from weight-bearing exercise, limiting
fluids, and increasing potassium are not indicated. Stress reduction is recommended,
but increasing protein is not. A patient has a blood pressure of 135/85 mm Hg on three
separate occasions. The nurse understands that this patient should be treated with a. a
beta blocker. b. a diuretic and a beta blocker. c. a diuretic. d. lifestyle changes. - correct
answerANS: D Prehypertension is defined as a systolic pressure of 120 to 139 and a
diastolic pressure between 80 and 89. Drug therapy is recommended if the blood
pressure is greater than 20/10 over the goal, which would be 140/90. Prehypertension is
generally treated first with lifestyle changes. A 65-year-old patient has a blood pressure
of 155/95 mm Hg. The nurse understands that with treatment, the goal for this patient's
blood pressure is a. 120/80 mm Hg b. 130/89 mm Hg c. 140/90 mm Hg d. 150/90 mm
Hg - correct answerANS: D According to the Joint National Committee (JNC) 8, a blood
pressure of 140/90 is the goal for the population younger than 60 years, with a target of
150/90 for those above 60. The guideline for normal blood pressure is less than 120/80
mm Hg. The nurse is caring for an African-American patient who has been taking a beta
blocker to treat hypertension for several weeks with only slight improvement in blood
pressure. The nurse will contact the provider to discuss a. adding a diuretic medication.
b. changing to an angiotensin-converting enzyme (ACE) inhibitor. c. decreasing the beta
blocker dose. d. doubling the beta blocker dose. - correct answerANS: A African
Americans do not respond well to beta blockers and ACE inhibitors, but do tend to
respond to diuretics and calcium channel blockers. Changing to an ACE inhibitor or
altering the beta blocker dose is not indicated. Hypertension in African-American
patients can be controlled by combining beta blockers with diuretics. The nurse
understands that the dose of a medication such as propranolol may need to be changed
for the patient of Asian descent. The nurse expects the provider to a. increase the daily
dose. b. decrease the frequency of the medication to every other day. c. decrease the
daily dose. d. add a second antihypertensive medication. - correct answerANS: C Asian
patients are twice as sensitive to the effects of propranolol regarding blood pressure
and heart rate, so the dose should be decreased or another antihypertensive drug may
Process Approach CH: 39
A patient is diagnosed with borderline hypertension and states a desire to make
lifestyle changes to avoid needing to take medication. The nurse will recommend which
changes? a. Changing from weight bearing exercise to yoga b. Decreased fluid intake
and increased potassium intake c. Stress reduction and increased protein intake d.
Weight reduction and decreased sodium intake - correct answerANS: D Weight loss
decreases the stress on the heart and the afterload. Decreasing salt intake decreases
the amount of retained fluid. Changing to yoga from weight-bearing exercise, limiting
fluids, and increasing potassium are not indicated. Stress reduction is recommended,
but increasing protein is not. A patient has a blood pressure of 135/85 mm Hg on three
separate occasions. The nurse understands that this patient should be treated with a. a
beta blocker. b. a diuretic and a beta blocker. c. a diuretic. d. lifestyle changes. - correct
answerANS: D Prehypertension is defined as a systolic pressure of 120 to 139 and a
diastolic pressure between 80 and 89. Drug therapy is recommended if the blood
pressure is greater than 20/10 over the goal, which would be 140/90. Prehypertension is
generally treated first with lifestyle changes. A 65-year-old patient has a blood pressure
of 155/95 mm Hg. The nurse understands that with treatment, the goal for this patient's
blood pressure is a. 120/80 mm Hg b. 130/89 mm Hg c. 140/90 mm Hg d. 150/90 mm
Hg - correct answerANS: D According to the Joint National Committee (JNC) 8, a blood
pressure of 140/90 is the goal for the population younger than 60 years, with a target of
150/90 for those above 60. The guideline for normal blood pressure is less than 120/80
mm Hg. The nurse is caring for an African-American patient who has been taking a beta
blocker to treat hypertension for several weeks with only slight improvement in blood
pressure. The nurse will contact the provider to discuss a. adding a diuretic medication.
b. changing to an angiotensin-converting enzyme (ACE) inhibitor. c. decreasing the beta
blocker dose. d. doubling the beta blocker dose. - correct answerANS: A African
Americans do not respond well to beta blockers and ACE inhibitors, but do tend to
respond to diuretics and calcium channel blockers. Changing to an ACE inhibitor or
altering the beta blocker dose is not indicated. Hypertension in African-American
patients can be controlled by combining beta blockers with diuretics. The nurse
understands that the dose of a medication such as propranolol may need to be changed
for the patient of Asian descent. The nurse expects the provider to a. increase the daily
dose. b. decrease the frequency of the medication to every other day. c. decrease the
daily dose. d. add a second antihypertensive medication. - correct answerANS: C Asian
patients are twice as sensitive to the effects of propranolol regarding blood pressure
and heart rate, so the dose should be decreased or another antihypertensive drug may
