Hypertension

• A client who exercises for 30 minutes every day and maintains a normal body weight develops primary hypertension. The client asks how this could have happened. Which finding in the​ client's health history should the nurse include in the response to the​ client? (Select all that​ apply.)

  A.

  ​Age: 62 years

  B.

  High magnesium intake

  C.

  Working as an air traffic controller

  D.

  Family history of hypertension

  E.

  Insulin resistance

  Age: 62 years

  
  

  Working as an air traffic controller

  
  

  Family history of hypertension

  
  

  Insulin resistance

  
  

  Rationale: The role of stress in primary hypertension is not clear. Frequent or continued stress may cause vascular smooth muscle hypertrophy or affect central integrative pathways of the brain. Insulin resistance has been found in people of normal weight and is linked with hypertension by its effects on the sympathetic nervous​ system, vascular smooth​ muscle, renal regulation of sodium and​ water, and changes in ion transport across cell membrane. Low magnesium intake contributes to hypertension by unknown mechanisms. Hypertension primarily affects​ middle-aged and older​ adults: More than​ 50% of people aged 60dash74 and about​ 75% of those 75 and older are hypertensive. Studies show a genetic link in up to​ 40% of people with primary hypertension.
• A client has been diagnosed with secondary hypertension. Which condition should the nurse expect to find in the​ client's medical​ history? (Select all that​ apply.)

  A.

  Diabetes

  B.

  Asthma

  C.

  Kidney disease

  D.

  Pregnancy

  E.

  Lupus

  ​diabetes

  pregnancy

  kidney disease

  
  

  Rationale: The conditions that can cause secondary hypertension include pregnancy after 20 weeks of​ gestation, diabetes, and kidney disease. Asthma and lupus are not known to cause secondary hypertension.
• The nurse is conducting a health screening within the Hispanic community. Which client is most likely to be at risk for​ hypertension?

  A.

  The client who exercises daily

  B.

  The client who is 30 years old

  C.

  The client who has a body mass index of 30

  D.

  The client who eats salads each day for lunch

  ​The client who has a body mass index of 30

  
  

  Rationale: High body mass index​ (BMI) is a risk factor for hypertension.​ Middle-aged and older adults are at a greater risk for hypertension. Daily exercise reduces the risk of hypertension. A diet that is high in fruits and vegetables reduces the risk for hypertension.
• A client diagnosed with primary aldosteronism has​ polyuria, weakness,​ paresthesia, and an elevated blood pressure. Which condition should the nurse expect as the most likely cause for the elevated blood​ pressure?

  A.

  Primary hypertension

  B.

  Stroke

  C.

  Hypertensive crisis

  D.

  Secondary hypertension

  Secondary hypertension

  
  

  Rationale: Secondary hypertension is an elevated blood pressure as a result of an underlying disease process. Primary aldosteronism can cause secondary hypertension with symptoms of​ hypertension, weakness,​ paresthesia, polyuria, and nocturia. Primary hypertension is a persistently elevated systemic blood pressure without an underlying disease process as the cause. Hypertensive crisis is a​ rapid, significant elevation in blood pressure. The​ client's symptoms were not those of a stroke.
• The nurse is teaching a client about the signs and symptoms of a stroke. Which client statement indicates a need for further​ teaching?

  A.

  ​"One-sided paralysis may be a​ stroke."

  B.

  ​"Sudden loss of taste or smell may be a​ stroke."

  C.

  ​"Increased urge to urinate at night may be a​ stroke."

  D.

  ​"Sudden loss of vision may be a​ stroke."

  ​"Increased urge to urinate at night may be a​ stroke."

  
  

  Rationale: Polyuria and nocturia are most likely not due to a stroke. Signs and symptoms of a stroke include sudden onset of loss of sensation or movement. This may manifest as​ hemiplegia, hemiparesis,​ flaccidity, spasticity, or loss of the sense of​ vision, hearing,​ taste, touch,​ proprioception, or smell.
• The nurse is planning to teach a client how to lower her cholesterol level. Which instruction should the nurse​ include?

  A.

  Practicing smoking cessation

  B.

  Exercising occasionally

  C.

  Eating a diet low in saturated fat

  D.

  Participating in stress reduction

  ​Eating a diet low in saturated fat

  
  

  Rationale: Elevated cholesterol is closely related to cardiovascular disease. The body manufactures​ 85% of the cholesterol found in the body. The other​ 15% comes from the diet. The American Heart Association recommends eating a diet low in fat to maintain normal cholesterol levels. The client can lower cholesterol and the risk of cardiovascular complications by eating a diet that is low in saturated fats. Aerobic exercise 5 days a week is recommended to lower blood pressure and cholesterol. Smoking is not directly linked to hypertension.​ However, smoking is closely linked to cardiovascular disease. In​ addition, smoking can interfere with some antihypertensive medications. Smoking cessation does not lower cholesterol. Stress is known to cause vasoconstriction because of the release of hormones.​ However, stress reduction alone will not reduce cholesterol levels.
• A nurse is evaluating teaching for a client who recently experienced a hypertensive crisis. Which statement by the client indicates an understanding of the​ instructions? (Select all that​ apply.)

  A.

  ​"I will exercise 3 days a​ week."

  B.

  ​"I need to restrict my alcohol intake to no more than 20 oz of beer a​ day."

  C.

  ​"I will set a schedule to remind me to take my medications each​ day."

  D.

  ​"I must stop​ smoking."

  E.

  ​"I will increase fruits and vegetables in my​ diet."

  ​

  "I need to restrict my alcohol intake to no more than 20 oz of beer a​ day."

  
  

  ​"I will set a schedule to remind me to take my medications each​ day."

  
  

  ​"I must stop​ smoking."

  .

  ​"I will increase fruits and vegetables in my​ diet."

  
  

  Rationale: Smoking is closely associated with cardiovascular​ disease, which is a complication of hypertension. In​ addition, smoking interferes with some antihypertensive medications. Clients with hypertension should drink only in moderation. The recommended alcohol intake is one alcoholic beverage per day. A diet that is high in fruits and vegetables will help maintain a normal weight and lower blood pressure. The client will also benefit from a diet that is low in fat. This client has experienced a hypertensive crisis. Failure to take medications as prescribed can cause hypertensive crisis. A routine that includes taking medications at a set time each day will help the client remember to take medications as prescribed. Exercise 5 days a week lasting 30dash45 minutes per day is recommended. Exercise helps with stress​ reduction, weight​ loss, and general feelings of​ well-being.
• The nurse is teaching a client diagnosed with prehypertension. Which instruction should be included in the​ teaching? (Select all that​ apply.)

  A.

  Engaging in regular physical activity

  B.

  Increasing the daily intake of saturated fats

  C.

  Avoiding baths that are extremely hot

  D.

  Maintaining a healthy weight

  E.

  Following the treatment regimen


  ​Engaging in regular physical activity

  
  

  Avoiding baths that are extremely hot

  
  

  Maintaining a healthy weight

  
  

  Following the treatment regimen

  
  

  Rationale: To avoid progressing to​ hypertension, clients with prehypertension should follow their treatment​ regimen, maintain a healthy weight and​ diet, reduce salt​ intake, reduce saturated and total fat​ intake, engage in regular physical​ activity, use​ stress-management techniques, and avoid baths that are too hot.
• A client has recently been diagnosed with hypertension. Which intervention should the nurse include in the plan of​ care? (Select all that​ apply.)

  A.

  Teaching the client about the health benefits of regular exercise

  B.

  Encouraging the client to reduce smoking

  C.

  Encouraging the client to perform stress reduction techniques

  D.

  Assisting the client to set a goal for a healthy weight

  E.

  Teaching the client how to adhere to the DASH diet

  ​Teaching the client about the health benefits of regular exercise

  
  

  Encouraging the client to perform stress reduction techniques

  
  

  Assisting the client to set a goal for a healthy weight

  
  

  Teaching the client how to adhere to the DASH diet

  
  

  Rationale: The client should be taught to​ stop, not​ reduce, smoking. The client should learn the DASH diet and benefits of regular exercise. The nurse should assist the client to set a realistic​ short-term goal for healthy weight. The client should learn stress reduction techniques.
• The nurse is following up with a client after a diagnosis of prehypertension. Which statement by the client indicates healthy​ coping? (Select all that​ apply.)

  A.

  ​"I get 4dash5 servings of fruit every​ day."

  B.

  ​"I have reduced my grain intake to​ 6-8 servings per​ week."

  C.

  ​"I have stopped​ smoking."

  D.

  ​"I eat about 3 servings per day of fats and​ oils."

  E.

  ​"I take brisk walks with my dog 6 days a​ week."

  ​I get 4dash5 servings of fruit every​ day."

  
  

  ​"I have stopped​ smoking."

  
  

  ​"I eat about 3 servings per day of fats and​ oils."

  
  

  ​"I take brisk walks with my dog 6 days a​ week."

  
  

  Rationale: Lifestyle modifications can stop the progression of prehypertension into primary hypertension. Good modifications include stopping smoking and getting regular exercise at least 5 days a week.​ Also, dietary modifications are​ recommended, such as following the DASH​ diet, which includes 4dash5 servings of fruit a​ day, limiting fats and oils to 2dash3 servings per​ day, including grain intake of 6dash8 servings per day.
• The nurse is teaching a client with hypertension about dietary changes. Which changes should the nurse​ include? (Select all that​ apply.)

  A.

  Switching to​ low-fat dairy products

  B.

  Limiting fat intake to saturated types of fat

  C.

  Eliminating cholesterol from the diet

  D.

  Avoiding salty foods

  E.

  Eating 4dash5 servings of fruits and vegetables each day


  ​Switching to​ low-fat dairy products

  
  

  Avoiding salty foods

  
  

  Eating 4dash5 servings of fruits and vegetables each day

  
  

  Rationale: Salt intake can cause retention of fluids and increase in blood pressure. Dairy products are​ beneficial, but reducing fats will decrease risk factors for development of atherosclerosis. Cholesterol should be lowered but not eliminated from the diet. Dietary guidelines are 4dash5 servings per day for vegetables and fruits. Saturated fats should be​ limited; unsaturated fats are preferred.
• The client wants to try complementary health methods to reduce stress. Which therapy should the nurse​ recommend? (Select all that​ apply.)

  A.

  Yoga

  B.

  Physical exercise

  C.

  Angiotensin II receptor blockers​ (ARBs)

  D.

  Tai chi

  E.

  Memory games

  Yoga

  tai chi

  phyiscal exercise

  
  

  Rationale: Complementary behavioral and minddashbody therapies used to reduce blood pressure in clients with hypertension include​ yoga, tai​ chi, and physical exercise. Memory games are not used to help clients with hypertension reduce blood pressure. ARBs are a type of​ medication, not a complementary behavioral or minddashbody ​therapy, used to treat clients with hypertension.
• The nurse is teaching a client about​ angiotensin-converting enzyme​ (ACE) inhibitors. Which client statement requires​ follow-up?

  A.

  ​"If I develop a persistent​ cough, I will call my healthcare​ provider."

  B.

  ​"I will use salt substitutes to help me decrease my sodium​ intake."

  C.

  ​"I will take my medication 1 hour before​ eating."

  D.

  ​"I will sit on the edge of the bed before getting up in the​ morning."

  ​​"I will use salt substitutes to help me decrease my sodium​ intake."

  
  

  Rationale: Clients taking ACE inhibitors should not use salt substitutes due to the risk of hyperkalemia. ACE inhibitors should be taken about 1 hour before meals. A persistent cough should be reported to the healthcare provider. Antihypertensive medications can cause orthostatic hypotension. Sitting on the end of the bed before getting up will help prevent falls and keep the client safe.
• A client recently diagnosed with hypertension has a family history of hyperaldosteronism. Which diagnostic test should the nurse expect to be​ ordered?

  A.

  Serum potassium

  B.

  Creatinine clearance

  C.

  Renal function panel

  D.

  Serum creatinine

  Serum potassium

  
  

  Rationale: The serum potassium level will be decreased with hyperaldosteronism. Serum creatinine is elevated and creatinine clearance is reduced if there is an underlying renal cause to the hypertension. A renal function panel is used to detect alterations in kidney function that may be causing the hypertension.
• The nurse is reviewing treatment for a client with hypertension. Which statement regarding collaborative treatment is true​?

  A.

  Most clients can take medications to control their blood pressure without lifestyle modifications.

  B.

  Lifestyle modifications do not help clients to control their blood pressure.

  C.

  Many clients require two or more medications plus lifestyle modifications to control their blood pressure.

  D.

  Most clients can control their blood pressure through lifestyle modifications alone.

  Many clients require two or more medications plus lifestyle modifications to control their blood pressure.

  
  

  Rationale: Medications plus lifestyle modifications are needed for most clients to maintain their blood pressure under​ 130/80 mmHg. Lifestyle modifications alone or medications alone are usually not​ enough, although both do have benefits.
• The nurse is creating a plan of care for a client with hypertension. Which instruction should the nurse​ include? (Select all that​ apply.)

  A.

  Using alcohol in moderation

  B.

  Beginning aerobic exercises

  C.

  Reducing smoking

  D.

  Ensuring that the diet includes at least 2 servings of milk products daily

  E.

  Following a​ low-fat, no-sodium diet

  ​Using alcohol in moderation

  
  

  Beginning aerobic exercises

  
  

  Ensuring that the diet includes at least 2 servings of milk products daily

  
  

  Rationale: Smoking should be​ eliminated, not reduced. A​ low-fat diet is​ recommended, but sodium should be reduced and not eliminated from the diet. Alcohol should be used in​ moderation, if at all. At least 2 servings of milk products daily are recommended. Aerobic exercises are recommended.
• The nurse is teaching a client who is newly diagnosed with hypertension. Which client statement requires an intervention by the​ nurse?

  A.

  ​"I will stop​ smoking."

  B.

  ​"I will take my blood pressure every morning and write it in the​ log."

  C.

  ​"I will begin doing aerobic exercises for 60 minutes every​ day."

  D.

  ​"I will decrease the sodium in my diet by adding herbs instead of salt to my​ food."

  ​"I will begin doing aerobic exercises for 60 minutes every​ day."

  
  

  Rationale: While aerobic exercises are recommended at least 5 days a​ week, the client should start slowly. Stopping​ smoking, taking blood pressure daily and​ recording, and decreasing the sodium in the diet are all good lifestyle modifications.
• The nurse is caring for a client with hypertension who has been noncompliant with the treatment plan and has gained weight. Which response should the nurse say to the​ client?

  A.

  ​"Because you have been unable to lose​ weight, we will need to add more medications to your treatment​ plan."

  B.

  ​"You have gained weight since the last​ follow-up."

  C.

  ​"Let me share with you the importance of following the treatment​ plan."

  D.

  ​"Why are you not following the treatment​ plan?"

  ​you have gained weight since the last​ follow-up."

  
  

  Rationale: Stating facts without judgment will open the client up to discussion. Asking why the client is not following the treatment plan is confrontational. The client probably already knows the importance of following the treatment plan. It is more important to determine why the client has gained weight. This is also more important than simply adding medications.
• The student nurse caring for a client with hypertension is listing interventions related to fluid volume. Which intervention should alert the nurse to​ intervene?

  A.

  Assisting the client set​ short-term goals to reach a realistic target weight

  B.

  Weighing the client daily

  C.

  Assessing intake and output

  D.

  Referring the client to a dietician for restricting sodium intake

  Assisting the client set​ short-term goals to reach a realistic target weight

  
  

  Rationale: Setting a target weight and​ short-term goals to reach are effective for promoting balanced nutrition but not for maintaining fluid volume. Assessing intake and output is a good implementation for maintaining fluid volume. Bedridden clients can develop sacral edema if the​ client's fluid volume is not balanced. Reducing sodium intake will help the client to maintain fluid volume.
• The nurse taught a client who is diagnosed with hypertension. Which outcome requires an intervention by the​ nurse?

  A.

  The client describes strategies for quitting smoking.

  B.

  The client demonstrates the ability to select foods that are low in sodium.

  C.

  The client describes when to stop taking prescribed antihypertensive medications.

  D.

  The client accurately performs blood pressure monitoring and maintains a log.

  The client describes when to stop taking prescribed antihypertensive medications.

  
  

  Rationale: Medications should be taken as prescribed. Hypertension often has no signs or symptoms. The client should be able to verbalize how to quit smoking and how to select foods low in sodium. The client should demonstrate how to take blood pressure and maintain a log.