Chapter 52: Management of Clients with Hypertensive Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 52: Management of Clients with Hypertensive Disorders

MULTIPLE CHOICE

1. When a client diagnosed with primary hypertension asks the nurse what causes this disease, the nurses best response would be High blood pressure is caused by

a.

a decrease in plasma renin levels.

b.

a number of factors, not just one cause.

c.

arteriosclerotic vessel disease.

d.

a kidney problem.

ANS: B

Primary hypertension results from an array of genetic and environmental factors.

DIF: Comprehension/Understanding REF: p. 1292 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

2. The nurse would explain to a client that the most common cause of secondary hypertension is

a.

chronic renal disease.

b.

oral contraceptive use.

c.

pregnancy.

d.

primary hyperaldosteronism.

ANS: A

Chronic renal disease, mainly chronic glomerulonephritis and renal artery stenosis, is the most common cause of secondary hypertension.

DIF: Comprehension/Understanding REF: pp. 1293, 1295

OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

3. A hypertensive client, age 55, is slightly obese, has a sedentary lifestyle, and smokes half a pack of cigarettes daily. For the behavioral change with the most immediate and positive impact on his blood pressure, the nurse would focus on

a.

caffeine restriction.

b.

regular exercise.

c.

smoking cessation.

d.

weight reduction measures.

ANS: D

The relationship between obesity and blood pressure has been clearly established from numerous studies. For many people with hypertension whose body weight is more than 10% over ideal, weight reduction of as little as 10 pounds can lower blood pressure. Also weight loss may improve the response to medication. While all the above measures are important for health promotion, weight reduction measures will have the most immediate impact.

DIF: Analysis/Analyzing REF: p. 1297 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Lifestyle Choices

4. In advising a hypertensive client who is reluctant to give up smoking, the nurse would state that nicotine from smoking

a.

causes significant, irreversible changes in blood vessels.

b.

does not affect blood pressure but increases risk of cardiovascular disease.

c.

increases blood pressure immediately for a short time.

d.

is statistically linked to the development of hypertension.

ANS: C

Although smoking has not been statistically linked to the development of hypertension, nicotine causes peripheral vasoconstriction, which raises the blood pressure for a short time. It also increases the risk of cardiovascular disease, stroke, and cancer.

DIF: Application/Applying REF: p. 1298 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Lifestyle Choices

5. When a client tells the nurse, I heard that potassium supplements are effective in treating hypertension, the nurses most appropriate reply would be as follows:

a.

Increased levels of potassium do not significantly affect blood pressure.

b.

Too much potassium can result in a dangerous rise in blood pressure.

c.

You can achieve the same benefits from low-sodium, high-potassium foods.

d.

You can try them for a while to see if you feel they are effective.

ANS: C

Reducing intake of high-sodium, low-potassium processed foods and increasing intake of low-sodium, high-potassium natural foods may be sufficient to achieve the potential benefits. Potassium supplements are also too costly and potentially too hazardous for routine use.

DIF: Comprehension/Understanding REF: p. 1298 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Lifestyle Choices

6. The nurse working with hypertensive clients knows that what factor is most important in order for the clients treatment plan to be successful?

a.

A sound treatment plan created by the health care team

b.

Consultation with specialists like physical therapy and a dietitian

c.

Long-term compliance and adherence to therapy

d.

Provider willingness to try different medications

ANS: C

Long-term compliance and adherence has emerged as the most essential element in reducing morbidity and mortality associated with hypertension. Noncompliance is often due to client beliefs and values that conflict with the treatment plan. The plan must be mutually designed by health care providers and the client. Referrals to the interdisciplinary team are important, as is provider willingness to change medications if side effects are intolerable, but the single most important determinant of success is compliance and adherence.

DIF: Comprehension/Understanding REF: pp. 1296-1297

OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Cultural Diversity/Religious/Spiritual Influences on Health

7. In conducting a health interview with a hypertensive client, the nurse would ask the client about the presence of the typical manifestations of the disorder, which are

a.

increasing muscle weakness.

b.

nausea, vomiting, and abdominal pain.

c.

none unless the hypertension is sustained.

d.

peripheral edema and abdominal bloating.

ANS: C

Typically the hypertensive client has no manifestations, which contributes to noncompliance. If the disorder goes undiagnosed, eventually the blood pressure will rise high enough to cause persistent headaches, fatigue, dizziness, palpitations, flushing, blurred or double vision, or epistaxis.

DIF: Application/Applying REF: p. 1294 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

8. An African-American male is being started on medication for hypertension, and the physician has prescribed a beta blocker as first-line therapy. The most appropriate action by the nurse is to

a.

consult with the physician about the choice of drug.

b.

have the pharmacist review the clients other meds for interactions.

c.

help the client plan ways to remain compliant with therapy.

d.

provide appropriate education on the medication and its side effects.

ANS: A

African Americans respond less well than other ethnic groups to beta-adrenergic blockers alone or as first-line treatment. The nurse should consult with the physician regarding the drug of choice. Once an appropriate medication is selected, the other three options would be important interventions.

DIF: Analysis/Analyzing REF: p. 1300 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

9. An important action the nurse can take that will most likely increase client compliance with a sodium- and fat-restricted diet is to

a.

offer to find the client a class on heart-healthy cooking.

b.

provide verbal education on ways to modify the clients current diet.

c.

refer the client for a consultation with a registered dietitian.

d.

tell the client about complications that may occur from not being compliant.

ANS: C

While all options have some place in working with hypertensive clients, the intervention that would have the most positive outcome would be referring the client to a dietitian. A highly individualized approach to dietary counseling is crucial and the dietitian can help the client plan, taking into account lifestyle; preferences; and ethnic, social, cultural, and financial influences. Some clients might like a cooking class, but this does not relieve the nurse from responsibilities related to diet teaching. Verbal education should be supplemented with written information. And education about complications is important, but simply telling the client about complications that might occur if the diet plan is not followed may be perceived as threatening.

DIF: Application/Applying REF: p. 1302 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Referrals

10. For a client who wants to walk for exercise to reduce hypertension, the nurse would offer the guideline to walk

a.

at the highest possible speed for 20 minutes, two or three times a week.

b.

briskly for 30 to 45 minutes most days of the week.

c.

slowly for 1 to 2 hours most days of the week.

d.

with variable speeds and on hills at least twice a week.

ANS: B

Blood pressure can be reduced with moderate-intensity physical activity, such as a brisk walk (at about to 3 miles per hour) for 30 to 45 minutes most days of the week.

DIF: Application/Applying REF: p. 1298 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

11. The nurse would consider referring a hypertensive client for step-down therapy when the blood pressure has been effectively controlled for at least

a.

3 months.

b.

6 months.

c.

1 year.

d.

2 years.

ANS: C

Reducing the number and amount of antihypertensive medications should be considered once a clients blood pressure has been controlled effectively for at least 1 year.

DIF: Application/Applying REF: p. 1300 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Expected Effects/Outcomes

12. The nurse providing care to a client being treated for a hypertensive emergency would monitor the blood pressure to ensure that it is slowly reduced during the therapy to prevent

a.

myocardial infarction.

b.

pulmonary embolism.

c.

renal ischemia.

d.

vascular collapse.

ANS: C

It is essential to avoid excessive falls in blood pressure, which can precipitate cerebral, renal, or coronary ischemia.

DIF: Application/Applying REF: p. 1304 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Diagnostic Tests/Treatments/Procedures

13. For a hypertensive client who reports being really fired up about losing weight, the nurse would recognize the need for more education on hearing the clients plan to

a.

abruptly eliminate sugar from the diet.

b.

lose 1 pound a week.

c.

use over-the-counter appetite suppressants.

d.

walk and climb stairs.

ANS: C

Clients should avoid over-the-counter (OTC) appetite suppressants because these preparations often contain ingredients that increase blood pressure.

DIF: Analysis/Analyzing REF: p. 1302 OBJ: Evaluation

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Lifestyle Choices

14. To reduce the risk of orthostatic hypotension in a client prescribed a diuretic antihypertensive medication, the nurse would teach the client to

a.

increase fluid intake.

b.

increase intake of potassium.

c.

sit up before standing, and stand before walking.

d.

stand up quickly using sturdy support.

ANS: A

A slow approach to standing and ambulation will reduce falls caused by orthostatic hypotension.

DIF: Application/Applying REF: p. 1305 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Injury Prevention

15. In an exercise program for weight reduction in a hypertensive client, the nurse would discourage the use of heavy weights because this may cause

a.

lactic acid buildup.

b.

muscle strain.

c.

rapid vasodilation.

d.

vasovagal response.

ANS: D

Blood pressure rises, sometimes to very high levels, with the vasovagal response that occurs during intense isometric muscle contraction. Therefore using light weights is a better option for the client who wishes to include weight lifting in an exercise program.

DIF: Application/Applying REF: p. 1298 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Alteration in Body Systems

MULTIPLE RESPONSE

1. The nurse would realize that outcomes for the diagnosis Ineffective Health Maintenance have been partly met when the client (Select all that apply)

a.

begins and maintains an exercise program.

b.

has ideas for incorporating medications into lifestyle.

c.

helps design a diet modification.

d.

says he/she will comply with whatever plan the nurse makes.

e.

shows the nurse the correct way to take the pulse.

ANS: A, B, C, E

Many aspects of hypertension set the stage for noncompliance. The client must be an active part in designing and adhering to a plan for treatment. The correct options all show the client taking an active role in health maintenance. Option d is the option most likely associated with noncompliance because the client is not involved in making choices.

DIF: Evaluation/Evaluating REF: pp. 1302-1303

OBJ: Evaluation MSC: Psychosocial Integrity Coping and Adaptation-Quality of Life

2. A client has two BP readings of and at a community screening event. The client smokes and has some sort of eye disease like my grandma had plus the client states, I might have high sugar. The most appropriate action by the nurse would be to (Select all that apply)

a.

advise the client to return tomorrow for repeat blood pressure readings.

b.

arrange for the client to be seen at a local urgent care center today.

c.

inform the client about the high risk of developing hypertension.

d.

tell the client that the blood pressure readings are not considered high.

e.

work with the client to identify risk factors and create a plan to address them.

ANS: C, E

This clients BP readings fall into the pre-hypertensive state. However, the client has several risk factors for target organ damage, including eye disease, which may be a retinopathy, and the possibility of diabetes. For this client, the risk of developing full-blown hypertension is twice the risk of someone whose readings are in the normal range. The nurse should work with the client to identify risk factors for hypertension and develop a plan to address them. Instead of returning to the screening the next day, the nurse should encourage the client to find a primary care provider or to see a primary care provider the client already knows. The client does not need urgent care.

DIF: Analysis/Analyzing REF: pp. 1295-1296

OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures/Health Alteration

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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