Chapter 32: Hypertension
Lewis: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. Which action will the nurse in the hypertension clinic take to obtain an accurate
baseline blood pressure (BP) for a new patient?
a.
Deflate the BP cuff at a rate of 5 to 10 mm Hg per second.
b.
Have the patient sit in a chair with the feet flat on the floor.
c.
Assist the patient to the supine position for BP measurements.
d.
Obtain two BP readings in the dominant arm and average the results.
ANS: B
The patient should be seated with the feet flat on the floor. The BP is obtained in both arms,
and the results of the two arms are not averaged. The patient does not need to be in the supine
position. The cuff should be deflated at 2 to 3 mm Hg per second.
DIF: Cognitive Level: Understand (comprehension) REF: 696
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
2. The nurse obtains the following information from a patient newly diagnosed with
prehypertension. Which finding is most important to address with the patient?
a.
Low dietary fiber intake
b.
No regular physical exercise
c.
Drinks a beer with dinner every night
d.
Weight is 5 pounds above ideal weight
ANS: B
The recommendations for preventing hypertension include exercising aerobically for 30
minutes most days of the week. A weight that is 5 pounds over the ideal body weight is not a
risk factor for hypertension. The Dietary Approaches to Stop Hypertension (DASH) diet is
high in fiber, but increasing fiber alone will not prevent hypertension from developing. The
patient’s alcohol intake is within guidelines and will not increase the hypertension risk.
DIF: Cognitive Level: Analyze (analysis) REF: 689
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
3. Which action should the nurse take when giving the initial dose of oral labetalol to a patient
with hypertension?
a.
Encourage the use of hard candy to prevent dry mouth.
b.
Teach the patient that headaches often occur with this drug.
c.
Instruct the patient to call for help if heart palpitations occur.
d.
Ask the patient to request assistance before getting out of bed.
ANS: D
Labetalol decreases sympathetic nervous system activity by blocking both - and -
adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause
severe orthostatic hypotension. Heart palpitations, dry mouth, dehydration, and headaches are
possible side effects of other antihypertensives.
, DIF: Cognitive Level: Apply (application) REF: 692
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
4. After the nurse teaches the patient with stage 1 hypertension about diet modifications that
should be implemented, which diet choice indicates that the teaching has been most
effective?
a.
The patient avoids eating nuts or nut butters.
b.
The patient restricts intake of chicken and fish.
c.
The patient drinks low-fat milk with each meal.
d.
The patient has two cups of coffee in the morning.
ANS: C
For the prevention of hypertension, the Dietary Approaches to Stop Hypertension (DASH)
recommendations include increasing the intake of calcium-rich foods. Caffeine restriction and
decreased protein intake are not included in the recommendations. Nuts are high in beneficial
nutrients and 4 to 5 servings weekly are recommended in the DASH diet.
DIF: Cognitive Level: Apply (application) REF: 687
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
5. A patient has just been diagnosed with hypertension and has been started on captopril . Which
information is most important to include when teaching the patient about this drug?
a.
Include high-potassium foods such as bananas in the diet.
b.
Increase fluid intake if dryness of the mouth is a problem.
c.
Change position slowly to help prevent dizziness and falls.
d.
Check blood pressure (BP) in both arms before taking the drug.
ANS: C
The angiotensin-converting enzyme (ACE) inhibitors frequently cause orthostatic
hypotension, and patients should be taught to change position slowly to allow the vascular
system time to compensate for the position change. Increasing fluid intake may counteract the
effect of the drug, and the patient is taught to use gum or hard candy to relieve dry mouth.
The BP should be taken in the nondominant arm by newly diagnosed patients in the morning,
before taking the drug, and in the evening. Because ACE inhibitors cause potassium retention,
increased intake of high-potassium foods is inappropriate.
DIF: Cognitive Level: Apply (application) REF: 691
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
6. Propranolol (Inderal) is prescribed for a patient diagnosed with hypertension. The nurse
should consult with the health care provider before giving this drug when the patient reveals a
history of
a.
daily alcohol use. c. reactive airway disease.
b.
peptic ulcer disease. d. myocardial infarction (MI).
ANS: C
Nonselective -blockers block 1- and 2-adrenergic receptors and can cause bronchospasm,
especially in patients with a history of asthma. -Blockers will have no effect on the patient’s
peptic ulcer disease or alcohol use. -Blocker therapy is recommended after MI.
DIF: Cognitive Level: Apply (application) REF: 692
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
Lewis: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. Which action will the nurse in the hypertension clinic take to obtain an accurate
baseline blood pressure (BP) for a new patient?
a.
Deflate the BP cuff at a rate of 5 to 10 mm Hg per second.
b.
Have the patient sit in a chair with the feet flat on the floor.
c.
Assist the patient to the supine position for BP measurements.
d.
Obtain two BP readings in the dominant arm and average the results.
ANS: B
The patient should be seated with the feet flat on the floor. The BP is obtained in both arms,
and the results of the two arms are not averaged. The patient does not need to be in the supine
position. The cuff should be deflated at 2 to 3 mm Hg per second.
DIF: Cognitive Level: Understand (comprehension) REF: 696
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
2. The nurse obtains the following information from a patient newly diagnosed with
prehypertension. Which finding is most important to address with the patient?
a.
Low dietary fiber intake
b.
No regular physical exercise
c.
Drinks a beer with dinner every night
d.
Weight is 5 pounds above ideal weight
ANS: B
The recommendations for preventing hypertension include exercising aerobically for 30
minutes most days of the week. A weight that is 5 pounds over the ideal body weight is not a
risk factor for hypertension. The Dietary Approaches to Stop Hypertension (DASH) diet is
high in fiber, but increasing fiber alone will not prevent hypertension from developing. The
patient’s alcohol intake is within guidelines and will not increase the hypertension risk.
DIF: Cognitive Level: Analyze (analysis) REF: 689
TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
3. Which action should the nurse take when giving the initial dose of oral labetalol to a patient
with hypertension?
a.
Encourage the use of hard candy to prevent dry mouth.
b.
Teach the patient that headaches often occur with this drug.
c.
Instruct the patient to call for help if heart palpitations occur.
d.
Ask the patient to request assistance before getting out of bed.
ANS: D
Labetalol decreases sympathetic nervous system activity by blocking both - and -
adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause
severe orthostatic hypotension. Heart palpitations, dry mouth, dehydration, and headaches are
possible side effects of other antihypertensives.
, DIF: Cognitive Level: Apply (application) REF: 692
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
4. After the nurse teaches the patient with stage 1 hypertension about diet modifications that
should be implemented, which diet choice indicates that the teaching has been most
effective?
a.
The patient avoids eating nuts or nut butters.
b.
The patient restricts intake of chicken and fish.
c.
The patient drinks low-fat milk with each meal.
d.
The patient has two cups of coffee in the morning.
ANS: C
For the prevention of hypertension, the Dietary Approaches to Stop Hypertension (DASH)
recommendations include increasing the intake of calcium-rich foods. Caffeine restriction and
decreased protein intake are not included in the recommendations. Nuts are high in beneficial
nutrients and 4 to 5 servings weekly are recommended in the DASH diet.
DIF: Cognitive Level: Apply (application) REF: 687
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
5. A patient has just been diagnosed with hypertension and has been started on captopril . Which
information is most important to include when teaching the patient about this drug?
a.
Include high-potassium foods such as bananas in the diet.
b.
Increase fluid intake if dryness of the mouth is a problem.
c.
Change position slowly to help prevent dizziness and falls.
d.
Check blood pressure (BP) in both arms before taking the drug.
ANS: C
The angiotensin-converting enzyme (ACE) inhibitors frequently cause orthostatic
hypotension, and patients should be taught to change position slowly to allow the vascular
system time to compensate for the position change. Increasing fluid intake may counteract the
effect of the drug, and the patient is taught to use gum or hard candy to relieve dry mouth.
The BP should be taken in the nondominant arm by newly diagnosed patients in the morning,
before taking the drug, and in the evening. Because ACE inhibitors cause potassium retention,
increased intake of high-potassium foods is inappropriate.
DIF: Cognitive Level: Apply (application) REF: 691
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
6. Propranolol (Inderal) is prescribed for a patient diagnosed with hypertension. The nurse
should consult with the health care provider before giving this drug when the patient reveals a
history of
a.
daily alcohol use. c. reactive airway disease.
b.
peptic ulcer disease. d. myocardial infarction (MI).
ANS: C
Nonselective -blockers block 1- and 2-adrenergic receptors and can cause bronchospasm,
especially in patients with a history of asthma. -Blockers will have no effect on the patient’s
peptic ulcer disease or alcohol use. -Blocker therapy is recommended after MI.
DIF: Cognitive Level: Apply (application) REF: 692
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
