Chapter 22 Nursing Care of Patients with Hypertension

Answers CHAPTER 22 NURSING CARE OF PATIENTS WITH HYPERTENSION AUDIO CASE STUDY Jenice and Hypertension 1. Jenice has the patient sit down with both feet on the floor, rest arm on the table at heart level, and remain quiet without talking for 5 minutes. She chooses a cuff of the right size—one that encircles 80% of the patient’s arm. 2. A normal blood pressure (BP). 3. Instructor confirms the BP, calls the patient’s health care provider (HCP), and informs the patient and spouse to go to the emergency room per the HCP. VOCABULARY 1. (2) 2. (5) 3. (4) 4. (3) 5. (1) 6. (7) 7. (8) 8. (6) DIURETICS 1. (3) 2. (2) 3. (1) 4. (2) 5. (2) 6. (3) 7. (1) 8. (1) HYPERTENSION RISK FACTORS 1. False 2. True 3. False 4. True 5. False 6. True 7. True CATEGORIES OF BLOOD PRESSURE 1. Elevated 2. Normal 3. Stage 2 hypertension 4. Elevated 5. Stage 1 hypertension CRITICAL THINKING 1. Diuretics remove excess salt and water to decrease blood volume and lower blood pressure. Hydrochlorothiazide (HydroDIURIL) is used for hypertension treatment if lifestyle modification does not lower blood pressure. 2. Weight, smoking history, diet and salt intake, alcohol use, exercise patterns, life roles, finances, and knowledge base. Data collected: 5 feet 4 inches, 156 lb; does not smoke or use alcohol; salts food liberally, eats three meals and snacks, moderate fat intake; walks when time permits; deals with issues as they come, which is often in her roles as wife and mother to three children; has no prescription insurance coverage; knows very little about hypertension. 3. Individualized teaching plan for Mrs. Martin’s needs should be developed to improve her health literacy. It should include addressing weight management, diet and salt intake, exercise and sleep importance, and medications. 4. Provide information regarding the importance of controlling her hypertension; do financial data collection to ensure that she has a funding source to buy medication because she may need lifelong medication. 5. BP readings on follow-up visits will be within normal limits with medication. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (1) is correct. Normal blood pressure is less than 120/80 mm Hg. (2) is incorrect. This is elevated blood pressure. (3) is incorrect. This is stage 1 hypertension. (4) is incorrect. This is stage 2 hypertension. 2. (3) is correct. Stage 2 hypertension is classified as a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher. (1) is incorrect. Elevated blood pressure is a systolic blood pressure of 120 to 129 mm Hg and diastolic blood pressure of lower than 80 mm Hg. (2) is incorrect. Stage 1 1 2 Chapter 22 Answers hypertension is a systolic blood pressure of 130 to 139 or a diastolic blood pressure of 80 to 89 mm Hg. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 3. (1) is correct. Enalapril maleate (Vasotec) inhibits the conversion of angiotensin I to angiotensin II, thereby decreasing the levels of angiotensin II, which decreases vasopressor activity. (2, 3, 4) are incorrect. The actions of enalapril maleate achieve antihypertensive effects by suppression of the renin-angiotensin-aldosterone system but not by adjusting the heart rate, dilating vessels, or decreasing cardiac output. 4. (2) is correct. Diltiazem (Cardizem) prevents the movement of extracellular calcium into the cell that results in a therapeutic effect of vasodilation. (1, 3, 4) are incorrect. It does not increase heart rate, affect fluid volume, or increase cardiac contractility. 5. (2, 3, 4, 5) are modifiable risk factors for hypertension. (1) is incorrect. Race is a nonmodifiable risk factor. 6. (2) is correct. Stage 2 hypertension is defined as a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher. (1) is incorrect. Blood pressure measurement is the pressure that occurs during heart contraction, or systole and during relaxation, or diastole. (3) is incorrect. Stress, activity, and emotions may temporarily raise blood pressure but do not cause hypertension. (4) is incorrect. It is stage 1. 7. (1) is correct. Regular aerobic exercise is recommended to prevent and control hypertension. (2) is incorrect. Smoking, even low-tar cigarettes, is a risk factor for heart disease. (3) is incorrect. Alcohol intake is limited to 1 oz/day. (4) is incorrect. A daily multivitamin supplement has not been shown to prevent or control hypertension. 8. (4) is correct. Headache is a side effect of hydralazine (Apresoline). (1, 2, 3) do not have headache as a side effect. 9. (3) is correct. Medications for hypertension should be taken daily as directed. (1) is incorrect. The sun may increase dehydration, a side effect of the drug. (2) is incorrect. Lifestyle modifications are to be continued with antihypertensive therapy. (4) is incorrect. The medication is keeping the blood pressure lowered and will have to be taken daily. 10. (2) is correct. Thiazide and thiazide-like diuretics reduce the reabsorption of potassium, so patients should be monitored for signs of hypokalemia or muscle weakness. (1, 3, 4) are incorrect. Numb hands, gastrointestinal distress, and nightmares are not common side effects of metolazone. 11. (2) is correct. Cough is a side effect of angiotensinconverting enzyme (ACE) inhibitors such as enalapril maleate (Vasotec). (1, 3, 4) are incorrect. Acne, diarrhea, and heartburn are not common side effects of enalapril maleate. 12. (3) is correct. Vital signs, especially blood pressure and heart rate, should be checked with antihypertensive medications such as diltiazem (Cardizem). (1) is incorrect. Diltiazem does not affect total serum calcium level. (2) is incorrect. Gastrointestinal side effects are not common. (4) is incorrect. Stopping diltiazem abruptly will not cause withdrawal syndrome like other medications, such as beta blockers, can. 13. (4) is correct. To manage hypertension, the patient must be willing to learn because knowledge is needed to control this chronic condition. (1) is incorrect. Hypertension is known as the “silent killer,” as there are usually no signs or symptoms. Defining characteristics of activity intolerance include abnormal electrocardiographic readings and vital signs as well as reports of dyspnea or fatigue. (2) is incorrect. Ineffective airway clearance is the state in which an individual is unable to clear secretions. (3) is incorrect. Impaired physical mobility is a temporary limitation of the ability to move freely, which is not the focus of care for hypertension. 14. (3, 5) are correct. Although a patient may feel better after taking medication, the hypertension is well controlled but never cured. (1, 2, 4) are incorrect. These are correct information, so more teaching is not required. Hypertension can damage the target organs if it is not controlled. 15. (2) is correct. Normal blood pressure is lower than 120/80 mm Hg. The blood pressure would be too low below 90 systolic. (1, 3, 4) are incorrect. They are not normal blood pressure readings.