Medical-Surgical Nursing Assessment and Management of Clinical Problems 9e Chapter 33

Chapter 33: Nursing Management: Hypertension
Test Bank
MULTIPLE CHOICE
1. Which action will the nurse in the hypertension clinic take in order 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: 723

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 aerobic exercise
c. Weight 5 pounds above ideal weight
d. Drinks a beer with dinner on most nights
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
patients alcohol intake is within guidelines and will not increase the hypertension risk.
DIF: Cognitive Level: Apply (application) REF: 716

TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
3. Which action should the nurse take when administering the initial dose of oral labetalol
(Normodyne) to a patient with hypertension?
a. Encourage the use of hard candy to prevent dry mouth.
b. Instruct the patient to ask for help if heart palpitations occur.
c. Ask the patient to request assistance when getting out of bed.
d. Teach the patient that headaches may occur with this medication.
ANS: C
Labetalol decreases sympathetic nervous system activity by blocking both - and b-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.
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 effective?
a. The patient avoids eating nuts or nut butters.
b. The patient restricts intake of chicken and fish.
c. The patient has two cups of coffee in the morning.
d. The patient has a glass of low-fat milk with each meal.
ANS: D
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.

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
5. A patient has just been diagnosed with hypertension and has been started on captopril
(Capoten). Which information is important to include when teaching the patient about this
medication?
a. Check blood pressure (BP) in both arms before taking the medication.
b. Increase fluid intake if dryness of the mouth is a problem.
c. Include high-potassium foods such as bananas in the diet.
d. Change position slowly to help prevent dizziness and falls.
ANS: D
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 medication, 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 medication, and in the evening. Because ACE inhibitors cause
potassium retention, increased intake of high-potassium foods is inappropriate.

6. Propranolol (Inderal) is prescribed for a patient diagnosed with hypertension. The nurse
should consult with the health care provider before giving this medication when the patient
reveals a history of
a. asthma.
b. daily alcohol use.
c. peptic ulcer disease.
d. myocardial infarction (MI).
ANS: A
Nonselective b-blockers block b1- and b2-adrenergic receptors and can cause bronchospasm,
especially in patients with a history of asthma. b-Blockers will have no effect on the patients
peptic ulcer disease or alcohol use. b-Blocker therapy is recommended after MI.
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
7. A 56-year-old patient who has no previous history of hypertension or other health problems
suddenly develops a blood pressure (BP) of 198/110 mm Hg. After reconfirming the BP, it is
appropriate for the nurse to tell the patient that
a. a BP recheck should be scheduled in a few weeks.
b. dietary sodium and fat content should be decreased.
c. there is an immediate danger of a stroke and hospitalization will be required.
d. diagnosis of a possible cause, treatment, and ongoing monitoring will be needed.
ANS: D
A sudden increase in BP in a patient over age 50 with no previous hypertension history or risk
factors indicates that the hypertension may be secondary to some other problem. The BP will
need treatment and ongoing monitoring. If the patient has no other risk factors, a stroke in the
immediate future is unlikely. There is no indication that dietary salt or fat intake have
contributed to this sudden increase in BP, and reducing intake of salt and fat alone will not be
adequate to reduce this BP to an acceptable level.

8. Which action will be included in the plan of care when the nurse is caring for a patient who is
receiving nicardipine (Cardene) to treat a hypertensive emergency?
a. Keep the patient NPO to prevent aspiration caused by nausea and possible
vomiting.
b. Organize nursing activities so that the patient has undisturbed sleep for 6 to 8
hours at night.
c. Assist the patient up in the chair for meals to avoid complications associated with
immobility.
d. Use an automated noninvasive blood pressure machine to obtain frequent blood
pressure (BP) measurements.
ANS: D
Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV
antihypertensive medications. This can be most easily accomplished with an automated BP
machine or arterial line. The patient will require frequent assessments, so allowing 6 to 8
hours of undisturbed sleep is not appropriate. When patients are receiving IV vasodilators, bed
rest is maintained to prevent decreased cerebral perfusion and fainting. There is no indication
that this patient is nauseated or at risk for aspiration, so an NPO status is unnecessary.

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
9. The nurse has just finished teaching a hypertensive patient about the newly prescribed
ramipril (Altace). Which patient statement indicates that more teaching is needed?
a. A little swelling around my lips and face is okay.
b. The medication may not work as well if I take any aspirin.
c. The doctor may order a blood potassium level occasionally.
d. I will call the doctor if I notice that I have a frequent cough.
ANS: A
Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an
indication that the ACE inhibitor should be discontinued. The patient should be taught that if
any swelling of the face or oral mucosa occurs, the health care provider should be
immediately notified because this could be life threatening. The other patient statements
indicate that the patient has an accurate understanding of ACE inhibitor therapy.
DIF: Cognitive Level: Apply (application) REF: eTable 33-2

10. During change-of-shift report, the nurse obtains the following information about a
hypertensive patient who received the first dose of nadolol (Corgard) during the previous
shift. Which information indicates that the patient needs immediate intervention?
a. The patients most recent blood pressure (BP) reading is 158/91 mm Hg.
b. The patients pulse has dropped from 68 to 57 beats/minute.
c. The patient has developed wheezes throughout the lung fields.
d. The patient complains that the fingers and toes feel quite cold.
ANS: C
The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a
common adverse effect of the noncardioselective b-blockers) is occurring. The nurse should
immediately obtain an oxygen saturation measurement, apply supplemental oxygen, and
notify the health care provider. The mild decrease in heart rate and complaint of cold fingers
and toes are associated with b-receptor blockade but do not require any change in therapy. The
BP reading may indicate that a change in medication type or dose may be indicated. However,
this is not as urgently needed as addressing the bronchospasm.

11. An older patient has been diagnosed with possible white coat hypertension. Which action will
the nurse plan to take next?
a. Schedule the patient for regular blood pressure (BP) checks in the clinic.
b. Instruct the patient about the need to decrease stress levels.
c. Tell the patient how to self-monitor and record BPs at home.
d. Inform the patient that ambulatory blood pressure monitoring will be needed.
ANS: C
Having the patient self-monitor BPs at home will provide a reliable indication about whether
the patient has hypertension. Regular BP checks in the clinic are likely to be high in a patient
with white coat hypertension. Ambulatory blood pressure monitoring may be used if the data
from self-monitoring are unclear. Although elevated stress levels may contribute to
hypertension, instructing the patient about this is unlikely to reduce BP.

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
12. Which blood pressure (BP) finding by the nurse indicates that no changes in therapy are
needed for a patient with stage 1 hypertension who has a history of diabetes mellitus?
a. 102/60 mm Hg
b. 128/76 mm Hg
c. 139/90 mm Hg
d. 136/82 mm Hg
ANS: B
The goal for antihypertensive therapy for a patient with hypertension and diabetes mellitus is
a BP <130/80 mm Hg. The BP of 102/60 may indicate overtreatment of the hypertension and
an increased risk for adverse drug effects. The other two blood pressures indicate a need for
modifications in the patients treatment.

13. Which information should the nurse include when teaching a patient with newly diagnosed
hypertension?
a. Increasing physical activity will control blood pressure (BP) for most patients.
b. Most patients are able to control BP through dietary changes.
c. Annual BP checks are needed to monitor treatment effectiveness.
d. Hypertension is usually asymptomatic until target organ damage occurs.
ANS: D
Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle
changes (e.g., physical activity, dietary changes) are used to help manage blood pressure, but
drugs are needed for most patients. Home BP monitoring should be taught to the patient and
findings checked by the health care provider frequently when starting treatment for
hypertension and then every 3 months once stable.

14. The nurse on the intermediate care unit received change-of-shift report on four patients with
hypertension. Which patient should the nurse assess first?
a. 43-year-old with a (blood pressure (BP) of 160/92 who is complaining of chest
pain
b. 52-year-old with a BP of 212/90 who has intermittent claudication
c. 50-year-old with a BP of 190/104 who has a creatinine of 1.7 mg/dL
d. 48-year-old with a BP of 172/98 whose urine shows microalbuminuria
ANS: A
The patient with chest pain may be experiencing acute myocardial infarction, and rapid
assessment and intervention are needed. The symptoms of the other patients also show target
organ damage but are not indicative of acute processes.
DIF: Cognitive Level: Analyze (analysis) REF: 726

OBJ: Special Questions: Prioritization; Multiple Patients
TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment
15. The nurse is reviewing the laboratory test results for a patient who has recently been
diagnosed with hypertension. Which result is most important to communicate to the health
care provider?
a. Serum creatinine of 2.8 mg/dL
b. Serum potassium of 4.5 mEq/L
c. Serum hemoglobin of 14.7 g/dL
d. Blood glucose level of 96 mg/dL
ANS: A
The elevated creatinine indicates renal damage caused by the hypertension. The other
laboratory results are normal.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
16. A patient with a history of hypertension treated with a diuretic and an angiotensin-converting
enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe
headache and nausea and has a blood pressure (BP) of 238/118 mm Hg. Which question
should the nurse ask first?
a. Did you take any acetaminophen (Tylenol) today?
b. Have you been consistently taking your medications?
c. Have there been any recent stressful events in your life?
d. Have you recently taken any antihistamine medications?
ANS: B
Sudden withdrawal of antihypertensive medications can cause rebound hypertension and
hypertensive crisis. Although many over-the-counter medications can cause hypertension,
antihistamines and acetaminophen do not increase BP. Stressful events will increase BP but
not usually to the level seen in this patient.

17. The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a
hypertensive emergency. Which finding is most important to report to the health care
provider?
a. Urine output over 8 hours is 250 mL less than the fluid intake.
b. The patient cannot move the left arm and leg when asked to do so.
c. Tremors are noted in the fingers when the patient extends the arms.
d. The patient complains of a headache with pain at level 8/10 (0 to 10 scale).
ANS: B
The patients inability to move the left arm and leg indicates that a hemorrhagic stroke may be
occurring and will require immediate action to prevent further neurologic damage. The other
clinical manifestations are also likely caused by the hypertension and will require rapid
nursing actions, but they do not require action as urgently as the neurologic changes.

18. A patient with hypertension who has just started taking atenolol (Tenormin) returns to the
health clinic after 2 weeks for a follow-up visit. The blood pressure (BP) is unchanged from
the previous visit. Which action should the nurse take first?
a. Inform the patient about the reasons for a possible change in drug dosage.
b. Question the patient about whether the medication is actually being taken.
c. Inform the patient that multiple drugs are often needed to treat hypertension.
d. Question the patient regarding any lifestyle changes made to help control BP.
ANS: B
Because noncompliance with antihypertensive therapy is common, the nurses initial action
should be to determine whether the patient is taking the atenolol as prescribed. The other
actions also may be implemented, but these would be done after assessing patient compliance
with the prescribed therapy.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
19. The registered nurse (RN) is caring for a patient with a hypertensive crisis who is receiving
sodium nitroprusside (Nipride). Which nursing action can the nurse delegate to an
experienced licensed practical/vocational nurse (LPN/LVN)?
a. Titrate nitroprusside to decrease mean arterial pressure (MAP) to 115 mm Hg.
b. Evaluate effectiveness of nitroprusside therapy on blood pressure (BP).
c. Set up the automatic blood pressure machine to take BP every 15 minutes.
d. Assess the patients environment for adverse stimuli that might increase BP.
ANS: C
LPN/LVN education and scope of practice include the correct use of common equipment such
as automatic blood pressure machines. The other actions require advanced nursing judgment
and education, and should be done by RNs.

OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
20. The charge nurse observes a new registered nurse (RN) doing discharge teaching for a patient
with hypertension who has a new prescription for enalapril (Vasotec). The charge nurse will
need to intervene if the new RN tells the patient to
a. increase the dietary intake of high-potassium foods.
b. make an appointment with the dietitian for teaching.
c. check the blood pressure (BP) with a home BP monitor at least once a day.
d. move slowly when moving from lying to sitting to standing.
ANS: A
The ACE inhibitors cause retention of potassium by the kidney, so hyperkalemia is a possible
adverse effect. The other teaching by the new RN is appropriate for a patient with newly
diagnosed hypertension who has just started therapy with enalapril.
DIF: Cognitive Level: Apply (application) REF: 15-16

OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
21. Which assessment finding for a patient who is receiving IV furosemide (Lasix) to treat stage 2
hypertension is most important to report to the health care provider?
a. Blood glucose level of 175 mg/dL
b. Blood potassium level of 3.0 mEq/L
c. Most recent blood pressure (BP) reading of 168/94 mm Hg
d. Orthostatic systolic BP decrease of 12 mm Hg
ANS: B
Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening
dysrhythmias. The health care provider should be notified of the potassium level immediately
and administration of potassium supplements initiated. The elevated blood glucose and BP
also indicate a need for collaborative interventions but will not require action as urgently as
the hypokalemia. An orthostatic drop of 12 mm Hg is common and will require intervention
only if the patient is symptomatic.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Evaluation
22. Which nursing action should the nurse take first in order to assist a patient with newly
diagnosed stage 1 hypertension in making needed dietary changes?
a. Collect a detailed diet history.
b. Provide a list of low-sodium foods.
c. Help the patient make an appointment with a dietitian.
d. Teach the patient about foods that are high in potassium.
ANS: A
The initial nursing action should be assessment of the patients baseline dietary intake through
a thorough diet history. The other actions may be appropriate, but assessment of the patients
baseline should occur first.

23. The nurse is caring for a 70-year-old who uses hydrochlorothiazide (HydroDIURIL) and
enalapril (Norvasc), but whose self-monitored blood pressure (BP) continues to be elevated.
Which patient information may indicate a need for a change?
a. Patient takes a daily multivitamin tablet.
b. Patient checks BP daily just after getting up.
c. Patient drinks wine three to four times a week.
d. Patient uses ibuprofen (Motrin) daily to treat osteoarthritis.
ANS: D
Because use of nonsteroidal antiinflammatory drugs (NSAIDs) can prevent adequate BP
control, the patient may need to avoid the use of ibuprofen. A multivitamin tablet will help
supply vitamin D, which may help lower BP. BP decreases while sleeping, so self-monitoring
early in the morning will result in obtaining pressures that are at their lowest. The patients
alcohol intake is not excessive.

SHORT ANSWER
1. The nurse obtains a blood pressure of 176/83 mm Hg for a patient. What is the patients mean
arterial pressure (MAP)?
ANS:
114 mm Hg
MAP = (SBP + 2 DBP)/3


Medical-Surgical Nursing Assessment and Management of Clinical Problems 9e Chapter 33

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Medical-Surgical Nursing Assessment and Management of Clinical Problems 9e Chapter 33

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Chapter 33: Nursing Management: Hypertension

DIF: Cognitive Level: Understand (comprehension) REF: 723

DIF: Cognitive Level: Apply (application) REF: 716

DIF: Cognitive Level: Apply (application) REF: 715

DIF: Cognitive Level: Apply (application) REF: 719

DIF: Cognitive Level: Apply (application) REF: 725

DIF: Cognitive Level: Apply (application) REF: 727

DIF: Cognitive Level: Apply (application) REF: eTable 33-2

DIF: Cognitive Level: Apply (application) REF: 718

DIF: Cognitive Level: Apply (application) REF: 715

DIF: Cognitive Level: Apply (application) REF: 717

DIF: Cognitive Level: Apply (application) REF: 713

DIF: Cognitive Level: Analyze (analysis) REF: 726

DIF: Cognitive Level: Apply (application) REF: 714

DIF: Cognitive Level: Apply (application) REF: 724

DIF: Cognitive Level: Apply (application) REF: 726

DIF: Cognitive Level: Apply (application) REF: 720

DIF: Cognitive Level: Apply (application) REF: 724

DIF: Cognitive Level: Apply (application) REF: 15-16

DIF: Cognitive Level: Apply (application) REF: 717

DIF: Cognitive Level: Apply (application) REF: 722-723

DIF: Cognitive Level: Apply (application) REF: 725-726

DIF: Cognitive Level: Apply (application) REF: 726

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