Hypertension

Question 0

How is BP calculated?

Answer 0

BP = CO x PVR

*Peripheral Vascular Resistance (PVR) is related to the diameter of the blood vessel and the viscosity of the blood.

Question 1

Define the ranges of the following types of hypertension as defined by the JNC7:

1) Prehypertension
2) Stage I Hypertension
3) Stage II Hypertension

Answer 1

1) Prehypertension: 120-139/80-89
2) Stage I Hypertension: 140-159/90-99
3) Stage II Hypertension: 160 & >/100 & >

Question 2

Distinguish between Primary and Secondary Hypertension.

Answer 2

1) Primary Hypertension (aka Essential or Idiopathic Hypertension) is high BP from an unidentified cause (95% of hypertensive cases)
2) Secondary Hypertension - High BP secondary to an identified cause i.e., renal disease or hyper-aldosteronism (5% of hypertensive cases).

Question 3

Distinguish between White-coat and Masked Hypertension.

Answer 3

1) White-coat - The patient has a normal ambulatory BP but elevated pressures (>140/90) in healthcare office or clinic.
2) Masked - Patient has normal pressure readings in provider setting but elevated BPs at home or at work.

Question 4

Define Metabolic Syndrome (aka Syndrome X).

Answer 4

Metabolic Syndrome occurs when three of the following symptoms are present: BP greater than 130/85, insulin resistance, dyslipidemia, and/or abdominal obesity, pro-inflammatory state (⬆ CRP), and prothrombotic state (⬆ fibrinogen).

Question 5

How is Pulse Pressure calculated? What is the significance of a widened pulse pressure?

Answer 5

Pulse Pressure = systolic minus diastolic (i.e., 120/80; pulse pressure = 40).
A widened pulse pressure over 50mmHg, is associated with increasing intracranial pressure, atherosclerosis, aortic insufficiency, and fever.

Question 6

How should the nurse go about selecting the correct cuff size when taking a patient’s BP?

Answer 6

Choose a cuff length of 80% of arm circumference and a width of about 40% of the circumference.

Question 7

Explain the Mechanism of Action of Central Alpha-2-Agonists when used to treat hypertension.

Answer 7

Central Alpha-2-Agonists block norepinephrine

Question 8

Explain the Mechanism of Action of Beta-Blockers when used to treat hypertension.

Answer 8

Beta-Blockers decreases cardiac output, decreases HR and vasodilates.

Question 9

Explain the Mechanism of Action of Alpha-1-Blockers when used to treat hypertension.

Answer 9

Alpha-1-Blockers act as peripheral vasodilators.

Question 10

Explain the Mechanism of Action of Calcium-Channel Blockers when used to treat hypertension.

Answer 10

1) ⬇ contractility
2) ⬇ AV node conduction
3) Dilates arteries.

Question 11

How does the JNC7 define a Hypertensive Crisis?

Answer 11

Hypertensive Crisis is a systolic BP > 180 mmHg or diastolic BP > 120 mmHg.

Question 12

Distinguish between a Hypertensive Emergency and a Hypertensive Urgency.

Answer 12

1) Hypertensive Emergency - When BP is higher than 180/120 mmHg and must be lowered quickly to halt or prevent damage to the target organs.
2) Hypertensive Urgency - When BP is higher than 180/120 mmHg but there is no evidence of impending or progressive target organ damage.

Question 13

Which electrolyte imbalance is the patient most at risk for when taking ACE Inhibitors and ARBs?

Answer 13

Hyperkalemia - ACE Inhibitors and ARBs block aldosterone and may cause Hyperkalemia, especially when used with potassium sparing diuretics.

Question 14

What are the 4 Uncontrollable Risk Factors of CAD, mentioned in Pellico?

Answer 14

1) Age (men > 45-yrs-old, women > 55-yrs-old)
2) Gender (men are at a greater risk than women before age 55; after age 55, men and women have the same risk)
3) Race (Blacks, Mexicans, Native Americans, and Asians have an increased risk)
4) Family Hx of l1st degree relative

Question 15

What are the 6 Modifiable Risk Factors of CAD, mentioned in Pellico?

Answer 15

1) Diabetes
2) Hypertension
3) Smoking
4) Obesity
5) Physical Inactivity
6) High Cholesterol

Question 16

Which type of diuretic is useful in the elderly population and patients with Osteoperosis?

Answer 16

Thiazide diuretics, because the decrease bone breakdown and preserve bone integrity.

Question 17

Why is it important for the nurse to implement measures to relieve emotional stress with hypertension?

Answer 17

Reduction of stress decreases the production of Neurotransmitters that constrict peripheral arterioles.

Question 18

What relevant data is significant when treating African Americans with ACE Inhibitors and ARBs?

Answer 18

African Americans produce less renin, therefore they do not respond as well to ACEIs and ARBs. They respond well to thiazide diuretics and low sodium diets.

Question 19

African Americans and Asians are at higher risk for which side effects when being treated with ACE Inhibitors?

Answer 19

1) Angioedema

2) Cough

Question 20

Why is Hypertension called the “Silent Killer”?

Answer 20

Because patients are frequently Asymptomatic until end target organ disease occurs.

Question 21

What are the 6 most common complications of HTN: End Organ Damage?

Answer 21

1) Coronary Artery Disease
2) Cerebrovascular Accidents
3) Peripheral Vascular Disease
4) Heart Failure
5) Renal Disease
6) Retinopathy

Question 22

Postural Hypertension BP measurement is indicated for which 4 types of patients?

Answer 22

1) PT > 65-yrs-old
2) PTs with Diabetes Mellitus II
3) Antihypertensive Therapy
4) PTs in whom volume loss is suspected

Question 23

How does Insulin Resistance on tribute to HTN?

Answer 23

High insulin levels stimulate SNS activity and impair vasodilation.

Question 24

What are the 4 target mechanisms for Antihypertensive Drugs?

Answer 24

1) Preload - Controlled by blood volume diuretics, and venous dilation drugs. i.e., Nitrate, CCBs, and centrally-acting Alpha2 Antagonists. 2) Afterload - Controlled by opening aortic valves, volume of blood ejected, and PVR. 3) Contractility - Forcefullness of contraction controlled by CCBs and BBs. 4) Heart Rate - Speed of contractions controlled by CCBs and BBs.

Question 25

Which drug is indicated for pregnant women with HTN?

Answer 25

Methyldopa (Central Alpha2 Antagonist) - No ACE Inhibitors should be given to pregnant women.

Question 26

What are the important teaching points for a patient taking Nitroglycerin or Isosorbide (Venous and Arterial dilators)?

Answer 26

1) Do not take with Viagra or Cialis 2) Change position slowly 3) Rotate site to reduce med tolerance 4) Take on an empty stomach with a full glass of water

Question 27

Give 4 examples of CCBs used to treat HTN.

Answer 27

1) Verapamil 2) Diltiazem 3) Nifedipine 4) Amlodipine

Question 28

What are the Nursing Implications to note before administering CCBs to a patient with HTN

Answer 28

1) Hold for low BP 2 Give before meals 3) Measure I&O d/t potential for edema 4) Monitor liver and kidney fxn (calcium is metabolized by the liver and excreted by the kidneys)

Question 29

What important points should the nurse teach the patient receiving CCBs for HTN?

Answer 29

1) Report blurred vision, dry mouth, edema, dizziness, weight gains of 2lbs/day or 5lbs/week 2) Change position slowly 3) No grapefruit juice - ⬆ level of CCBs by blocking liver enzyme

Question 30

What are the less known side effects of Diuretics?

Answer 30

1) ⬆ Triglycerides 2) ⬆ Glucose tolerance (do not use in diabetics) 3) ⬆ Uric Acid levels (do not use in gout patients) 4) Impotence

Question 31

What are the nursing motivations to not when administering Diuretics to HTN patients?

Answer 31

1) Daily weights 2) Monitor for hearing loss 3) Monitor BUN, Crea, and Uric acid 4) NSAIDs may increase effect

Question 32

What are the side effects of ACE Inhibitors?

Answer 32

1) Hypotension 2) Dizziness 3) Fatigue 4) Dry Cough

Question 33

Which lab values should nurse monitor for a patient taking ACE Inhibitors?

Answer 33

1) WBCs 2) Potassium (Hyperkalemia) 3) Liver fxn 4) Crea

Question 34

What are the lesser known side effects of Beta-Blockers, used to treat HTN?

Answer 34

1) ⬆ Glucose and lipids 2) Impotence 3) Wheezing and Dyspnea 4) Dizziness, fatigues, depression and unusual dreams

Question 35

(T/F) Beta-Blockers are indicated for long-term prevention of angina.

Answer 35

True

Question 36

# Define the following types of hypertension: 1) Isolated Systolic HTN 2) Accelerated HTN 3) Labile HTN 4) Persistent/Resistant HTN 5) Malignant HTN

Answer 36

1) Isolated Systolic HTN - ⬆ SBP ( > 160 mmHg) usually found in the elderly. 2) Accelerated HTN - ⬆ in BP that is recent and associated with fundoscopic changes, excluding papilledema. 3) Labile HTN - Intermittently ⬆ BP; PT sometimes referred to as borderline. 4) Persistent/Resistant HTN - ⬆ BP despite the use of 3 antihypertensive drugs. 5) Malignant HTN - ⬆ BP of 200/130.

Question 37

How is Mean Arterial Pressure (MAP) calculated?

Answer 37

MAP = [(2 x DBP) + SBP] / 3

Question 38

How is Pulmonary Vascular Resistance (PVR) calculated?

Answer 38

``` PVR = 80 x (MPAP - PAWP)/CO PVRI = 80 x (MPAP - PAWP)/CI Normal = less than 250 dynes ```