UNIT 4: Assessment and Management of Patients with Hypertension

Question 1

An older adult is newly diagnosed with primary hypertension and has just been started
on a beta-blocker. Which topic should the nurse include in health education?
A. Increasing fluids to avoid extracellular volume depletion from the diuretic effect
of the beta-blocker
B. Maintaining a diet high in dairy to increase protein necessary to prevent organ
damage
C. Use of strategies to prevent falls stemming from orthostatic hypotension
D. Limiting exercise to avoid injury that can be caused by increased intracranial
pressure

Answer 1

ANS: C
Rationale: Older adults have impaired cardiovascular reflexes and are more sensitive to
orthostatic hypotension. The nurse teaches clients to change positions slowly when
moving from lying or sitting positions to a standing position and counsels older clients to
use supportive devices as necessary to prevent falls that could result from dizziness.
Lifestyle changes, such as regular physical activity/exercise, and a diet rich in fruits,
vegetables, and low-fat dairy products, are strongly recommended. Increasing fluids in
older clients may be contraindicated due to cardiovascular disease. Increased intracranial
pressure is not a risk, and activity should not normally be limited.

Question 1

A client with primary hypertension comes to the clinic reporting a gradual onset of
blurry vision and decreased visual acuity over the past several weeks. The nurse is aware
that these symptoms could be indicative of which condition?
A. Retinal blood vessel damage
B. Glaucoma
C. Cranial nerve damage
D. Hypertensive emergency

Answer 1

ANS: A
Rationale: Blurred vision, spots in front of the eyes, and diminished visual acuity can
mean retinal blood vessel damage indicative of damage elsewhere in the vascular system
as a result of hypertension. Glaucoma and cranial nerve damage do not normally cause
these symptoms. A hypertensive emergency would have a more rapid onset.

Question 2

At a blood pressure screening, the nurse learns that a client has a family history of
hypertension, high cholesterol, and elevated lipid levels. The client says reports smoking
one pack of cigarettes daily and drinking “about a pack of beer” every day. The nurse
notes which nonmodifiable risk factor for hypertension?
A. Hyperlipidemia
B. Excessive alcohol intake
C. A family history of hypertension
D. Closer adherence to medical regimen

Answer 2

ANS: C
Rationale: Unlike cholesterol levels, alcohol intake, and adherence to treatment, family
history is not modifiable

Question 3

The staff educator is teaching emergency department nurses about hypertensive
crisis. The nurse educator should explain that hypertensive urgency differs from
hypertensive emergency in which way?
A. The blood pressure (BP) is always higher in a hypertensive emergency.
B. Vigilant hemodynamic monitoring is required during treatment of hypertensive
emergencies.
C. Hypertensive urgency is treated with rest and benzodiazepines to lower BP.
D. Hypertensive emergencies are associated with evidence of target organ
damage.

Answer 3

ANS: D
Rationale: Hypertensive emergencies are acute, life-threatening BP elevations that
require prompt treatment in an intensive care setting because of the serious target organ
damage that they cause. Blood pressures are extremely elevated in both urgency and
emergencies, but there is no evidence of target organ damage in hypertensive urgency.
Extremely close hemodynamic monitoring of the client’s BP is required in both situations.
The medications of choice in hypertensive emergencies are those with an immediate
effect, such as intravenous vasodilators. Oral doses of fast-acting agents, such as
beta-adrenergic blocking agents, angiotensin-converting enzyme inhibitors, or
alpha-agonists, are recommended for the treatment of hypertensive urgencies

Question 4

A 56-year-old client at a screening event has a blood pressure reading of 146/96 mm
Hg. Upon hearing the reading, the client states, “My pressure has never been this high.
Do you think my doctor will prescribe medication to reduce it?” What is the nurse’s best
response?
A. “Yes. It is fortunate we caught this during your routine examination.”
B. “We will need to reevaluate your blood pressure because your age places you at
high risk for hypertension.”
C. “A single elevated blood pressure does not confirm hypertension. Diagnosis
requires multiple elevated readings.”
D. “You have no need to worry. Your pressure is probably elevated because you are
being tested.”

Answer 4

ANS: C
Rationale: Hypertension is confirmed by two or more readings with systolic pressure of at
least 140 mm Hg and diastolic pressure of at least 90 mm Hg. An age of 56 does not
constitute a risk factor in and of itself. The nurse should not tell the client that there is no
need to worry.

Question 5

A client newly diagnosed with hypertension is discussing risk factors with the nurse.
The nurse talks about lifestyle changes with the client and advises that the client should
avoid tobacco use. What is the primary rationale behind that advice to the client?
A. Quitting smoking will cause the client’s hypertension to resolve.
B. Tobacco use increases the client’s concurrent risk of heart disease.
C. Tobacco use is associated with a sedentary lifestyle.
D. Tobacco use causes ventricular hypertrophy.

Answer 5

ANS: B
Rationale: Smoking increases the risk for heart disease, for which a client with
hypertension is already at an increased risk. Quitting will not necessarily cause
hypertension to resolve and smoking does not directly cause ventricular hypertrophy.
The association with a sedentary lifestyle is true, but this is not the main rationale for the
nurse’s advice; the association with heart disease is more salient.

Question 6

The nurse identifies a nursing diagnosis of Ineffective Health Maintenance related to
nonadherence to therapeutic regimen in a client with hypertension who has not been
taking their medication as prescribed. When planning this client’s care, which outcome
would be appropriate?
A. Client takes medication as prescribed and reports any adverse effects.
B. Client’s BP remains consistently below 140/90 mm Hg.
C. Client denies signs and symptoms of hypertensive urgency.
D. Client is able to describe modifiable risk factors for hypertension.

Answer 6

ANS: A
Rationale: The most appropriate expected outcome for a client who is given the nursing
diagnosis of risk for ineffective health maintenance is that the client takes the medication
as prescribed. The other listed goals are valid aspects of care, but none directly relates to
the client’s role in the treatment regimen.

Question 7

The nurse is providing education to a client newly diagnosed with hypertension. Which
outcome would be most appropriate for this client?
A. Client will have no visual disturbances.
B. Client will return demonstrate measuring a blood pressure.
C. Client will state two side effects of not taking antihypertensives.
D. Client will lose two pounds within two weeks.

Answer 7

ANS: B
Rationale: The primary outcome for this client is making sure that blood pressure
remains under control. This is best done by measurement of blood pressure (BP) reading.
Visual disturbances can happen with uncontrolled hypertension, but it is not the primary
client outcome. Stating two detrimental effects of hypertension is important but not as
important as measurement of BP. Losing weight is also important in controlling BP, but
the question is not addressing obesity.

Question 8

A client newly diagnosed with hypertension asks the nurse what happens when
uncontrolled hypertension is prolonged. The nurse explains that a client with prolonged,
uncontrolled hypertension is at risk for developing which health problem?
A. Chronic kidney disease
B. Right ventricular hypertrophy
C. Glaucoma
D. Anemia

Answer 8

ANS: A
Rationale: When uncontrolled hypertension is prolonged, it can result in chronic kidney
disease, myocardial infarction, stroke, impaired vision, left ventricular hypertrophy, and
cardiac failure. Glaucoma and anemia are not directly associated with hypertension.

Question 9

A client with primary hypertension reports dizziness with ambulation when taking the
prescribed alpha-adrenergic blocker. When teaching this client, what should the nurse
emphasize?
A. Rising slowly from a lying or sitting position
B. Increasing fluids to maintain BP
C. Stopping medication if dizziness persists
D. Taking medication first thing in the morning

Answer 9

ANS: A
Rationale: Clients who experience postural hypotension should be taught to rise slowly
from a lying or sitting position and use a cane or walker if necessary for safety. It is not
necessary to teach these clients about increasing fluids or taking medication in the
morning (this would increase the effects of dizziness). Clients should not be taught to
stop the medication if dizziness persists because this is unsafe and beyond the nurse’s
scope of practice.

Question 10

The nurse is planning the care of a client who has been diagnosed with hypertension,
but who otherwise enjoys good health. When assessing the response to an
antihypertensive drug regimen, which blood pressure would be the goal of treatment?
A. 160/90 mm Hg or lower
B. 100/80 mm Hg or lower
C. Average of two BP readings of 150/80 mm Hg
D. 130/80 mm Hg or lower

Answer 10

ANS: D
Rationale: A pressure of 130/80 mm Hg or less is the goal for clients. All other readings
are out of range or not appropriate

Question 11

The nurse is caring for a client in the emergency department who was admitted for a
hypertensive emergency. The nurse knows the goal of intravenous vasodilator therapy
for a hypertensive emergency would be which outcome?
A. Lower the blood pressure to reduce the onset of neurological changes
B. Decrease the blood pressure to a normal level based on the client’s age
C. Decrease the systolic blood pressure by no more than 25% within the first hour
D. Decrease the blood pressure to less than or equal to 120/80 as quickly as
possible

Answer 11

ANS: C
Rationale: The initial treatment for hypertensive crisis is to decrease the systolic blood
pressure by no more than 25% within the first hour of treatment. Lowering the blood
pressure too fast may cause hypotension in a client whose body has adjusted to
hypertension and could cause a stroke, myocardial infarction, or visual changes.
Neurologic symptoms should be addressed, but this is not the primary focus of treatment
planning.

Question 12

The nursing lab instructor is teaching student nurses how to take blood pressure. To
ensure accurate measurement, the lab instructor would teach the students to avoid
which action?
A. Measuring the BP after the client has been seated quietly for more than 5
minutes
B. Taking the BP 10 minutes after nicotine or coffee ingestion
C. Using a cuff with a bladder that encircles at least 80% of the limb
D. Using a bare forearm supported at heart level on a firm surface

Answer 12

ANS: B
Rationale: Blood pressures should be taken with the client seated with arm bare,
supported, and at heart level. The client should not have smoked tobacco or taken
caffeine in the 30 minutes preceding the measurement. The client should rest quietly for
5 minutes before the reading is taken. The cuff bladder should encircle at least 80% of
the limb being measured and have a width of at least 40% of limb circumference. Using
a cuff that is too large results in a lower BP and a cuff that is too small will give a higher
BP measurement.

Question 13

A nurse is teaching an client about the risk factors for hypertension. Which factors
should the nurse explain as risk factors for primary hypertension?
A. Obesity and high intake of sodium and saturated fat
B. Diabetes and use of oral contraceptives
C. Metabolic syndrome and smoking
D. Renal disease and coarctation of the aorta

Answer 13

ANS: A
Rationale: Obesity, stress, high intake of sodium or saturated fat, and family history are
all risk factors for primary hypertension. Diabetes and oral contraceptives are risk factors
for secondary hypertension. Metabolic syndrome, smoking, renal disease, and
coarctation of the aorta are causes of secondary hypertension.

Question 14

The nurse is caring for an older adult with a diagnosis of hypertension who is being
treated with a diuretic and beta-blocker. Which item should the nurse integrate into the
management of this client’s hypertension?
A. Ensure that the client receives a larger initial dose of antihypertensive
medication due to impaired absorption.
B. Pay close attention to hydration status because of increased sensitivity to
extracellular volume depletion.
C. Recognize that an older adult is less likely to adhere to the medication regimen
than a younger client.
D. Carefully assess for weight loss because of impaired kidney function resulting
from normal aging.

Answer 14

ANS: B
Rationale: Older adults have impaired cardiovascular reflexes and thus are more
sensitive to extracellular volume depletion caused by diuretics. The nurse needs to
assess hydration status, low BP, and postural hypotension carefully. Older adults may
have impaired absorption, but they do not need a higher initial dose of an antihypertensive than a younger person. Adherence to treatment is not necessarily
linked to age. Kidney function and absorption decline with age; less, rather than more,
antihypertensive medication is prescribed. Weight gain is not necessarily indicative of
kidney function decline

Question 15

A client with secondary hypertension has come into the clinic for a routine check-up.
When comparing this client’s diagnosis to primary hypertension, the nurse recognizes
that secondary hypertension:
A. has a specific cause.
B. has a more gradual onset than primary hypertension.
C. does not normally cause target organ damage.
D. does not normally respond to antihypertensive drug therapy.

Answer 15

ANS: A
Rationale: Secondary hypertension has a specific identified cause. A cause could include
narrowing of the renal arteries, renal parenchymal disease, hyperaldosteronism, certain
medications, pregnancy, and coarctation of the aorta. Secondary hypertension does
respond to antihypertensive drug therapy and can cause target organ damage if left
untreated.

Question 16

The nurse is assessing a client new to the clinic. Records brought to the clinic show
that the client’s hypertension has not improved. What contributing factor should the
nurse first explore in an effort to identify the cause of the client’s inadequate BP control?
A. Progressive target organ damage
B. Possibility of medication interactions
C. Lack of adherence to prescribed drug therapy
D. Possible heavy alcohol use or use of recreational drugs

Answer 16

ANS: C
Rationale: Deviation from the therapeutic program is a significant problem for people
with hypertension and other chronic conditions requiring lifetime management. An
estimated 50% of clients discontinue their medications within 1 year of beginning to take
them. Consequently, this is a more likely problem than substance use, organ damage, or
adverse drug interactions.

Question 17

The nurse is monitoring blood pressure for a client with unstable readings. How often
should the nurse check the client’s blood pressure?
A. Every 5 minutes
B. Every 30 minutes
C. Every 30 minutes until stable
D. Every 2 minutes

Answer 17

ANS: A
Rationale: The exact frequency of monitoring is a matter of clinical judgment and varies
with the client’s condition. Taking vital signs every 5 minutes is appropriate if the blood
pressure is changing rapidly; taking vital signs at 15- or 30-minute intervals in a more stable situation may be sufficient. A precipitous drop in blood pressure can occur that
would require immediate action to restore blood pressure to an acceptable level

Question 18

The nurse is providing care for a client with a diagnosis of hypertension. The nurse
should consequently assess the client for signs and symptoms of which other health
problem?
A. Migraines
B. Atrial–septal defect
C. Atherosclerosis
D. Thrombocytopenia

Answer 18

ANS: C
Rationale: Hypertension is both a sign and a risk factor for atherosclerotic heart disease.
It is not associated with structural cardiac defects, low platelet levels, or migraines.

Question 19

The nurse is developing a nursing care plan for a client who is being treated for
hypertension. Which outcome is most appropriate for the nurse to include?
A. Client will reduce Na+ intake to less than 2 g daily.
B. Client will have a stable BUN and serum creatinine levels.
C. Client will abstain from fat intake and reduce calorie intake.
D. Client will maintain a normal body weight.

Answer 19

ANS: A
Rationale: Dietary sodium intake of less than 2 g daily is recommended as a dietary
lifestyle modification to prevent and manage hypertension. Also, giving a specific amount
of allowable sodium intake makes this a measurable goal and therefore more appropriate
than the other goals, which are not quantifiable or measurable.

Question 20

A client with newly diagnosed hypertension has come to the clinic for a follow-up visit.
The client asks the nurse why the client has to come in so often. Which response by the
nurse would be best?
A. “To identify any of the early symptoms of a stroke”
B. “To determine how your blood pressure changes throughout the day”
C. “To see how often you should change your medication dose”
D. “To make sure your health is stable”

Answer 20

ANS: D
Rationale: When hypertension is initially detected, nursing assessment involves carefully
monitoring the blood pressure at frequent intervals to ensure that the client’s condition is
stable. Once it is determined that the client’s condition is stable, then visits may be
scheduled at less frequent but routine intervals. The reference to stroke is frightening
and does not capture the overall rationale for the monitoring regimen. Changes
throughout the day are not a clinical priority for most clients. The client must not change
medication doses unilaterally.

Question 21

The community health nurse cares for many clients who have hypertension. What
nursing diagnosis is most common among clients who are being treated for this health
problem?
A. Deficient knowledge regarding the lifestyle modifications for management of
hypertension
B. Noncompliance with therapeutic regimen related to adverse effects of
prescribed therapy
C. Deficient knowledge regarding BP monitoring
D. Noncompliance with treatment regimen related to medication costs

Answer 21

ANS: B
Rationale: Deviation from the therapeutic program is a significant problem for people
with hypertension and other chronic conditions requiring lifetime management. For many
clients, this is related to adverse effects of medications. Medication cost is relevant for
many clients, but adverse effects are thought to be a more significant barrier. Many
clients are aware of necessary lifestyle modification, but do not adhere to them. Most
clients are aware of the need to monitor their BP.

Question 22

The nurse is teaching a client about some of the health consequences of uncontrolled
hypertension. What health problems should the nurse describe? Select all that apply.
A. Transient ischemic attacks (TIAs)
B. Cerebrovascular disease
C. Retinal hemorrhage
D. Venous insufficiency
E. Right ventricular hypertrophy

Answer 22

ANS: A, B, C
Rationale: Potential complications of hypertension include the following: left ventricular
hypertrophy; MI; heart failure; transient ischemic attacks; cerebrovascular disease;
renal insufficiency and failure; and retinal hemorrhage. Venous insufficiency and right
ventricular hypertrophy are not potential complications of uncontrolled hypertension.

Question 23

The nurse is collaborating with the dietitian and a client with hypertension to plan
dietary modifications. Which modifications should be the priority?
A. Reduced intake of protein and carbohydrates
B. Increased intake of calcium and vitamin D
C. Reduced intake of fat and sodium
D. Increased intake of potassium, vitamin B12 and vitamin D

Answer 23

ANS: C
Rationale: Lifestyle modifications usually include restricting sodium and fat intake,
increasing intake of fruits and vegetables, and implementing regular physical activity.
There is no need to increase calcium, potassium, and vitamin intake. Calorie restriction
may be required for some clients, but a specific reduction in protein and carbohydrates is
not normally indicated.

Question 24

The critical care nurse is caring for a client just admitted in a hypertensive
emergency. The nurse should anticipate the administration of what medication?
A. Warfarin
B. Furosemide
C. Sodium nitroprusside
D. Ramipril

Answer 24

ANS: C
Rationale: The medications of choice in hypertensive emergencies are those that have an
immediate effect. IV vasodilators, including sodium nitroprusside, nicardipine
hydrochloride, clevidipine, fenoldopam mesylate, enalaprilat, and nitroglycerin, have
immediate actions that are short lived (minutes to 4 hours), and they are therefore used
for initial treatment. Ramipril is given orally and would not meet the client’s immediate
need for BP management. Diuretics, such as furosemide, are not used as initial
treatments and there is no indication for anticoagulants such as warfarin.

Question 25

A client with a hypertensive emergency is being treated in the intensive care unit. The
nurse knows that which client is at risk for developing this type of emergency?
A. A client who stops their antihypertensive medication abruptly
B. A client with a diagnosis of primary hypertension
C. A client with well-controlled hypertension
D. A client with hypertension that was diagnosed 2 years ago

Answer 25

ANS: A
Rationale: Clients who abruptly stop their antihypertensive medications are at risk for
developing hypertensive emergencies. Clients with secondary, not primary, hypertension
are also at risk. A client who is undiagnosed is at risk, not one who was diagnosed 2 years
ago. A client who has good control of their hypertension is less likely to be at risk.

Question 26

The nurse takes the client’s blood pressure, and the reading is 161/101 mm Hg. The
nurse knows this blood pressure would be classified as which type?
A. Elevated
B. Normal
C. Stage 1 hypertensive
D. Stage 2 hypertensive

Answer 26

ANS: D
Rationale: The latest guidelines (November 2017) released by the American College of
Cardiology and the American Heart Association are: Normal blood pressure: Systolic less
than 120 mm Hg and diastolic less than 80 mm Hg. Elevated blood pressure: Systolic
between 120 and 129 mm Hg and diastolic less than 80 mm Hg. Stage 1 hypertension:
Systolic between 130 and 139 mm Hg or diastolic between 80 and 89 mm Hg. Stage 2
hypertension: Systolic of 140 or greater mm Hg or diastolic of 90 or greater mm Hg.

Question 27

A client has been diagnosed as being prehypertensive. What should the nurse
encourage this client to do to aid in preventing a progression to a hypertensive state?
A. Avoid excessive potassium intake.
B. Exercise on a regular basis.
C. Eat less protein and more vegetables.
D. Limit morning activity.

Answer 27

ANS: B
Rationale: To prevent or delay progression to hypertension and reduce risk, JNC 7 urged
health care providers to encourage people with blood pressures in the prehypertension
category to begin lifestyle modifications, such as nutritional changes and exercise. There
is no need for clients to limit their activity in the morning or to avoid potassium and
protein intake.

Question 28

The nurse is screening a number of adults for hypertension. Which range of blood
pressure is considered normal?
A. Less than 110/80 mm Hg
B. Less than 120/80 mm Hg
C. Less than 130/90 mm Hg
D. Less than 140/90 mm Hg

Answer 28

ANS: B
Rationale: JNC 7 defines a blood pressure of less than 120/80 mm Hg as normal, 120 to
129/80 to 89 mm Hg as prehypertension, and 140/90 mm Hg or higher as hypertension.

Question 29

A community health nurse is planning an educational campaign addressing
hypertension. The nurse should anticipate that the incidence and prevalence of
hypertension are likely to be highest among members of what ethnic group?
A. Pacific Islanders
B. African-Americans
C. Asians
D. Hispanics

Answer 29

ANS: B
Rationale: The prevalence of hypertension varies by ethnicity and gender, and is
estimated at approximately 32.9% among Caucasian men, 30.1% among Caucasian
women, 44.9% among black men, 46.1% among black women, 29.6% among Hispanic
men, and 29.9% among Hispanic women. The prevalence of hypertension among blacks
is among the highest in the world.

Question 30

The home health nurse is caring for a client who has a diagnosis of hypertension.
What assessment question most directly addresses the possibility of worsening
hypertension?
A. “Are you eating less salt in your diet?”
B. “How is your energy level these days?”
C. “Do you ever get chest pain when you exercise?”
D. “Do you ever see spots in front of your eyes?”

Answer 30

ANS: D
Rationale: To identify complications or worsening hypertension, the client is questioned
about blurred vision, spots in front of the eyes, and diminished visual acuity. The heart,
nervous system, and kidneys are also carefully assessed, but angina pain and decreased
energy are not normally suggestive of worsening hypertension. Sodium limitation is a
beneficial lifestyle modification, but nonadherence to this is not necessarily a direct sign
of worsening symptoms.

Question 31

The nurse is providing health education to an older adult client. What should the
nurse teach the client about the relationship between hypertension and age?
A. “Because of reduced smooth muscle tone in blood vessels, blood pressure tends
to go down with age, not up.”
B. “Decreases in the strength of arteries and the presence of venous insufficiency
cause hypertension in older adults.”
C. “Structural and functional changes in the cardiovascular system that occur with
age contribute to an increase in blood pressure.”
D. “The neurologic system of older adults is less efficient at monitoring and
regulating blood pressure.”

Answer 31

ANS: C
Rationale: Structural and functional changes in the heart and blood vessels contribute to
an increase in BP that occurs with aging. Venous insufficiency does not cause
hypertension, however. Increased BP is not primarily a result of neurologic changes

Question 32

A 55-year-old client comes to the clinic for a routine check-up. The client’s BP is
159/100 mm Hg and the health care provider diagnoses hypertension after referring to
previous readings. The client asks why it is important to treat hypertension, since the
client denies any discomfort. What would be the nurse’s best response?
A. “Hypertension can cause you to develop dangerous blood clots in your legs that
can migrate to your lungs.”
B. “Hypertension puts you at increased risk of type 1 diabetes and cancer in your
age group.”
C. “Hypertension is the leading cause of death in people your age.”
D. “Hypertension greatly increases your risk of stroke and heart disease.”

Answer 32

ANS: D
Rationale: Hypertension, particularly elevated systolic BP, increases the risk of death,
stroke, and heart failure in people older than 50 years. Hypertension is not a direct
precursor to pulmonary emboli, and it does not put older adults at increased risk of type
1 diabetes or cancer. It is not the leading cause of death in people 55 years of age.

Question 33

The nurse is reviewing the medication administration record of a client who takes a
variety of medications for the treatment of hypertension. What potential therapeutic
benefits of antihypertensives should the nurse identify? Select all that apply.
A. Increased venous return
B. Decreased peripheral resistance
C. Decreased blood volume
D. Decreased strength and rate of myocardial contractions
E. Decreased blood viscosity

Answer 33

ANS: B, C, D
Rationale: The medications used for treating hypertension decrease peripheral
resistance, blood volume, or the strength and rate of myocardial contraction.
Antihypertensive medications do not increase venous return or decrease blood viscosity.

Question 34

A newly diagnosed client with hypertension is prescribed a thiazide diuretic. What
client education should the nurse provide to this client?
A. “Eat a banana every day because this medication causes moderate
hyperkalemia.”
B. “Take over-the-counter potassium pills because this medication causes your
kidneys to lose potassium.”
C. “This medication can cause low blood pressure and dizziness, especially when
you get up suddenly.”
D. “This medication increases sodium levels in your blood, so cut down on your salt.”

Answer 34

ANS: C
Rationale: Thiazide diuretics can cause postural hypotension, which may be potentiated
by alcohol, barbiturates, opioids, or hot weather. Thiazide diuretics do not cause either
moderate hyperkalemia or severe hypokalemia and they do not result in hypernatremia

Question 35

A client in hypertensive urgency is admitted to the hospital. The nurse should be
aware of which goal of treatment for a client in hypertensive urgency?
A. Normalizing blood pressure (BP) within 2 hours
B. Obtaining a BP of less than 110/70 mm Hg within 36 hours
C. Obtaining a BP of less than 120/80 mm Hg within 36 hours
D. Normalizing BP within 24 to 48 hours

Answer 35

ANS: D
Rationale: In cases of hypertensive urgency, oral agents can be given with the goal of
normalizing BP within 24 to 48 hours. For clients with this health problem, a BP of
<120/80 mm Hg may be unrealistic. Normalizing BP within only 2 hours is not realistic.

Question 36

A client’s medication regimen for the treatment of hypertension includes
hydrochlorothiazide. Following administration of this medication, the nurse should
anticipate what effect?
A. Drowsiness or lethargy
B. Increased urine output
C. Decreased heart rate
D. Mild agitation

Answer 36

ANS: B
Rationale: Thiazide diuretics lower BP by reducing circulating blood volume; this results
in a short-term increase in urine output. These drugs do not cause bradycardia,
agitation, or drowsiness.

Question 37

A client’s recently elevated BP has prompted the primary care provider to prescribe
furosemide. The nurse should closely monitor which of the following levels?
A. The client’s oxygen saturation level
B. The client’s red blood cells, hematocrit, and hemoglobin
C. The client’s level of consciousness
D. The client’s potassium level

Answer 37

ANS: D
Rationale: Loop diuretics can cause potassium depletion. They do not normally affect
level of consciousness, erythrocytes, or oxygen saturation.

Question 38

During an adult client’s last two office visits, the nurse obtained BP readings of
122/76 mm Hg and 128/78 mm Hg, respectively. How would this client’s BP be
categorized?
A. Normal
B. Elevated
C. Stage 1 hypertension
D. Stage 2 hypertension

Answer 38

ANS: B
Rationale: The latest guidelines (November 2017) released by the American College of
Cardiology and the American Heart Association are: Normal blood pressure: Systolic less
than 120 mm Hg and diastolic less than 80 mm Hg. Elevated blood pressure: Systolic
between 120 and 129 mm Hg and diastolic less than 80 mm Hg. Stage 1 hypertension:
Systolic between 130 and 139 mm Hg or diastolic between 80 and 89 mm Hg.
Stage 2 hypertension: Systolic of 140 or greater mm Hg or diastolic of 90 or greater mm
Hg.