SAS #8

Case Study

1. What contributing factors to the development of ISH are present in K.J.?

Increasing age, which leads to loss of elasticity in large arteries from
atherosclerosis, and more prevalent in women (and in African Americans).
2. What additional risk factors are present?
High sodium intake from canned foods, sedentary lifestyle, and weight gain.
3. What specific dietary changes would the nurse recommend for K.J.?
The Dietary Approaches to Stop Hypertension (DASH) eating plan is rich in
fresh or frozen fruits and vegetables, fat-free or low-fat milk, whole grains,
fish, poultry, beans, seeds, and nuts. In this eating plan there are less salt and
sodium, less sweets, less fat, and less red meat than in the typical American
diet. Increasing activity and losing weight (if necessary) is encouraged.
Increasing calcium, magnesium, potassium, and fiber occurs with the
increased fruits and vegetables.
4. If drug therapy became necessary to treat K.J.'s hypertension, what diuretic
would be indicated based on her laboratory results?
Because of K.J.'s low potassium level, a potassium-sparing diuretic, such as
spironolactone, amiloride, or triamterine, could be used. If a stronger diuretic
were needed, potassium supplementation would be indicated. If an ACE
inhibitor were also needed, the diuretic would need to be changed related to
additional potassium sparing.
5. Priority Decision: What other priority teaching measures should be
instituted by the nurse?
The nurse should teach K.J. about regular daily aerobic exercise and weight
reduction; avoiding canned food and reading labels for sodium content; the
need for stress management indicated by weight gain in response to
her husband's death and availability of counseling; the pathology,
complications, and management of hypertension; and medications and the
potential of orthostatic hypotension.
6. Priority Decision: Based on the assessment data presented, what are the
priority nursing diagnoses? Are there any
collaborative problems?
Nursing diagnoses: 
Ineffective health maintenance related to increased
caloric intake and deficiency of potassium sources 
• Ineffective coping related to use of food as coping
mechanism 
• Deficient knowledge related to lack of knowledge
of pathology, complications, and management of
hypertension and treatment
Collaborative problems:
Potential complications: cerebrovascular accident, MI, renal failure

1. What are non-modifiable risk factors for primary hypertension (select all
that apply)?
a. Age
b. Obesity
c. Gender
d. Ethnicity
e. Genetic link
Hypertension progresses with increasing age. It
is more prevalent in men up to age 45 and above the age of 64 in women.
African Americans have a higher incidence of hypertension than do white
Americans. Children and siblings of patients with hypertension should be
screened and taught about healthy lifestyles.

2. How is secondary hypertension

differentiated from primary hypertension?
a. Has a more gradual onset than primary
hypertension
b. Does not cause the target organ damage
that occurs with primary hypertension
c. Has a specific cause, such as renal disease, that often can be treated by
medicine or
surgery
d. Is caused by age-related changes in BP regulatory mechanisms in people
over 65 years of age
Secondary hypertension has an underlying cause that can often be treated, in
contrast to primary or essential hypertension,which has no single known
cause.

What is the patient with primary

hypertension likely to report?
a. No symptoms
b. Cardiac palpitations
c. Dyspnea on exertion
d. Dizziness and vertigo
Hypertension is often asymptomatic, especially if it is mild or moderate, and
has been called the "silent killer."

4. A patient with stage 2 hypertension who is

taking hydrochlorothiazide (Hydrodiuril) and
lisinopril (Prinivil) has prazosin (Minipress)
added to the medication regimen. What is
most important for the nurse to teach the
patient to do?
a. Weigh every morning to monitor for fluid
retention
b. Change position slowly and avoid prolonged
standing
c. Use sugarless gum or candy to help relieve
dry mouth
d. Take the pulse daily to note any slowing of
the heart rate
Hydrochlorothiazide is a thiazide diuretic that causes sodium and potassium
loss through the kidneys. High-potassium foods should be included in the diet
or potassium supplements should be used to prevent hypokalemia. 

5. A 38-year-old man is treated for

hypertension with triamterene and
hydrochlorothiazide (Maxzide) and metoprolol
(Lopressor). Four months after his last clinic
visit, his BP returns to pretreatment levels and
he admits he has not been taking his
medication regularly. What is the nurse’s best
response to this patient?
a. <Try always to take your medication when
you carry out another daily routine so you do
not forget to take it.=
b. <You probably would not need to take
medications for hypertension if you would
exercise more and stop smoking.=
c. <The drugs you are taking cause sexual
dysfunction in many patients. Are you
experiencing any problems? in this area?
d. <You need to remember that hypertension
can be only controlled with medication, not
cured, and you must always take your
medication.

6. A 78-year-old patient is admitted with a BP

of 180/98 mm Hg. Which age-related physical
changes may contribute to this patient’s
hypertension? (Select All That Apply)
a. Decreased renal function
b. Increased baroreceptor reflexes
c. Increased peripheral vascular resistance
d. Increased adrenergic receptor sensitivity
e. Increased collagen and stiffness of the
myocardium
f. Loss of elasticity in large arteries from
arteriosclerosis
The age-related changes that contribute to
hypertension include decreased renal function, increased peripheral vascular
resistance, increased collagen and stiffness of the myocardium, and decreased
elasticity in large arteries from arteriosclerosis.

7. What should the nurse emphasize when

teaching a patient who is newly prescribed
clonidine (Catapres)?
a. The drug should never be stopped abruptly.
b. The drug should be taken early in the day to
prevent nocturia.
c. The first dose should be taken when the
patient is in bed for the night.
d. Because aspirin will decrease the drug’s
effectiveness, Tylenol should be used instead.

8. What is included in the correct technique for

BP measurements?
a. Always take the BP in both arms.
b. Position the patient supine for all readings.
c. Place the cuff loosely around the upper arm.
d. Take readings at least two times at least 1
minute apart
includes taking
two or more readings at least 1 minute apart. Initially BP measurements
should be taken in both arms to detect any differences. If there is a difference,
the arm with the higher
reading should be used for all subsequent BP readings.

9. Which manifestation is an indication that a

patient is having a hypertensive emergency?
a. Symptoms of a stroke with an elevated BP
b. A systolic BP >200 mm Hg and a diastolic BP
>120 mm Hg
c. A sudden rise in BP accompanied by
neurologic impairment
d. A severe elevation of BP that occurs over
several days or weeks
Hypertensive emergency, a type of hypertensive crisis, is a situation that
develops over hours or days in which a patient's BP is severely elevated with
evidence of acute target organ disease (e.g., cerebrovascular, cardiovascular,
renal, or retinal). The neurologic manifestations are often
similar to the presentation of a stroke but do not show the focal or lateralizing
symptoms of stroke.

10. During treatment of a patient with a BP of

222/148 mm Hg and confusion, nausea, and
vomiting, the nurse initially titrates the
medications to achieve which goal?
a. Decrease the mean arterial pressure (MAP)
to 129 mm Hg
b. Lower the BP to the patient’s normal within
the second to third hour
c. Decrease the SBP to 160 mm Hg and the DBP
to between 100- and 110-mm Hg as quickly as
possible
d. Reduce the systolic BP (SBP) to 158 mm Hg
and the diastolic BP (DBP) to 111 mm Hg
within the first 2 hours

Initially the treatment goal in hypertensive emergencies is to reduce the mean

arterial pressure (MAP) by no more than 20% to 25% in the first hour, with
further gradual reduction
over the next 24 hours. In this case the MAP is 172, so decreasing it by 25%
equals 129.