(Osborn) Chapter 21: Learning Outcomes (Number and Title)

[Osborn] chapter 21
Learning Outcomes [Number and Title]

Learning Outcome 1
Compare and contrast the differences between the types of
hypertension: prehypertension, stage 1 hypertension, and stage
2 hypertension.
Learning Outcome 2
Describe the pathophysiology of hypertension.
Learning Outcome 3
Discuss the risk factors associated with the development of
hypertension.
Learning Outcome 4
Explain the therapeutic agents used to manage hypertension.
Learning Outcome 5
Compare and contrast how social and cultural influences affect
the plan of care for the hypertensive patient.
Learning Outcome 6
Develop a nursing plan of care with the hypertensive client.
Learning Outcome 7
Discuss how multidisciplinary therapeutic interventions are
associated with patient outcome.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for
Practice Copyright 2010 by Pearson Education, Inc.
1. A clients visit to the health care clinic reveals a blood pressure of 130/82. The clients
blood pressure has been 138/88 at each of the last three clinic visits. The nurse recognizes
that:
1. The client should be educated on lifestyle modifications now to diminish the
clients increased risk of developing stage 1 or stage 2 hypertension.
2. The client is at higher risk for developing stage 1 or stage 2 hypertension. The
nurse will provide education on lifestyle modifications and anticipates the client
will be started on medications at this visit.
3. The client is not at any higher risk for developing hypertension than anyone else
and will therefore continue to be monitored periodically.
4. The clients blood pressure meets the criteria for stage 1 hypertension. In addition
to educating the client on lifestyle modifications, the nurse anticipates no need to
start medication unless the blood pressure continues to climb.
Correct Answer: The client should be educated on lifestyle modifications now to diminish
the clients increased risk of developing stage 1 or stage 2 hypertension.
Rationale: This clients blood pressure meets the criteria for prehypertension (systolic
120139 or diastolic 8089), according to the JNC 7 report, and has been elevated at
multiple clinic visits. Prehypertension increases the clients risk of developing stage 1 or
stage 2 hypertension. At the prehypertensive stage, the primary goal is lifestyle
modification and health education. Medications are not usually part of the therapeutic
plan until stage 1 or stage 2 hypertension.
Cognitive Level: Applying
Nursing Process: Planning
Client Need: Health Promotion and Maintenance
LO: 1
2. A clients visit to the health care clinic reveals a blood pressure of 142/90. The nurses
next step would be to:
1. Check the clients record for the past several blood pressure readings.
2. Discuss the diagnosis of hypertension with the client.
3. Notify the physician or primary health care provider immediately.
4. Identify medications the client has been taking.
Correct Answer: Check the clients record for the past several blood pressure readings.
Rationale: This clients blood pressure meets the criteria for stage 1 hypertension
(systolic 140159 or diastolic 8099), according to the JNC 7 report. It is important for
the nurse to first compare this blood pressure reading with previous blood pressure
readings since the actual diagnosis of hypertension requires multiple readings that are
high. Discussing the diagnosis of hypertension may be needed, but not until it is
established that the client meets the criteria for stage 1 hypertension of multiple readings
between systolic 140159 or diastolic 8099. The physician or primary health care
provider does not need to be notified immediately, but will need to be ultimately involved
in this clients therapeutic plan. The nurse will identify the clients medications, which
may impact the blood pressure reading. However, this would follow establishing whether
the high blood pressure reading is a pattern or a new event.
Cognitive Level: Analyzing
Nursing Process: Diagnosis
LO: 1
3. A client is asking about being diagnosed with stage 2 hypertension. The nurse
identifies which of the following as a priority to teach the client?
1. The client will need to take the prescribed medication as directed.
2. The client will need to exercise routinely or be faced with having to take
medication.
3. The client can stop taking medication when the blood pressure returns to
normal limits.
4. The client should limit activity to promote the blood pressures return to
normal.
Correct Answer: The client will need to take the prescribed medication as directed.
Rationale: The priority teaching includes ensuring the client understands that the
medication must be taken as directed even when the client is feeling well. Stage 2
hypertensive clients will require not only exercise as part of the therapeutic plan, but also
medication. Even though the clients blood pressure will return to normal levels, the
client should not stop taking the antihypertensive medications. The client requires
exercise as part of the therapeutic plan, not limiting activity.
Nursing Process: Implementation
LO: 1
4. The nurse recognizes that the client education has not been effective when the client
states:
1. Hypertension affects my blood vessels only if I have other underlying health
problems.
2. Hypertension causes my blood vessels to become inflamed and decreases the
blood supply to my organs if left untreated.
3. I am more prone to heart disease and eye problems if I discontinue my blood
pressure medications.
4. Hypertension creates damage to my blood vessels even if I dont have any
symptoms.
Correct Answer: Hypertension affects my blood vessels only if I have other underlying
health problems.
Rationale: Essential and secondary hypertension can both have the same impact and
effect on blood vessels. The effect of hypertension is not dependent upon the underlying
cause. Hypertension does cause inflammation and decreased blood supply to organs if left
untreated. Other health problems, such as heart disease and eye problems, can result from
untreated hypertension. Symptoms from high blood pressure are not required to have
underlying organ damage.
Nursing Process: Evaluation
LO: 2
5. A hospitalized client complains of fatigue, vision changes, and a significant headache.

Which assessment finding would support a diagnosis of hypertension?
1. A retinal exam finding by the health care provider of microaneurysms and
hard exudates
2. Blood pressure reading of 110/78
3. A one-time blood pressure reading of 140/99
4. Crackles bilaterally in all lung fields
Correct Answer: A retinal exam finding by the health care provider of microaneurysms
and hard exudates
Rationale: High blood pressure can be detected in the eye during a retinal exam by the
presence of diffuse arteriole narrowing, microaneurysms, bleeding, cotton wool patches,
and hard exudates. A blood pressure reading of 110/78 is within normal limits. A blood
pressure reading of 140/99 is not significant with only one reading, but might be
significant if repeated on more than one occasion. Crackles in all lung fields are not
conclusive of hypertension without other assessment data.
Client Need: Physiological Integrity
LO: 2
6. The nurse is evaluating the effectiveness of a clients antihypertensive medication,

captopril (Capoten). The nurse knows this medication has less effectiveness on which of
the following?
1.
2.
3.
4.
The 47-year-old African American client

The 23-year-old white male
The 62-year-old white female
The 78-year-old Asian male
Correct Answer: The 47-year-old African American client

Rationale: ACE inhibitors have less effectiveness on African American clients than other
client types. African American clients also have a greater incidence of angioedema with
ACE inhibitors than non-African Americans.
LO: 2
7. The nurse is screening clients for their risk potential of developing hypertension. The
nurse knows that which of the following clients has the most risk factors for developing
hypertension?
1. A 56-year-old African American male from Georgia with a BMI of 28, eats
canned soups daily, episodic exercise
2. A 55-year-old African American female executive from Arkansas with a BMI
of 24, most recent blood pressure readings were 118/78, exercises rarely
3. A 30-year-old Caucasian female from Maine with a BMI of 27, smokes two
pack of cigarettes a day, exercises rarely
4. A 65-year-old Caucasian male from California with a BMI of 23, sleep apnea,
exercises three times a week
Correct Answer: A 56-year-old African American male from Georgia with a BMI of 28,
eats canned soups daily, episodic exercise
Rationale: It is important for nurses to identify clients who may have factors that put
them at increased risk for hypertension based upon culture, environment, lifestyle,
gender, genetics, and race. Each of the answer choices has some level of risk for
developing hypertension. African Americans are almost twice as likely to develop
hypertension as Caucasian Americans. Stress, obesity, cigarette smoking, alcohol
consumption, diet, and comorbidities, as well as where an individual lives, can all
increase the likelihood of hypertension.
Nursing Process: Assessment
LO: 3
8. A client has been diagnosed with prehypertension. The nurse instructs the client in
lifestyle changes before leaving the clinic. The client understands the instructions when
which of the following statements is made?
1. I cannot change my age or gender, but if I stop smoking and increase my
exercise, I can reduce my chances of developing worse high blood pressure.
2. I can stop taking my diabetic medication to help reduce my chances of
developing worse high blood pressure.
3. If I can stop smoking and increase my alcohol intake to help me relax more, I
am less likely to develop worse high blood pressure.
4. To reduce my overall stress, I can eat more fast foods and prepared foods so
that I have more time to exercise.
Correct Answer: I cannot change my age or gender, but if I stop smoking and increase
my exercise, I can reduce my chances of developing worse high blood pressure.
Rationale: Clients should be instructed in lifestyle choices to reduce their risk of
hypertension. Age, race, genetics, and gender are nonmodifiable risk factors. Clients
should understand ways they may modify and minimize other risk factors, such as
smoking, weight, diet, excessive alcohol intake, stress, and management of comorbidities.
LO: 3
9. An African American 45-year-old male has developed essential hypertension. The

nurse knows which of the following is likely the biggest contributor to hypertension for
this client?
1. This client is obese.
2. This client smoked for 6 months when he was 17 years old.
3. This client has a family history of obesity.
4. This client runs 4 miles per day.
Correct Answer: This client is obese.
Rationale: African American males have a higher incidence of hypertension than
Caucasians. Obesity increases the risk for hypertension. Smoking for 6 months 28 years
prior will not significantly impact this clients risk for hypertension. A family history of
obesity will be a risk factor, but not put the client at as high of risk as the client having
obesity himself. Running 4 miles per day will decrease a clients risk factor for
hypertension.
LO: 3
10. A client has an order to take propranolol (Inderal) 80 mg twice daily. To maximize the
clients safety, it is imperative that the nurse teaches the client which of the following?
1. Do not abruptly stop the medication without consulting the physician.
2. Stop the medication immediately if experiencing nausea or a cough, then
contact the health care provider.
3. Contact the health care provider immediately if experiencing fatigue.
4. If the client experiences headaches, the client should take an extra tablet.
Correct Answer: Do not abruptly stop the medication without consulting the health care
provider.
Rationale: Propranolol (Inderal), a beta adrenergic blocking agent, may be administered
for hypertension. The client needs to know that this medication should not be abruptly
stopped. Abrupt withdrawal of the medication could cause life-threatening dysrhythmias.
The client may experience fatigue. This is something the client should address with the
health care provider upon the next visit unless the fatigue is debilitating. If the fatigue is
overpowering, the client can contact the health care provider to discuss this. However, it
is not cause for immediate contact. Taking extra medication is never advised unless the
health care provider is consulted.
LO: 4
11. A client has just been started on diltiazem hydrochloride (Cardizem SR) for high
blood pressure. The nurse recognizes the clients understanding when the client states:
1. I need to use sunscreen every day.
2. I will contact the health care provider immediately if I develop swelling of
the hands and feet.
3. I can break this medication into smaller parts since it is too large to swallow.
4. I will take this medication only at bedtime because it makes me sleepy.
Correct Answer: I need to use sunscreen every day.
Rationale: Diltiazem hydrochloride (Cardizem SR), a calcium channel blocker, works to
decrease the blood pressure. This medication can cause photosensitivity and therefore
sunscreen should be worn daily. Sustained-release (SR) types of medications should not
be crushed or broken. Cardizem should be taken before meals and at bedtime. Swelling of
the hands and feet may occur with angiotension-converting enzyme (ACE) inhibitors, not
Cardizem.
LO: 4
12. A hospitalized client is receiving hydralazine (Apresoline). The nurse is teaching the
client about how to take the medication after discharge from the hospital. The nurse
knows the teaching has been effective when the client states which of the following?
1. I will take this medication every evening before bedtime.
2. I can stop taking this medication after I am home for a few days.
3. Any dizziness that might occur is the result of my kidneys not working right.
4. I can expect a frequent headache.
Correct Answer: I will take this medication every evening before bedtime.
Rationale: Hydralazine is a vasodilating medication given to reduce the blood pressure.
The client has understood the instructions when the client verbalizes taking the
medication at bedtime to reduce any side effects of hypotension. This medication should
not be stopped without the advice of the physician. Dizziness and headaches are side
effects of this medication and should be reported to the health care provider.
Cognitive Level: Analysis
LO: 4
13. As the nurse is preparing a community education plan regarding high blood pressure,
he knows that which of the following may impact the information that is shared?
1. When taking ACE inhibitors, African Americans have a higher incidence of
significant side effects, such as angioedema.
2. Undergoing Westernization by American Indians helps them reduce their
incidence of high blood pressure.
3. There is no difference in the incidence of hypertension across the United States.
4. Caucasian Americans have a higher incidence of complications from high blood
pressure.
Correct Answer: When taking ACE inhibitors, African Americans have a higher incidence
of significant side effects, such as angioedema.
Rationale: African Americans have up to four times the risk of Caucasians in
experiencing angioedema and cough from ACE inhibitors. Westernization by American
Indians increasesnot lowerstheir incidence of high blood pressure. There are regional
differences for high blood pressure within the United States. African Americans are more
likely to experience complications from high blood pressure.
LO: 5
14. A medicalsurgical nurse is implementing a plan of care for a hypertensive client.

Which of the following is the most important information to consider?
1.
2.
3.
4.
Whether the client utilizes any complementary and alternative therapies

Whether the client has ever had symptoms from hypertension
When the client last saw the physician
The clients family history
Correct Answer: Whether the client utilizes any complementary and alternative therapies
Rationale: While the clients family history is important in determining the risk factors
for hypertension, once the diagnosis has been made and a plan of care is being
established, it is more important to note whether the client utilizes any complementary
therapies since they will often conflict or enhance other therapies. Taking the
complementary and alternative therapies into account will help to establish a plan of care
that the client can manage. The plan of care is not dependent upon the client having ever
had symptoms from the silent killer hypertension; however, the client needs to be
aware of what symptoms are urgent or emergent, and these must be addressed with the
health care provider once the client is discharged. When the client last saw the health care
provider has no bearing on the plan of care.
LO: 5
15. A male client who has a career in the New York stock market has complained to the
nurse how tired he has become. This client has a history of hypertension that is controlled
with medication. The nurse has encouraged this client to begin to exercise. The primary
purpose of this instruction is to:
1. Help the client decrease and manage stress.
2. Assist the client to build new muscle.
3. Decrease the clients risk of tolerance to the medication.
4. Improve the clients mood.
Correct Answer: Help the client decrease and manage stress.
Rationale: The client has a stressful career that can eventually impact his health. The
nurse advises the client to begin exercise primarily to assist with management of stress. It
may assist with building new muscle, but that will not be beneficial for this clients blood
pressure, stress, or fatigue. Exercise will not decrease the risk of tolerance to medication;
while it may improve the clients mood, that is a peripheral benefit.
LO: 5
16. The medicalsurgical nurse is providing the client and family with discharge
instructions for the hypertensive client. The family is concerned about complications
from hypertension. The nurse responds:
1. There are potential complications, but the risks can be minimized if the
hypertension is well controlled.
2. The complications are relatively minor.
3. The physician will discuss the complications with you at a later date.
4. The client could die if she doesnt follow these instructions.
Correct Answer: There are potential complications, but the risks can be minimized if
the hypertension is well controlled.
Rationale: The potential complications from hypertension can be minimized if
hypertension is kept under control. Some of the potential complications can also be life
threatening. The client should be aware of the seriousness of hypertension early in the
treatment plan without unduly alarming the client.
LO: 6
17. After reviewing the hypertensive clients chart and history, the nurse discovers the
client has ongoing peripheral edema, as well as difficulty breathing and a cough
following ambulation. The nurse chooses which of the following priority nursing
diagnosis?
1. Impaired Tissue Perfusion
2. Imbalance Nutrition
3. Fatigue
4. Risk of Noncompliance
Correct Answer: Impaired Tissue Perfusion
Rationale: The client with difficulty breathing and a cough following exercise, as well as
ongoing peripheral edema, has impaired tissue perfusion related to resistance to blood
flow. Imbalanced nutrition, fatigue, and risk of noncompliance may all be issues, but are
not directly related to the presenting symptoms and would not carry as high of priority as
impaired tissue perfusion.
LO: 6
18. A client who has been newly diagnosed with hypertension asks the nurse how long
medication must be taken. The nurse knows the client requires more teaching when the
client responds:
1. I will stop the medication when I am feeling better.
2. I will likely need to continue the medication for the rest of my life,
3. I will take my medication as instructed.
4. I may need to be on different types of medication.
Correct Answer: I will stop the medication when I am feeling better.
Rationale: A client with hypertension will likely require medication for the rest of his or
her life unless there are other lifestyle changes that impact the blood pressure or
condition. The client should not stop the medication when feeling better. Taking the
medication as instructed will ensure the greatest likelihood of a positive response to the
medicine. The client may need to be on different medications all at once or have the
medications changed throughout the course of a treatment regimen.
LO: 6
19. The nurse has performed a nutritional assessment and determined that several lifestyle
modifications will need to be made. The nurse will want to include which other
professional?
1. Dietician
2. Physician
3. Occupational therapist
4. Clergy
Correct Answer: Dietician
Rationale: The dietician should be consulted for the hypertensive client who needs to
make major dietary modifications since it is usually a significant lifestyle change. The
health care provider will be collaboratively involved in the clients care, but is not the
nutritional expert. An occupational therapist is not needed at this time. The clergy may be
appropriate at any time at the clients request.
LO: 7
20. The client will be discharged on multiple antihypertensive medications. The nurse has
reviewed the medications with the client. However, the client still has questions regarding
the interactions and precautions for the medications. Whom should the nurse contact for
the client prior to discharge?
1. Pharmacist
2. Physician
3. Fitness leader
4. Dietician
Correct Answer: Pharmacist
Rationale: The pharmacist should be consulted for the hypertensive client who continues
to have questions regarding medications; the pharmacist would be the most
knowledgeable regarding the interactions and precautions. The health care provider will
be collaboratively involved in the clients care. The fitness leader and dietician will
potentially play important roles in the management of this clients illness, but would not
be the experts for this clients support regarding medications.
LO: 7
21. A client with recently diagnosed hypertension has been receiving guidance from
many different multidisciplinary health care providers. The client asks the nurse why one
person doesnt just take care of her. The nurse responds:
1. Clients have the best outcomes when there is a multidisciplinary
approach to care.
2. Clients enjoy different providers; it keeps it interesting.
3. Clients remember things when they hear it from different sources.
4. Clients get a better-rounded education if it doesnt come from the nurse.
Correct Answer: Clients have the best outcomes when there is a multidisciplinary
approach to care.
Rationale: Clients who receive multidisciplinary care receive instruction from the
individuals who specialize in the corresponding topics. Therefore, they receive the best
education from the individual experts in that area. A nurses role is to facilitate each of
these encounters, and to provide supplemental information as needed. Although clients
may enjoy different providers, that is not the reason for their involvement. Clients may
recall information better when they hear it from different sources, and each specialty may
also build upon another specialty. However, a client will receive the best information
from the specialist in that topic area, not because it doesnt come from the nurse.
LO: 7

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[Osborn] chapter 21

Learning Outcomes [Number and Title]

5. A hospitalized client complains of fatigue, vision changes, and a significant headache.

6. The nurse is evaluating the effectiveness of a clients antihypertensive medication,

The 47-year-old African American client

Correct Answer: The 47-year-old African American client

9. An African American 45-year-old male has developed essential hypertension. The

14. A medicalsurgical nurse is implementing a plan of care for a hypertensive client.

Whether the client utilizes any complementary and alternative therapies

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