Basics of BP
What 4 things determine Blood Pressure?
1) The force of blood pushing against the artery walls (as well as the size and condition of the arteries)
2) CO
3)Resistance
4)Systolic and diastolic pressure
What is the literal translation to "impaired perfusion"?
Bad/improper blood flow
What is hypertension referred to as?
"______ Killer"
Why?
-Silent killer
-Hypertension cannot be identified until symptoms begin (but hypertension occurs prior to the onset of sx)
A client is prescribed spironolactone for heart failure. Which statement by the client indicates a need for further teaching?
A. “I will avoid salt substitutes that contain potassium.”
B. “I will report muscle weakness or palpitations to my provider.”
C. “I will increase bananas and oranges in my diet.”
D. “I know this medication may make me urinate more.”
Answer: C
Rationale: Spironolactone is potassium-sparing; increasing potassium-rich foods increases the risk of hyperkalemia.
A 62-year-old client with hypertension is prescribed lisinopril (an ACE inhibitor). The nurse reviews the client’s lab results:
K⁺: 5.8 mEq/L
BUN: 28 mg/dL
Creatinine: 2.0 mg/dL
The client reports a dry, persistent cough.
Which nursing interventions are most appropriate? Select all that apply.
A. Hold the dose and notify the provider.
B. Teach the client to supplement potassium in the diet.
C. Monitor intake and output closely.
D. Encourage the client to continue taking the medication despite the cough.
E. Assess for swelling of the face, lips, and throat.
Answer: A, C, E
Rationale:
A: Correct — Hyperkalemia and kidney impairment are contraindications; provider must be notified.
B: Incorrect — Potassium should be avoided since level is already high.
C: Correct — I&O monitoring is critical with renal compromise.
D: Incorrect — Dry cough is a side effect and often requires switching to ARB.
E: Correct — Angioedema is life-threatening; assess immediately.
Describe hypotension
lower than normal blood pressure (important to check trends, what is their normal?), hypotension is a result of when the force of blood pushing against the arterial walls as your heart pumps is too low (90/60)
What are the 4 drug treatments for HTN?
RAAS suppressants
Calcium channel blockers
antiadrenergic
Direct-acting vasodilators
Describe Primary and secondary hypertension
Primary: has no known cause, is a result of increased resistance, 90% of people have this, there are no sx until organ damage begins to occur, dangerous if prolonged force on vessels continue
Secondary: Increased blood pressure due to an identifiable cause such as kidney disease (most common), cushings syndrome, hyperthyroidism and hypothyroidism, OSA, Pregnancy induced
The nurse is monitoring a client prescribed losartan. Which finding is most concerning?
A. Blood pressure 96/62 mmHg
B. Serum potassium 5.6 mEq/L
C. Complaint of dizziness
D. Report of mild headache
Answer: B
Rationale: Hyperkalemia is the most concerning finding because it can cause life-threatening cardiac arrhythmias.
Which patient teaching statement for beta blockers indicates a need for further teaching?
A. “I will check my pulse daily before taking this medication.”
B. “If my pulse is below 60, I’ll call my provider before taking the dose.”
C. “If I start feeling chest pain, I should stop the drug immediately.”
D. “I will rise slowly from sitting or lying down to prevent dizziness.”
Answer: C
Rationale: Beta blockers should never be stopped abruptly; stopping suddenly increases risk of angina or MI.
*HARD*
1a) RAAS drug classes?
2b) Explain RAAS
1a) ACE inhibitors, ARBS, Aldosterone antagonists, Direct Renin Inhibitors
2b) They regulate BP once blood volume drops, causes vasoconstriction and release of aldosterone, elevates the blood pressure and maintains tissue perfusion, aldosterone retains sodium and water while excreting K+
what classifies a hypertensive emergency?
Systolic of over 180, diastolic of over 120.
AKA: Malignant hypertension, hypertensive crisis, cerebral edema may result from cerebral artery spasms
Treatment within 1 hour is vital to prevent cardiac, renal, neurological and vascular damage
What are the damages that occur from hypertension?
The increase in BP results in permanent thickening and remodeling of the blood vessels. This as a result causes peripheral resistance to increase and a backup of pressure to vital organs such as the heart, kidneys and brain
A client taking captopril reports swelling of the lips and tongue. What is the nurse’s priority action?
A. Administer diphenhydramine as ordered.
B. Call the provider after reassessing vital signs.
C. Discontinue the medication at the next dose.
D. Stop the drug immediately and call 911.
Answer: D
Rationale: Angioedema is a medical emergency that can obstruct the airway. The nurse should stop the drug and seek immediate emergency care.
A client prescribed metoprolol asks about taking the medication. The nurse should instruct the client to take the drug:
A. On an empty stomach only
B. With food to enhance absorption
C. With milk to prevent GI upset
D. Only in the morning to avoid nocturia
Answer: B
Rationale: Metoprolol absorption is enhanced with food. Atenolol, however, is taken before meals or at bedtime.
Describe severe hypotension and shock
A progression of low blood pressure resulting in shock and death as the cells are not able to get oxygen and nutrients.
Shock is classified as circulatory failure that causes inadequate oxygen delivery, producing cellular and tissue hypoxia-can result in multiorgan failure and death
What populations are at risk for hypertension?
Middle aged older adults, white men, black and hispanic women, native americans are at high risk
Mrs. Lee, a 70-year-old client with a history of MI, is prescribed metoprolol. She reports fatigue and shortness of breath. VS:
HR = 52 bpm
BP = 100/60 mmHg
O₂ sat = 95%
Reports swelling in ankles and night cough.
Question 2a — Multiple Choice
What should the nurse do first?
A. Administer the medication as prescribed.
B. Hold the medication and notify the provider.
C. Instruct the patient to elevate her legs.
D. Recheck the blood pressure in 30 minutes.
Answer: B
Rationale: HR < 60 bpm → hold med, notify provider. Swelling and night cough suggest worsening heart failure.
Which laboratory values would require the nurse to hold an ACE inhibitor and notify the provider?
A. Sodium 140 mEq/L, potassium 4.0 mEq/L
B. BUN 16 mg/dL, creatinine 0.8 mg/dL
C. Potassium 6.1 mEq/L, creatinine 2.5 mg/dL
D. Sodium 136 mEq/L, potassium 3.9 mEq/L
Answer: C
Rationale: Both hyperkalemia (>5.0) and impaired renal function (elevated creatinine) are contraindications for ACE inhibitor use.
A 70-year-old client with heart failure is prescribed furosemide (Lasix).
Place the nursing interventions in the correct order of priority.
Monitor daily weights.
Teach client to rise slowly when standing.
Monitor potassium and sodium levels.
Assess lung sounds and edema.
Record intake and output.
Answer Order: 4 → 3 → 1 → 5 → 2
Rationale:
First, assess status (lung sounds, edema).
Next, evaluate electrolytes before/after therapy.
Weight monitoring is key to fluid balance.
I&O helps track diuretic effect.
Teaching about orthostatic hypotension comes after safety and assessment.
What are all of the possible causes for hypotension?
Dehydration, antihypertensive drugs, heart problems such as bradycardia, and heart valve issues, orthostatic hypotension (sx include dizziness, lightheaded, nausea, change in vision, syncope in elders), hormonal imbalances, severe infections such as sepsis)
How can you prevent and maintain proper perfusion?
BMI 18.5-24.9
DASH diet
Regular PA, stress management, medication regimen, smoking cessation, restricting alcohol consumption, regular BP monitoring
What are the following values?
-Normal BP:
-Prehypertension:
-Hypertension stage 1:
-Hypertension Stage 2:
Normal =180/20 mmHG
Prehypertension: 120-139/80-90
Hypertension stage 1: 140-159/ 90/99
Hypertension Stage 2: more than 160mmHG, more than 100mmHG
Mrs. Rivera, 59, with type 2 diabetes and HTN, is prescribed losartan after developing a cough on lisinopril. She reports dizziness, headache, and nausea. VS:
BP: 94/60 mmHg
HR: 78 bpm
Labs:
K⁺ = 5.1 mEq/L
BUN = 22 mg/dL
Creatinine = 1.6 mg/dL
Q2a — Multiple Choice
Which nursing action is most appropriate?
A. Encourage the patient to increase potassium-rich foods.
B. Hold the medication and notify the provider.
C. Reassure the patient that dizziness is harmless.
D. Discontinue the drug immediately.
Answer: B
Rationale: BP is low and potassium elevated → hold and notify provider. Do not encourage potassium (can worsen hyperkalemia). ARBs should not be discontinued without provider order.
A nurse is providing discharge teaching to a client prescribed valsartan. Which statement indicates correct understanding?
A. “I should avoid becoming pregnant while on this drug.”
B. “I will double my dose if I miss one to catch up.”
C. “This drug will prevent a heart attack if I keep taking it.”
D. “I should stop the medication immediately if I feel dizzy.”
Answer: A
Rationale: ARBs are teratogenic and should not be taken during pregnancy. Missed doses should not be doubled, ARBs do not prevent acute MI, and dizziness should be reported but is not cause to stop the drug abruptly.