Hypertension and Hypertensive Crisis (20 Questions)

1. Mr. Jacques Lavoie, 67 years old, is admitted for uncontrolled hypertension. At 08:00, he received his scheduled antihypertensive medications: amlodipine 10 mg PO daily and losartan 50 mg PO daily (administered as ordered).

At 08:30, he suddenly reports a severe occipital headache (8/10) and blurred vision. You reassess his blood pressure using the appropriate cuff size and confirm it manually: BP 224/128 mmHg, HR 96, RR 20, SpO₂ 97% RA. He is restless and photophobic.

Medical orders include:
*Continuous cardiac monitoring
*Neuro vital signs q15 min if SBP ≥ 180 or DBP ≥ 120
*Labetalol 20 mg IV STAT, may repeat 20 mg IV q10 min PRN if SBP remains > 200 (max 80 mg), then call MD
*CBC, electrolytes, creatinine, troponin, ECG now

Question:
What is the nurse’s initial intervention? *

Wait another 30 minutes to verify the full therapeutic effect of the morning antihypertensives

Administer labetalol 20 mg IV and reassess BP

Encourage Mr. Lavoie to ambulate to reduce anxiety-related blood pressure elevation

Offer oral fluids and provide a quiet environment, then reassess in 1 hour

2. Ms. Élodie Tremblay, 59 years old, presents to the ED with BP 212/122 mmHg. She reports chest pressure (6/10), shortness of breath, and diaphoresis. ECG shows new ST-segment depression; troponin is pending.

Question:
Which interpretation is most appropriate? *

Hypertensive urgency because there is no seizure activity

White-coat hypertension because she is in the ED

Controlled hypertension because DBP is < 130 mmHg

Hypertensive emergency because there are signs of acute target-organ damage

3. Mr. Henri Beaulieu, 72 years old, has BP 198/116 mmHg with a pounding headache. Orders: hydralazine 10 mg IV q20 min PRN if SBP ≥ 180; hold if HR > 120. Before administration, you note HR 52 and he reports dizziness when sitting up.

Question:
What should the nurse do first? *

Administer hydralazine IV as ordered because SBP is ≥ 180

Recheck BP in 30 minutes because he may be anxious

Notify the physician before giving the PRN dose

Give a second dose of his scheduled oral antihypertensive now

4. Mr. André Desrosiers, 55 years old, has chronic hypertension and asks which over-the-counter product could increase blood pressure and reduce antihypertensive effectiveness.

Question:
Which instruction is most appropriate? *

“Use NSAIDs (e.g., ibuprofen) freely; they protect your kidneys.”

“Avoid NSAIDs unless prescribed; they can increase BP and reduce medication effectiveness.”

“Use decongestants like pseudoephedrine because they lower BP.”

“Stop your antihypertensive when your BP is normal.”

5. Ms. Chantal Bérubé, 70 years old, has an automated BP reading of 208/112 mmHg during routine vitals. She denies symptoms. The cuff appears too small for her arm.

Question:
What should the nurse do first? *

Document the value and recheck at the end of the shift

Repeat BP promptly using the correct cuff size and manual confirmation

Wait 30 minutes for spontaneous improvement and then repeat

Administer her scheduled antihypertensive early without reassessment

6. Mr. Pierre Gagnon, 74 years old, has a history of heart failure and hypertension. For the past year, he has been taking Furosemide (Lasix) 40 mg PO daily and Potassium Chloride (K-Dur) 20 mEq PO daily. During his clinic visit today, the physician decides to optimize his heart failure management. The physician writes an order to: "Discontinue Furosemide. Start Spironolactone (Aldactone) 25 mg PO daily." The nurse reviews the medication list and notes that the K-Dur 20 mEq has not been discontinued and remains on the active medication list. Mr. Gagnon’s latest potassium level is 4.5 mmol/L.

Question:
What is the most appropriate nursing action? *

Teach Mr. Gagnon to take the Spironolactone in the morning and the K-Dur in the evening to avoid drug interaction.

Withhold the K-Dur and contact the physician to clarify the order

Administer both medications as ordered

Instruct the patient to cut the K-Dur tablet in half

7. Ms. Lise Tremblay, 58 years old, was diagnosed with hypertension one month ago and started on Ramipril (Altace) 5 mg PO daily. She returns to the clinic today reporting a persistent, dry, tickling cough that keeps her awake at night. She denies fever, chills, rhinorrhea, or sore throat. Her lungs are clear on auscultation. Her blood pressure is 128/82 mmHg.

Question:
What is the nurse’s priority intervention? *

Advise the patient to buy an over-the-counter antitussive (cough syrup) to suppress the cough.

Reassure the patient that this is a transient side effect that usually disappears after 3 months of therapy.

Explain that this is a common side effect of the medication and notify the provider to discuss changing to a different class of antihypertensive.

Instruct the patient to stop the medication immediately and go to the Emergency Department to rule out pneumonia.

8. Mr. Marc Roy, 45 years old, visits the clinic for newly diagnosed hypertension. He has a significant medical history of moderate persistent asthma, for which he uses a Fluticasone/Salmeterol inhaler daily and Salbutamol (Ventolin) PRN. The physician prescribes Propranolol 40 mg PO BID for blood pressure control.

Question:
What is the nurse’s most appropriate action regarding this prescription? *

Teach the patient to take his Salbutamol inhaler 15 minutes before taking the Propranolol.

Contact the physician to question the order

Administer the first dose and observe the patient for 30 minutes for signs of wheezing.

Document the patient’s asthma history in the chart and proceed with the discharge teaching.

9. Mrs. Diane Cote, 78 years old, was recently started on Amlodipine 5 mg PO daily and Hydrochlorothiazide 12.5 mg PO daily. She calls the nurse station stating, "I almost fell this morning when I got out of bed to go to the bathroom. I felt very dizzy and saw spots." Her lying BP is 138/80 mmHg, and her standing BP is 110/68 mmHg.

Question:
Which instruction should the nurse prioritize in the teaching plan? *

"Stop taking your blood pressure medications immediately until you see the doctor."

"Drink a large glass of water with salt before getting out of bed to boost your pressure."

"This is a normal reaction to new medications; try to get up quickly to stimulate blood flow."

"Change positions slowly, sit on the edge of the bed for a few minutes before standing, and ensure your path to the bathroom is clear."

10. Mr. Luc Fortin, 62 years old, is admitted to the unit for uncontrolled hypertension.
At 08:00, the nurse administered his scheduled daily dose of Nifedipine XL 30 mg PO.
At 08:30, Mr. Fortin rings the call bell. He is agitated, holding his head, and reports, "I have the worst headache of my life and my vision is blurry."
The nurse assesses his Vital Signs: BP 230/130 mmHg, HR 92, RR 22.
The medical orders include a PRN protocol: "Labetalol 20 mg IV push for SBP > 200 mmHg or DBP > 120 mmHg. May repeat q15min x 3."

Question:
What is the nurse’s initial intervention? *

Administer the Labetalol 20 mg IV push immediately as per the PRN order.

Wait another 30 minutes to verify the full therapeutic effect of the Nifedipine XL administered at 08:00.

Place the patient in a supine position with legs elevated to promote cerebral perfusion.

Reassess the blood pressure in the other arm to confirm accuracy before taking action.

11. Mr. Arthur Miller, 54 years old, is newly diagnosed with Stage 1 Hypertension. The nurse provides discharge teaching regarding the DASH (Dietary Approaches to Stop Hypertension) diet. Mr. Miller states, "I usually eat lunch at the cafeteria at work." The nurse asks him to select a meal from the cafeteria menu that adheres to the DASH guidelines to verify his understanding.

Question:
Which meal choice indicates that Mr. Miller understands the dietary teaching? *

A Caesar salad with dressing, croutons, and bacon bits.

A grilled chicken breast sandwich on whole-wheat bread with lettuce and tomato, and an apple.

A bowl of canned tomato soup with saltine crackers and a pickle.

A deli-meat sandwich (ham and salami) with cheese and mustard on white bread.

12. Mr. David Chen, 60 years old, has successfully managed his hypertension with Lisinopril 10 mg PO daily for two years; his average BP is usually 128/78 mmHg. He presents to the walk-in clinic today with a BP of 156/94 mmHg. He reports, "I haven't changed my diet or missed any pills, but I have had a bad cold and backache for the last few days."

Question:
What is the most relevant assessment question for the nurse to ask to determine the cause of the blood pressure elevation? *

"Have you been drinking more grapefruit juice lately?"

"Have you been taking over-the-counter decongestants or NSAIDs (like Ibuprofen)?"

"Did you switch from sea salt to table salt in your cooking?"

"Have you been sleeping with two pillows instead of one?"

13. Ms. Sarah Jenkins, 45 years old, has a BMI of 32 (Obese) and a family history of hypertension. Her current BP is 138/88 mmHg (Pre-hypertension/Stage 1). She asks the nurse, "I want to lower my pressure naturally so I don't have to take pills. What kind of exercise should I do?"

Question:
Which response by the nurse best reflects current clinical guidelines for blood pressure reduction? *

"You should perform high-intensity weightlifting (isometric exercises) for 20 minutes daily to build muscle mass."

"You need to engage in moderate-intensity aerobic physical activity (like brisk walking or swimming) for at least 150 minutes per week."

"Exercise only helps if you lose at least 20 kg first; focus on diet immediately."

"Start with gentle yoga once a week to avoid putting stress on your heart."

14. Mr. Robert Leblanc, 52 years old, is seen for a follow-up of his hypertension. Despite adherence to his medication (Amlodipine) and a low-sodium diet, his BP remains elevated at 150/92 mmHg. During the lifestyle assessment, Mr. Leblanc mentions, "I enjoy unwinding with a few drinks after work."

Question:
What teaching should the nurse provide regarding alcohol consumption and hypertension? *

"Alcohol acts as a vasodilator, so it actually helps lower your blood pressure in the evening."

"You should switch from beer to red wine, as red wine has no effect on blood pressure."

"Excessive alcohol intake is a common cause of resistant hypertension; men should limit intake to no more than 2 drinks per day."

"You must stop drinking alcohol completely immediately, or your medication will not work."

15. Ms. Elena Gomez, 68 years old, has had uncontrolled hypertension for 15 years. She visits her primary care nurse. She reports no pain or symptoms but mentions, "My doctor insisted I go see an ophthalmologist for an eye exam, but I see perfectly fine. It seems like a waste of money."

Question:
What is the best rationale the nurse should give Ms. Gomez for the eye exam? *

"Hypertension causes glaucoma, which is high pressure inside the eye that you cannot feel."

"The doctor wants to check for cataracts, which are common side effects of blood pressure medications."

"The blood vessels in the eye are the only place we can directly see the damage high blood pressure is doing to your vessels elsewhere in the body."

"If you have high blood pressure, you are at high risk for eye infections."

16. Mr. Henri Dubois, 68 years old, was prescribed Amlodipine (Norvasc) 10 mg PO daily for hypertension two months ago. He presents to the clinic concerned about his legs. He states, "My ankles are so swollen by the end of the day that I can barely get my shoes off. I'm worried my heart is failing."
Assessment:

BP: 130/80 mmHg.
Lungs: Clear to auscultation bilaterally.
Heart: Regular rhythm, no S3 gallop.
Extremities: 2+ pitting edema to bilateral ankles.

Question:
What is the most appropriate nursing response? *

"You are showing signs of worsening heart failure; we need to admit you immediately for IV diuretics."

"This is likely a blood clot; you need to go to the emergency room for an ultrasound."

"This is a common side effect of Amlodipine caused by fluid leaking into the tissues, not heart failure."

"You are drinking too much water. Restrict your fluid intake to 1 liter per day."

17. A nursing student is preparing to measure the blood pressure of Ms. Joan Rivers, 55 years old, who has just arrived at the clinic for a hypertension follow-up. The patient is sitting on the exam table with her legs crossed at the knees and is chatting excitedly about her vacation.

Question:
Which intervention by the supervising nurse is required to ensure an accurate reading? *

Instruct the student to use the bell of the stethoscope to hear the Korotkoff sounds better while the patient talks.

Stop the procedure, ask the patient to uncross her legs, place feet flat on the floor, and rest quietly for 5 minutes before measuring.

Tell the student to pump the cuff to 220 mmHg to ensure the systolic pressure is not missed due to the patient's activity.

Proceed with the measurement immediately to capture the "stress" blood pressure, which is more reflective of daily life.

18. Mrs. Sophie Gagnon, 32 years old, has a history of chronic hypertension managed with Lisinopril 10 mg PO daily. She visits the clinic for a preconception counseling appointment. She tells the nurse, "My husband and I want to start trying to have a baby next month."

Question:
What is the nurse’s priority action regarding her medication regimen? *

Advise her to continue the Lisinopril until she has a positive pregnancy test.

Instruct her to stop all blood pressure medications immediately to "cleanse" her system before conception.

Recommend adding a diuretic to prevent fluid retention during pregnancy.

Notify the physician immediately to discuss switching her medication to Methyldopa or Labetalol.

19. Mr. Arthur Vandelay, 45 years old, has had elevated blood pressure readings (150/90 range) during his last three clinic visits. However, he insists, "I bought a machine at the pharmacy, and at home, my pressure is always around 120/75. It only goes up when I see doctors."

Question:
What is the most appropriate recommendation to verify the patient's status? *

"Pharmacy machines are inaccurate; we must treat you based on the clinic readings."

"Take an extra dose of your medication before coming to your next appointment."

"Bring your home machine to the clinic to verify its accuracy, and we will arrange for 24-hour Ambulatory Blood Pressure Monitoring (ABPM)."

"We will diagnose you with Anxiety Disorder instead of Hypertension."

20. Ms. Clara Barton, 60 years old, has a 10-year history of hypertension. During her annual check-up, the physician orders a urinalysis to check for Microalbuminuria. Ms. Barton asks, "Why do I need a urine test? I don't have a bladder infection."

Question:
What is the best explanation by the nurse? *

"Blood pressure medications can cause kidney stones, so we are checking for crystals."

"High blood pressure can damage the small filters in your kidneys. Protein in the urine is the earliest sign of this damage."

"We need to check if you are dehydrated, which causes high blood pressure."

"This test checks if your liver is functioning properly."