Hypertension nursing test questions and answers

Follow a low-sodium and high-potassium diet, adjust medication as directed by your doctor, and start the emergency treatment process immediately if your blood pressure is ≥180/120mmHg and you feel unwell. If you are in a hurry to prepare for the exam, you can save these three sentences when you see this. The rest are practical breakdowns to help you understand the test points.

A while ago, I helped create an assessment paper for a community nursing station, and I specifically placed the multiple-choice question "Can hypertensive patients stop taking medication on their own" as the first question. As a result, 3 of the 20 nurses who took reference chose "If blood pressure is normal, they can stop." When I asked later, I had encountered patients asking this question, and I was not sure. In fact, there is indeed new research in the academic field: for low-risk first-level hypertensive patients without target organ damage, diabetes and other comorbidities, if their blood pressure is stabilized within the normal range through lifestyle intervention for more than 12 consecutive months, they can be treated strictly under the strict evaluation of a specialist. It is estimated that the medication should be gradually reduced or even discontinued, but this premise is too harsh. Let alone the patient's own judgment, many grassroots doctors are afraid to make casual decisions. Therefore, whether it is answering questions or clinical care guidance, the unified message is "You cannot stop the medication on your own, and you must consult a doctor for evaluation when adjusting the medication." Don't get confused on this point. Losing points is a small matter, but pointing the patient to the wrong path is a big deal.

There is a common true-false question that is particularly easy to trip up: "Patients with high blood pressure should stay in bed strictly and avoid exercise." The answer is definitely ×. When I first rotated to the cardiology department, I really answered this question wrong for the first time. At that time, all I could think about was "exercise raises blood pressure." Later, I took care of a 68-year-old patient with the head nurse. His blood pressure used to be 150/90. He took antihypertensive drugs every day. Later, he insisted on walking for 40 minutes every day, and his blood pressure dropped after half a year. My blood pressure stabilized at 130/80, and I reduced the amount of medicine by half. Then I realized that moderate exercise is a good helper for lowering blood pressure. Only when the blood pressure soars above 180/100mmHg should I exercise less. If I don't move at all, it will easily cause blood clots and increase blood lipids, which is even worse for blood pressure control.

There is also a frequently used multiple-choice question, asking which of the following are hypertensive emergencies. Many people also select conditions such as high blood pressure but no discomfort such as headaches and chest tightness. This is actually wrong. The core of a hypertensive emergency is "blood pressure ≥180/120mmHg + acute damage to target organs such as the heart, brain, and kidneys", such as hypertensive encephalopathy with headache and vomiting, acute left heart failure with breathlessness, and aortic dissection with chest tearing pain. These are the emergencies that require immediate intravenous infusion of sodium nitroprusside. ； If the blood pressure is only measured to be high, nothing will happen to the person. It is a sub-emergency. Oral sustained-release antihypertensive drugs can be adjusted slowly. Lowering blood pressure too quickly may lead to insufficient cerebral perfusion. Last time, a new nurse in our department used an emergency anti-hypertensive regimen for sub-emergency patients and was scolded by the head nurse. This should be remembered in both exams and clinicals.

Finally, let’s talk about the case analysis questions that accounted for the highest score. The questions are pretty much the same from test to test: an elderly patient with a history of high blood pressure, irregular medication intake, sudden headache and vomiting after an argument or constipation after exertion, unable to move half of the body, and a blood pressure of 200/120mmHg or above. How do you deal with it?

You don’t need to memorize the rules and regulations in the textbooks. You can get points by writing them in the order of actual clinical operations: first, support the person to lie flat, tilt the head to one side, and don’t let vomit choke the trachea. Don’t move blindly at this time. Moving around will be more dangerous in case of cerebral hemorrhage.； Then call the doctor immediately and put on ECG monitoring and measure blood pressure every 5 minutes. ； Wait until the doctor gives the order before prescribing antihypertensive drugs. Usually sodium nitroprusside is used. Remember to avoid light. Don’t instill it too fast at the beginning. Don’t lower blood pressure by more than 25% of the previous blood pressure in the first hour. Otherwise, there will be insufficient blood supply to the brain and it will easily cause infarction. ； Next, keep an eye on the patient's consciousness, whether the headache has worsened, and whether the hands and feet can move. If anything is wrong, call the doctor immediately. ； When the patient's condition is stable, explain clearly to him and his family that antihypertensive drugs should not be taken before he thinks about it, don't get angry at every turn, and don't strain against constipation. These clichés cannot be said too many times.

Oh, by the way, don't write "immediately take sublingual nifedipine ordinary tablets" in your answer. This operation is now unanimously not recommended. Ordinary tablets reduce blood pressure too quickly and too fiercely, and can easily induce cerebral infarction. Nowadays, sustained-release or controlled-release preparations are used. Points will be deducted directly if you write this, so don't step on it.

In fact, the questions on hypertension care are really not difficult. They are all things that are encountered every day in clinical practice. Don’t just endorse them. Take care of two patients at least, and be mentioned by the head nurse twice at least. Then you will naturally remember them all. If you are really overwhelmed before the exam, go back and remember the three sentences at the beginning. You are absolutely right.