NUR 111 (Nursing Care of Clients with Life –

Threatening Conditions, Acutely Ill/Multi-organ

Problems, High Acuity and Emergency
STUDENT ACTIVITY SHEET Situation)
BS NURSING / FOURTH YEAR
Session # 8

Materials: MS notebook, paper, pen, index card,

LESSON TITLE: Hypertensive Emergency and Urgency and bond paper (short & long size)
LEARNING TARGETS: References:

At the end of the lesson, the student nurses will be to:
1. Differentiate hypertensive emergency from
hypertensive urgency;
2. Identify conditions associated with hypertensive
emergency;
3. Describe conditions associated with hypertensive
urgency; and,
4. Enumerate drug of choice for the management of the
condition
Smeltzer S.C., & Bare B.G. (2010) Brunner and
Suddarth’s Textbook of Medical- Surgical Nursing.
Lippincott William & Wilkins
Sommer S., Johnson J. (2013) RN Adult Medical
Surgical Nursing. Assessment Technology
Institute, LLC.
https://www.nurseslab.com

LESSON PREVIEW/REVIEW (10 minutes)

Instruction: Differentiate coronary cardiogenic shock and non-coronary cardiogenic shock.
Coronary cardiogenic shock ____________________________________________________________________
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On the other hand, Coronary non cardiogenic shock _________________________________________________
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MAIN LESSON (60 minutes)

Hypertensive emergencies and urgencies may occur in patients whose hypertension has been poorly controlled,
whose hypertension has been undiagnosed, or in those who have abruptly discontinued their medications. The current
recommendations for management of both hypertensive emergencies and urgencies are based on expert opinions
because there are not clinical trial data comparing treatment options or identifying the impact of treatment on morbidity
and mortality.

A hypertensive emergency is a situation in which blood pressure is extremely elevated (more than 180/120 mm Hg) and
must be lowered immediately (not necessarily to less than 140/90 mm Hg) to halt or prevent damage to the target organs.

Assessment will reveal actual or developing clinical dysfunction of the target organ.

Conditions associated with a hypertensive emergency include

 hypertension of pregnancy,
 acute myocardial infarction,
 dissecting aortic aneurysm, and
 intracranial hemorrhage.

Hypertensive emergencies are acute, life-threatening blood pressure elevations that require prompt treatment in an
intensive care setting because of the serious target organ damage that may occur.
The therapeutic goals are:
 reduction of the mean blood pressure by up to 25% within the first hour of treatment,
 a further reduction to a goal pressure of about 160/100 mm Hg over a period of up to 6 hours, and then a

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Education (Department of Nursing) 1 of 5
  more gradual reduction in pressure over a period of days.
The medications of choice in hypertensive emergencies are those that have an immediate effect.
 Intravenous vasodilators, including:
 sodium nitroprusside (Nitropress),
 nicardipine hydrochloride (Cardene),
 fenoldopam mesylate (Corlopam),
 enalaprilat, and
 nitroglycerin has immediate actions that are short lived (minutes to 4 hours), and they are therefore used for initial
treatment.

Experts also recommend assessing the individual’s fluid volume status. If there is volume depletion secondary to
natriuresis caused by the elevated blood pressure, then volume replacement with normal saline can prevent large sudden
drops in blood pressure when antihypertensive medications are administered.

A hypertensive urgency describes a situation in which blood pressure is very elevated but there is no evidence of
impending or progressive target organ damage (Chobanian, et al., 2003).

Elevated blood pressures associated with severe headaches, nosebleeds, or anxiety are classified as urgencies.
In these situations, oral agents can be administered with the goal of normalizing blood pressure within 24 to 48 hours.

The medication of choice for hypertensive urgencies.

 Oral doses of fast-acting agents such as beta-adrenergic blocking agents (eg, labetalol [Trandate]), ACE
inhibitors (eg, captopril Capoten), or alpha2agonists (eg, clonidine [Catapres]) are recommended for the treatment
of hypertensive urgencies.
 Extremely close hemodynamic monitoring of the patient’s blood pressure and cardiovascular status is required
during treatment of hypertensive emergencies and urgencies.
 The exact frequency of monitoring is a matter of clinical judgment and varies with the patient’s condition.

Taking vital signs every 5 minutes is appropriate if the blood pressure is changing rapidly; taking vital signs at 15- or 30-
minute intervals in a more stable situation may be sufficient.
A precipitous drop in blood pressure can occur that would require immediate action to restore blood pressure to an
acceptable level.

CHECK FOR UNDERSTANDING (25 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 25 minutes for this activity:

Multiple Choice

1. The client is admitted to the hospital with a hypertensive crisis. Diazoxide (Hyperstat) is ordered. During administration
the nurse should:
A. Utilize an infusion pump
B. Check the blood glucose level
C. Place the patient in Trendelenburg position
D. Cover the solution with foil
ANSWER: ________
RATIO:___________________________________________________________________________________________
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2. A 52-year-old patient who has no previous history of hypertension or other health problems suddenly develops a BP of
188/106 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that
A. a BP recheck should be scheduled in a few weeks.
B. the dietary sodium and fat content should be decreased.
C. there is an immediate danger of a stroke and hospitalization will be required.
D. more diagnostic testing may be needed to determine the cause of the hypertension.
ANSWER: ________

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Education (Department of Nursing) 2 of 5
RATIO:___________________________________________________________________________________________
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3. Which action will be included in the plan of care when the nurse is caring for a patient who is receiving sodium
nitroprusside (Nipride) to treat a hypertensive emergency?
A. Organize nursing activities so that the patient has undisturbed sleep for 6 to 8 hours at night.
B. Assist the patient up in the chair for meals to avoid complications associated with immobility.
C. Use an automated noninvasive blood pressure machine to obtain frequent BP measurements.
D. Place the patient on NPO status to prevent aspiration caused by nausea and the associated vomiting.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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4. The nurse has just finished teaching a hypertensive patient about the newly prescribed quinapril (Accupril). Which
patient statement indicates that more teaching is needed?
A. "The medication may not work as well if I take any aspirin."
B. "The doctor may order a blood potassium level occasionally."
C. "I will call the doctor if I notice that I have a frequent cough."
D. "I won't worry if I have a little swelling around my lips and face."
ANSWER: ________
RATIO:___________________________________________________________________________________________
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5. During change-of-shift report, the nurse obtains this information about a hypertensive patient who received the first
dose of propranolol (Inderal) during the previous shift. Which information indicates that the patient needs immediate
intervention?
A. The patient's most recent BP reading is 156/94 mm Hg.
B. The patient's pulse has dropped from 64 to 58 beats/minute.
C. The patient has developed wheezes throughout the lung fields.
D. The patient complains that the fingers and toes feel quite cold.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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6. Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP)
for a new patient?
A. Obtain a BP reading in each arm and average the results.
B. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second.
C. Have the patient sit in a chair with the feet flat on the floor.
D. Assist the patient to the supine position for BP measurements.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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7. The nurse obtains this information from a patient with prehypertension. Which finding is most important to address with
the patient?
A. Low dietary fiber intake
B. No regular aerobic exercise
C. Weight 5 pounds above ideal weight
D. Drinks wine with dinner once a week
ANSWER: ________
RATIO:___________________________________________________________________________________________
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Education (Department of Nursing) 3 of 5
8. Your patient's blood pressure is 172/98. Is this a hypertensive emergency?
A. Yes -it this
B. No - it would be considered Stage 2 Hypertension
C. No - this is considered pre-hypertension
D. No - it would be considered Stage 1 Hypertension
ANSWER: ________
RATIO:___________________________________________________________________________________________
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9. Why is HTN considered a silent killer?

A. Because symptoms don't usually present until end organ damage occurs
B. It is not; myocardial infarctions are considered the silent killer
C. Because at no point in the disease progression does symptoms ever present
D. Because it never progresses slowly, it occurs suddenly and immediately
ANSWER: ________
RATIO:___________________________________________________________________________________________
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10. You are taking care of a patient in the hospital and the CNA reports to you that their blood pressure is 198/101. They
have been running 140's/80's throughout their stay. What will you do first?
A. Check the cuff size to make sure it’s appropriate and recheck blood pressure
B. STAT page the physician
C. Ensure the recording has been appropriately documented and continue to monitor them with their next BP reading in 4
hours
D. Check the chart, obtain any PRN antihypertensives and immediately administer them

ANSWER: ________
RATIO:___________________________________________________________________________________________
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RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
RATIO:_______________________________________________________________________________________
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2. ANSWER: ________
RATIO:_______________________________________________________________________________________
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3. ANSWER: ________
RATIO:_______________________________________________________________________________________
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4. ANSWER: ________
RATIO:_______________________________________________________________________________________
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5. ANSWER: ________

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Education (Department of Nursing) 4 of 5
 RATIO:_______________________________________________________________________________________
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6. ANSWER: ________
RATIO:_______________________________________________________________________________________
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7. ANSWER: ________
RATIO:_______________________________________________________________________________________
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8. ANSWER: ________
RATIO:_______________________________________________________________________________________
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9. ANSWER: ________
RATIO:_______________________________________________________________________________________
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10. ANSWER: ________

RATIO:_______________________________________________________________________________________
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LESSON WRAP-UP (25 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Strategy 1 - Think-Pair-Share
Instruction: Find a pair (seatmate) and formulate one nursing diagnosis with nursing care plan for a patient with for
hypertensive emergency and urgency. Your work will be collected after 20 minutes.

AL Strategy 2 – TWO ROSES AND A THORN

Note two topic or concepts you enjoyed learning about, and one you don’t like or still have question about.
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(For Related Learning Experience, please refer to your clinical instructor.)

This document and the information thereon is the property of PHINMA

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