Which vital sign change is the most likely indicator of hypertension?

Appeared in: HPSSSB Staff Nurse - 2016

Explanation

Hypertension is defined as a sustained elevation of blood pressure.
According to current guidelines, Stage 2 hypertension is diagnosed when the systolic pressure is 140 mmHg or higher OR the diastolic pressure is 90 mmHg or higher.
A single high reading is not sufficient for diagnosis; the measurement must be confirmed on at least two separate occasions.
Diastolic pressure represents the minimal pressure against the arterial walls when the heart is at rest between beats. A persistently high resting pressure is a direct sign of hypertension.

Option A: A narrowing pulse pressure (the difference between systolic and diastolic pressure) is not a sign of hypertension. It indicates a reduced stroke volume.
Option B: Blood pressure naturally fluctuates throughout the day (diurnal variation). While excessive lability can be a concern, it is not the primary diagnostic indicator for hypertension.
Option D: An irregular pulse points to an arrhythmia, which is an issue with the heart's rhythm, not the pressure within the arteries.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Diagnostic criteria for hypertension as background academic context rather than a clinical decision trigger.
Hypertension is often called the 'silent killer' because it is frequently asymptomatic. Nurses play a crucial role in screening, patient education, and monitoring.
Accurate blood pressure measurement is critical. Nurses must use the correct cuff size and technique to avoid false readings that could lead to misdiagnosis or improper treatment.
Patient education should focus on lifestyle modifications such as diet (low sodium), exercise, weight management, and medication adherence to control blood pressure and prevent complications like stroke, heart attack, and kidney disease.

How to Approach the Question

First, understand the question is asking for the MOST LIKELY indicator of hypertension. This requires knowing the definition of hypertension.
Recall or look up the standard classification of blood pressure levels (Normal, Elevated, Stage 1, Stage 2).
Evaluate each option against this definition.
Option A (Narrowing pulse pressure): Pulse pressure is systolic minus diastolic. This is not a primary indicator of high blood pressure.
Option B (Fluctuating systolic pressure): Blood pressure normally fluctuates. This is not a defining characteristic.
Option C (Diastolic pressure exceeding 90 mmHg): This directly fits the definition of Stage 2 Hypertension.

Concept Tested & Keywords

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E6 Nursing Fundamentals Potter Perry 12e Part 3 p. 26-28

E6 Nursing Fundamentals Taylor p. 130-132

E6 Physiology Ganong 27e Vol 2 Part 1 p. 125-127

Practise the full HPSSSB Staff Nurse - 2016

Attempt every question from this paper in a timed mock, then review the full solution for each one.