Hypertension nursing test questions

This set of hypertension nursing assessment questions for clinical nurses and community health managers focuses on the three dimensions of hierarchical individualized assessment, implementation of non-drug intervention, and long-term compliance management. The full score is 100 points, 60% are real clinical scenario case questions, and 40% are basic theory questions. The passing mark is 70 points. It is currently one of the most frequently used assessment question banks for nursing posts in primary medical institutions in China.

Last year, I helped the nursing department of the community health service center near my home to develop a revised version of this set of questions. At that time, I deliberately cut nearly half of the rote-memorized conceptual questions and replaced them with real scenarios that we often encounter during home visits and outpatient clinics. After the exam, an old nurse who had been working for 18 years joked with me and said, "There are so many pitfalls in this question. I almost fell on Aunt Zhang's question."

The question she mentioned is currently the most frequently tested multiple-choice question: 62-year-old Aunt Zhang is 155cm tall and weighs 79kg. She likes to eat homemade pickled radishes and dances square dancing for an hour every day. She has no underlying medical history such as diabetes or kidney disease. The blood pressure measured in the clinic three times in a row on different days was 148/92mmHg. Which of the following nursing measures is not recommended? The options are: A Direct prescription nifedipine controlled-release tablets for oral administration once a day ； B It is recommended that the daily salt intake be controlled within 5g and the frequency of eating pickled products gradually be reduced. ； C In addition to square dancing, add light resistance exercises such as lifting mineral water bottles twice a week ； D. Monitor blood pressure during monthly follow-up visits. If blood pressure still does not meet the standard after 3 months, medication should be considered.

The correct answer is A. However, a controversial and ambiguous point is deliberately left here - if we refer to the 2017 American ACC/AHA hypertension guidelines, 140/90mmHg is already considered grade 2 hypertension. Combined with the risk factor of obesity, drug treatment can be initiated directly. However, our 2023 version of the national hypertension guidelines prefers low-risk grade 1 hypertension to undergo a 3-month lifestyle intervention first to avoid over-medication. When setting the questions, I specifically noted the differences between different guidelines in the analysis, just to avoid people memorizing the standard answers and not being able to adjust flexibly when encountering patients.

Don’t think it’s useless to dig into the details of these questions. We met a 70-year-old man in our center before. Every time he came to the clinic to measure his blood pressure, it was around 150/95mmHg. When he measured it at home, it was always below 130/80mmHg. The little nurse who memorized the knowledge points almost gave him more medicine, but the old head nurse asked one more question: Did you ride here for 20 minutes and take the measurement directly? Later, I asked the uncle to sit in the rest area for 15 minutes, empty his bladder and then take another test. The value was immediately normal. It was typical white coat hypertension, and there was no need to adjust his medication at all. The corresponding test questions are also very common: Which of the following measurement methods can be used as the basis for the diagnosis of hypertension? The wrong options were specifically listed as "measurement just after climbing the third floor and resting for 2 minutes", "measurement in a sitting position while holding in urine", "measurement in a supine position with the upper arm below the level of the heart", which are all common mistakes that people usually make.

There is also a question about nurse-patient communication that everyone gets wrong: the patient asks, "My blood pressure has been normal for the past two months, can I stop taking the medicine?" ”Which of the following responses is most appropriate? The wrong options include the outrageous answer "Yes, you can stop once it becomes normal", and the too absolute statement "You must take medication for high blood pressure for life, and you must never stop it" - if you really encounter a patient with secondary hypertension whose blood pressure has completely returned to normal after the adrenal adenoma was removed, wouldn't this be a lie? The correct answer is "You should monitor your blood pressure for one month first. If it is stable below 130/80mmHg, you can ask the attending doctor to evaluate whether you need to reduce the medication, and don't stop it on your own." This leaves room for leeway and complies with the norm.

To be honest, memorizing knowledge points is useless for exams. Many people memorize the guidelines by heart, but when they meet a patient, they are like holding a recipe and not knowing how to cook. They are either too dogmatic or too casual. The last time our center took this set of questions, the highest score was given by the old head nurse who had been working for 18 years. She couldn’t even remember when the latest guide was updated, but she hit the score point for every scenario question, all based on her daily experience: I know that it is useless for an uncle who likes to drink just saying no to drink. You have to calculate for him: "Drinking up to 1 tael of white wine a day is better than half a kilogram of white wine, and the risk of stroke can be reduced by half."” ； Knowing that the aunt who was taking care of her grandson didn't have time to exercise specifically, she asked her to get off the bus two stops in advance and walk over when she picked up her child, so that she could get enough exercise.

Oh, by the way, when revising the exam questions this year, we specifically added a test point for home blood pressure monitor calibration. After all, more than 90% of patients now buy electronic blood pressure monitors at home. Many people have used them for three or four years without calibrating them. It is common for the measured values ​​to be 10mmHg different. If patients are not taught how to calibrate and read the values, half of the nursing work is done.

Anyway, this set of questions never tests memorization, but whether you can really stand from the patient's perspective and implement nursing measures in a practical way. After all, we, the nursing staff, can help patients keep their blood pressure within the normal range and avoid complications, which is much more effective than getting a score of 100 on the test.