CNA Basic Nursing Skills 17 2 — Questions and Answers

Question 1: A patient's blood pressure reading is 158/92 mmHg. This value is classified as:

Normal blood pressure for all adults
Stage 2 hypertension (Correct answer)
Hypotension requiring emergency intervention
Stage 1 hypertension

Correct answer: Stage 2 hypertension

A systolic of 158 (≥140) and diastolic of 92 (≥90) both meet Stage 2 hypertension criteria per AHA 2017 guidelines.

Wait — 158/92: systolic 158 ≥ 140 and diastolic 92 ≥ 90 — this IS Stage 2. Let me correct the answer selection: correct should be 1 (Stage 2). Blood pressure classification per AHA 2017: Normal: <120/<80. Elevated: 120–129/<80. Stage 1 HTN: 130–139 OR 80–89. Stage 2 HTN: ≥140 OR ≥90. Hypertensive Crisis: >180/>120. A reading of 158/92 meets both Stage 2 criteria. The CNA should report this to the charge nurse and document it accurately. Symptoms such as headache, visual changes, or chest pain alongside a high blood pressure reading indicate a possible hypertensive urgency or emergency.

Question 2: Which symptom might a patient with hypertension (high blood pressure) report?

Rapid heart rate and palpitations
Often no symptoms — hypertension is frequently called 'the silent killer' (Correct answer)
Low energy due to decreased heart output
Constant low-grade fever

Correct answer: Often no symptoms — hypertension is frequently called 'the silent killer'

Hypertension is frequently asymptomatic, which is why it often goes undetected — when symptoms do occur they may include headache and dizziness but are non-specific.

Hypertension is known as the 'silent killer' because it typically produces no symptoms until it has caused significant organ damage (heart disease, kidney disease, stroke, retinopathy). When symptomatic, patients may report morning headache (especially occipital), dizziness, nausea, visual disturbances, or nosebleeds — but these are non-specific and often absent. This is why routine blood pressure screening is critical. CNAs play an important role in regular blood pressure monitoring in at-risk patients. A sudden sharp increase in blood pressure with symptoms (headache, chest pain, shortness of breath, vision changes, confusion) is a hypertensive crisis and requires immediate emergency response.

Question 3: When measuring a patient's blood pressure, which action will give the MOST accurate reading?

Take the reading immediately after the patient has walked briskly to the room
Have the patient seated quietly for at least 5 minutes before taking the measurement (Correct answer)
Wrap the cuff loosely so the patient is more comfortable
Take the reading with the patient's arm held above their heart level

Correct answer: Have the patient seated quietly for at least 5 minutes before taking the measurement

Blood pressure should be measured after the patient has rested quietly for at least 5 minutes, in a seated position with the arm supported at heart level, for the most accurate reading.

Multiple factors can cause artificially high blood pressure readings: recent physical activity, stress or anxiety, a full bladder, cold temperatures, pain, talking during measurement, and improper positioning. Standardized blood pressure measurement technique: patient seated in a chair (not on the exam table) with feet flat on the floor, arm supported at heart level (upper arm at the level of the fourth intercostal space), cuff properly fitted and centered over the brachial artery, patient has rested quietly for ≥5 minutes, no talking during measurement, cuff inflated and deflated at correct rate, reading taken to nearest 2 mmHg. A loose cuff gives falsely high readings.

Question 4: What is the CORRECT placement of the blood pressure cuff on the arm?

Wrapped around the wrist, over the radial pulse
On the upper arm with the cuff's artery marker positioned over the brachial artery (Correct answer)
Just below the elbow crease over the antecubital fossa
On the lower arm between the wrist and elbow

Correct answer: On the upper arm with the cuff's artery marker positioned over the brachial artery

The blood pressure cuff is placed on the upper arm (approximately 2 cm above the antecubital fossa) with the artery marker directly over the brachial artery for accurate measurement.

Standard BP cuff placement: (1) select the correct cuff size (the cuff bladder should encircle 80% of the upper arm circumference — a too-small cuff gives falsely high readings), (2) position the cuff on the bare upper arm (not over clothing), (3) align the artery marker (usually labeled 'artery' or with an arrow) directly over the palpated brachial artery (medial side of the upper arm), (4) place the bottom edge of the cuff 2–3 cm (approximately 1 inch) above the antecubital fossa. The stethoscope diaphragm is then placed over the brachial artery just below the cuff edge. Wrist cuffs are less accurate and should be used only when upper arm measurement is not possible.

Question 5: A CNA takes a patient's blood pressure and gets 182/108 mmHg. The patient reports a severe headache. What should the CNA do FIRST?

Reassure the patient the reading is probably an error and retake it
Immediately notify the charge nurse with both the reading and the symptom (Correct answer)
Administer the patient's usual antihypertensive medication from the medication cart
Ask the patient to lie down and check again in 30 minutes

Correct answer: Immediately notify the charge nurse with both the reading and the symptom

A blood pressure of 182/108 with severe headache is a possible hypertensive urgency/emergency and requires immediate nursing notification without delay.

A systolic ≥180 mmHg or diastolic ≥120 mmHg constitutes a hypertensive crisis. Combined with a severe headache (which can indicate increased intracranial pressure or impending stroke), this is an urgent/emergent situation. The CNA's immediate actions: (1) do not leave the patient alone, (2) immediately notify the charge nurse verbally (tell them both the specific blood pressure reading and the headache symptom), (3) keep the patient calm and still, (4) do not administer any medication (even the patient's own antihypertensives — timing and dose decisions are the nurse's and physician's), (5) document the time and values accurately. The nurse will assess further and contact the physician immediately.

Question 6: Which of the following is a modifiable risk factor for hypertension that a CNA can support patients in managing?

The patient's age and genetic history
Encouraging daily activity, a low-sodium diet, stress reduction, and medication adherence (Correct answer)
The patient's race and family history of cardiovascular disease
Pre-existing kidney disease or diabetes

Correct answer: Encouraging daily activity, a low-sodium diet, stress reduction, and medication adherence

Daily physical activity, a low-sodium diet, stress reduction, and medication adherence are the modifiable lifestyle factors CNAs can encourage to help patients manage hypertension.

Hypertension risk factors are divided into non-modifiable (age, race, family history, genetic factors, underlying diseases) and modifiable (diet, physical activity, weight, alcohol use, stress, smoking, medication adherence). CNAs support modifiable factor management through: (1) encouraging daily physical activity (walking, chair exercises) within the care plan, (2) reinforcing low-sodium dietary choices at mealtimes (directing patients away from salt packets, high-sodium foods), (3) promoting relaxation techniques (deep breathing, quiet music, pleasant conversation), (4) reminding patients to take medications at prescribed times and reporting refusals to the nurse, (5) monitoring weight as assigned. CNAs do not change medications but advocate for adherence.

CNA Basic Nursing Skills 17 2

A patient's blood pressure reading is 158/92 mmHg.
This value is classified as: