2800 perfusion practice quiz

While obtaining subjective assessment data from a patient with hypertension, the nurse recognizes that a modifiable risk factor for the development of hypertension is: a) Excessive alcohol consumption b) A low-calcium diet c) A family history of hypertension d) Consumption of a high-protein diet

A Alcohol intake is a modifiable risk factor for hypertension. Excessive alcohol intake is strongly associated with hypertension. Patients with hypertension should limit their daily intake to 1 oz of alcohol.

After questioning a patient about some of her symptoms, the nurse practitioner decides to perform a physical assessment. Which assessments should be prioritized to check for heart failure? a) Breath sounds b) Jugular venous distention c) Peripheral edema d) Pulse strength

A Heart failure = edema & pulmonary congestion

The nurse teaches a 28-year-old man newly diagnosed with hypertension about lifestyle modifications to reduce his blood pressure. Which statement by the patient requires an intervention by the nurse? a) "I can lower my blood pressure by switching to smokeless tobacco." b) "Diet changes can be as effective as taking blood pressure medications." c) "If I lose weight, I might not need to continue taking medications." d) "I will avoid adding salt to my food during or after cooking."

A

A 36-year-old mother of two children has anemia related to inadequate intake of essential nutrients. Which intervention would be appropriate for the nurse to include in the plan of care for this woman? a) Encourage foods high in protein, iron, vitamin C, and folate. b) Plan for 30 minutes of rest before and after every meal. c) Give the patient a list of medications that inhibit iron absorption. d) Instruct the patient to select soft, bland, and non-acidic foods.

A Increased intake of protein, iron, folate, and vitamin C provides nutrients needed for maximum iron absorption and hemoglobin production. The other interventions do not address the patient's identified problem of inadequate intake of essential nutrients. Selection of foods that are soft, bland, and nonacidic is appropriate if the patient has oral mucosal irritation. Scheduled rest is an appropriate intervention if the patient has fatigue related to anemia. Providing information about medications that may inhibit iron absorption (e.g., antacids, tetracycline, soft drinks, tea, coffee, calcium, phosphorus, and magnesium salts) is important but does not address the patient's problem of inadequate intake of essential nutrients.

Which patient is most at risk for developing coronary artery disease? a) A hypertensive 68 year old white male patient who smokes cigarettes b) A 44 year old sedentary female patient who has elevated homocysteine levels c) A 28 year old female patient who has diabetes and uses methamphetamines d) An 34 year old African-American patient who is overweight and uses smokeless tobacco

A Rationale: The four major modifiable risk factors for coronary artery disease are elevated serum lipids, hypertension, tobacco use, and physical inactivity. Other risk factors include diabetes mellitus, metabolic syndrome, psychologic states, high levels of homocysteine, and substance abuse.

The community health nurse is planning health promotion teaching targeted at preventing coronary artery disease (CAD). Which ethnic group would the nurse select as the highest priority for this intervention? a) White male b) Hispanic male c) Native American female d) African American male

A The incidence of CAD and myocardial infarction (MI) is highest among white, middle-aged men. Hispanic individuals have lower rates of CAD than non-Hispanic whites or African Americans. African Americans have an earlier age of onset and more severe CAD than whites and more than twice the mortality rate of whites of the same age. Native Americans have increased mortality in less than 35-year-olds and have major modifiable risk factors such as diabetes.

When caring for a patient with metastatic cancer, the nurse notes a hemoglobin level of 8.7 g/dL and hematocrit of 26%. What associated clinical manifestations does the nurse anticipate observing? a) Fatigue b) Headache c) Thirst d) Abdominal pain

A The patient with a low hemoglobin and hematocrit is anemic and would be most likely to experience fatigue. Fatigue develops because of the lowered oxygen-carrying capacity that leads to reduced tissue oxygenation to carry out cellular functions. Thirst, headache, and abdominal pain are not related to anemia.

The nurse is teaching a women's group about prevention of hypertension. What information should be included in the teaching for all the women? (select all that apply) a) Exercise 30 minutes most days b) Increase fruits and vegetables c) Limit sodium and fat intake d) Lose weight e) Limit nuts and seeds

ABC Not "All" the women are overweight

A patient admitted with heart failure appears very anxious and complains of shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety? (select all that apply) a) Administer ordered morphine sulfate. b) Position patient in a semi-Fowler's position. c) Use a calm, reassuring approach while talking to patient. d) Instruct patient on the use of relaxation techniques. e) Position patient on left side with head of bed flat.

ABCD

Which information should the nurse consider when planning care for older adult patients with hypertension? (Select all that apply.) a) Blood pressures should be maintained near 120/80 mm Hg. b) Systolic blood pressure increases with aging. c) Blood pressure drops 1 hour after eating in many older patients. d) White coat syndrome is prevalent in older patients. e) Older patients require higher doses of anti-hypertensive medications f) Volume depletion contributes to orthostatic hypotension.

ABCDF Systolic blood pressure increases with age and patients older than age 60 years should be maintained below 150/90 mm Hg. Older adults are more likely to have elevated blood pressure when taken by health care providers (white coat syndrome). Older patients have orthostatic hypotension related to dehydration, reduced compensatory mechanisms, and medications. One hour after eating, many older patients have a drop in blood pressure. Lower doses of medications may be needed to control blood pressures in older adults related to decreased absorption rates and excretion ability.

A male patient with a long-standing history of heart failure has recently qualified for hospice care. What measure should the nurse now prioritize when providing care for this patient? a) Taper the patient off his current medications. b) Choose interventions to promote comfort and prevent suffering. c) Pursue experimental therapies or surgical options. d) Continue education for the patient and his family.

B

In a severely anemic patient, the nurse would expect to find: a) Ventricular dysrhythmias and wheezing. b) Dyspnea and tachycardia. c) Cardiomegaly and pulmonary fibrosis. d) Cyanosis and pulmonary edema.

B

At a clinic visit, the nurse provides dietary teaching for a 56-year-old woman who was recently hospitalized with an exacerbation of chronic heart failure. The nurse determines that teaching is successful if the patient makes which statement? a) "I can have unlimited amounts of foods labeled as reduced sodium." b) "I will limit the amount of milk and cheese in my diet." c) "I can add salt when cooking foods but not at the table." d) "I will take an extra diuretic pill when I eat a lot of salt."

B Milk products should be limited to 2 cups per day for a 2500-mg sodium-restricted diet. Salt should not be added during food preparation or at the table. Diuretics should be taken as prescribed (usually daily) and not based on sodium intake. Foods labeled as reduced sodium contain at least 25% less sodium than regular.

A patient's blood pressure has not responded consistently to prescribed drugs for hypertension. The first cause of this lack of responsiveness the nurse should explore is: a) The possibility of drug interactions. b) The patient not adhering to therapy. c) Progressive target organ damage. d) The patient's possible use of recreational drugs.

B Rationale: Side effects of antihypertensive drugs are common and may be so severe or undesirable that the patient does not comply with therapy.

Which individuals would the nurse identify as having the highest risk for CAD? a) A 62-year-old female who has a sedentary lifestyle and body mass index (BMI) of 23 kg/m2 b) A 45-year-old depressed male with a high-stress job c) A 54-year-old female vegetarian with elevated high-density lipoprotein (HDL) levels d) A 60-year-old male with below normal homocysteine levels

B The 45-year-old depressed male with a high-stress job is at the highest risk for CAD. Studies demonstrate that depression and stressful states can contribute to the development of CAD. Elevated HDL levels and low homocysteine levels actually help to prevent CAD. Although a sedentary lifestyle is a risk factor, a BMI of 23 kg/m2 depicts normal weight, and thus the patient with two risk factors is at greatest risk for developing CAD.

When teaching a patient about dietary management of stage 1 hypertension, which instruction is most appropriate? a) More vigorous changes in the patient's lifestyle are needed for a longer time before starting medications. b) Medication will be required because the BP is still not at goal. c) BP monitoring should continue for another 3 months to confirm the diagnosis of hypertension. d) Lifestyle changes are less important, since they were not effective, and medications will be started.

B The patient has hypertension, stage 1. Lifestyle modifications will continue, but drug initiation of therapy is a priority. Reduction of BP can help to prevent serious complications related to hypertension.

A patient with varicose veins has been prescribed compression stockings. How should the nurse teach the patient to use these? a) "Try to keep your stockings on 24 hours a day, as much as possible." b) "While you're still lying in bed in the morning, put on your stockings." c) "Your stockings will be most effective if you can remove them for a few minutes several times a day." d) "Dangle your feet at your bedside for 5 minutes before putting on your stockings."

B The patient with varicose veins should apply stockings in bed, before rising in the morning. Stockings should not be worn continuously, but they should not be removed several times daily. Dangling at the bedside prior to application is likely to decrease their effectiveness.

When assessing the patient for orthostatic hypotension, after taking the blood pressure (BP) and pulse (P) in the supine position, what should the nurse do next?B a) Repeat BP and P in this position. b) Take BP and P with patient sitting. c) Record the BP and P measurements. d) Take BP and P with patient standing.

B When assessing for orthostatic changes in BP after measuring BP in the supine position, the patient is placed in a sitting position and BP is measured within 1 to 2 minutes and then repositioned to the standing position with BP measured again, within 1 to 2 minutes. The results are then recorded with a decrease of 20 mm Hg or more in SBP, a decrease of 10 mm Hg or more in DBP, and/or an increase in pulse of greater than or equal to 20 beats/minute from supine to standing indicating orthostatic hypotension.

While teaching a patient about the DASH diet for hypertension, you identify which food groups as being a good source of magnesium, potassium, and fiber? There are four correct answers. a) Low-Fat Dairy b) Fruits c) Nuts, seeds, and dry beans d) Vegetables e) Meat, poultry, fish f) Grains and grain products

BCDF

a) Whole milk b) Tofu c) Orange juice d) Tuna fish e) Walnuts

BDE Tuna fish, tofu, and walnuts are all rich in omega-3 fatty acids, which have been shown to reduce the risks associated with CAD when consumed regularly.

After having an MI, the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108/minute. What should the nurse suspect is happening? a) Left-sided HF b) Chronic obstructive pulmonary disease c) Right-sided HF d) Chronic HF

C

The nurse practitioner identifies understanding of dietary teaching when a patient with congestive heart failure states that she will eat which dinner menus? a) Canned tomato soup and grilled cheese sandwich b) Prepackaged frozen lasagna dinner c) Spaghetti, spinach salad, and canned pears d) Ham sandwich, canned corn, and yogurt

C No canned vegetables/soups (high sodium) prepackaged dinners are high in sodium and bullshits

While performing blood pressure screening at a health fair, the nurse counsels which person as having the greatest risk for developing hypertension? a) A 43-year-old man who travels extensively with his job and exercises only on weekends b) A 68-year-old man who uses herbal remedies to treat his enlarged prostate gland c) A 66-year-old woman whose father died at age 62 from a stroke d) A 30-year-old female advertising agent who is unmarried and lives alone

C Rationale: History of a close blood relative (e.g., father to son) with hypertension is associated with an increased risk for developing hypertension; atherosclerosis is the most common cause of cerebrovascular disease. Hypertension is the major risk factor for cerebral atherosclerosis and strokeC

After teaching about ways to decrease risk factors for CAD, the nurse recognizes that further instruction is needed when the patient says, a) "I can change my diet to decrease my intake of saturated fats." b) "I will change my lifestyle to reduce activities that increase my stress." c) "I would like to add weight lifting to my exercise program." d) "I can keep my blood pressure normal with medication."

C Weight lifting is not a cardioprotective exercise. An example of health-promoting regular physical activity is brisk walking (3 to 4 miles/hr) for at least 30 minutes 5 or more times each week.

In teaching a patient with hypertension about controlling the condition, the nurse recognizes that: a) All patients with elevated BP require medication. b) It is not necessary to limit salt in the diet if taking a diuretic. c) Obese persons must achieve a normal weight to lower BP. d) Lifestyle modifications are indicated for all persons with elevated BP.

D

The nurse teaches a patient with hypertension that uncontrolled hypertension may damage organs in the body primarily by which mechanism? a) Hypertension increases blood viscosity, which contributes to intravascular coagulation and tissue necrosis distal to occlusions. b) Hypertension causes thickening of the capillary membranes, leading to hypoxia of organ systems. c) Hypertension causes direct pressure on organs, resulting in necrosis and replacement of cells with scar tissue. d) Hypertension promotes atherosclerosis and damage to the walls of the arteries.

D

The nurse prepares a discharge teaching plan for a 44-year-old male patient who has recently been diagnosed with coronary artery disease. Which risk factor should the nurse plan to focus on during the teaching session? a) Family cardiac history b) Hyperhomocysteinemia c) Type A personality d) Elevated serum lipids

D Dyslipidemia is one of the four major modifiable risk factors for coronary artery disease (CAD). The other major modifiable risk factors are hypertension, tobacco use, and physical inactivity. Research findings related to psychologic states (i.e., type A personality) as a risk factor for coronary artery disease have been inconsistent. Family history is a nonmodifiable risk factor. High homocysteine levels have been linked to an increased risk for CAD.

Which factor should be considered when caring for a woman with suspected coronary artery disease? a) Classic signs and symptoms are expected. b) Increased risk is present before menopause. c) Women are more likely to develop collateral circulation. d) Fatigue may be the first symptom.

D Fatigue, rather than pain or shortness of breath, may be the first symptom of impaired cardiac circulation. Women may not exhibit the classic signs and symptoms of ischemia such as chest pain which radiates down the left arm. Neck, throat, or back pain may be symptoms experienced by women. Risk for coronary artery disease increases four times after menopause. Men are more likely to develop collateral circulation.

The nurse determines that teaching about implementing dietary changes to decrease the risk of CAD has been effective when the patient says: a) "I should have some type of fish at least 3 times a week." b) "If I reduce the fat in my diet to about 5% of my calories, I will be much healthier." c) "I should not eat any red meat such as beef, pork, or lamb." d) "Most of my fat intake should be from olive oil or the oils in nuts."

D Monounsaturated fats for CAD fat intake should be 25-35%

A patient with left-sided heart failure is prescribed oxygen at 4 L/min per nasal cannula, furosemide (Lasix), spironolactone (Aldactone), and enalapril (Vasotec). Which assessment should the nurse complete to best evaluate the patient's response to these drugs? a) Measure blood pressure b) Observe skin turgor c) Review intake and output d) Auscultate lung sounds

D Rationale: Left-sided heart failure will prevent normal blood flow and will cause blood to back up into the left atrium and into the pulmonary veins. The increased pulmonary pressure causes fluid extravasation from the pulmonary capillary bed into the interstitium and then the alveoli, which manifests as pulmonary congestion and edema. The most important assessment to determine if the drugs are improving the patient's condition is to auscultate lung sounds. The other assessments are important, but the best indicator of improvement of left ventricular function is a reduction in adventitious lung sounds (crackles).

When teaching a patient about dietary management of stage 1 hypertension, which instruction is most appropriate? a) Restrict all caffeine b) Use calcium supplements c) Increase protein intake d) Restrict sodium intake

D The patient should decrease intake of sodium. This will help to control hypertension, which can be aggravated by excessive salt intake, which in turn leads to fluid retention. Caffeine and protein intake do not affect hypertension. Calcium supplements are not recommended to lower BP.

In caring for a patient admitted with poorly controlled hypertension, which laboratory test result should the nurse understand as indicating the presence of target organ damage? a) BUN of 15 mg/dL b) Serum uric acid of 3.8 mg/dL c) Serum potassium of 3.5 mEq/L d) Serum creatinine of 2.6 mg/dL

D The normal serum creatinine level is 0.6-1.3 mg/dL. This elevated level indicates target organ damage to the kidneys. The other lab results are within normal limits.