Ch 32
Despite a high dosage, a male patient who is taking nifedipine (Procardia XL) for antihypertensive therapy continues to have blood pressures over 140/90 mm Hg. What should the nurse do next? A Assess his adherence to therapy. B Ask him to make an exercise plan. C Instruct him to use the DASH diet. D Request a prescription for a thiazide diuretic.
A
The nurse teaches a patient with hypertension that uncontrolled hypertension may damage organs in the body primarily by which mechanism? A Hypertension promotes atherosclerosis and damage to the walls of the arteries. B Hypertension causes direct pressure on organs, resulting in necrosis and replacement of cells with scar tissue. C Hypertension causes thickening of the capillary membranes, leading to hypoxia of organ systems. D Hypertension increases blood viscosity, which contributes to intravascular coagulation and tissue necrosis distal to occlusions.
A
When caring for elderly patients with hypertension, which information should the nurse consider when planning care (select all that apply.)? A Systolic blood pressure increases with aging. B Blood pressures should be maintained near 120/80 mm Hg. C White coat syndrome is prevalent in elderly patients. D Volume depletion contributes to orthostatic hypotension. E Blood pressure drops 1 hour postprandially in many older patients. F Older patients will require higher doses of antihypertensive medications.
ACDE
When providing dietary instruction to a patient with hypertension, the nurse would advise the patient to restrict intake of which meat? A Broiled fish B Roasted duck C Roasted turkey D Baked chicken breast
B
When teaching a patient about dietary management of stage 1 hypertension, which instruction is most appropriate? A Increase water intake. B Restrict sodium intake. C Increase protein intake. D Use calcium supplements.
B
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 Serum uric acid of 3.8 mg/dL B Serum creatinine of 2.6 mg/dL C Serum potassium of 3.5 mEq/L D Blood urea nitrogen of 15 mg/dL
B
The nurse admits a 73-yr-old male patient with dementia for treatment of uncontrolled hypertension. The nurse will closely monitor for hypokalemia if the patient receives which medication? A Clonidine (Catapres) B Bumetanide (Bumex) C Amiloride (Midamor) D Spironolactone (Aldactone)
B
The nurse is caring for a patient admitted with a history of hypertension. The patient's medication history includes hydrochlorothiazide daily for the past 10 years. Which parameter would indicate the optimal intended effect of this drug therapy? A Weight loss of 2 lb B BP 128/86 mm Hg C Absence of ankle edema D Output of 600 mL per 8 hours
B
The nurse is caring for a patient with hypertension who is scheduled to receive a dose of metoprolol (Lopressor). The nurse should withhold the dose and consult the prescribing physician for which vital sign taken just before administration? A O2 saturation 93% B Pulse 48 beats/min C Respirations 24 breaths/min D Blood pressure 118/74 mm Hg
B
The nurse supervises an unlicensed assistant personnel (UAP) who is taking the blood pressure of 58-yr-old obese female patient admitted with heart failure. Which action by the UAP will require the nurse to intervene? A Waiting 2 minutes after position changes to take orthostatic pressures B Deflating the blood pressure cuff at a rate of 8 to 10 mm Hg per second C Taking the blood pressure with the patient's arm at the level of the heart D Taking a forearm blood pressure because the largest cuff will not fit the patient's upper arm
B
A patient with a history of chronic hypertension is being evaluated in the emergency department for a blood pressure of 200/140 mm Hg. Which patient assessment question is the priority? A Is the patient pregnant? B Does the patient need to urinate? C Does the patient have a headache or confusion? D Is the patient taking antiseizure medications as prescribed?
C
The UAP is taking orthostatic vital signs. In the supine position, the blood pressure (BP) is 130/80 mm Hg, and the heart rate (HR) is 80 beats/min. In the sitting position, the BP is 140/80, and the HR is 90 beats/min. Which action should the nurse instruct the UAP to take next? A Repeat BP and HR in this position. B Record the BP and HR measurements. C Take BP and HR with patient standing. D Return the patient to the supine position
C
The nurse is caring for a patient admitted with chronic obstructive pulmonary disease (COPD), angina, and hypertension. Before administering the prescribed daily dose of atenolol 100 mg PO, the nurse assesses the patient carefully. Which adverse effect is this patient at risk for given the patient's health history? A Hypocapnia B Tachycardia C Bronchospasm D Nausea and vomiting
C
The nurse teaches a 28-yr-old man newly diagnosed with hypertension about lifestyle modifications to reduce his blood pressure. Which patient statement requires reinforcement of teaching? A "I will avoid adding salt to my food during or after cooking." B "If I lose weight, I might not need to continue taking medications." C "I can lower my blood pressure by switching to smokeless tobacco." D "Diet changes can be as effective as taking blood pressure medications."
C
When teaching how lisinopril (Zestril) will help lower the patient's blood pressure, which mechanism of action should the nurse explain? A Blocks β-adrenergic effects B Relaxes arterial and venous smooth muscle C Inhibits conversion of angiotensin I to angiotensin II D Reduces sympathetic outflow from central nervous system
C
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 Lose weight. B Limit nuts and seeds. C Limit sodium and fat intake. D Increase fruits and vegetables. E Exercise 30 minutes most days.
CDE
A 44-yr-old man is diagnosed with hypertension and receives a prescription for benazepril (Lotensin). After providing instruction, which statement by the patient indicates correct understanding? A "If I take this medication, I will not need to follow a special diet." B "It is normal to have some swelling in my face while taking this medication." C "I will need to eat foods such as bananas and potatoes that are high in potassium." D "If I develop a dry cough while taking this medication, I should notify my doctor."
D
A 67-yr-old woman with hypertension is admitted to the emergency department with a blood pressure of 234/148 mm Hg and was started on nitroprusside (Nitropress). After one hour of treatment, the mean arterial blood pressure (MAP) is 55 mm Hg. Which nursing action is a priority? A Start an infusion of 0.9% normal saline at 100 mL/hr. B Maintain the current administration rate of the nitroprusside. C Request insertion of an arterial line for accurate blood pressure monitoring. D Stop the nitroprusside infusion and assess the patient for potential complications.
D
