Lewis Chapter 32: Hypertension
A patient's blood pressure is 140/100. What is their pulse pressure?
140-100=40
Which of the following cardiovascular effects of aging should the nurse anticipate when providing care for older adults (select all that apply)? A) Arterial stiffening B) Increased blood pressure C) Increased maximal heart rate D) Decreased maximal heart rate E) Increased recovery time from activity
A) Arterial stiffening B) Increased blood pressure D) Decreased maximal heart rate E) Increased recovery time from activity Well-documented cardiovascular effects of the aging process include arterial stiffening, possible increased blood pressure, and an increased amount of time that is required for recovery from activity. Maximal heart rate tends to decrease rather than increase with age.
A nurse is caring for a patient immediately following a transesophageal echocardiogram (TEE). Which assessments are appropriate for this patient (select all that apply)? A. Assess for return of gag reflex. B. Assess groin for hematoma or bleeding. C. Monitor vital signs and oxygen saturation. D. Position patient supine with head of bed flat. E. Assess lower extremities for circulatory compromise.
A. Assess for return of gag reflex. Correct C. Monitor vital signs and oxygen saturation. Correct The patient undergoing a TEE has been given conscious sedation and has had the throat numbed with a local anesthetic spray, thus eliminating the gag reflex until the effects wear off. Therefore it is imperative that the nurse assess for gag reflex return before allowing the patient to eat or drink. Vital signs and oxygen saturation are also important assessment parameters resulting from the use of sedation. A TEE does not involve invasive procedures of the circulatory blood vessels. Therefore it is not necessary to monitor the patient's groin and lower extremities in relation to this procedure or to maintain a flat position.
In palpating the patient's pedal pulses, the nurse determines the pulses are absent. What factor could contribute to this result? A. Atherosclerosis B. Hyperthyroidism C. Arteriovenous fistula D. Cardiac dysrhythmias
A. Atherosclerosis Correct Atherosclerosis can cause an absent peripheral pulse. The feet would also be cool and may be discolored. Hyperthyroidism causes a bounding pulse. Arteriovenous fistula gives a thrill or vibration to the vessel, although this would not be in the foot. Cardiac dysrhythmias cause an irregular pulse rhythm.
The nurse is providing care for a patient who has decreased cardiac output related to heart failure. What should the nurse recognize about cardiac output? A. Calculated by multiplying the patient's stroke volume by the heart rate B. The average amount of blood ejected during one complete cardiac cycle C. Determined by measuring the electrical activity of the heart and the patient's heart rate D. The patient's average resting heart rate multiplied by the patient's mean arterial blood pressure
A. Calculated by multiplying the patient's stroke volume by the heart rate Correct Cardiac output is determined by multiplying the patient's stroke volume by heart rate, thus identifying how much blood is pumped by the heart over a 1-minute period. Electrical activity of the heart and blood pressure are not direct components of cardiac output.
A chronotropic medication like digoxin affects: A. contractility B. cardiac reserve C. preload D. afterload
A. Contractility
A 64-year-old patient with a history of myocardial infarction is scheduled for a transesophageal echocardiogram to visualize a suspected clot in the left atrium. What information should the nurse include when teaching the patient about this diagnostic study? A. IV sedation may be administered to help the patient relax. B. Food and fluids are restricted for 2 hours before the procedure. C. Ambulation is restricted for up to 6 hours before the procedure. D. Contrast medium is injected into the esophagus to enhance images.
A. IV sedation may be administered to help the patient relax. IV sedation is administered to help the patient relax and ease the insertion of the tube into the esophagus. Food and fluids are restricted for at least 6 hours before the procedure. Smoking and exercise are restricted for 3 hours before exercise or stress testing, but not before TEE. Contrast medium is administered IV to evaluate the direction of blood flow if a septal defect is suspected.
The P wave represents: A. The depolarization of atria B. Repolarization of atria C. Depolarization of the ventricles D. Repolarization of the ventricles
A. The p wave represents the depolarization, that is the contraction, of the atria (triggered by SA node)
Cardiac output is determine by the rate the heart is beating times its stroke volume. What 3 specific factors affect stroke volume? A. Cardiac reserve B. Contractility C. Preload D. Afterload
B,C,D
The patient is confused about how there can be a blockage in the left anterior descending artery (LAD), but there is damage to the right ventricle. The nurse can help the patient understand this with which explanation? A. "The one vessel curves around from the left side to the right ventricle." B. "The LAD supplies blood to the left side of the heart and part of the right ventricle." C. "The right ventricle is supplied during systole primarily by the right coronary artery." D. "It is actually on your right side of the heart, but we call it the left anterior descending vessel."
B. "The LAD supplies blood to the left side of the heart and part of the right ventricle." Correct The best response is explaining that the lower portion of the right ventricle receives blood flow from the left anterior descending artery as well as the right coronary artery during diastole.
The nurse is admitting a patient who is scheduled to undergo a cardiac catheterization. What allergy is most important for the nurse to assess before this procedure? A. Iron B. Iodine C. Aspirin D. Penicillin
B. Iodine Correct The physician will usually use an iodine-based contrast to perform this procedure. Therefore it is imperative to know whether or not the patient is allergic to iodine or shellfish. Knowledge of allergies to iron, aspirin, or penicillin will be secondary.
The nurse is assessing a 62-year-old woman undergoing radiation treatment for breast cancer. How should the nurse position the patient to auscultate for signs of acute pericarditis? A. Supine without a pillow B. Sitting and leaning forward C. Left lateral sidelying position D. Head of bed at a 45-degree angle
B. Sitting and leaning forward Correct A pericardial friction rub indicates pericariditis. To auscultate a pericardial friction rub, the patient should be sitting and leaning forward. The nurse will hear the pericardial friction rub at the end of expiration.
A 55-year-old man with aortic valve stenosis is being admitted for valve replacement surgery. Which assessment finding should the nurse expect? A. Pulse deficit B. Systolic murmur C. Distended neck veins D. Splinter hemorrhages
B. Systolic murmur Correct The turbulent blood flow across a diseased valve results in a murmur. Aortic stenosis produces a systolic murmur. A pulse deficit indicates a cardiac dysrhythmia, most commonly atrial fibrillation. Distended neck veins may be caused by right-sided heart failure. Splinter hemorrhages occur in patients with infective endocarditis.
A 59-year-old man has presented to the emergency department with chest pain. What component of his subsequent blood work is most clearly indicative of a myocardial infarction (MI)? A. CK-MB B. Troponin C. Myoglobin D. C-reactive protein
B. Troponin Correct Troponin is the biomarker of choice in the diagnosis of MI, with sensitivity and specificity that exceed those of CK-MB and myoglobin. CRP levels are not used to diagnose acute MI.
Auscultation of a patient's heart reveals the presence of a murmur. What is this assessment finding a result of? A. Increased viscosity of the patient's blood B. Turbulent blood flow across a heart valve C. Friction between the heart and the myocardium D. A deficit in heart conductivity that impairs normal contractility
B. Turbulent blood flow across a heart valve Correct Turbulent blood flow across the affected valve results in a murmur. A murmur is not a direct result of variances in blood viscosity, conductivity, or friction between the heart and myocardium.
A nurse is preparing to teach a group of women in a community volunteer group about heart disease. What should the nurse include in the teaching plan? A. Women are less likely to delay seeking treatment than men. B. Women are more likely to have noncardiac symptoms of heart disease. C. Women are often less ill when presenting for treatment of heart disease. D. Women experience more symptoms of heart disease at a younger age than men.
B. Women are more likely to have noncardiac symptoms of heart disease. Correct Women often have atypical angina symptoms and nonpain symptoms. Women experience the onset of heart disease about 10 years later than men. Women are often more ill on presentation and delay longer in seeking care than men.
An S3 heart sound may be normal in: A. Pts with left-sided heart failure B. Young adults C. mitral valve regurgitation D. Pts with severe stenosis
B. Young adults
A patient has significant atherosclerosis. The nurse knows that this affects his cardiac output because it: A. Affects contractility B. Affects the afterload C. Affects preload D. Affects cardiac reserve
B. afterload Afterload is affected by the size of the ventricle, wall tension, and arterial blood pressure.
What type of blood vessel serves as the major control of arterial BP and distribution of blood flow? A. Veins B. Capillaries C. Arterioles D. Arteries
C. Arterioles. They respond readily to local conditions such as low oxygen and increasing levels of carbon dioxide by dilating or constricting.
When looking at the electrocardiogram (ECG) of the patient, the nurse knows that the QRS complex recorded on the ECG represents which part of the heart's beat? A. Depolarization of the atria B. Repolarization of the ventricles C. Depolarization from AV node throughout ventricles D. The length of time it takes for the impulse to travel from the atria to the ventricles
C. Depolarization from AV node throughout ventricles The QRS recorded on the ECG represents depolarization from the AV node throughout the ventricles. The P wave represents depolarization of the atria. The T wave represents repolarization of the ventricles. The interval between the PR and QRS represents the length of time it takes for the impulse to travel from the atria to the ventricles.
Which is not a normal consequence of aging? A. An increase in pulse pressure B. A blunted heart rate response C. hypertension D. Decrease of beta adrenergic receptors
C. Hypertension is not a normal consequence of aging, however all of the other answers are. Other age-related changes: increase in collagen, decrease in elastin, decrease heart rate response to stress, cardiac valves become thicker and stiffer, arterial and venous blood vessels thicken, arteries less sensitive to vasopressin (antidiuretic hormone), cellular aging and fibrosis of the conduction system; kyphosis
When assessing the cardiovascular system of a 79 year old patient, you might expect to find A. a narrowed pulse pressure B. diminished carotid artery pulses C. difficulty in isolating the apical pulse D. an increased heart rate in response to stress
C. Myocardial hypertrophy and the downward displacement of the heart in an older adult may cause difficulty in isolating the apical pulse.
Alpha-1 adrenergic receptors are located in ____ and stimulation results in_____ A. the heart; decreased contractility B. primary renal blood vessels; vasodilation C. vascular smooth muscle and heart; vasoconstriction and increased contractility D. Juxtaglomerular cells of the kidney; increased renin secretion
C. Vascular smooth muscle and the heart; vasoconstriction and increased contractility
While assessing the cardiovascular status of a patient, the nurse performs auscultation. Which intervention should the nurse implement in the assessment during auscultation? A. Position the patient supine. B. Ask the patient to hold his or her breath. C. Palpate the radial pulse while auscultating the apical pulse. D. Use the bell of the stethoscope when auscultating S1 and S2.
C.Palpate the radial pulse while auscultating the apical pulse. Correct In order to detect a pulse deficit, simultaneously palpate the radial pulse when auscultating the apical area. The diaphragm is more appropriate than the bell when auscultating S1 and S2. A sitting or side-lying position is most appropriate for cardiac auscultation. It is not necessary to ask the patient to hold his or her breath during cardiac auscultation.
When assessing a pt, you note a pulse deficit of 23 beats. This find may be caused by: A. dysrhythmias B. heart murmurs C. gallop rhythms D. pericardial friction rubs
Correct answer: a Rationale: A pulse deficit occurs if there is a difference between the apical and radial beats per minute. A pulse deficit indicates cardiac dysrhythmias.
When a person's blood pressure rises, the homeostatic mechanism to compensate for an elevation involves stimulation of A. baroreceptors that inhibit the sympathetic nervous system, causing vasodilation B. chemoreceptors that inhibit the sympathetic nervous system causing vasodilation C. baroreceptors that inhibit the parasympathetic nervous system, causing vasodilation D. chemoreceptors that stimulate the sympathetic nervous system, causing an increased heart rate
Correct answer: a Rationale: Baroreceptors in the aortic arch and carotid sinus are sensitive to stretch or pressure within the arterial system. Stimulation of these receptors sends information to the vasomotor center in the brainstem. This results in temporary inhibition of the sympathetic nervous system and enhancement of the parasympathetic influence, which cause a decrease in heart rate and peripheral vasodilation.
A P wave on an ECG represents an impulse arising at the A. SA node and repolarizing the atria B. SA node and depolarizing the atria C. AV node and depolarizing the atria D. AV node and spreading to the bundle of His
Correct answer: b Rationale: The first wave, P, begins with the firing of the sinoatrial (SA) node and represents depolarization of the fibers of the atria.
The portion of the vascular system responsible for hemostasis is the A. thin capillary vessels B. endothelial layer of the arteries C. elastic middle layer of the veins D. smooth muscle of the arterial wall
Correct answer: b Rationale: The innermost lining of the arteries is the endothelium. The endothelium maintains hemostasis, promotes blood flow, and under normal conditions, inhibits blood coagulation.
The ausculatory area in the left midclavicular line at the level of the fifth ICS is the best location to hear sounds from which heart valve? A. aortic B. mitral C. tricuspid D. pulmonic
Correct answer: b Rationale: The mitral valve can be assessed by auscultation at the left midclavicular line at the fifth intercostal space (ICS).
A pt with tricuspid valve disorder will have impaired blood flow between the A. vena cava and right atrium B. left atrium and left ventricle C. right atrium and right ventricle D. right ventricle and pulmonary artery
Correct answer: c Rationale: The tricuspid valve is located between the right atrium and the right ventricle.
Which nursing responsibilities are priorities when caring for a patient returning from a cardiac catheterization (select all that apply)? A. monitoring VS and ECG B. Checking the catheter insertion site and distal pulses C. assisting the pt to ambulate to the bathroom to void D. informing the pt that he will be sleepy from the general anesthesia E. instructing the patient about the risks of the radioactive isotope injection
Correct answers: a, b Rationale: The nursing responsibilities after cardiac catheterization include assessment of the puncture site for hematoma and bleeding; assessment of circulation to the extremity used for catheter insertion and of peripheral pulses, color, and sensation of the extremity; and monitoring vital signs and electrocardiographic rhythm. Other nursing responsibilities are described in Table 32-6.
A pt has a severe blockage in his right coronary artery. Which cardiac structures are most likely to be affected by this blockage (select all that apply)? A. AV node B. left ventricle C. Coronary sinus D. right ventricle E. pulmonic valve
Correct answers: a, b, d Rationale: The right coronary artery (RCA) supplies blood to the right atrium, the right ventricle, and a portion of the posterior wall of the left ventricle. In 90% of people, the RCA supplies blood to the atrioventricular (AV) node, the bundle of His, and part of the cardiac conduction system.
Which instruction given to a patient who is about to undergo Holter monitoring is most appropriate? A. "You may remove the monitor only to shower or bathe." B. "You should connect the monitor whenever you feel symptoms." C. "You should refrain from exercising while wearing this monitor." D. "You will need to keep a diary of all your activities and symptoms."
D. "You will need to keep a diary of all your activities and symptoms." Correct A Holter monitor is worn continuously for at least 24 hours while a patient continues with usual activity and keeps a diary of activities and symptoms. The patient should not take a bath or shower while wearing this monitor.
To listen to the aorta, place the diaphragm of your stethoscope: A. 3rd left ICS (intracostal space) B. 2nd ICS to the left of the sternum C. 2nd left ICS D. 2nd ICS to right of sternum
D. 2nd ICS to right of sternum The pulmonic area can be heard in the 2nd ICS to the left of the sternum, the tricuspid area in the 5th left ICS close to the sternum, the mitral area in the left midclavicular line at the fifth ICS
A common finding of an elevated right atrial pressure would be: A. Orthostatic hypotension B. Increased cardiac output C. Postprandial hypotension D. Distended neck veins
D. Distended neck veins, or JVD, is a common finding when pressure is increased in the right side of the heart.
The blood pressure of a 71-year-old patient admitted with pneumonia is 160/70 mm Hg. What is an age-related change that contributes to this finding? A. Stenosis of the heart valves B. Decreased adrenergic sensitivity C. Increased parasympathetic activity D. Loss of elasticity in arterial vessels
D. Loss of elasticity in arterial vessels Correct An age-related change that increases the risk of systolic hypertension is a loss of elasticity in the arterial walls. Because of the increasing resistance to flow, pressure is increased within the blood vessel, and hypertension results. Valvular rigidity of aging causes murmurs, and decreased adrenergic sensitivity slows the heart rate. Blood pressure is not raised. Increased parasympathetic activity would slow the heart rate.
The electrical impulse that starts polarization begins where? A. Perkinje fibers B. The AV node C. The bundle of His D The SA node
D. The SA or sinoatrial node
On return from surgery, the patient is wearing intermittent sequential compression stockings that he does not want to keep on. How should the nurse explain their necessity to the patient while he is on bed rest? A. The socks keep the legs warm while the patient is not moving much. B. The socks maintain the blood flow to the legs while the patient is on bed rest. C. The socks keep the blood pressure down while the patient is stressed after surgery. D. The socks provide compression of the veins to keep the blood moving back to the heart.
D. The socks provide compression of the veins to keep the blood moving back to the heart. Intermittent sequential compression stockings provide compression of the veins while the patient is not using skeletal muscles to compress the veins, which keeps the blood moving back to the heart and prevents blood pooling in the legs that could cause deep vein thrombosis. The warmth is not important. Blood flow to the legs is not maintained. Blood pressure is not decreased with the use of intermittent sequential compression stockings.
A 74-year-old woman who is admitted with severe dyspnea has a history of heart failure and chronic obstructive lung disease. Which diagnostic study would the nurse expect to be elevated if the cause of dyspnea was cardiac related? A. Serum potassium B. Serum homocysteine C. High-density lipoprotein D. b-type natriuretic peptide (BNP)
D. b-type natriuretic peptide (BNP) Correct Elevation of b-type natriuretic peptide (BNP) indicates the presence of heart failure. Elevations help to distinguish cardiac vs. respiratory causes of dyspnea. Elevated potassium, homocysteine, or HDL levels may indicate increased risk for cardiovascular disorders but do not indicate that cardiac disease is present.
As blood flows through the heart, the following events occur. Place them in the correct order A. Oxygenated blood flows from the lungs to the left atrium by way of the pulmonary veins B. Right ventricle pumps blood through pulmonic valve C. Blood passes through tricuspid valve D. Blood passes through mitral/bicuspid valve E. Blood is ejected through aortic valve into the aorta F. Right atrium receives venous blood
F, C, B, A, D, E Pg. 687
Which effects of aging on the cardiovascular system should the nurse anticipate when providing care for older adults (select all that apply)? A. Systolic murmur B. Diminished pedal pulses C. Increased maximal heart rate D. Decreased maximal heart rate E. Increased recovery time from activity
Systolic murmur Correct Diminished pedal pulses Correct Decreased maximal heart rate Correct Increased recovery time from activity Correct Well-documented cardiovascular effects of the aging process include valvular rigidity leading to systolic murmur, arterial stiffening leading to diminished pedal pulses or possible increased blood pressure, and an increased amount of time that is required for recovery from activity. Maximal heart rate tends to decrease rather than increase with age related to cellular aging and fibrosis of the conduction system.
When collecting subjective data related to the cardiovascular system, which information should be obtained from the pt (select all that apply)? A. annual income B. smoking history C. religious preference D. number of pillows used to sleeo E. blood for basic laboratory studies
The health history should include assessment of tobacco use. The patient should be asked about any cultural or religious beliefs that may influence the management of the cardiovascular problem. Patients with heart failure may need to sleep with the head elevated on pillows or sleep in a chair.
14. The nurse on the intermediate care unit received change-of-shift report on four patients with hypertension. Which patient should the nurse assess first? a. 43-year-old with a (blood pressure (BP) of 160/92 who is complaining of chest pain b. 52-year-old with a BP of 212/90 who has intermittent claudication c. 50-year-old with a BP of 190/104 who has a creatinine of 1.7 mg/dL d. 48-year-old with a BP of 172/98 whose urine shows microalbuminuria
a. 43-year-old with a (blood pressure (BP) of 160/92 who is complaining of chest pain
9. The nurse has just finished teaching a hypertensive patient about the newly prescribed ramipril (Altace). Which patient statement indicates that more teaching is needed? a. A little swelling around my lips and face is okay. b. The medication may not work as well if I take any aspirin. c. The doctor may order a blood potassium level occasionally. d. I will call the doctor if I notice that I have a frequent cough.
a. A little swelling around my lips and face is okay.
22. Which nursing action should the nurse take first in order to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes? a. Collect a detailed diet history. b. Provide a list of low-sodium foods. c. Help the patient make an appointment with a dietitian. d. Teach the patient about foods that are high in potassium.
a. Collect a detailed diet history.
15. The nurse is reviewing the laboratory test results for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider? a. Serum creatinine of 2.8 mg/dL b. Serum potassium of 4.5 mEq/L c. Serum hemoglobin of 14.7 g/dL d. Blood glucose level of 96 mg/dL
a. Serum creatinine of 2.8 mg/dL
6. Propranolol (Inderal) is prescribed for a patient diagnosed with hypertension. The nurse should consult with the health care provider before giving this medication when the patient reveals a history of a. asthma. b. daily alcohol use. c. peptic ulcer disease. d. myocardial infarction (MI).
a. asthma.
12. Which blood pressure (BP) finding by the nurse indicates that no changes in therapy are needed for apatient with stage 1 hypertension who has a history of diabetes mellitus? a. 102/60 mm Hg b. 128/76 mm Hg c. 139/90 mm Hg d. 136/82 mm Hg
b. 128/76 mm Hg
21. Which assessment finding for a patient who is receiving IV furosemide (Lasix) to treat stage 2 hypertension is most important to report to the health care provider? a. Blood glucose level of 175 mg/dL b. Blood potassium level of 3.0 mEq/L c. Most recent blood pressure (BP) reading of 168/94 mm Hg d. Orthostatic systolic BP decrease of 12 mm Hg
b. Blood potassium level of 3.0 mEq/L
1. Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new patient? a. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second. b. Have the patient sit in a chair with the feet flat on the floor. c. Assist the patient to the supine position for BP measurements. d. Obtain two BP readings in the dominant arm and average the results.
b. Have the patient sit in a chair with the feet flat on the floor.
16. A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and nausea and has a blood pressure (BP) of 238/118 mm Hg. Which question should the nurse ask first? a. Did you take any acetaminophen (Tylenol) today? b. Have you been consistently taking your medications? c. Have there been any recent stressful events in your life? d. Have you recently taken any antihistamine medications?
b. Have you been consistently taking your medications?
2. The nurse obtains the following information from a patient newly diagnosed with prehypertension. Which finding is most important to address with the patient? a. Low dietary fiber intake b. No regular aerobic exercise c. Weight 5 pounds above ideal weight d. Drinks a beer with dinner on most nights
b. No regular aerobic exercise
18. A patient with hypertension who has just started taking atenolol (Tenormin) returns to the health clinic after 2 weeks for a follow-up visit. The blood pressure (BP) is unchanged from the previous visit. Which action should the nurse take first? a. Inform the patient about the reasons for a possible change in drug dosage. b. Question the patient about whether the medication is actually being taken. c. Inform the patient that multiple drugs are often needed to treat hypertension. d. Question the patient regarding any lifestyle changes made to help control BP.
b. Question the patient about whether the medication is actually being taken.
17. The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a hypertensive emergency. Which finding is most important to report to the health care provider? a. Urine output over 8 hours is 250 mL less than the fluid intake. b. The patient cannot move the left arm and leg when asked to do so. c. Tremors are noted in the fingers when the patient extends the arms. d. The patient complains of a headache with pain at level 8/10 (0 to 10 scale).
b. The patient cannot move the left arm and leg when asked to do so.
3. Which action should the nurse take when administering the initial dose of oral labetalol (Normodyne) to a patient with hypertension? a. Encourage the use of hard candy to prevent dry mouth. b. Instruct the patient to ask for help if heart palpitations occur. c. Ask the patient to request assistance when getting out of bed. d. Teach the patient that headaches may occur with this medication.
c. Ask the patient to request assistance when getting out of bed.
19. The registered nurse (RN) is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside (Nipride). Which nursing action can the nurse delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Titrate nitroprusside to decrease mean arterial pressure (MAP) to 115 mm Hg. b. Evaluate effectiveness of nitroprusside therapy on blood pressure (BP). c. Set up the automatic blood pressure machine to take BP every 15 minutes. d. Assess the patients environment for adverse stimuli that might increase BP.
c. Set up the automatic blood pressure machine to take BP every 15 minutes.
11. An older patient has been diagnosed with possible white coat hypertension. Which action will the nurse plan to take next? a. Schedule the patient for regular blood pressure (BP) checks in the clinic. b. Instruct the patient about the need to decrease stress levels. c. Tell the patient how to self-monitor and record BPs at home. d. Inform the patient that ambulatory blood pressure monitoring will be needed.
c. Tell the patient how to self-monitor and record BPs at home.
10. During change-of-shift report, the nurse obtains the following information about a hypertensive patient who received the first dose of nadolol (Corgard) during the previous shift. Which information indicates that the patient needsimmediate intervention? a. The patients most recent blood pressure (BP) reading is 158/91 mm Hg. b. The patients pulse has dropped from 68 to 57 beats/minute. c. The patient has developed wheezes throughout the lung fields. d. The patient complains that the fingers and toes feel quite cold.
c. The patient has developed wheezes throughout the lung fields.
5. A patient has just been diagnosed with hypertension and has been started on captopril (Capoten). Which information is important to include when teaching the patient about this medication? a. Check blood pressure (BP) in both arms before taking the medication. b. Increase fluid intake if dryness of the mouth is a problem. c. Include high-potassium foods such as bananas in the diet. d. Change position slowly to help prevent dizziness and falls.
d. Change position slowly to help prevent dizziness and falls.
13. Which information should the nurse include when teaching a patient with newly diagnosed hypertension? a. Increasing physical activity will control blood pressure (BP) for most patients. b. Most patients are able to control BP through dietary changes. c. Annual BP checks are needed to monitor treatment effectiveness. d. Hypertension is usually asymptomatic until target organ damage occurs.
d. Hypertension is usually asymptomatic until target organ damage occurs.
23. The nurse is caring for a 70-year-old who uses hydrochlorothiazide (HydroDIURIL) and enalapril (Norvasc), but whose self-monitored blood pressure (BP) continues to be elevated. Which patient information may indicate a need for a change? a. Patient takes a daily multivitamin tablet. b. Patient checks BP daily just after getting up. c. Patient drinks wine three to four times a week. d. Patient uses ibuprofen (Motrin) daily to treat osteoarthritis.
d. Patient uses ibuprofen (Motrin) daily to treat osteoarthritis.
4. After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented, which diet choice indicates that the teaching has been effective? a. The patient avoids eating nuts or nut butters. b. The patient restricts intake of chicken and fish. c. The patient has two cups of coffee in the morning. d. The patient has a glass of low-fat milk with each meal.
d. The patient has a glass of low-fat milk with each meal.
8. Which action will be included in the plan of care when the nurse is caring for a patient who is receiving nicardipine (Cardene) to treat a hypertensive emergency? a. Keep the patient NPO to prevent aspiration caused by nausea and possible vomiting. b. Organize nursing activities so that the patient has undisturbed sleep for 6 to 8 hours at night. c. Assist the patient up in the chair for meals to avoid complications associated with immobility. d. Use an automated noninvasive blood pressure machine to obtain frequent blood pressure (BP) measurements.
d. Use an automated noninvasive blood pressure machine to obtain frequent blood pressure (BP) measurements.
7. A 56-year-old patient who has no previous history of hypertension or other health problems suddenly develops a blood pressure (BP) of 198/110 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that a. a BP recheck should be scheduled in a few weeks. b. dietary sodium and fat content should be decreased. c. there is an immediate danger of a stroke and hospitalization will be required. d. diagnosis of a possible cause, treatment, and ongoing monitoring will be needed.
d. diagnosis of a possible cause, treatment, and ongoing monitoring will be needed.
