CC HTN
One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which of the following electrolyte imbalances should the nurse suspect? a. Hypocalcemia b. Hypermagnesemia c. Hypokalemia d. Hypernatremia
c. Hypokalemia Furosemide is a potassium-depleting diuretic than can cause hypokalemia. In turn, hypokalemia increases myocardial excitability, leading to ventricular tachycardia.
When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride: a. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. b. Increases norepinephrine secretion and thus decreases blood pressure and heart rate. c. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. d. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II
a. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing conduction.
Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension often goes undetected until symptoms of other system failures occur. This may occur in the form of: a. Cerebrovascular accident b. Liver disease c. Myocardial infarction d. Pulmonary disease
a. Cerebrovascular accident Hypertension is referred to as the silent killer for adults, because until the adult has significant damage to other systems, the hypertension may go undetected. CVA's can be related to long-term hypertension. Liver or pulmonary disease is generally not associated with hypertension. Myocardial infarction is generally related to coronary artery disease.
A nurse notes 2+ bilateral edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. The nurse would plan to do which of the following next? a. Review the intake and output records for the last 2 days b. Change the time of diuretic administration from morning to evening c. Request a sodium restriction of 1 g/day from the physician d. Order daily weights starting the following morning
a. Review the intake and output records for the last 2 days Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by intake greater than output and by a sudden increase in weight. Diuretics should be given in the morning whenever possible to avoid nocturia. Strict sodium restrictions are reserved for clients with severe symptoms.
Prolonged occlusion of the right coronary artery produces an infarction in which of the following areas of the heart? a. Anterior b. Apical c. Inferior d. Lateral
c. Inferior The right coronary artery supplies the right ventricle, or the inferior portion of the heart. Therefore, prolonged occlusion could produce an infarction in that area. The right coronary artery doesn't supply the anterior portion (left ventricle), lateral portion (some of the left ventricle and the left atrium), or the apical portion (left ventricle) of the heart.
Which of the following factors can cause blood pressure to drop to normal levels? a. Kidneys' excretion of sodium only b. Kidneys' retention of sodium and water c. Kidneys' excretion of sodium and water d. Kidneys' retention of sodium and excretion of water
c. Kidneys' excretion of sodium and water
A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and informs the nurse that his father died of a heart attack at 60 years of age. The client is presently complaining of indigestion. The nurse connects him to an ECG monitor and begins administering oxygen at 2 L/minute per NC. The nurse's next action would be to: a. Call for the doctor b. Start an intravenous line c. Obtain a portable chest radiograph d. Draw blood for laboratory studies
b. Start an intravenous line Advanced cardiac life support recommends that at least one or two intravenous lines be inserted in one or both of the antecubital spaces. Calling the physician, obtaining a portable chest radiograph, and drawing blood are important but secondary to starting the intravenous line.
When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse bases teaching on the knowledge that: a. Moderate doses of two different types of diuretics are more effective than a large dose of one type b. This combination promotes diuresis but decreases the risk of hypokalemia c. This combination prevents dehydration and hypovolemia d. Using two drugs increases osmolality of plasma and the glomerular filtration rate
b. This combination promotes diuresis but decreases the risk of hypokalemia Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.
Direct-acting vasodilators have which of the following effects on the heart rate? a. Heart rate decreases b. Heart rate remains significantly unchanged c. Heart rate increases d. Heart rate becomes irregular
c. Heart rate increases Heart rate increases in response to decreased blood pressure caused by vasodilation.
Which of the following arteries primarily feeds the anterior wall of the heart? a. Circumflex artery b. Internal mammary artery c. Left anterior descending artery d. Right coronary artery
c. Left anterior descending artery The left anterior descending artery is the primary source of blood flow for the anterior wall of the heart. The circumflex artery supplies the lateral wall, the internal mammary supplies the mammary, and the right coronary artery supplies the inferior wall of the heart.
The most important long-term goal for a client with hypertension would be to: a. Learn how to avoid stress b. Explore a job change or early retirement c. Make a commitment to long-term therapy d. Control high blood pressure
c. Make a commitment to long-term therapy Compliance is the most critical element of hypertensive therapy. In most cases, hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully without drug therapy. Stress management and weight management are important components of hypertension therapy, but the priority goal is related to compliance.
A 57-year-old client with a history of asthma is prescribed propranolol (Inderal) to control hypertension. Before administered propranolol, which of the following actions should the nurse take first? a. Monitor the apical pulse rate b. Instruct the client to take medication with food c. Question the physician about the order d. Caution the client to rise slowly when standing
c. Question the physician about the order Propranolol and other beta-adrenergic blockers are contraindicated in a client with asthma, so the nurse should question the physician before giving the dose. The other responses are appropriate actions for a client receiving propranolol, but questioning the physician takes priority. The client's apical pulse should always be checked before giving propranolol; if the pulse rate is extremely low, the nurse should withhold the drug and notify the physician.
A client is experiencing tachycardia. The nurse's understanding of the physiological basis for this symptom is explained by which of the following statements? a. The demand for oxygen is decreased because of pleural involvement b. The inflammatory process causes the body to demand more oxygen to meet its needs c. The heart has to pump faster to meet the demand for oxygen when there is lowered arterial oxygen tension d. Respirations are labored
c. The heart has to pump faster to meet the demand for oxygen when there is lowered arterial oxygen tension The arterial oxygen supply is lowered and the demand for oxygen is increased, which results in the heart's having to beat faster to meet the body's needs for oxygen.
A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin (Coumadin). The client's prothrombin time is 20 seconds, with a control of 11 seconds. The nurse assesses that this result is: a. The same as the client's own baseline level b. Lower than the needed therapeutic level c. Within the therapeutic range d. Higher than the therapeutic range
c. Within the therapeutic range The therapeutic range for prothrombin time is 1.5 to 2 times the control for clients at risk for thrombus. Based on the client's control value, the therapeutic range for this individual would be 16.5 to 22 seconds. Therefore the result is within therapeutic range.
A client is receiving spironolactone to treat hypertension. Which of the following instructions should the nurse provide? a. "Eat foods high in potassium." b. "Take daily potassium supplements." c. "Discontinue sodium restrictions." d. "Avoid salt substitutes."
d. "Avoid salt substitutes." Because spironolactone is a potassium-sparing diuretic, the client should avoid salt substitutes because of their high potassium content. The client should also avoid potassium-rich foods and potassium supplements. To reduce fluid-volume overload, sodium restrictions should continue.
A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The nurse ensures accurate measurement by avoiding which of the following? a. Seating the client with arm bared, supported, and at heart level. b. Measuring the blood pressure after the client has been seated quietly for 5 minutes. c. Using a cuff with a rubber bladder that encircles at least 80% of the limb. d. Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.
d. Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion. BP should be taken with the client seated with the arm bared, positioned with support and at heart level. The client should sit with the legs on the floor, feet uncrossed, and not speak during the recording. The client should not have smoked tobacco or taken in caffeine in the 30 minutes preceding the measurement. The client should rest quietly for 5 minutes before the reading is taken. The cuff bladder should encircle at least 80% of the limb being measured. Gauges other than a mercury sphygmomanometer should be calibrated every 6 months to ensure accuracy.
Which of the following parameters is the major determinant of diastolic blood pressure? a. Baroreceptors b. Cardiac output c. Renal function d. Vascular resistance
d. Vascular resistance Vascular resistance is the impedance of blood flow by the arterioles that most predominantly affects the diastolic pressure. Cardiac output determines systolic blood pressure.
