Chapter 13: PrepU

A nurse is caring for a client who experienced an MI. The client is ordered to received metoprolol. The nurse understands that this medication has which therapeutic effect? 1- Decreases resting heart rate 2- Decreases cholesterol level 3- Increases cardiac output 4- Decreases platelet aggregation

1

A nurse is educating about lifestyle modifications for a group of clients with newly diagnosed hypertension. While discussing dietary changes, which point would the nurse emphasize? 1- It takes 2 to 3 months for the taste buds to adapt to decreased salt intake. 2- The taste buds never adapt to decreased salt intake. 3- There is usually no need to change alcohol consumption for clients with hypertension. 4- A person with hypertension should never consume alcohol.

1

A patient newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a patient with prolonged uncontrolled hypertension is at risk for developing what health problem? 1- Renal failure 2- Right ventricular hypertrophy 3- Glaucoma 4- Anemia

1

It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine 1- increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. 2- decreases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. 3- increases the heart rate, constricts arterioles, and increases the heart's ability to eject blood. 4- decreases circulating blood volume.

1

Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through: 1- ophthalmic examination. 2- using a sphygmomanometer. 3- laboratory tests. 4- an MRI.

1

The nurse is administering medications on a medical-surgical unit. A client is ordered to receive 40 mg oral nadolol for the treatment of hypertension. Before administering the medication, the nurse should 1- check the client's heart rate. 2- check the client's serum K+ level. 3- check the client's urine output. 4- weigh the client.

1

The nurse is caring for a client newly diagnosed with hypertension. Which statement by the client indicates the need for further teaching? 1- "If I take my blood pressure and it is normal, I don't have to take my blood pressure pills." 2- "I think I'm going to sign up for a yoga class twice a week to help reduce my stress." 3- "When getting up from bed, I will sit for a short period before standing up." 4- "I will consult a dietician to help get my weight under control."

1

The nurse is caring for a client prescribed bumetanide for the treatment of stage 2 hypertension. Which finding indicates the client is experiencing an adverse effect of the medication? 1- Serum potassium value of 3.0 mEq/L 2- Electrocardiogram (EGG) tracing demonstrating peaked T waves 3- Urine output of 90 mL 1 hour after medication administration 4- Blood glucose value of 160 mg/dL

1

The nurse is caring for an elderly client with a diagnosis of hypertension, who is taking several antihypertensive medications. Which safety precaution is the nurse most likely to reinforce? 1- Changing positions slowly related to possible hypotension 2- Eating extra potassium due to loss of potassium related to medications 3- Being sure to keep follow-up appointments 4- Walking as far as the client is able every day

1

The nurse is caring for an older adult client who has come to the clinic for a yearly physical. When assessing the client, the nurse notes the blood pressure (BP) is 140/93. The nurse knows that in older clients what happens that may elevate the systolic BP? 1- Loss of arterial elasticity 2- Decrease in blood volume 3- Increase in calcium intake 4- Decrease in cardiac output

1

The nurse is completing a cardiac assessment on a client. The patient has a blood pressure (BP) reading of 126/80. What would the nurse would identify this blood pressure reading as? 1- Prehypertension 2- Normal 3- Stage 1 hypertension 4- Stage 2 hypertension

1

The nurse is instructing a student on the proper technique for measuring blood pressure (BP). Which student action indicates a need for further teaching? 1- Positions the arm at waist level 2- Palpates the systolic pressure before auscultating blood pressure 3- Centers the blood pressure cuff bladder directly over the brachial artery 4- Wraps the blood pressure cuff firmly around the arm

1

Which finding indicates that hypertension is progressing to target organ damage? 1- Retinal blood vessel damage 2- Urine output of 60 mL over 2 hours 3- Blood urea nitrogen concentration of 12 mg/dL 4- Chest x-ray showing pneumonia

1

A nurse is providing education about hypertension to a community group. What are possible consequences of untreated hypertension? Select all that apply. 1- Coronary artery disease 2- Myocardial infarction 3- Pancreatitis 4- Tension pneumothorax 5- Stroke

1,2,5

Which condition(s) indicates target organ damage from untreated/undertreated hypertension? Select all that apply. 1- Heart failure 2- Retinal damage 3- Diabetes 4- Hyperlipidemia 5- Stroke

1,2,5

Which statements are true when the nurse is measuring blood pressure (BP)? Select all that apply. 1- Using a BP cuff that is too small will give a higher BP measurement. 2- The client's arm should be positioned at the level of the heart. 3- Using a BP cuff that is too large will give a higher BP measurement. 4- The client's BP should be measured 1 hour before consuming alcohol. 5- The client should sit quietly while BP is being measured.

1,2,5

The nurse is performing an assessment on a patient to determine the effects of hypertension on the heart and blood vessels. What specific assessment data will assist in determining this complication? (Select all that apply.) 1- Heart rate 2- Respiratory rate 3- Heart rhythm 4- Character of apical and peripheral pulses 5- Lung sounds

1,3,4

A 40-year-old man newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the patient and advises that the patient should avoid tobacco use. What is the rationale behind that advice to the patient? 1- Smoking directly causes high blood pressure. 2- Smoking increases the risk of heart disease. 3- Smoking causes obesity, which exacerbates hypertension. 4- Smoking increases cardiac output.

2

A client is taking amiloride and lisinopril for the treatment of hypertension. What laboratory studies should the nurse monitor while the client is taking these two medications together? 1- Magnesium level 2- Potassium level 3- Calcium level 4- Sodium level

2

A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. What will the nurse specify about this client's target blood pressure? 1- 145/95 or lower 2- 130/80 or lower 3- 150/95 or lower 4- 125/85 or lower

2

A nurse is teaching about lifestyle modifications to a group of clients with known hypertension. Which statement would the nurse include in the education session? 1- Maintain a body mass index between 30 and 35. 2- Engage in aerobic activity at least 30 minutes/day most days of the week. 3- Maintain a waist circumference of 45 inches (114 cm) (men) and 40 inches (102 cm) (women) or less. 4- Limit alcohol consumption to no more that 3 drinks per day.

2

A patient is flying overseas for 1 week for business and packed antihypertensive medications in a suitcase. After arriving at the intended destination, the patient found that the luggage had been stolen. If the patient cannot take the medication, what condition becomes a concern? 1- Isolated systolic hypertension 2- Rebound hypertension 3- Angina 4- Left ventricular hypertrophy

2

After a series of visits to her care provider, a 40-year-old woman has been diagnosed with primary hypertension and metabolic syndrome. In addition to her persistently high blood pressure (BP) readings, what criterion would contribute to the woman's diagnosis of metabolic syndrome? 1- Serum sodium levels of ≥135 mmol/L 2- Abnormal lipid levels 3- Increased serum creatinine and/or blood urea nitrogen (BUN) levels 4- Presence of proteinuria

2

Mr. Faulkner is a 69-year-old man who has enjoyed generally good health for his entire adult life. As a result, he has been surprised to receive a new diagnosis of hypertension after a series of visits to his primary care provider. The nurse who is working with Mr. Faulkner should recognize which of the following aspects of aging and hypertension? 1- The diagnostic criteria for hypertension in adults over 65 differ from those for younger adults. 2- The incidence and prevalence of hypertension increase with age. 3- Blood pressure remains stable throughout adulthood but tends to be assessed more often by health care providers of older adults. 4- Older adults are less vulnerable to the pathophysiological effects of hypertension than are younger adults.

2

The nurse is caring for a client with essential hypertension. The nurse reviews labwork and assesses kidney function. Which action of the kidney would the nurse evaluate as the body's attempt to regulate high blood pressure? 1- The kidney retains sodium and water. 2- The kidney excretes sodium and water. 3- The kidney retains sodium and excretes water. 4- The kidney retains water and excretes sodium.

2

The nurse is caring for a client with hypertension. The nurse is correct to realize that a 24-hour urine is ordered to determine if the cause of hypertension is related to the dysfunction of which of the following? 1- The thyroid gland 2- The adrenal gland 3- The pituitary gland 4- The thymus

2

The nurse is performing patient education for a patient who has been prescribed hydrochlorothiazide and metoprolol (Lopressor) for the treatment of hypertension. What teaching point should the nurse emphasize when teaching the patient about this medication regimen? 1- "It's best not to take aspirin for pain while you're taking your antihypertensives." 2- "Avoid taking over-the-counter decongestants because they can increase your blood pressure (BP)." 3- "Most allergy medications can't be taken with BP meds, so make sure to check with your doctor or pharmacist." 4- "If you get an infection, make sure that your care provider knows you have hypertension before he or she prescribes an antibiotic."

2

A blood pressure (BP) of 140/90 mm Hg is considered to be 1- normal. 2- prehypertension. 3- hypertension. 4- a hypertensive emergency.

3

A client with high blood pressure is receiving an antihypertensive drug. When developing a client teaching plan to minimize orthostatic hypotension, which instruction should the nurse include? 1- "Avoid drinking alcohol and straining at stool, and eat a low-protein snack at night." 2- "Wear elastic stockings, change positions quickly, and hold onto a stationary object when rising." 3- "Flex your calf muscles, avoid alcohol, and change positions slowly." 4- "Rest between demanding activities, eat plenty of fruits and vegetables, and drink 6 to 8 cups of fluid daily."

3

An 80-year-old man, newly diagnosed with primary hypertension, has just been started on a beta-blocker. The nurse knows that in addition to teaching the patient about his medication (ie, side effects, purpose, and schedule), she should also focus her teaching on what? 1- Limiting fluids in order to decrease vascular volume 2- Maintaining a diet high in dairy to increase protein necessary to prevent organ damage 3- Use of supportive devices such as hand rails and walkers to prevent falls stemming from postural hypotension 4- Limiting exercise to avoid injury that can be caused by postural hypotension

3

It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position 1- help reduce the blood pressure to resupply oxygen to the brain. 2- help reduce the work required by the heart to resupply oxygen to the brain. 3- provide time for the heart to increase the rate of contraction to resupply oxygen to the brain. 4- provide time for the heart to reduce the rate of contraction to resupply oxygen to the brain.

3

The nurse understands that client education related to antihypertensive medication should include which of the following? 1- inform client that recommended lifestyle changes are not necessary 2- Inform client if a dosage of medication is missed , to double the next scheduled dose 3- inform client to avoid over-the-counter cold and sinus medications 4- inform client to discontinue antihypertensives once blood pressure is normal

3

When measuring the blood pressure in each arm of a healthy adult client, the nurse recognizes that which statement is true? 1- Pressures must be equal in both arms. 2- Pressures may vary 10 mm Hg or more between arms. 3- Pressures should not differ more than 5 mm Hg between arms. 4- Pressures may vary, with the higher pressure found in the left arm.

3

A client is being seen at the clinic for a routine physical when the nurse notes the client's blood pressure is 150/97. The client is considered to be a healthy, well-nourished young adult. What type of hypertension does this client have? 1- Secondary 2- Pathologic 3- Malignant 4- Essential (primary)

4

A nurse is caring for a client who has hypertension and diabetes mellitus. The client's blood pressure this morning was 150/92 mm Hg. When the client asks the nurse what his or her blood pressure should be, what is the nurse's most appropriate response? 1- "Your blood pressure is fine. Just keep doing what you're doing." 2- "The current recommendation is for everyone to have blood pressure of 140/90 mm Hg or lower." 3- "The lower the better. Blood pressure of 120/80 mm Hg is best for everyone." 4- "Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg."

4

A nurse on a busy medical unit is aware of the importance of accurate blood pressure (BP) measurement. To ensure accuracy when assessing patients' blood pressures, the nurse should always: 1- Use a manual, rather than automated, sphygmomanometer 2- Alternate blood pressure readings between patients' right and left arms 3- Take serial blood pressure readings on each patient 4- Ensure that the correct cuff size is used for each patient

4

A patient comes to the walk-in clinic. While assessing the patient's vital signs, the nurse assesses the patient's blood pressure at 128/89 mm Hg. According to JNC7, how would this patient's blood pressure be classified? 1- Hypertensive 2- Normal 3- Slightly hypertensive 4- Prehypertensive

4

An adult patient's blood pressure readings have ranged from 138/92 to 154/100 during the past several weeks. As a result, the patient's nurse practitioner has ordered diagnostic follow-up. Which of the following diagnostic tests should the nurse prioritize when assessing the patient for target organ damage? 1- C-reactive protein (CRP) levels 2- Sodium, chloride, and potassium levels 3- Arterial blood gas (ABG) results 4- Blood urea nitrogen (BUN) and creatinine levels

4

An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for? 1- Postural hypertension and resulting injury 2- Rebound hypertension 3- Sexual dysfunction 4- Postural hypotension and resulting injury

4

Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress 1- increases the production of neurotransmitters that constrict peripheral arterioles. 2- increases the resistance that the heart must overcome to eject blood. 3- increases blood volume and improves the potential for greater cardiac output. 4- decreases the production of neurotransmitters that constrict peripheral arterioles.

4

The staff educator is talking to a group of new emergency department nurses about hypertensive crises. The nurse educator is aware that hypertensive urgency differs from hypertensive emergency in what way? 1- The patient's blood pressure (BP) is always higher in a hypertensive emergency. 2- Close hemodynamic monitoring is required during treatment of hypertensive emergencies. 3- Hypertensive urgency is treated with rest and tranquilizers to lower BP. 4- Hypertensive emergencies are associated with evidence of target organ damage.

4

A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. What are risk factors for cardiovascular problems in clients with hypertension? Select all that apply. 1- Gallbladder disease 2- Smoking 3- Diabetes mellitus 4- Physical inactivity 5- Frequent upper respiratory infections

2,3,4

The nurse in an oncology clinic notes that the client being treated has hypertension. What tumor is a predisposing condition for secondary hypertension? 1- Pheochromocytoma 2- Wilm's tumor 3- Astrocytoma 4- Lymphoma

1

According to the DASH diet, how many servings of vegetables should a person consume each day? 1- 2 or fewer 2- 2 or 3 3- 4 or 5 4- 7 or 8

3

Hypertension that can be attributed to an underlying cause is termed 1- primary hypertension. 2- essential hypertension. 3- secondary hypertension. 4- isolated systolic hypertension.

3

A 66-year-old client presents to the emergency department reporting severe headache and mild nausea for the past 6 hours. Upon assessment, the client's BP is 210/120 mm Hg. The client has a history of hypertension and takes 1.0 mg clonidine twice daily. Which question is most important for the nurse to ask the client next? 1- "Have you taken your prescribed clonidine today?" 2- "Do you have a dry mouth or nasal congestion?" 3- "Are you having chest pain or shortness of breath?" 4- "Did you take any medication for your headache?"

1

A client is being seen at the clinic on a monthly basis for assessment of blood pressure. The client has been checking blood pressure at home as well and has reported a systolic pressure of 158 and a diastolic pressure of 64. What does the nurse suspect this client is experiencing? 1- Isolated systolic hypertension 2- Secondary hypertension 3- Primary hypertension 4- Hypertensive urgency

1

A client is taking 50 mg of oral spironolactone twice a day to assist with blood pressure control. While the nurse is performing the morning assessment, the client reports nausea, general muscle cramps, and weakness. The ECG strip shows a peaked, narrow T-wave, which is a change. What electrolyte imbalance does the nurse suspect? 1- Hyperkalemia 2- Hypokalemia 3- Hypernatremia 4- Hyponatremia

1

A nurse is discussing with a nursing student how to accurately measure blood pressure. What statement by the student indicates an understanding of the education? 1- A cuff that is too small will give a false high blood pressure. 2- A cuff that is too small will give a false low blood pressure. 3- A cuff that is too large will give a false high blood pressure. 4- The size of the cuff does not matter as long as it fits snugly around the arm.

1

A client in a clinic setting has just been diagnosed with hypertension. When the client asks what the end goal is for treatment, what is the nurse's best response? 1- To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less 2- To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less 3- To stop smoking and increase physical activity to 30 minutes/day most days of the week 4- To lose weight, achieve a body mass index of 24 or less, and to eat a diet rich in fruits and vegetables

1

A community health nurse is conducting a workshop for adults who have hypertension and is now teaching participants about reading food labels when they are shopping at the supermarket. What teaching point should this nurse prioritize? 1- "Take particular note of the amount of sodium that a serving contains." 2- "Try to buy foods that have a high ratio of fiber to carbohydrates." 3- "If a food has ingredients that you can't pronounce, it's best to avoid it." 4- "Look at the percentage of the daily recommended intake of vitamins that is in a serving."

1

The nurse is caring for a client who is prescribed medication for the treatment of hypertension. The nurse recognizes that which medication conserves potassium? 1- Furosemide 2- Spironolactone 3- Chlorothiazide 4- Chlorthalidone

2

A nurse is educating a client about monitoring blood pressure readings at home. What will the nurse be sure to emphasize? 1- "Avoid smoking cigarettes for 8 hours prior to taking blood pressure." 2- "Sit quietly for 5 minutes prior to taking blood pressure." 3- "Sit with legs crossed when taking your blood pressure." 4- "Be sure the forearm is well supported above heart level while taking blood pressure."

2