MED-SURG CH. 38 EAQ QUESTIONS

What is the leading cause of death for individuals with hypertension? A) Cardiac disease B) Stage 4 kidney failure C) Cerebral vascular accident D) Peripheral vascular occlusion

A) Cardiac disease Cardiac disease is the leading cause of death in people with hypertension. Complications of hypertension may include damage to the brain, eyes, and blood vessels.

A patient has recently been diagnosed with hypertension and started on amlodipine. When educating the patient, which side effects should the nurse discuss with the patient? Select all that apply. A) Edema B) Flushing C) Dizziness D) Coughing E) Hypoglycemia F) Nausea and vomiting

A) Edema B) Flushing C) Dizziness The side effects of amlodipine include edema, flushing, dizziness, bradycardia, headache, and palpitations. The medication is not associated with coughing, hypoglycemia, or nausea and vomiting.

A thorough initial assessment of a patient's blood pressure includes checking the blood pressure in which positions? Select all that apply. A) Sitting B) Supine C) Kneeling D) Standing E) Lithotomy F) Knee-chest

A) Sitting B) Supine D) Standing For the initial assessment, multiple readings should be taken and the blood pressure taken in both arms in the sitting, supine, and standing positions. Kneeling, lithotomy, and knee-chest positions are not included in blood pressure measurement.

A patient has been instructed by the health care provider to adhere to the Dietary Approaches to Stop Hypertension (DASH) diet. The patient asks the nurse what this includes. How would the nurse describe the DASH diet to this patient? Select all that apply. A) Use low-fat dairy products B) High in fruits and vegetables C) Drink 6 to 8 glasses of water daily D) Reduce sodium intake to 1200 mg/day E) Increase monosaturated and polyunsaturated fats

A) Use low-fat dairy products B) High in fruits and vegetables The DASH diet is a diet high in fruits, vegetables, and low-fat dairy, with reduced content of saturated and total fat. This diet reduces systolic blood pressure an average of 8 to 14 mm Hg. The DASH diet does not focus on drinking water, reducing sodium, or increasing mono- and polyunsaturated fats.

A patient is admitted to the hospital with a blood pressure of 220/138 mm Hg and is diagnosed with a hypertensive emergency. What does the nurse recognize as the mechanism of action of the prescribed sodium nitroprusside? A) A diuretic agent to reduce fluid volume B) A vasodilator to relax the arteriolar smooth muscle C) A centrally acting drug to act on the central nervous system D) A beta-adrenergic receptor blocker to decrease cardiac stimulation

B) A vasodilator to relax the arteriolar smooth muscle Sodium nitroprusside is a vasodilator that acts by relaxing the arteriolar smooth muscle to lower the blood pressure. Diuretics, centrally acting drugs, and beta-adrenergic receptor blockers do not have this mechanism of action.

An older adult is being treated with diuretic medications for the diagnosis of hypertension. The patient reports irritability, muscle weakness, and anorexia. The health care provider relates these symptoms to hypokalemia and prescribes a potassium-sparing diuretic agent. The nurse expects which drug to be prescribed? A) Losartan B) Amiloride C) Furosemide D) Hydrochlorothiazide

B) Amiloride Amiloride is a potassium-sparing diuretic agent. Losartan is an angiotensin II-receptor antagonist, not a diuretic agent. Furosemide is a loop diuretic agent. Hydrochlorothiazide is a thiazide diuretic agent.

A patient has diabetes with hypertension and is admitted for frequent bouts of hypoglycemia. Which prescription drug might be causing the hypoglycemia? A) Enalapril B) Atenolol C) Hydralyzine D) Mecamylamine

B) Atenolol Atenolol is a beta-adrenergic receptor blocker and has potential side effects of bradycardia, fatigue, drowsiness, depression, hypoglycemia, and bronchial constriction. Enalapril, hydralyzine, and mecamylamine do not cause hypoglycemia.

The LPN is caring for a patient who is beginning treatment with a beta-blocker medication for hypertension. The LPN notes that the patient experiences frequent episodes of diaphoresis. The priority action by the nurse should be to check the results of which diagnostic tool? A) Electrocardiogram B) Blood glucose level C) Heart rate by telemetry D) Low-density lipoprotein

B) Blood glucose level Diaphoresis (excessive perspiration) may be the only sign of hypoglycemia when people with diabetes are taking beta blockers. It would not be the priority at this time to check the patient's heart rate, electrocardiogram, and low-density lipoprotein.

A patient has been diagnosed with hypertension and has not been able to control the blood pressure through lifestyle changes. The patient's average systolic blood pressure is 145 mm Hg. What pharmacologic therapy would usually be the first recommendation? A) Tetrandrine B) Diuretic agent C) ACE inhibitor and beta-blockers D) Ganglionic blocker and vasodilator

B) Diuretic agent An average systolic blood pressure of 145 indicates stage 1 hypertension. A single agent is preferred if good control can be reached. For most, a diuretic agent will be used as a first therapy. If good control is not reached, then another medication would be added after 3 to 6 months. Tetrandrine is used as an herbal remedy for hypertension.

consistent blood pressure of 155/96 mm Hg is defined in which manner? A) Low B) High C) Normal D) Borderline

B) High Hypertension, or high blood pressure, is defined as a persistent systolic blood pressure greater than or equal to 140 mm Hg or diastolic blood pressure greater than or equal to 90 mm Hg

An older adult patient comes to the emergency department with a severe nosebleed. The patient stated that the nosebleed started without cause. What does the nurse suspect is the problem? A) Anemia B) Hypertension C) Heart disease D) Blow to the nose

B) Hypertension Many people with hypertension have no symptoms. Symptoms that may accompany hypertension include epistaxis (nosebleed), occipital headaches, and lightheadedness. The nurse would suspect hypertension. A blow to the nose, anemia, and heart disease would not be suspected.

The primary care provider for a patient with hypertension has ordered a urinalysis. The nurse knows that which is a possible explanation for this test being ordered? A) Hypertension can decrease blood flow to various organs. A urinalysis could find proteinuria and pyuria indicating damage to the heart. B) Hypertension can decrease blood flow to various organs. A urinalysis could find proteinuria and hematuria indicating damage to the kidneys. C) Hypertension can decrease blood flow to various organs. A urinalysis could find pyuria and glucosuria indicating damage to the heart. D) Hypertension can decrease blood flow to various organs. A urinalysis could find hematuria and glucosuria indicating damage to the kidneys.

B) Hypertension can decrease blood flow to various organs. A urinalysis could find proteinuria and hematuria indicating damage to the kidneys. Narrowing of the renal arteries may decrease renal function and lead to chronic renal failure. A urinalysis can indicate renal failure and may reveal proteinuria and hematuria.

Hypertension is called by which name because it often has no symptoms and is not discovered until a serious complication occurs such as damage to the kidneys, eyes, heart, or brain? A) Slow killer B) Silent killer C) Unknown predator D) Aggressive disease

B) Silent killer Hypertension is called the silent killer because it often has no symptoms and is not discovered until a serious complication occurs such as damage to the kidneys, eyes, heart, or brain.

patient with a history of hypertension comes to the emergency department with complaints of severe headache, blurred vision, nausea, restlessness, and confusion. The patient admits that he ran out of medication 3 weeks ago. Place the nursing interventions for this patient in the correct order. A) Record intake and output B) Take blood pressure C) Take pulse and respiratory rate D) Administer prescribed medications

B) Take blood pressure C) Take pulse and respiratory rate D) Administer prescribed medications A) Record intake and output Hypertensive crisis is a life-threatening medical emergency. The patient can present with severe headache, blurred vision, nausea, restlessness, and confusion. Care in the emergency department begins with measuring the blood pressure, pulse, and respiratory rate. After data collection, the next step is treatment with diuretic agents and potent vasodilators. While receiving diuretic agents, it is important to record intake and output.

A patient with hypertension has been prescribed lisinopril. The nurse is responsible for monitoring for which adverse effects? Select all that apply. A) Depression B) Urine output C) Pulse deficits D) Potassium levels E) Sexual dysfunction F) Decreased white blood cell counts

B) Urine output D) Potassium levels F) Decreased white blood cell counts Lisinopril is an ACE inhibitor and works by relaxing blood vessels so that blood can flow more easily. This medication can cause decreased white blood cell counts and hyperkalemia. If the patient has renal artery stenosis, renal failure can occur. This medication is not associated with depression, pulse deficits, or sexual dysfunction.

Upon admission to a long-term care facility, a resident's health history reveals a long history of high blood pressure, decreased kidney function, cardiovascular disease, and diabetes. Which risk group would this resident belong to? A B C D

C Individuals in Risk Group C have target organ damage and clinical cardiovascular disease, diabetes, or all of these conditions, with or without other risk factors. Patients with hypertension are classified as Risk Group A if they have no major risk factors, no target organ damage, and no clinical cardiovascular disease. Individuals in Risk Group B have one or more risk factors, not including diabetes, no target organ damage, and no clinical cardiovascular disease. Risk Group D does not exist.

The nurse is reviewing the charts of four patients with hypertension prior to assessing them. The nurse knows that which patient is most at risk for serious complications of hypertension? A) 50-year-old Hispanic man B) 70-year-old Caucasian woman C) 60-year-old African-American man D) 65-year-old African-American woman

C) 60-year-old African-American man Complications of hypertension increase after 50 years of age. Men, especially African Americans, suffer serious complications more often than women.

When the nurse is taking a blood pressure reading, the bladder of the blood pressure cuff should encircle at least which percentage of the circumference of the patient's arm? A) 60 B) 70 C) 80 D) 90

C) 80 The bladder in the cuff should encircle at least 80 percent of the circumference of the patient's arm. Too small a cuff may give a false-high reading, whereas a cuff that is too large may give a false-low reading.

Which type of medication would be prescribed to block the adrenal cortex from releasing aldosterone? A) Direct vasodilator B) Calcium antagonist C) Angiotensin II receptor antagonist D) Angiotensin-converting enzyme inhibitor

C) Angiotensin II receptor antagonist Angiotensin II receptor antagonists prevent vasoconstriction in response to angiotensin and prevent the release of aldosterone, which increases excretion of salt and water, thereby reducing blood volume.

A patient was instructed by the health care provider to attempt relaxation techniques for good blood pressure control. The patient asks the nurse for clarification. Which examples of relaxation techniques should the nurse include in the discussion with the patient? Select all that apply. A) Karate B) Swimming C) Biofeedback D) Watching TV E) Stress management F) Behavior modification

C) Biofeedback E) Stress management F) Behavior modification Biofeedback, relaxation, behavior modification, and stress management should be included in the discussion. In general, relaxation techniques involve refocusing attention on something calming and increasing awareness of the body. Karate and swimming are physical exercise, which would likely be helpful, but they are not included in relaxation techniques. Watching television is not considered a relaxation technique.

The patient is beginning to exhibit symptoms of depression after beginning to take an antihypertensive medication 10 days earlier. Which should be the nurse's priority action? A) Explain to the patient that the symptoms may diminish. B) Instruct the patient not to stop taking the antihypertensive medication. C) Contact the health care provider so that another drug can be substituted. D) Encourage the patient to seek out a referral to a mental health professional.

C) Contact the health care provider so that another drug can be substituted. If the patient is exhibiting symptoms of depression, the nurse would contact the health care provider so that another drug can be substituted. The symptoms may diminish at some point, but the nurse would contact the health care provider first so that a drug substitution can be made. The patient should not stop taking the antihypertensive medication until instructed to do so by the health care provider. The patient may require treatment by a mental health professional, but the nurse would contact the health care provider first so that a drug substitution can be made.

A patient has been diagnosed with primary hypertension. The nurse expects the health care provider to prescribe which treatment initially? A) Surgery B) Diuretic agents C) Diet modification D) Antihypertensive medications

C) Diet modification For the treatment of primary hypertension, a conservative, nonpharmacologic method (without drugs) is usually tried first. Diet modification is a common nonpharmacological method. Surgery is not a treatment for hypertension. Medications, like diuretic agents and antihypertensive medications, may be added if needed.

A patient has type 2 diabetes, hypertension, and coronary artery disease and is receiving a beta blocker. The patient should be monitored closely for which side effect? A) Tachycardia B) Hyperkalemia C) Hypoglycemia D) Hypernatremia

C) Hypoglycemia Beta blockers act by decreasing cardiac stimulation. Side effects include bradycardia, fatigue, drowsiness, hypoglycemia, bronchial constriction, and depression. In this case, since the patient has type 2 diabetes, monitoring the blood sugar closely is prudent.

Which interventions are appropriate for a 32-year-old patient who is 20 pounds overweight and is diagnosed with a blood pressure of 155/90 mm Hg? A) Continue to monitor blood pressure and weight for 6 months to see if there is a change. B) Obtain an electrocardiogram, and schedule an MRI to further assess cardiovascular status. C) Incorporate nutrition, exercise, and stress management along with education regarding prescribed medications. D) Immediately place the patient on blood pressure medications and a liquid protein diet to meet a weight-loss goal of 5 pounds per week.

C) Incorporate nutrition, exercise, and stress management along with education regarding prescribed medications. Adherence to therapy requires commitment and active participation on the part of the patient. Lifestyle changes are required and include exercise, stress management, and nutrition. Continuing to monitor delays patient treatment. Further testing may not be indicated at this time. A liquid protein diet does not follow nutrition recommendations

The licensed practical nurse (LPN) is caring for a patient who is scheduled to begin treatment with prazosin. The nurse's priority action when administering the first dose of this drug would be to monitor for which adverse effect? A) Drowsiness and nausea B) Headache and dizziness C) Severe orthostatic hypotension D) Reflex tachycardia and palpitations

C) Severe orthostatic hypotension Although all of these side effects can potentially occur when administering prazosin, severe orthostatic hypotension, which is likely to occur with the first dose, can be the most detrimental to the patient the fastest. A lesser priority would be to monitor for drowsiness, nausea, headache, dizziness, reflex tachycardia, and palpitations.

The patient is at the clinic for a well woman exam and asks the nurse what is a normal blood pressure. The nurse responds that The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) defines normal blood pressure as which readings? A) Persistent systolic blood pressure greater than or equal to 140 mm Hg B) Persistent diastolic blood pressure greater than or equal to 90 mm Hg C) Systolic blood pressure of less than 120 mm Hg and diastolic blood pressure less than 80 mm Hg D) Systolic blood pressure between 120 and 139 mm Hg and diastolic blood pressure between 80 and 89 mm Hg

C) Systolic blood pressure of less than 120 mm Hg and diastolic blood pressure less than 80 mm Hg The JNC7 defines normal blood pressure as a systolic blood pressure less than 120 mm Hg and a diastolic blood pressure less than 80 mm Hg. Patients with a systolic blood pressure between 120 and 139 mm Hg and a diastolic blood pressure between 80 and 89 mm Hg are said to have prehypertension. Hypertension is defined as a persistent systolic blood pressure greater than or equal to 140 mm Hg, a persistent diastolic blood pressure greater than or equal to 90 mm Hg, or the current use of an antihypertensive medication.

A patient has not been taking prescribed antihypertensive medications and has lost health insurance. The patient developed an episode of right-sided weakness that resolved within 18 hours. The nurse recognizes these symptoms associated with which disease process? A) Retinal hemorrhage B) Myocardial infarction C) Transient ischemic attack D) Cerebrovascular accident

C) Transient ischemic attack A transient ischemic attack is a temporary neurologic dysfunction caused by cerebral ischemia. A retinal hemorrhage occurs in the eyes. A myocardial infarction occurs in the coronary blood vessels. A cerebrovascular accident, or stroke, results from a clot that occludes the vessel.

A 45-year-old Caucasian female patient asks the nurse how she can reduce the risk for developing hypertension. The patient is 65 inches tall and weighs 160 lb. She has a history of anxiety, type 2 diabetes mellitus, and arthritis. The patient smokes one pack of cigarettes per day. Which risk factors for hypertension should the nurse discuss with this patient? Select all that apply. A) Age B) Height C) Weight D) Anxiety E) Arthritis F) Smoking status

C) Weight D) Anxiety F) Smoking status This patient's ideal body weight (IBW) is 125 lb; her weight of 160 lb is 28 percent over the IBW. A weight of 20 percent over IBW, stress, and diabetes are risk factors for hypertension. Nicotine constricts blood vessels and causes the release of epinephrine and norepinephrine, which also constrict blood vessels. The patient's age cannot be modified, and arthritis is not a risk factor associated with hypertension.

The Dietary Approaches to Stop Hypertension (DASH) eating plan does not only help lower blood pressure in those with hypertension, but it can also decrease the risk for developing hypertension. The nurse has provided instructions for this diet and knows the instructions were effective if the patient selects which meal items? A) Salt, poultry, and fish B) Fruits, red meats, and nuts C) Whole grains, protein, and fiber D) Vegetables, low-fat dairy products, and cholesterol

C) Whole grains, protein, and fiber The DASH plan is high in fruits, vegetables, low-fat dairy products, whole grains, poultry and fish, nuts, potassium, calcium, magnesium, protein, and fiber. The DASH plan is low in saturated fat, total fat, and cholesterol and would not include red meats, sugared beverages, or sodium.

A patient is reading her medical record and is concerned that her health care provider has diagnosed stage 1 hypertension. The nurse should explain that this means the patient's blood pressure has been at which level? A) less than 120 systolic and less than 80 diastolic B) ≥160 systolic or ≥100 diastolic C) 120 to 139 systolic or 80 to 89 diastolic D) 140 to 159 systolic or 90 to 99 diastolic

D) 140 to 159 systolic or 90 to 99 diastolic Rationale: Normal blood pressure is defined as less than 120 systolic and less than 80 diastolic. Prehypertension is defined as 120 to 139 systolic or 80 to 89 diastolic. Stage 1 hypertension is defined as 140 to 159 systolic or 90 to 99 diastolic. Stage 2 hypertension is defined as ≥160 systolic or ≥100 diastolic.

High blood pressure is usually detected in which age groups? A) 20 to 30 years of age B) 25 to 35 years of age C) 30 to 40 years of age D) 30 to 50 years of age

D) 30 to 50 years of age High blood pressure is a condition that is usually detected in people who are 30 to 50 years of age.

A patient with a history of primary hypertension complains of increasing nocturia, and the urinalysis reveals 1+ proteinuria. The patient should be further evaluated for which condition? A) Pneumonia B) Osteoporosis C) Hepatomegaly D) Kidney disease

D) Kidney disease Narrowing of the renal arteries may decrease renal function and lead to chronic renal failure. Initial indicators of renal failure are nocturia and azotemia. In addition, urinalysis may reveal protein, blood, or both in the urine. Osteoporosis is a condition of the bones that would not reveal these findings. Pneumonia is an infection of the lungs, and hepatomegaly is enlargement of the liver.

The plan of care for a patient receiving an antihypertensive agent calls for monitoring for orthostatic hypotension. What symptoms should the patient be monitored for regarding the orthostatic hypotension? A) Hypertension and headache. B) Heart palpitations and dyspnea. C) Distended neck veins and headache. D) Lightheadedness, dizziness, and syncope (fainting)

D) Lightheadedness, dizziness, and syncope (fainting) Orthostatic hypotension is a sudden drop in systolic blood pressure when moving from a lying or sitting position to a standing position. The nurse should monitor the patient for lightheadedness, dizziness, and syncope (fainting). The patient has hypertension, and would not be monitored for headache, distended neck veins, heart palpitations, or dyspnea.

A patient states he is only willing to make minor lifestyle modifications to lower his blood pressure. The nurse should explain that which lifestyle modification, when implemented alone, lowers blood pressure the least? A) Weight reduction B) Aerobic physical activity C) Dietary sodium reduction D) Moderation of alcohol consumption E) Dietary Approaches to Stop Hypertension (DASH) eating plan

D) Moderation of alcohol consumption Moderation of alcohol consumption reduces systolic blood pressure an average 2 to 4 mm Hg. Weight reduction reduces systolic blood pressure an average 5 to 20 mm Hg. The DASH eating plan reduces systolic blood pressure an average 8 to 14 mm Hg. Aerobic physical activity reduces systolic blood pressure an average 4 to 9 mm Hg. Dietary sodium reduction reduces systolic blood pressure an average of 2 to 8 mm Hg.

A 67-year-old patient has a blood pressure of 160/80 mm Hg while lying in bed. After the patient moves from a lying position to a standing position, the blood pressure is 140/85 mm Hg. How is this change in blood pressure documented? A) Hypertensive crisis B) Nocturnal dyspnea C) Paroxsymal dyspnea D) Orthostatic hypotension

D) Orthostatic hypotension Orthostatic or postural hypotension is a sudden drop in systolic blood pressure, usually 20 mm Hg, when moving from a lying or sitting position to a standing position. Hypertensive crisis occurs when the blood pressure rises to a dangerous level. Nocturnal or paroxysmal dyspnea is shortness of breath. Dyspnea is not involved in this situation.

Which is the first step that the LPN would take in obtaining a patient's systolic blood pressure by palpation? A) Determine the pressure when the last pulse is felt. B) Deflate the cuff and take the pressure by auscultation. C) Reinflate the cuff above the palpated systolic pressure. D) Palpate the radial or brachial pulse while inflating the cuff.

D) Palpate the radial or brachial pulse while inflating the cuff. The first step in obtaining the systolic blood pressure by palpation is to palpate the radial or brachial pulse while inflating the cuff. Then, inflate the cuff to determine the pressure when the last pulse is felt. At this point, one can either continue to inflate the cuff to 30 mm Hg past when the last pulse is felt or make note of the pressure at which the pulse disappeared and deflate the cuff. Once deflated, the nurse should reinflate the cuff to 30 mm Hg past when the last pulse is felt. Finally, slowly deflate the cuff to determine when the pulse is felt again; this is the patient's systolic blood pressure and is charted as SBP/P, where "P" stands for palpation. If the nurse doubts the accuracy of the systolic pressure by palpation, it would be appropriate to deflate the cuff and take the pressure by auscultation

The LPN is working at a health fair where nurses are screening patients' blood pressure. The nurse finds a patient whose blood pressure is initially high. Which should be the nurse's next action? A) No action is needed at this time. B) Refer the patient for medical evaluation. C) Have the patient transported to a medical facility. D) Reassess the patient's blood pressure within 1 to 5 minutes

D) Reassess the patient's blood pressure within 1 to 5 minutes When screening individuals for hypertension, if the blood pressure is initially elevated, it should be reassessed after 1 to 5 minutes. Doing nothing is not an appropriate response because the nurse would need to take the blood pressure at least a second time to verify that it has decreased. If the pressure remains elevated, the patient would be referred for a medical evaluation. Transporting the patient to a medical facility would not be needed unless the blood pressure is severely elevated (e.g., diastolic pressure of 115 mm Hg or more), which would place the patient in imminent danger of a stroke. Immediate medical care would be needed.

A common side effect of many antihypertensive medications is sexual dysfunction. Which is the most appropriate way to address issues of sexual dysfunction? A) Do not say anything until the information is volunteered during the conversation. B) Ask, "How many times a week do you have sexual relations? How many times per month?" C) Say, "Some people with hypertension have sexual problems. Tell me about your sexual relations." D) Say, "Some people taking this medication have changes in sexual function. Has this been an issue for you?"

D) Say, "Some people taking this medication have changes in sexual function. Has this been an issue for you?" A common side effect of many antihypertensive medications is sexual dysfunction. Many patients consider sexual function to be a very personal subject, so it must be handled in a sensitive manner. Some patients volunteer information about sexual changes; others may fail to relate the problem with the medications. It can be introduced by letting the patient know that for a particular medication, sexual dysfunction is a side effect. Direct or insensitive questioning is not appropriate.