Chapter 33 Lewis Med Surg, Ch. 32 - Hypertension, Medical-Surgical Exam 2

The nurse is teaching a womens group about prevention of hypertension. What information should be included in the teaching for all the women? a. Lose weight b. Limits nuts and seeds c. Limit sodium and fat intake d. increase fruits and vegetables. e. Exercise 30 mins most days.

c, d, e

Heparin is ordered for a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI). How should the nurse explain the purpose of the heparin to the patient? a. "Heparin enhances platelet aggregation at the plaque site." b. "Heparin decreases the size of the coronary artery plaque." c. "Heparin prevents the development of new clots in the coronary arteries." d. "Heparin dissolves clots that are blocking blood flow in the coronary arteries."

c. "Heparin prevents the development of new clots in the coronary

A patient with ST-segment elevation in three contiguous electrocardiographic leads is admitted to the emergency department and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which question should the nurse ask to determine whether the patient is a candidate for thrombolytic therapy? a. "Do you have any allergies?" b. "Do you take aspirin daily?" c. "What time did your pain begin?" d. "Can you rate the pain on a 0 to 10 scale?"

c. "What time did your pain begin?"

A patient recovering from a myocardial infarction (MI) develops chest pain on day 3 that increases when taking a deep breath and is relieved by leaning forward. Which action should the nurse take as focused follow-up on this symptom? a. Assess both feet for pedal edema. b. Palpate the radial pulses bilaterally. c. Auscultate for a pericardial friction rub. d. Check the heart monitor for dysrhythmias.

c. Auscultate for a pericardial friction rub.

The nurse obtains the following data when assessing a patient who experienced an ST-segment-elevation myocardial infarction (STEMI) 2 days previously. Which information is most important to report to the health care provider? a. The troponin level is elevated. b. The patient denies having a heart attack. c. Bilateral crackles in the mid-lower lobes. d. Occasional premature atrial contractions (PACs).

c. Bilateral crackles in the mid-lower lobes.

Which data indicates to the nurse that the patient with stable angina is experiencing a side effect of metoprolol (Lopressor)? a. Patient is restless and agitated. b. Patient reports feeling anxious. c. Blood pressure is 90/54 mm Hg. d. Heart monitor shows normal sinus rhythm.

c. Blood pressure is 90/54 mm Hg.

The nurse is administering a thrombolytic agent to a patient with an acute myocardial infarction. What patient data indicates that the nurse should stop the drug infusion? a. Bleeding from the gums b. An increase in blood pressure c. Decreased level of consciousness d. A nonsustained episode of ventricular tachycardia

c. Decreased level of consciousness

Diltiazem (Cardizem) is prescribed for a patient with newly diagnosed Prinzmetal's (variant) angina. Which action of diltiazem is accurate for the nurse to include in the teaching plan? a. Reduces heart palpitations. b. Prevents coronary artery plaque. c. Decreases coronary artery spasms. d. Increases contractile force of the heart.

c. Decreases coronary artery spasms.

A patient who has chest pain is admitted to the emergency department (ED), and all of the following items are prescribed. Which one should the nurse arrange to be completed first? a. Chest x-ray b. Troponin level c. Electrocardiogram (ECG) d. Insertion of a peripheral IV

c. Electrocardiogram (ECG)

A patient with hyperlipidemia has a new order for colesevelam (Welchol). Which nursing action is appropriate when scheduling this medication? a. Administer the medication at the patient's usual bedtime. b. Have the patient take the colesevelam 1 hour before breakfast. c. Give the patient's other medications 2 hours after colesevelam. d. Have the patient take the dose at the same time as the prescribed aspirin.

c. Give the patient's other medications 2 hours after colesevelam.

Which nursing intervention is likely to be most effective when assisting the patient with coronary artery disease to make appropriate dietary changes? a. Inform the patient about a diet containing no saturated fat and minimal salt. b. Emphasize the increased cardiac risk unless the patient makes dietary changes. c. Help the patient modify favorite high-fat recipes by using monounsaturated oils. d. Give the patient a list of low-sodium, low-cholesterol foods to include in the diet.

c. Help the patient modify favorite high-fat recipes by using monounsaturated oils.

Which information about a patient receiving thrombolytic therapy for an acute myocardial infarction is most important for the nurse to communicate to the health care provider? a. An increase in troponin levels from baseline b. A large bruise at the patient's IV insertion site c. No change in the patient's reported level of chest pain d. A decrease in ST-segment elevation on the electrocardiogram

c. No change in the patient's reported level of chest pain

A patient with diabetes mellitus and chronic stable angina has a new order for captopril. What should the nurse teach this patient about the primary purpose of captopril? a. Decreases the heart rate. b. Controls blood glucose levels. c. Prevents changes in heart muscle. d. Reduces the frequency of chest pain.

c. Prevents changes in heart muscle.

Which electrocardiographic (ECG) change by a patient with chest pain is most important for the nurse to report rapidly to the health care provider? a. Inverted P wave b. Sinus tachycardia c. ST-segment elevation d. First-degree atrioventricular block

c. ST-segment elevation

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. rationale: labetalol decreases sympathetic nervous system activity by blocking both a- and b-adrenergic receptors, leading to vasodilation and a decrease in HR, which can cause orthostatic hypotension

The nurse is caring for a patient admitted with COPD, angina, and hypertension. Before administering the prescribed daily dose of atenolol 100 mg PO, the nurse assesses the patient carefully. Which adverse effect is this patient at risk for given the patients health history. a. Hypocapnia b. Tachycardia c. Bronchospasm d. Nausea and vomiting.

c. bronchospasm rationale: Atenolol is a cardioselective B1-adrenergic blocker that reduces blood pressure and could affect B2-receptors in the lungs with larger doses or with drug accumulation

A patient with a history of chronic hypertension is being evaluated in the ED for BP of 200/140 mm Hg. Which patient assessment question is the priority? a. Is the patient pregnant. b. Does the patient need to urinate c. Does the patient have a headache or confusion d. Is the patient taking antiseizure medications as prescribed

c. does the patient have a headache or confusion rationale: The nurses priority assessments include neurologic deficits, retinal damage, heart failure, pulmonary edema, and renal failure.

The nurse teaches a 28 yr old man newly diagnosed with hypertension about lifestyle modifications to reduce his BP. Which patient statement requires reinforcement of teaching. a. I will avoid adding salt to my food during or after cooking b. If I lose weight, I might not need to continue taking medications c. I can lower my BP by switching to smokeless tobacco d. Diet changes can be as effective as taking blood pressure medications.

c. i can lower my bp by switching to smokeless tobacco. rationale: Nicotine contained in tobacco products cause vasoconstriction and increase BP.

When teaching how lisinopril (Zestril) will help lower the patients BP, which mechanism of action should the nurse explain. a. Blocks b-adrenergic effects. b. Relaxes arterial and venous smooth muscle. c. Inhibits conversion of angiotensin 1 to angiotensin 2 d. Reduces sympathetic outflow from central nervous system.

c. inhibits conversion of angiotensin 1 to angiotensin 2 rationale: Lisinopril is an angiotensin-converting enzyme inhibitor that inhibits the conversion of angiotensin 1 to angiotensin 2, which reduces angiotensin 2-mediated vasoconstriction and sodium and water retention.

A patient with diabetes mellitus and chronic stable angina has a new order for captopril . The nurse should teach the patient that the primary purpose of captopril is to a. decrease the heart rate. b. control blood glucose levels. c. prevent changes in heart muscle d. reduce the frequency of chest pain.

c. prevent changes in heart muscle The purpose for angiotensin-converting enzyme (ACE) inhibitors in patients with chronic stable angina who are at high risk for a cardiac event is to decrease ventricular remodeling. ACE inhibitors do not directly impact angina frequency, blood glucose, or heart rate.

The 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 a. titrate nitroprusside to decrease mean arterial pressure to 115 b. evaluate effectiveness of nitroprusside therapy on BP c. set up the automatic BP machine to take BP readings every 15 mins. d. Assess the patients environment for adverse stimuli that might increase BP

c. set up the automatic BP machine to take BP readings every 15 mins

The UAP is taking orthostatic vital signs. In the supine position, the BP is 130/80, and the HR is 80. In the sitting position, the BP is 140/80, and the HR is 90. Which action should the nurse instruct the UAP to take next. a. Repeat BP and HR in this position b. Record the BP and HR measurements. c. Take BP and HR with patient standing d. Return the patient to the supine position.

c. take the BP and HR with patient standing. rationale: The vital signs taken do no reflect orthostatic changes, so the UAP will continue with the measurements while the patient is standing.

An older patient has been diagnoses with possible white coat hypertension. Which action will the nurse plan to take next. a. Schedule the patient for regular 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. rationale: having the patient self monitor BPs at home will provide a reliable indication about whether that patient has hypertension.

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 needs immediate intervention a. The patients most recent blood pressure is 158/91 mm Hg. b. the patients pulse has dropped from 68 to 57 beats/min 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. rationale: the most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective b-blockers) is occurring.

Which patient statement indicates that the nurse's teaching about sublingual nitroglycerin (Nitrostat) has been effective? a. "I can expect nausea as a side effect of nitroglycerin." b. "I should only take nitroglycerin when I have chest pain." c. "Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart." d. "I will call an ambulance if I have pain after taking 3 nitroglycerin 5 minutes apart."

d. "I will call an ambulance if I have pain after taking 3 nitroglycerin 5 minutes apart."

Which statement made by a patient with coronary artery disease after the nurse has completed teaching about the therapeutic lifestyle changes (TLC) diet indicates that further teaching is needed? a. "I will switch from whole milk to 1% milk." b. "I like salmon and I will plan to eat it more often." c. "I can have a glass of wine with dinner if I want one." d. "I will miss being able to eat peanut butter sandwiches."

d. "I will miss being able to eat peanut butter sandwiches."

Which information from a patient helps the nurse confirm the previous diagnosis of chronic stable angina? a. "The pain wakes me up at night." b. "The pain is level 3 to 5 (0 to 10 scale)." c. "The pain has gotten worse over the last week." d. "The pain goes away after a nitroglycerin tablet."

d. "The pain goes away after a nitroglycerin tablet."

After receiving change-of-shift report about the following four patients on the cardiac care unit, which patient should the nurse assess first? a. A 39-year-old patient with pericarditis who is complaining of sharp, stabbing chest pain. b. A 56-year-old patient with variant angina who is scheduled to receive nifedipine (Procardia). c. A 65-year-old patient who had a myocardial infarction (MI) 4 days ago and is anxious about today's planned discharge. d. A 59-year-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI).

d. A 59-year-old patient with unstable angina who has just returned after a percutaneous coronary intervention (PCI).

A patient who has had chest pain for several hours is admitted with a diagnosis of rule out acute myocardial infarction (AMI). Which laboratory test is most specific for the nurse to monitor in determining whether the patient has had an AMI? a. Myoglobin b. Homocysteine c. C-reactive protein d. Cardiac-specific troponin

d. Cardiac-specific troponin

A patient admitted to the coronary care unit (CCU) with an ST-segment-elevation myocardial infarction (STEMI) is restless and anxious. The blood pressure is 86/40 mm Hg, and heart rate is 132 beats/min. Based on this information, which patient problem is the priority? a. Anxiety related to perceived threat of death b. Acute pain related to myocardial infarction c. Stress management related to acute change in health d. Decreased cardiac output related to cardiogenic shock

d. Decreased cardiac output related to cardiogenic shock

A 44 yr old man is diagnosed with hypertension and receives a prescription for benazepril (Lotensin). After providing instruction, which statement by the patient indicates correct understanding. a. If I take this medication, I will not need to follow a special diet. b. It is normal to have some swelling in my face while taking this medication c. I will need to eat foods such as bananas and potatoes that are high in potassium d. If I develop a dry cough while taking this medication, I should notify my doctor.

d. If I develop a dry cough while taking this medication, I should notify my doctor. rationale: Benazepril is an angiotensin-converting enzyme inhibitor. The medication inhibits breakdown of bradykinin, which may cause a dry, hacking cough.

Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left ventricular dysfunction. What data would indicate to the nurse that the drug is effective? a. Decreased blood pressure and heart rate b. Improvement in the strength of the distal pulses c. Fewer complaints of having cold hands and feet d. Participation in daily activities without chest pain

d. Participation in daily activities without chest pain

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 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 the position slowly to help prevent dizziness and falls.

d. change the position slowly to help prevent dizziness and falls. rationale: the angiotensin-converting enzyme (ACE) inhibitors frequently cause orthostatic hypotension, and patients should be taught to change position slowly to allow the vascular system time to compensate for the position change.

A 56 yr old patient who has no previous history of hypertension or other health problems suddenly develops a blood pressure of 198/110. 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. rationale: a sudden increase in BP in a patient over age 50 with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem.

Which information should the nurse include when teaching a patient with newly diagnosed hypertension. a. increasing physical activity will control 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. rationale: hypertension is usually asymptomatic until target organ damage has occurred.

the nurse is caring for a 70 yr old who uses hydrochlorothiazide (HydroDIURIL) and enalapril (Norvasc), but whose self monitored 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 daily to treat osteoarthritis.

d. patient uses ibuprofen daily to treat osteoarthritis. rationale: because use of NSAIDs can prevent adequate BP control, the patient may need to avoid the use of ibuprofen

A 67 yr old with hypertension is admitted to the ED with a BP of 234/148 mm Hg and was started on nitroprusside (Nitropress). After one hour of treatment, the MAP is 55 mm Hg. Which nursing action is a priority. a. Start an infusion of 0.9% normal saline at 100mL/hr. b. Maintain the current administration rate of the nitroprusside. c. Request insertion of an arterial line for accurate BP monitoring d. Stop the nitroprusside infusion and assess the patient for potential complications

d. stop the nitroprusside infusion and assess the patient for potential complications rationale: Nitroprusside is a potent vasodilator medication. Minimal MAP required to perfuse organs is around 60 to 65 mm Hg. Lowering the BP too rapidly may decrease cerebral, coronary, or renal perfusion and could precipitate a stroke, myocardial infarction, or renal failure.

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. rationale: for the prevention of hypertension, the dietary approaches to stop hypertension (DASH) recommendations include increasing the intake of calcium-rich foods.

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 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 measurements.

d. use an automated noninvasive BP machine to obtain frequent BP measurements. rationale: frequent monitoring of BP is needed when the patient is receiving rapid-acting IV antihypertensive medications.

When caring for elderly patients with hypertension, which information should the nurse consider when planning care? select all a. Systolic blood pressure increases with aging b. blood pressures should be maintained near 120/80 mm Hg. c. White coat syndrome is prevalent in elderly patients d. Volume depletion contributes to orthostatic hypotension e. Blood pressure drops 1 hour postprandially in many older patients. f. older patients will require higher doses of antihypertensive medications.

a, c, d, e rationale: systolic blood pressure increases with age and patients older than 60 should be maintained below 150/90. Older patients have significantly higher blood pressure readings when take by HCPs. Older patients experience orthostatic hypotension related to dehydration, reduced compensatory mechanisms, and medications.

In preparation for discharge, the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that the teaching has been effective? a. "I will sit down before I put the nitroglycerin under my tongue." b. "I will check my pulse rate before I take any nitroglycerin tablets." c. "I will put the nitroglycerin patch on as soon as I get any chest pain." d. "I will remove the nitroglycerin patch before taking sublingual nitroglycerin."

a. "I will sit down before I put the nitroglycerin under my tongue."

After having a myocardial infarction (MI) and successful percutaneous coronary intervention, the patient states, "It was just a little chest pain. As soon as I get out of here, I'm going for my vacation as planned." Which reply would be most appropriate for the nurse to make? a. "What do you think caused your chest pain?" b. "Where are you planning to go for your vacation?" c. "Sometimes plans need to change after a heart attack." d. "Recovery from a heart attack takes at least a few weeks."

a. "What do you think caused your chest pain?"

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 yr old with a BP of 160/92 who is complaining of chest pain b. 52 yr old with a BP of 212/90 who has intermittent claudication c. 50 yr old with a BP of 190/104 who has creatine of 1.7 mg/dL d. 48 yr old with BP of 172/98 whose urine shows microalbuminuria

a. 43 yr old with a BP of 160/92 who is complaining of chest pain. rationale: the patient with chest pain may be experiencing acute myocardial infarction, and rapid assessment and intervention are needed.

When admitting a patient with a non-ST-segment-elevation myocardial infarction (NSTEMI) to the intensive care unit, which action should the nurse perform first? a. Attach the heart monitor. b. Obtain the blood pressure. c. Assess the peripheral pulses. d. Auscultate the breath sounds.

a. Attach the heart monitor.

A patient who has recently started taking pravastatin (Pravachol) and niacin reports several symptoms to the nurse. Which information is most important to communicate to the health care provider? a. Generalized muscle aches and pains b. Dizziness with rapid position changes c. Nausea when taking the drugs before meals d. Flushing and pruritus after taking the drugs

a. Generalized muscle aches and pains

A patient had a non-ST-segment-elevation myocardial infarction (NSTEMI) 3 days ago. Which nursing intervention is appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/VN)? a. Reinforcement of teaching about the prescribed medications b. Evaluation of the patient's response to walking in the hallway c. Completion of the referral form for a home health nurse follow-up d. Education of the patient about the pathophysiology of heart disease

a. Reinforcement of teaching about the prescribed medications

A patient with acute coronary syndrome has returned to the coronary care unit after having angioplasty with stent placement. Which assessment data indicate the need for immediate action by the nurse? a. Report of severe chest pain b. Heart rate 102 beats/min c. Pedal pulses 1+ bilaterally d. Blood pressure 103/54 mm Hg

a. Report of severe chest pain

A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of daily medications to the nurse. Which medication has the most immediate implications for the patient's care? a. Tadalafil (Cialas) b. Furosemide (Lasix) c. Warfarin (Coumadin) d. Diltiazem (Cardizem)

a. Tadalafil (Cialas)

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 ok rationale: angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an indication that the ACE inhibitor should be discontinued.

Despite a high dosage, a male patient who is taking nifedipine (Procardia XL) for antihypertensive therapy continues to have BP over 140/90 mm Hg. What should the nurse do next. a. Assess his adherence to therapy. b. ask him to make an exercise plan c. Instruct him to use the DASH diet. d. Request a prescription for a thiazide diuretic

a. assess his adherence to therapy. rationale: A long acting calcium-channel blocker such as nifedipine causes vascular smooth muscle relaxation, resulting in decreased systemic vascular resistance and arterial blood pressure and related side effects. So the nurse needs to be assessing adherence to therapy.

Propranolol (Inderal) is prescribed for a patient diagnosed with hypertension. The nurse should consult with the HCP 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 (reactive airway disease) rationale: nonselective b-blockers block b1 and b2 adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma

Which nursing action should the nurse take first in order to assist a patient with newly diagnosed stage 1 hypertension in making 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 dietician d. teach the patient about foods that are high in potassium.

a. collect a detailed diet history rationale: the initial nursing action should be assessment of the patients baseline dietary intake through a thorough diet history.

The nurse teaches a patient with hypertension that uncontrolled hypertension may damage organs in the body primarily by which mechanism? a. hypertension promotes atherosclerosis and damage to the walls of the arteries. b. Hypertension causes direct pressure on organs, resulting in necrosis and replacement of cells with scar tissue. c. Hypertension causes thickening of the capillary membranes, leading to hypoxia of organ systems. d. hypertension increases blood viscosity, which contributes to intravascular coagulation and tissue necrosis distal to occlusions.

a. hypertension promotes atherosclerosis and damage to the walls of the arteries. rationale: when atherosclerosis develops, it damages the walls of arteries and reduces circulation to target organs and tissues.

The charge nurse observes a new registered nurse doing discharge teaching for a patient with hypertension who has a new prescription for enalapril (Vasotec). the charge nurse will need to intervene if the new RN tells the patient a. increase the dietary intake of high potassium foods. b. make an appointment with the dietitian for teaching c. check the BP with home BP monitor at least once a day. d. move slowly when moving from lying to sitting to standing.

a. increase the dietary intake of high potassium foods. rationale: the ACE inhibitor cause retention of potassium by the kidney, so hyperkalemia is a possible adverse effect.

The nurse is reviewing the lab test results for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the HCP. 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 creatine of 2.8 mg/dL rationale: the elevated creatinine indicates renal damage caused by the hypertension

The nurse is evaluating the effectiveness of preoperative teaching with a patient scheduled for coronary artery bypass graft (CABG) surgery using the internal mammary artery. Which patient statement indicates that additional teaching is needed? a. "They will circulate my blood with a machine during surgery." b. "I will have incisions in my leg where they will remove the vein." c. "They will use an artery near my heart to go around the area that is blocked." d. "I will need to take aspirin every day after the surgery to keep the graft open."

b. "I will have incisions in my leg where they will remove the vein."

Which patient statement indicates that the nurse's teaching about carvedilol (Coreg) for preventing anginal episodes has been effective? a. "Carvedilol will help my heart muscle work harder." b. "It is important not to suddenly stop taking the carvedilol." c. "I can expect to feel short of breath when taking carvedilol." d. "Carvedilol will increase the blood flow to my heart muscle."

b. "It is important not to suddenly stop taking the carvedilol."

A patient who is recovering from an acute myocardial infarction (AMI) asks the nurse about safely resuming sexual intercourse. Which response by the nurse is best? a. "Most patients are able to enjoy intercourse without any complications." b. "Sexual activity uses about as much energy as climbing two flights of stairs." c. "The doctor will provide sexual guidelines when your heart is strong enough." d. "Holding and cuddling are good ways to maintain intimacy after a heart attack."

b. "Sexual activity uses about as much energy as climbing two flights of stairs."

Which BP finding by the nurse indicates that no changes in therapy are needed for a patient with stage 1 hypertension who has a history of diabetes mellitus. a. 102/60 b. 128/76 c. 139/90 d. 136/82

b. 128/76 - the goal for antihypertensive therapy for a patient with hypertension and diabetes mellitus is a BP <130/80.

The nurse is caring for a patient who is recovering from a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI). What should the nurse anticipate teaching the patient? a. Sudden cardiac death events rarely reoccur. b. Additional diagnostic testing will be required. c. Long-term anticoagulation therapy will be needed. d. Limiting physical activity will prevent future SCD events.

b. Additional diagnostic testing will be required.

Three days after experiencing a myocardial infarction (MI), a patient who is scheduled for discharge asks for assistance with hygiene activities, saying, "I am too nervous about my heart to be alone while I get washed up." Based on this information, which nursing diagnosis is appropriate? a. Activity intolerance related to weakness b. Anxiety related to change in health status c. Denial related to lack of acceptance of the MI d. Altered body image related to cardiac disease

b. Anxiety related to change in health status

Which action will the nurse take to evaluate the effectiveness of IV nitroglycerin for a patient with a myocardial infarction (MI)? a. Monitor heart rate. b. Ask about chest pain. c. Check blood pressure. d. Observe for dysrhythmias.

b. Ask about chest pain.

The nurse is caring for a patient admitted with a history of hypertension. The patients medication history includes hydrochlorothiazide daily for the past 10 years. Which parameter would indicate the optimal intended effect of this drug therapy. a. Weight loss of 2 lb. b. BP 128/86 mm Hg. c. Absence of ankle edema d. Output of 600 mL per 8 hrs.

b. BP 128/86 mm Hg. rationale: Hydrochlorothiazide may be used alone as monotherapy to manage hypertension or in combination with other medications if not effective alone. Because the patient has been taking the medication for 10 years, the most direct measurement of its intended effect would be the blood pressure.

After reviewing a patient's history, vital signs, physical assessment, and laboratory data, which information shown in the accompanying figure is most important for the nurse to communicate to the health care provider? a. Hyperglycemia b. Bilateral crackles c. Q waves on ECG d. Elevated troponin

b. Bilateral crackles

To improve the physical activity level for a mildly obese 68-year-old patient, which action should the nurse plan to take? a. Stress that weight loss is a major benefit of increased exercise. b. Determine what kind of physical activities the patient usually enjoys. c. Tell the patient that older adults should exercise for no more than 20 minutes at a time. d. Teach the patient to include a short warm-up period at the beginning of physical activity.

b. Determine what kind of physical activities the patient usually enjoys.

The nurse is developing a teaching plan for a 64-year-old patient with coronary artery disease (CAD). Which factor should the nurse focus on during the teaching session? a. Family history of coronary artery disease b. Elevated low-density lipoprotein (LDL) level c. Greater risk associated with the patient's gender d. Increased risk of cardiovascular disease with aging

b. Elevated low-density lipoprotein (LDL) level

The nurse is caring for a patient who has just arrived on the telemetry unit after having cardiac catheterization. What task should the nurse delegate to a licensed practical/vocational nurse (LPN/VN)? a. Teach the patient about the postprocedure plan of care. b. Give the scheduled aspirin and lipid-lowering medication. c. Perform the initial assessment of the catheter insertion site. d. Titrate the heparin infusion according to the agency protocol.

b. Give the scheduled aspirin and lipid-lowering medication.

A patient who has recently had an acute myocardial infarction (AMI) ambulates in the hospital hallway. Which data would indicate to the nurse that the patient should stop and rest? a. O2 saturation drops from 99% to 95%. b. Heart rate increases from 66 to 98 beats/min. c. Respiratory rate goes from 14 to 20 breaths/min. d. Blood pressure (BP) changes from 118/60 to 126/68 mm Hg.

b. Heart rate increases from 66 to 98 beats/min.

Which assessment finding in a patient who has had coronary artery bypass grafting using a right radial artery graft is most important for the nurse to communicate to the health care provider? a. Complaints of incisional chest pain b. Pallor and weakness of the right hand c. Fine crackles heard at both lung bases d. Redness on both sides of the sternal incision

b. Pallor and weakness of the right hand

Which patient at the cardiovascular clinic requires the most immediate action by the nurse? a. Patient with type 2 diabetes whose current blood glucose level is 145 mg/dL. b. Patient with stable angina whose chest pain has recently increased in frequency. c. Patient with familial hypercholesterolemia and a total cholesterol of 465 mg/dL. d. Patient with chronic hypertension whose blood pressure today is 172/98 mm Hg.

b. Patient with stable angina whose chest pain has recently increased in frequency.

3. The nurse is admitting a patient who has chest pain. Which assessment data suggest that the pain is from an acute myocardial infarction? a. The pain increases with deep breathing. b. The pain has lasted longer than 30 minutes. c. The pain is relieved after the patient takes nitroglycerin. d. The pain is reproducible when the patient raises the arms.

b. The pain has lasted longer than 30 minutes.

The nurse is caring for a patient who was admitted to the coronary care unit following an acute myocardial infarction (AMI) and percutaneous coronary intervention the previous day. What should teaching for this patient include today? a. Typical emotional responses to AMI b. When cardiac rehabilitation will begin c. Pathophysiology of coronary artery disease d. Information regarding discharge medications

b. When cardiac rehabilitation will begin

Which assessment finding for a patient who is receiving IV furosemide (LASIX) to treat stage 2 hypertension is most important to report to the HCP. a. blood glucose level of 175 mg/dL b. blood potassium level of 3.0 mEq/L c. most recent 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 rationale: hypokalemia is a frequent adverse effect of the loop diuretics and can cause life threatening dysrhythmias.

The nurse admits a 73 yr old male patient with dementia for treatment of uncontrolled hypertension. The nurse will closely monitor for hypokalemia if the patient receives which medication. a. Clondine (Catapres) b. Bumetanide (Bumex) c. Amiloride (Midamor) d. Sprinolactone (Aldactone)

b. bumetanide (Bumex) rationale: Bumetanide is a loop diuretic. Hypokalemia is a common adverse effect of this medication.

The nurse supervises an UAP who is taking blood pressure of 58 yr old female patient admitted with heart failure. Which action by the UAP will require the nurse to intervene. a. Waiting 2 minutes after position changes to take orthostatic pressures. b. Deflating the blood pressure cuff at a rate of 8 to 10 mm Hg per second. c. Taking blood pressure with the patients arm at the level of the heart. d. Taking a forearm BP because the largest cuff will not fit the patients upper arm.

b. deflating the cuff at a rate of 8 to 10 mm Hg per second. rationale: The cuff should be deflated at a rate of 2 to 3 mm Hg per second.

Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure 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.

A patient with a history of hypertension treated with a diuretic and an angiotensin-converting (ACE) enzyme inhibitor arrives in the ED complaining of a severe headache and nausea and has BP of 238/118. Which question should the nurse ask first. a. Did you take any acetaminophen 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 rationale: sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis.

The nurse obtains the following information from a patient newly diagnosed with pre-hypertension. Which finding is most important to address with the patient. a. low dietary fiber intake b. No regular aerobic exercise c. Weight 5lbs above ideal weigh. d. Drinks a beer with dinner on most nights.

b. no regular aerobic exercise rationale: the recommendations for preventing hypertension include exercising aerobically for 30 mins most days of the week

The nurse is caring for a patient with hypertension who is scheduled to receive a dose of metoprolol (Lopressor). The nurse should withhold the dose and consult the prescribing physician for which vital sign taken just before administration. a. O2 saturation of 93% b. Pulse 48 beats/min c. Respirations 24 breaths/min d. BP 118/74 mm Hg.

b. pulse 48 beats/min rationale: Because metoprolol is a B1-adrenergic blocking agent, it can cause hypotension and bradycardia as adverse effects.

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 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 as prescribed c. inform the patient the multiple drugs are often needed to treat hypertension d. Question the patient regarding any life style changes made to help control BP

b. question the patient about whether the medication is actually being taken as prescribed rationale: because noncompliance with anytihypertensive therapy is common, the nurses initial action should be to determine whether the patient is taking the atenolol as prescribed.

When teaching a patient about dietary management of stage 1 hypertension, which instruction is most appropriate? a. Increase water intake b. restrict sodium intake c. Increase protein intake d. Use calcium supplements.

b. restrict sodium intake rationale: This will help to control hypertension, which can be aggravated by excessive salt intake, which in turn leads to fluid retention.

When providing dietary instruction to a patient with hypertension, the nurse would advise the patient to restrict intake of which meat? a. Broiled fish b. Roasted duck c. Roasted turkey d. Baked chicken breast.

b. roasted duck rationale: Roasted duck in high in fat, which should be avoided by the patient with hypertension.

In caring for a patient with poorly controlled hypertension, which lab test result should the nurse understand as indicating the presence of target organ damage. a. Serum uric acid of 3.8 mg/dL b. Serum creatinine of 2.6 mg/dL c. Serum potassium of 3.5 mEq/L d. Blood urea nitrogen of 15 mg/dL

b. serum creatinine of 2.6 mg/dl rationale: The normal serum creatinine level is 0.6 to 1.3 mg/dL. This elevated level indicates target organ damage to the kidneys.

A patient who is being admitted to the emergency department with intermittent chest pain gives the following list of daily medications to the nurse. Which medication has the most immediate implications for the patient's care? a. captopril b. sildenafil (Viagra) c. furosemide (Lasix) d. warfarin (Coumadin)

b. sildenafil (Viagra) The nurse will need to avoid giving nitrates to the patient because nitrate administration is contraindicated in patients who are using sildenafil because of the risk of severe hypotension caused by vasodilation. The other home medications should also be documented and reported to the health care provider but do not have as immediate an impact on decisions about the patient's treatment.

The nurse is assessing a patient who has been admitted to the ICU with a hypertensive emergency. Which finding is most important to report to the HCP a. urine output over 8 hours is 250mL less that 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 arm d. the patient complains of a headache with pain at level 8/10

b. the patient cannot move the arm and leg when asked to do so. rationale: the patients inability to move the left arm and leg indicates that a hemorrhagic stroke may be occurring and will require immediate action to prevent further neurologic damage.