104: Unit 2 Q's
While conducting a cardiac assessment for a patient who is 78 years old, the nurse notes that he is suffering from sinus dysrhythmias. A reduction in which type of cells leads to this condition? 1 Pacemaker cells in the sinoatrial (SA) node 2 Conduction cells in the internodal tracts 3 Conduction cells in the bundle of His 4 Conduction cells in the bundle branches
1 A reduction in the number of pacemaker cells in the SA node may account for sinus dysrhythmias in the older adult patient. Reductions in the number of conduction cells in the internodal tracts, bundle of His, and bundle branches contribute to the development of atrial dysrhythmias and heart blocks.
While palpating the patient's pedal pulses, the nurse determines that the pulses are absent. What factor could contribute to this result? 1 Atherosclerosis 2 Hyperthyroidism 3 Arteriovenous fistula 4 Cardiac dysrhythmias
1 Atherosclerosis can cause an absent peripheral pulse. The feet would be cool also and may be discolored. Hyperthyroidism causes a bounding pulse. An arteriovenous fistula gives a thrill or vibration to the vessel, although this would not be in the foot. Cardiac dysrhythmias cause an irregular pulse rhythm.
The nurse is reviewing the function of the vascular system. What portion of the vascular system exchanges cellular nutrients and metabolic end products? 1 Capillary vessels 2 Smooth muscle of the arteriole 3 Endothelial layer of the arteries 4 Elastic middle layer of the veins
1 The exchange of cellular nutrients and metabolic end products takes place through the thin-walled capillaries, which connect the arterioles and the venules. Exchange of cellular nutrients and metabolic end products does not occur in the arteriole, arteries, or veins.
A patient with a history of pheochromocytoma is in the emergency department and has a blood pressure of 246/144 mm Hg. The health care provider prescribes sodium nitroprusside. What nursing interventions are required when administering this medication? Select all that apply. 1 Measuring hourly urine output. 2 Continuous blood pressure monitoring. 3 Administering the sodium nitroprusside by slow intravenous (IV) push. 4 Decreasing the mean arterial pressure (MAP) by 50% within the first hour. 5 Titrate the infusion according to mean arterial pressure or blood pressure (BP) as prescribed.
1,2,5 Measure urine output hourly to assess renal perfusion. Patients being treated with IV sodium nitroprusside should have continuous blood pressure monitoring. The drug is titrated according to MAP or BP as prescribed. When a patient is to receive sodium nitroprusside for a hypertensive emergency, the nurse will prepare for an infusion of the medication, because it is not given by IV push. The initial goal is to decrease MAP by no more than 20% to 25%, or to decrease MAP to 110 to 115 mm Hg. If the patient is clinically stable, drugs can be titrated to gradually lower BP over the next 24 hours. Lowering the BP too quickly or too much may decrease cerebral, coronary, or renal perfusion. This could precipitate a stroke, myocardial infarction (MI), or renal failure.
The nurse is teaching the male patient about the most common side effects of antihypertensive medications. Which information would the nurse discuss with the patient? Select all that apply. 1 Sexual dysfunction 2 Resistant hypertension 3 Orthostatic hypotension 4 Frequent voiding and dry mouth 5 Rebound hypotension if the drug is stopped abruptly
1,3,4 Reduced libido or erectile dysfunction are examples of sexual dysfunction as a side effect of antihypertensive medications. Alteration of the autonomic nervous system mechanism by antihypertensive medications leads to orthostatic hypotension. Diuretics are one class of medications for treatment of hypertension that cause frequent urination and dry mouth. "Resistant hypertension" is a term used to describe failure to reach desired blood pressure (BP) in the patient who takes multiple antihypertensive medications. Rebound hypertension results from abrupt stopping of antihypertensive medication use. Text Reference - p. 721
The nurse is assessing a patient's blood pressure and reviewing factors that contribute to primary hypertension. Which of these may be contributing factors to the development of primary hypertension? Select all that apply. 1 Tobacco use 2 Thyroid disease 3 Diabetes mellitus 4 Increased sodium intake 5 Greater-than-ideal body weight 6 Underproduction of sodium-retaining hormones
1,3,4,5 Contributing factors to primary hypertension include increased sympathetic nervous system (SNS) activity, overproduction (not underproduction) of sodium-retaining hormones and vasoconstricting substances, increased sodium intake, greater-than-ideal body weight, diabetes mellitus, tobacco use, and excessive alcohol consumption. Thyroid disease is related to secondary hypertension. Text Reference - p. 712
A nurse is preparing discharge teaching for a patient with orthostatic hypotension. Which instructions should be a part of the discharge plan? Select all that apply. 1 Rise slowly from a supine to sitting position. 2 Avoid sleeping with the head elevated. 3 Lie down or sit if dizziness occurs. 4 Do not stand still for prolonged periods. 5 Perform leg exercises to increase venous return.
1,3,4,5 Orthostatic hypotension is a condition in which there is a decrease in blood pressure upon rising to a standing position from a lying down or sitting position. The patient should be instructed to rise slowly from the sitting and lying down positions and to move only when no dizziness occurs. The patient should sit or lie down if there is dizziness. This prevents the risk of falling. Standing still for prolonged periods may cause venous stasis and worsen hypotension. Doing leg exercises helps to increase venous return to the heart and lowers blood pressure. Sleeping with the head elevated helps to keep the blood flow to the brain uniform and prevents orthostatic hypotension. Text Reference - p. 723
A patient is prescribed lisinopril for the treatment of hypertension. The patient asks about side effects of this medication. Which side effects should the nurse include? Select all that apply. 1 Cough 2 Edema 3 Dizziness 4 Impotence 5 Hypotension 6 Muscle stiffness
1,3,5 Cough, dizziness, and hypotension are side effects of angiotensin-converting enzyme (ACE) inhibitors. Peripheral edema is a side effect of calcium channel blockers. Impotence is a side effect of thiazide diuretics, aldosterone receptor blockers, central-acting alpha-adrenergic antagonists, peripheral-acting alpha-adrenergic antagonists, beta-adrenergic blockers, and mixed alpha 1 and beta 1 blockers. Muscle stiffness is not associated with an ACE inhibitor. Text Reference - p. 724
During a physical examination of a patient, a nurse is able to hear murmurs on auscultation. How should the nurse interpret the finding? 1 The cardiac valves are affected. 2 There is a decreased compliance of ventricles during filling. 3 The patient has pericardial friction rub. 4 The patient has high blood pressure
1. Murmurs are heard when the blood flow is turbulent due to dysfunctional valves. The valves may get affected due to accumulation of lipids, degeneration of collagen, and fibrosis. A decreased compliance of ventricles during filling would result in the S4 heart sound. A pericardial friction rub is usually heard as a high-pitched, scratchy sound. High blood pressure does not cause murmurs. Text Reference - p. 691
A patient has a prescription for nadolol 50 mg by mouth (PO) daily. The nurse questions the prescription after noting which medical diagnosis in the patient's health record? 1 Chronic obstructive pulmonary disease (COPD) 2 Renal insufficiency 3 Diabetes mellitus 4 Hypertension
1. Nadolol is a nonselective β1-adrenergic-blocking agent that reduces blood pressure and could affect the β2 receptors in the lungs with larger doses or with drug accumulation. It should be used cautiously in patients with COPD, because it could trigger bronchospasm, a potentially life-threatening adverse effect. Nadolol will not worsen renal insufficiency and diabetes and will treat, not worsen, hypertension. Text Reference - p. 718
Despite a high dosage, a male patient who is taking nifedipine for antihypertensive therapy continues to have blood pressures over 140/90 mm Hg. What should the nurse do next? 1 Assess the patient's adherence to therapy 2 Ask the patient to make an exercise plan 3 Instruct the patient to use the dietary approaches to stop hypertension (DASH) diet 4 Request a prescription for a thiazide diuretic
1. A long-acting calcium-channel blocker, such as nifedipine, causes vascular smooth muscle relaxation, resulting in decreased systemic vascular resistance (SVR) and arterial blood pressure (BP) and related side effects. The nurse needs to assess the patient's adherence to therapy. The patient's blood pressure is still elevated and must be addressed. Asking the patient to make an exercise plan or use the DASH diet is not addressing the blood pressure. It is not necessary to request another medication without assessing if the patient actually is taking the medication prescribed. Text Reference - p. 720
The patient diagnosed with prehypertension asks the nurse: "What could I do to decrease my blood pressure?" Which response by the nurse is the most appropriate? 1 "Walk for at least 30 minutes daily." 2 "Reduce sodium intake to less than 3000 mg per day." 3 "Reducing weight by 10 lbs will decrease systolic blood pressure (SBP) by 10 to 20 mm Hg." 4 "Restrict alcohol consumption to no more than three drinks daily."
1. Moderate physical activity, such as walking for at least 30 minutes, is recommended at least five days per week to reduce BP. Salt intake has to be restricted to less than 2300 mg per day. Weight reduction by 20 lbs leads to a reduction in SBP of 5 to 20 mm Hg. Alcohol consumption should be restricted to no more than one drink per day for women and no more than two drinks per day for men. Text Reference - p. 716
2. A nurse is providing information to a new graduate about measuring the blood pressure in a cardiac patient. Which information should the nurse include? 1 Take the blood pressure in the right-lying and left-lying positions 2 Take the blood pressures in both the left and the right arms 3 A variation in blood pressure of 50 mm Hg from supine to standing is normal 4 A variation in blood pressure directly corresponds to a variation in respirations
2 The correct method of obtaining the blood pressure is by taking blood pressure on both arms. The blood pressure may vary in the arms. The arm with the higher blood pressure should be used for further measurements of blood pressure. The nurse should take the blood pressure in three positions—with the patient supine, sitting, and standing. There may be slight variations in the three readings. A variation of 20 mm Hg from supine to standing is normal. A variation in blood pressure does not correspond to a variation in respirations. Text Reference - p. 694 Topics
A patient has a history of angina and is being treated with nitrates and beta blockers. What important information should the nurse give to the patient regarding sexuality? 1 "You cannot have sexual intercourse while taking these medicines." 2 "You cannot take medicines like Viagra." 3 "Stop taking beta blockers, because they can cause impotence." 4 "Stop taking nitrates when planning to have sexual intercourse."
2 The nurse should advise the patient to avoid taking erectile dysfunction (ED) drugs such as Viagra. This is because the combination of ED drugs and nitrates can cause significant hypotension. The patient should not be asked to avoid sex. Beta blockers may cause erectile dysfunction; however, the drug should not be stopped without consulting the primary healthcare provider. Discontinuing nitrates can worsen the angina. Text Reference - p. 694
While obtaining objective data during the assessment of the cardiovascular system of a patient, what findings can be the cause(s) of concern for a nurse? Select all that apply. 1 Edema is absent in the extremities. 2 Hands and feet are cold to touch. 3 Capillary refill takes longer than two seconds. 4 Presence of a thready pulse. 5 Veins in the neck are not distended.
2,3,4 Hands and feet that are cold to the touch may indicate intermittent claudication, peripheral arterial disease, low cardiac output, or severe anemia. Capillary refill taking longer than two seconds indicates the possibility of reduced arterial capillary perfusion or anemia. Blood loss, decreased cardiac output, aortic valve disease, or peripheral arterial disease can result in a thready pulse. Absence of edema in the extremities and lack of distention of the veins in the neck are not causes for concern. Text Reference - p. 696
While instructing a patient about the serum test for triglycerides and lipoproteins, what does the nurse tell him? 1 Avoid alcohol for at least 12 hours before the test. 2 Maintain at least 12 hours fasting before the test. 3 Avoid water intake for 12 hours before the test. 4 Repeat the test in 6 hours for accurate diagnosis.
2. The nurse instructs the patient to fast for at least 12 hours before the test. Similarly, consumption of alcohol should be restricted for at least 24 hours before the test. Water intake is not restricted during the 12-hour fasting period. The nurse does not ask the patient to repeat the test in 6 hours. However, because there are marked day-to-day fluctuations in the serum lipid levels, more than one test is required for accurate diagnosis and treatment.
Auscultation of a patient's heart reveals the presence of a murmur. Of what is this assessment finding a result? 1 Increased viscosity of the patient's blood 2 Turbulent blood flow across a heart valve 3 Friction between the heart and the myocardium 4 A deficit in heart conductivity that impairs normal contractility
2. Turbulent blood flow across the affected valve results in a murmur. A murmur is not a direct result of variances in blood viscosity, conductivity, or friction between the heart and myocardium.
A patient's laboratory report reveals increased creatine kinase (CK-MB) enzymes. The nurse suspects what diagnosis? 1 Stroke 2 Myocardial infarction (MI) 3 Coronary artery disease (CAD) 4 Peripheral vascular disease (PVD)
2. Creatine kinase (CK-BB) enzymes are present in the cardiac muscle and are released into the blood due to cell injury. An increase in creatine kinase (CK-MB) enzymes indicates the onset of symptoms of myocardial infarction (MI). Homocysteine is an amino acid produced during protein catabolism; elevated levels of this amino acid are an indication of stroke, coronary artery disease (CAD), and peripheral vascular disease (PVD).
A nurse is conducting an examination of a patient who is a smoker with a two-year history of using oral contraceptives. Based on the findings, the patient should be assessed for which condition? 1 Hypotension 2 Venous thromboembolism 3 Cardiomyopathy 4 Dependent edema
2. Long-term use of oral contraceptives can lead to serious side effects. In addition, smoking enhances the risk of developing complications such as venous thromboembolism. Hypotension is not an effect of oral contraceptives. Similarly, contraceptives do not affect the muscles of the heart and do not cause cardiomyopathy. Dependent edema is not a common side effect of oral contraceptives. Text Reference - p. 692
The nurse understands that which medication may increase the risk of hypoglycemia unawareness in a patient with diabetes mellitus? 1 Cardizem 2 Metoprolol 3 Prednisone 4 Hydromorphone
2. Metoprolol, a beta blocker, slows the heart rate. Tachycardia is a classic symptom of hypoglycemia; therefore patients must be made aware of failure of the heart rate to respond to decreasing blood sugars and should be instructed to look for other signs of hypoglycemia. Cardizem and hydromorphone will not affect blood sugars or signs/symptoms of hypoglycemia. Prednisone will increase, not decrease, blood sugar levels. Text Reference - p. 718.
When providing dietary instruction to a patient with hypertension, the nurse would advise the patient to restrict intake of which meat? 1 Broiled fish 2 Roasted duck 3 Roasted turkey 4 Baked chicken breast
2. Roasted duck is high in fat, which should be avoided by the patient with hypertension. Weight loss may slow the progress of atherosclerosis and overall cardiovascular disease risk. Broiled fish, roasted turkey, and baked chicken breast are lower in fat and are therefore acceptable in the diet. Text Reference - p. 715
In caring for a patient admitted with poorly controlled hypertension, the nurse should understand that which laboratory test result would indicate the presence of target organ damage? 1 Blood urea nitrogen (BUN) of 15 mg/dL 2 Serum uric acid of 3.8 mg/dL 3 Serum creatinine of 2.6 mg/dL 4 Serum potassium of 3.5 mEq/L
3. The normal serum creatinine level is 0.6 to 1.3 mg/dL. This elevated level indicates target organ damage to the kidneys. BUN of 15 mg/dL, serum uric acid of 3.8 mg/dL, and serum potassium of 3.5 mEq/L are within normal limits. Text Reference - p. 715
While assessing a patient with cardiovascular disease, the nurse observes a bluish tinge around the ears. What does the nurse suspect is the likely reason behind the assessment finding? 1 Diabetes 2 Endocarditis 3 Vasoconstriction 4 Venous thromboembolism
3 A bluish tinge around the ears or in the ears indicates peripheral cyanosis, which is characterized by vasoconstriction. Vasoconstriction is the narrowing of blood vessels due to the contraction of muscular walls of the vessels, resulting in reduced blood flow. This reduced blood flow will result in insufficient oxygen supply by the heart to other parts of the body, causing a bluish tinge in the extremities of ears. Diabetes causes ulcers in patients with cardiovascular disease. Endocarditis causes clubbing of nail beds. Venous thromboembolism results in asymmetry in limb circumference. Text Reference - p. 696
The nurse is teaching the patient about the Dietary Approaches to Stop Hypertension (DASH) diet. Which statement indicates that the patient understood the teaching? 1 "I should eat more red meat, such as pork or beef." 2 "I should drink no more than three glasses of whole milk per day." 3 "I should include four to five servings of fruits and vegetables daily." 4 "I should consume whole grain products no more than once per week."
3 The DASH diet encourages consumption of fruits and vegetables. Pork and beef are high in fat and therefore have to be restricted according to the DASH diet; poultry and fish have to be consumed instead of red meat. Fat-free or low-fat milk has to be used instead of whole milk according to the DASH recommendations. The DASH diet recommends a few servings of whole grain products daily. Text Reference - p. 715
While assessing the cardiovascular status of a patient, the nurse performs auscultation. Which intervention should the nurse implement to assess the patient's pulse deficit? 1 Position the patient supine 2 Ask the patient to hold his or her breath 3 Palpate the radial pulse while auscultating the apical pulse 4 Use the bell of the stethoscope when auscultating S1 and S2
3 To detect a pulse deficit, simultaneously palpate the radial pulse when auscultating the apical area. A sitting or side-lying position is most appropriate for cardiac auscultation. It is not necessary to ask the patient to hold his or her breath during cardiac auscultation. The diaphragm is more appropriate than the bell when auscultating S1 and S2.
While auscultating a patient's heart, the nurse hears turbulent sounds between normal heart sounds. Which complication does the nurse suspect? 1 Aneurysm 2 Cardiac dysrhythmias 3 Cardiac valve disorder 4 Left ventricular failure
3 Turbulent sounds heard between normal heart sounds are known as murmurs. Murmurs are found in patients with cardiac valve disorder. An aneurysm is associated with a turbulent flow sound in the peripheral artery. Cardiac dysrhythmias are characterized by an apical heart rate exceeding the peripheral pulse rate. Left ventricular failure is associated with an extra, low-pitched heart sound in early diastole. Text Reference - p. 696
A patient with cardiovascular disease is diagnosed with venous thromboembolism. What assessment finding does the nurse expect? 1 Abnormal capillary refill 2 Unusually warm extremities 3 Asymmetry in limb circumference 4 Pitting edema of lower extremities
3 Venous thrombosis is the formation of clots and most commonly occurs in the pelvis or lower extremity—that is, in the deep veins of the legs. This condition results in asymmetry in limb circumference. Possible reduced arterial capillary perfusion and anemia cause abnormal capillary refill. Thyrotoxicosis results in unusually warm extremities. Interruption of venous return to the heart and right-sided heart failure are associated with pitting edema of the lower extremities.
The nurse is teaching a patient, recently diagnosed with hypertension (HTN), about diagnostic studies prescribed by a primary health care provider. Which information would the nurse include? Select all that apply. 1 Echocardiography to evaluate cardiac status 2 ECG to evaluate degree of left ventricular hypertrophy 3 Lipid profile to provide information about the risk factor for HTN 4 Uric acid level because it frequently decreases with diuretic therapy 5 Blood urea nitrogen (BUN) and serum creatinine levels to provide information on renal function
3,5 An elevated lipid profile is an additional risk factor for hypertension because having elevated blood lipids leads to development of atherosclerosis. BUN, creatinine, and urinalysis provide information about baseline renal function and help to identify renal damage. Echocardiography evaluates the degree of ventricular hypertrophy, whereas ECG is used to assess baseline cardiac function. Diuretic therapy frequently leads to an increase in uric acid. Text Reference - p. 715
For what change in vital signs would the nurse assess a patient experiencing postural hypotension? 1 Increased systolic blood pressure, decreased pulse rate 2 Increased diastolic blood pressure, increased pulse rate 3 Decreased systolic blood pressure, decreased diastolic blood pressure, increased pulse rate 4 Decreased systolic blood pressure, increased diastolic blood pressure, no change in pulse rate
3. A decrease in both systolic and diastolic blood pressure and an increase in pulse would be seen in a patient with postural hypotension. Blood pressure drops as the volume of circulating blood decreases when a patient abruptly stands from a lying or sitting position. The pulse rate increases as the heart attempts to compensate by increasing the amount of circulating blood by increasing cardiac output. Increased systolic blood pressure and decreased pulse rate; increased diastolic blood pressure and increased pulse rate; and decreased systolic blood pressure, increased diastolic blood pressure, and no change in pulse rate are all incorrect. Text Reference - p. 723
A patient has a new prescription for doxazosin. When providing education about this drug, the nurse will include which instructions? 1 "Weigh yourself daily, and report any weight loss to your prescriber." 2 "Increase your potassium intake by eating more bananas and apricots." 3 "Take this drug at bedtime because of the risk of orthostatic hypotension." 4 "The impaired taste associated with this medication usually goes away in two to three weeks."
3. A patient who is starting doxazosin should take the first dose while lying down because there is a first-dose hypotensive effect with this medication. Taking the drug at bedtime reduces risks associated with orthostatic hypotension. The patient does not need to increase potassium intake. Doxazosin does not cause impaired taste. It does not cause weight loss, because it is not a diuretic. Text Reference - p. 723
A patient with hypertension has been prescribed an antihypertensive medication. During a follow-up visit, the patient asks if the medication can be stopped because the blood pressure (BP) is now within the normal range. Which nursing response is appropriate? 1 Stop the medication because the BP is normal. 2 Reduce the dose of the medication because the BP has decreased. 3 Continue the medication until the health care provider advises to discontinue it. 4 Stop taking the medication and manage the BP with lifestyle modifications.
3. Antihypertensive medications are effective at reducing BP; however, the medications should not be stopped abruptly, because this can cause a severe hypertensive reaction. The medications should be discontinued only after consulting with the primary health care provider. The medication should not be stopped even if the BP measurements show normal readings. Medications should be taken regularly for sustained therapeutic effects. A reduction of the dosage may reduce the efficacy of the drug. Lifestyle modifications are necessary to reduce cardiovascular risks; however, antihypertensive medications should also be used for effective reduction of BP. Text Reference - p. 724
A patient is scheduled a dose of metoprolol. The nurse should withhold the dose and consult the health care provider after noting which assessment finding? 1 Migraine headache 2 Pulse 112 beats/minute Correct3 Expiratory wheezing 4 Blood sugar 217 mg/dL
3. Metoprolol is a β-adrenergic-blocking agent that reduces blood pressure and could affect the β2 receptors in the lungs with larger doses or with drug accumulation. It should be used cautiously in patients with wheezing or respiratory disorders because it could cause bronchospasm, a potentially life-threatening adverse effect. Metoprolol will not worsen migraine, will decrease the elevated pulse rate, and will not lower or further elevate the blood sugar. Text Reference - p. 718
The nurse observes blanching of a patient's nail beds for two seconds after release of pressure. Which does the nurse recognize as the potential cause of the assessment finding? 1 Thyrotoxicosis 2 Intermittent claudication 3 Reduced arterial capillary perfusion 4 Interruption of venous return to heart
3. Reduced arterial capillary perfusion results in a decreased amount of oxygen supply to body parts, which results in blanching of nail beds for two seconds after release of pressure. Hands and feet that are warmer than normal indicate thyrotoxicosis. When the hands and feet are cold to the touch, it indicates intermittent claudication. Visible finger pitting on application of firm pressure indicates interruption of venous return to the heart. Text Reference - p. 696
The nurse just received the shift report. Which patient should the nurse assess first? 1 The patient who is complaining about dizziness and whose blood pressure (BP) is 150/92. 2 The patient with a hip fracture who is complaining about pain 2 out of 10 3 The patient who is complaining about severe headache and has a nose bleed 4 The patient complaining of fatigue and who just received an angiotensin-converting enzyme (ACE) inhibitor.
3. Severe headache and nose bleed are signs of hypertensive crisis that is an emergency situation, and therefore the nurse has to see this patient first. Dizziness is one of the symptoms of hypertension and the patient has an elevated blood pressure, but it is not an emergency situation. Pain 2 out of 10 is mild pain and therefore this patient is not a priority. Fatigue is one of the symptoms of hypertension, but the patient just received antihypertensive medication. Text Reference - p. 714
Which instruction given to a patient who is about to undergo Holter monitoring is most appropriate? 1 "You may remove the monitor only to shower or bathe." 2 "You should connect the monitor whenever you feel symptoms." 3 "You should refrain from exercising while wearing this monitor." 4 "You will need to keep a diary of all your activities and symptoms."
4 A Holter monitor is worn continuously for at least 24 hours while a patient continues with usual activity and keeps a diary of activities and symptoms. The patient should not take a bath or shower while wearing this monitor. Text Reference - p. 700
While measuring a patient's blood pressure (BP), a nurse finds that there is a difference in BP and heart rate when the patient changes position form supine to standing. There is a decrease of 20 mm Hg in systolic BP (SBP), a decrease of 10 mm Hg in diastolic BP (DBP), and an increase in the heart rate of 20 beats/minute. How should the nurse interpret these findings? 1 The patient has resistant hypertension. 2 The patient has an auscultatory gap. 3 The patient is experiencing a hypertensive crisis. 4 The patient is experiencing orthostatic hypotension.
4 A decrease in BP with change of position indicates orthostatic hypotension. It may manifest as light-headedness, dizziness, or syncope. Intravascular volume loss and inadequate vasoconstrictor mechanisms related to disease or medications are common causes. Resistant hypertension is a condition in which the patient fails to reach blood pressure goals despite an effective treatment regimen. An auscultatory gap is commonly seen in elderly patients as a wide gap between the first Korotkoff sound and subsequent beats. A hypertensive crisis is characterized by severely elevated BP with or without the presence of target organ damage. Text Reference - p. 722
The blood pressure of a 71-year-old patient admitted with pneumonia is 160/70 mm Hg. What is an age-related change that contributes to this finding? 1 Stenosis of the heart valves 2 Decreased adrenergic sensitivity 3 Increased parasympathetic activity 4 Loss of elasticity in arterial vessels
4 An age-related change that increases the risk of systolic hypertension is a loss of elasticity in the arterial walls. Because of the increasing resistance to flow, pressure is increased within the blood vessel and hypertension results. Valvular rigidity of aging causes murmurs and decreased adrenergic sensitivity slows the heart rate. Blood pressure is not raised. Increased parasympathetic activity would slow the heart rate. Text Reference - p. 691
A patient has been prescribed atenolol. Before administering the drug, the nurse should assess for which condition? 1 Asthma 2 Dry cough 3 Depression 4 Diabetes mellitus
4 Atenolol reduces blood pressure by blocking β-adrenergic effects. It should be used with caution in patients with diabetes mellitus. It depresses the tachycardia associated with hypoglycemia and may prevent diagnosing hypoglycemia. A history of asthma, dry cough, or depression does not affect administration of the drug. Nonselective blockers should not be used in patients with asthma due to the risk of bronchospasm. Angiotensin-converting enzymes may cause dry cough. Reserpine should not be administered in patients with depression, because this may cause the condition to worsen. Text Reference - p. 718
The patient is admitted with reports of awakening during the night with sudden shortness of breath. The nurse documents this as: 1 Orthopnea 2 Atrial fibrillation 3 Intermittent claudication 4 Paroxysmal nocturnal dyspnea
4 Paroxysmal nocturnal dyspnea is defined as "attacks of shortness of breath, especially at night," which awakens the patient. Orthopnea is the need to sleep in an upright position. Atrial fibrillation is a conduction abnormality of the heart. Intermittent claudication affects the muscles of the leg during exercise related to decreased oxygen delivery to the muscle. Text Reference - p. 721
A nurse is caring for a patient admitted to the hospital with a diagnosis of hypertension. The primary health care provider prescribes prazosin. What is the priority nursing intervention? 1 Check for history of depression. 2 Do not give with grapefruit juice. 3 Monitor for cardiac dysrhythmias. 4 Assess for orthostatic hypotension.
4. Low blood pressure or postural hypotension can cause a fall from dizziness. The peripheral-acting alpha-adrenergic antagonist reserpine is contraindicated in patients with a history of depression. Administrating grapefruit juice with certain calcium channel blockers may increase the serum concentrations, resulting in toxicity. The direct vasodilator minoxidil may cause EKG changes of flattened and inverted T waves. Text Reference - p. 718
The nurse is caring for a patient admitted with chronic obstructive pulmonary disease (COPD), angina, and hypertension. Before administering the prescribed daily dose of atenolol 100 mg orally (PO), the nurse assesses the patient carefully. Which adverse effect is this patient at risk for given the patient's health history? 1 Hypocapnia 2 Tachycardia 3 Bronchospasm 4 Nausea and vomiting
Atenolol is a cardioselective β1-adrenergic blocker that reduces blood pressure and could affect the β2 receptors in the lungs with larger doses or with drug accumulation. Although the risk of bronchospasm is less with cardioselective β-blockers than nonselective β-blockers, atenolol should be used cautiously in patients with COPD. Text Reference - p. 718
A nurse helps a patient move from a lying down position to a standing position. The patient suddenly becomes dizzy. What is the probable reason for the dizziness? Correct1 The vasomotor center may not have been activated. Incorrect2 The peripheral arteries may have constricted. 3 The venous return to the heart may be increased. 4 The force of contraction of the heart may be increased
During any change in position, the vasomotor center is activated and stimulates the sympathetic nervous system (SNS) response. The SNS response ensures that cerebral blood flow is maintained by causing peripheral vasoconstriction and by increasing venous return. If the patient feels dizzy when changing positions, it means that the vasomotor center is not being stimulated. If the peripheral arteries constrict and the venous return to the heart is increased, the blood flow to the heart is maintained and may prevent dizziness in the patient. If the force of contraction is increased, the patient would not experience dizziness, because the blood flow to the brain would be maintained. Text Reference - p. 711
A patient is being discharged from the hospital. The primary health care provider prescribes propranolol for hypertension. Which instruction should the nurse include in the patient's discharge teaching plan? Correct1 Do not stop taking abruptly. 2 Take initial doses at bedtime. 3 Monitor for peripheral edema. 4 Take with orange juice
Patients should not stop taking this medication abruptly, because this may cause rebound hypertension. The initial dose of alpha-1 adrenergic blockers should be taken at bedtime because of the possible profound orthostatic hypotension with syncope within 90 minutes after the initial dose. Calcium channel blockers may cause peripheral edema. Beta blockers are not potassium wasting, so it is not necessary to take them with orange juice. Text Reference - p. 725
The nurse is teaching a women's group about prevention of hypertension. What information should be included in the teaching for all the women? Select all that apply. 1 Lose weight 2 Limit nuts and seeds 3 Limit sodium and fat intake 4 Increase fruits and vegetables 5 Exercise 30 minutes most days
Primary prevention of hypertension is to make lifestyle modifications that prevent or delay the increase in blood pressure (BP). Along with exercise for 30 minutes on most days, the dietary approaches to stop hypertension (DASH) eating plan is a healthy way to lower BP by limiting sodium and fat intake, increasing fruits and vegetables, and increasing nutrients that are associated with lowering BP. Weight loss may or may not be necessary for the individual. Nuts and seeds and dried beans are used for protein intake. Text Reference - p. 715
Calculate the pulse pressure of a patient whose blood pressure is 140/85 mm Hg after exercise. Fill in the blank using a whole number.
Pulse pressure is the difference between the systolic blood pressure and the diastolic blood pressure. 140 - 85 = 55.
