Chapter 26

A young female patient is being treated for hypertension. The nurse would be most concerned if the patient became pregnant while taking which drug? 1. Enalapril (Vasotec) 2. Potassium supplement 3. Doxazosin (Cardura) 4. Hydrochlorothiazide (HCTZ)

1

Which interventions would be indicated and take highest priority for a 30-year-old female with a BMI of 20 who smokes and has a blood pressure of 137/88? 1. Smoking-cessation program 2. Diuretic therapy 3. Weight-loss program 4. Stress management

1

The patient receives hydrochlorothiazide (Microzide). He tells the nurse he is urinating a lot and questions how this drug affects his blood pressure. What is the best response by the nurse? 1. "Hydrochlorothiazide (Microzide) enhances kidney function causing you to urinate more and that decreases your blood pressure." 2. "Hydrochlorothiazide (Microzide) decreases the fluid in your bloodstream and this lowers your blood pressure." 3. "Hydrochlorothiazide (Microzide) dilates your blood vessels so you urinate more and your blood pressure decreases." 4. "Hydrochlorothiazide (Microzide) increases your heart rate; this pumps blood faster to your kidneys so you urinate more and your blood pressure decreases."

2

The patient with hypertension is receiving nifedipine (Procardia XL). The nurse determines that the patient needs additional medication education when the patient selects which menu for breakfast? 1. Whole-wheat pancakes with syrup, and bacon, oatmeal, and orange juice 2. Eggs, whole-wheat toast with butter, cereal, milk, and grapefruit juice 3. Eggs and sausage, a biscuit with margarine, coffee with cream, and cranberry juice 4. Egg and cheese omelet, tea with sugar and lemon, hash brown potatoes, and prune juice

2

What is a priority nursing intervention for a patient who has just begun antihypertensive treatment with enalapril (Vasotec)? 1. Monitor the patient for headaches. 2. Take the patient's blood pressure. 3. Order a sodium-restricted diet for the patient. 4. Review the patient's lab results for hypokalemia.

2

Which lists include the three factors that make up blood pressure? 1. Blood volume, heart rate, and stroke volume 2. Cardiac output, blood volume, and peripheral vascular resistance 3. Age, weight, and race 4. Body mass index, diet, and genetics

2

Which statement is accurate in regard to secondary hypertension? 1. There is no known cause. 2. It can result from chronic renal impairment. 3. It is also known as idiopathic. 4. It accounts for 90% of all hypertensive cases.

2

The nurse is taking the initial history of a patient admitted to the hospital for hypertension. The physician has ordered a beta-adrenergic blocker. Which statement by the patient does the nurse recognize as most significant? 1. "I don't handle stress well; I have a lot of diarrhea." 2. "When I have a migraine headache, I need to have the room darkened." 3. "My father died of a heart attack when he was 48-years-old." 4. "I have always had problems with my asthma."

4

The patient has been recently diagnosed with hypertension. Assessment data include Wt: 200 pounds Ht: 5' 4" Diet: Mostly starches Alcohol intake: 3 beers/week Stressors: Works 60 hours/week In planning care with this patient, what is the priority outcome? 1. Patient will eliminate alcohol from the diet. 2. Patient will decrease stress by limiting work to 40 hours/week. 3. Patient will balance diet according to the food pyramid. 4. Patient will achieve and maintain optimum weight.

4

The patient with hypertension has experienced heart failure. The nurse notes that the patient is receiving nifedipine (Procardia). What is a priority assessment for the nurse? 1. Review recent lab results for hypokalemia. 2. Assess urinary output. 3. Assess level of orientation. 4. Auscultate breath sounds for crackles.

4

Which laboratory test would be the priority for a patient with hypertension who takes a thiazide diuretic? 1. Magnesium 2. Calcium 3. Chloride 4. Potassium

4

For the last 3 months, the nurse has been working with a group of patients who have been using nonpharmacological methods to try to manage their hypertension. The nurse anticipates that which patients will require the addition of a pharmacological intervention? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A 30-year-old female whose blood pressure is 138/88 mmHg who is otherwise healthy. 2. A 61-year-old man whose blood pressure is 144/90 mmHg who also has type 2 diabetes. 3. A 56-year-old woman whose blood pressure is 135/84 who also has Cushing's disease. 4. A 65-year-old man whose blood pressure is 148/88 mmHg who is otherwise healthy. 5. A 61-year-old woman whose blood pressure is 153/92 mmHg who is otherwise healthy.

2,5

The nurse is teaching the patient about lifestyle modifications to help manage the patient's hypertension. The nurse determines that teaching has been effective when the patient makes which statement? 1. "I need to get started on my medications right away." 2. "My father had hypertension, did nothing, and lived to be 90-years-old." 3. "I know I need to give up my cigarettes and alcohol." 4. "I won't be able to run in the marathon race anymore."

3

The patient comes to the emergency department with a blood pressure of 200/120 mmHg. The physician orders hydralazine (Apresoline) IV. What will the nurse's priority assessment include? 1. Hypotension and bradycardia 2. Hypotension and hyperthermia 3. Hypotension and tachycardia 4. Hypotension and tachypnea

3

The patient is receiving doxazosin (Cardura) for hypertension. He asks the nurse how the medication works. What is the nurse's best response? 1. "It works by causing your kidneys to excrete more urine." 2. "It works by making your heart work more efficiently." 3. "It works by making your blood vessels expand." 4. "It works by decreasing the release of your stress hormones."

3

The patient is receiving hydrochlorothiazide (Microzide) as well as digoxin (Lanoxin). Which lab result would the nurse recognize as most significant? 1. ALT level of 35 units/L 2. Sodium level of 140 mEq/L 3. Potassium level of 2.9 mEq/L 4. BUN level of 20 mg/dl

3

The nurse is caring for a patient recently diagnosed with hypertension. The patient asks what medications may be used to treat the condition. The nurse begins by discussing the primary antihypertensive agents, which include Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. thiazide diuretics. 2. angiotensin-II receptor blockers (ARBs). 3. beta-adrenergic antagonists. 4. direct-acting vasodilators. 5. peripheral adrenergic antagonists.

1,2

The nurse is caring for an African American male who has just been diagnosed with hypertension and mild heart failure. The nurse anticipates that this patient will be started on which medications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A combination drug like hydralazine and isosorbide dinitrate 2. A calcium channel blocker like nifedipine (Adalat) 3. An ACE inhibitor like enalapril (Vasotec) 4. A beta-adrenergic antagonist like atenolol (Tenormin) 5. An angiotensin-II receptor blocker like clonidine (Catapres)

1,2

The patient has been recently diagnosed with hypertension with a sustained blood pressure of 144/90 mmHg. The patient is concerned about effects on the body. What effects of hypertension on the body will the nurse include in her education of this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Kidney damage 2. Stroke 3. Liver failure 4. Heart failure 5. Blindness

1,2,4,5

A patient has had great difficulty controlling hypertension with standard drug therapy. She says, "My neighbor couldn't get her blood pressure down until the doctor started her on hydralazine (Apresoline). Which response, by the nurse, is indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Because you had rheumatic fever that damaged your heart, this is not a good drug for you." 2. "Your neighbor must be over age 70." 3. "Your lupus diagnosis keeps us from using that drug." 4. "You should not use that drug because you have rheumatoid arthritis." 5. "We try to avoid using hydralazine (Apresoline) because it causes constant coughing."

1,3

A patient is brought to the emergency department in hypertensive crisis. The nurse plans care to protect which bodily systems that are most implicated in compensating for this crisis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Cardiac 2. Respiratory 3. Integumentary 4. Gastrointestinal 5. Renal

1,5

A patient has been prescribed nifedipine (Adalat CC) as treatment for hypertension. The nurse would evaluate medication instruction as effective if the patient makes which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "If I drink alcohol while taking this medication, I will get very sick to my stomach." 2. "I should stop taking my melatonin sleep medication." 3. "I should no longer drink grapefruit juice." 4. "I should no longer drink sports drinks with caffeine in them." 5. "I should stop taking my vitamin C supplement."

2,3

The nurse is conducting the initial group education session for patients who have hypertension. What is the most important information to include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Blood pressures tend to decrease as people age, due to decreased blood volume. 2. The aorta has sensors that help regulate blood pressure. 3. Anger can result in hypertension. 4. The vasomotor center, located in the limbic system of the brain, helps regulate blood pressure. 5. Hypertension is diagnosed when the blood pressure is greater than 145/95 mmHg.

2,3

The nurse is educating a patient whose blood pressure is 140/90 mmHg on ways to lower blood pressure and avoid hypertension. Which lifestyle choices may eliminate the need for pharmacotherapy in this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Increasing intake of wine 2. Restricting salt intake 3. Increasing intake of red meat 4. Increasing activity 5. Stopping smoking

2,4,5

The nurse completed medication education with the patient who receives hydrochlorothiazide (Microzide). The nurse determines that teaching has been effective when the patient makes which statement? 1. "I really need to avoid grapefruit juice when I take this medication." 2. "I need to avoid salt substitutes and potassium-rich foods." 3. "I take my medication early in the morning." 4. "If I develop a cough, I should call my doctor."

3

The nurse educator is reviewing the body's control of blood pressure. In which order will the nurse explain the steps of this process? 1. Angiotension II is produced 2. Renin acts 3. Liver produces angiotensinogen 4. Angiotension I is produced 5. Vasoconstriction occurs

3,2,4,1,5

A hospitalized patient has been started on enalapril (Vasotec). The nurse would hold this drug and discuss which findings with the prescriber? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Cough 2. Light-headedness on ambulation 3. Swelling around the eyes 4. Sneezing 5. Difficulty swallowing

3,5