32: Hypertension

Blood pressure = ______ x _______

CO x SVR

CO = __________ x _________

SV x HR

The nurse teaches a patient with hypertension that uncontrolled hypertension may damage organs in the body primarily by which mechanism? 1. Hypertension promotes atherosclerosis and damage to the walls of the arteries. 2. Hypertension causes direct pressure on organs, resulting in necrosis and replacement of cells with scar tissue. 3. Hypertension causes thickening of the capillary membranes, leading to hypoxia of organ systems. 4.Hypertension increases blood viscosity, which contributes to intravascular coagulation and tissue necrosis distal to occlusions.

1. Hypertension promotes atherosclerosis and damage to the walls of the arteries. Hypertension is a major risk factor for the development of atherosclerosis by mechanisms not yet fully known. However, once atherosclerosis develops, it damages the walls of arteries and reduces circulation to target organs and tissues.

A patient is to receive an infusion of 250 mL of platelets over 2 hours through tubing that is labeled: 1 mL equals 10 drops. How many drops per minute will the nurse infuse?

ANS: 21 To infuse 250 mL over 2 hours, the calculated drip rate is 20.8 drops/minute or 21 drops/minute

An appropriate nursing intervention for a patient with non-Hodgkin's lymphoma whose platelet count drops to 18,000/µL during chemotherapy is to a. check all stools for occult blood. b. encourage fluids to 3000 mL/day. c. provide oral hygiene every 2 hours. d. check the temperature every 4 hours.

ANS: A Because the patient is at risk for spontaneous bleeding, the nurse should check stools for occult blood. A low platelet count does not require an increased fluid intake. Oral hygiene is important, but it is not necessary to provide oral care every 2 hours. The low platelet count does not increase risk for infection, so frequent temperature monitoring is not indicated

A patient is diagnosed with hypertension and nadolol (Corgard) is prescribed. The nurse should consult with the health care provider before giving this medication upon finding a history of a. asthma. b. peptic ulcer disease. c. alcohol dependency. d. myocardial infarction (MI).

ANS: A Nonselective β-blockers block β1- and β2-adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma. β-blockers will have no effect on the patient's peptic ulcer disease or alcohol dependency. β-blocker therapy is recommended after MI.

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 *most* effective? a. The patient avoids eating nuts or nut butters. b. The patient restricts intake of chicken and fish. c. The patient drinks low-fat milk with each meal. d. The patient has two cups of coffee in the morning.

ANS: C For the prevention of hypertension, the Dietary Approaches to Stop Hypertension (DASH) recommendations include increasing the intake of calcium-rich foods. Caffeine restriction and decreased protein intake are not included in the recommendations. Nuts are high in beneficial nutrients and 4 to 5 servings weekly are recommended in the DASH diet.

The nurse is reviewing the laboratory test results for a patient who has recently been diagnosed with hypertension. Which result is *most* important to communicate to the health care provider? a. Serum creatinine of 2.8 mg/dL c. Serum hemoglobin of 14.7 g/dL b. Serum potassium of 4.5 mEq/L d. Blood glucose level of 96 mg/dL

ANS: A The elevated serum creatinine indicates renal damage caused by the hypertension. The other laboratory results are normal.

After receiving change-of-shift report for several patients with neutropenia, which patient should the nurse assess first? a. 56-year-old with frequent explosive diarrhea b. 33-year-old with a fever of 100.8° F (38.2° C) c. 66-year-old who has white pharyngeal lesions d. 23-year old who is complaining of severe fatigue

ANS: B Any fever in a neutropenic patient indicates infection and can quickly lead to sepsis and septic shock. Rapid assessment and (if prescribed) initiation of antibiotic therapy within 1 hour are needed. The other patients also need to be assessed but do not exhibit symptoms of potentially life-threatening problems

Which patient information is most important for the nurse to monitor when evaluating the effectiveness of deferoxamine (Desferal) for a patient with hemochromatosis? a. Skin color b. Hematocrit c. Liver function d. Serum iron level

ANS: D Because iron chelating agents are used to lower serum iron levels, the most useful information will be the patient's iron level. The other parameters will also be monitored, but are not the most important to monitor when determining the effectiveness of deferoxamine

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 blood pressure (BP) is unchanged from the previous visit. Which action should the nurse take *first*? a. Tell the patient why a change in drug dosage is needed. b. Ask the patient if the medication is being taken as prescribed. c. Inform the patient that multiple drugs are often needed to treat hypertension. d. Question the patient regarding any lifestyle changes made to help control BP.

ANS: B Because nonadherence with antihypertensive therapy is common, the nurse's initial action should be to determine whether the patient is taking the atenolol as prescribed. The other actions also may be implemented, but these would be done after assessing patient adherence with the prescribed therapy.

Which BP-regulating mechanism(s) can result in the development of hypertension if defective (select all that apply)? a. Release of norepinephrine b. Secretion of prostaglandins c. Stimulation of the sympathetic nervous system d. Stimulation of the parasympathetic nervous system e. Activation of the renin-angiotensin-aldosterone system

a, c, e

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 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

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. "I should include four to five servings of fruits and vegetables daily." 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

An older patient has been diagnosed with possible white coat hypertension. Which planned action by the nurse *best* addresses the suspected cause of the hypertension? a. Instruct the patient about the need to decrease stress levels. b. Teach the patient how to self-monitor and record BPs at home. c. Schedule the patient for regular blood pressure (BP) checks in the clinic. d. Inform the patient and caregiver that major dietary changes will be needed.

ANS: B In the phenomenon of "white coat" hypertension, patients have elevated BP readings in a clinical setting and normal readings when BP is measured elsewhere. Having the patient self-monitor BPs at home will provide a reliable indication about whether the patient has hypertension. Regular BP checks in the clinic are likely to be high in a patient with white coat hypertension. There is no evidence that this patient has elevated stress levels or a poor diet, and those factors do not cause white coat hypertension.

Which problem reported by a patient with hemophilia is most important for the nurse to communicate to the physician? a. Leg bruises b. Tarry stools c. Skin abrasions d. Bleeding gums

ANS: B Melena is a sign of gastrointestinal bleeding and requires collaborative actions such as checking hemoglobin and hematocrit and administration of coagulation factors. The other problems indicate a need for patient teaching about how to avoid injury, but are not indicators of possible serious blood loss

Which action will the admitting nurse include in the care plan for a 30-year old woman who is neutropenic? a. Avoid any injections. b. Check temperature every 4 hours. c. Omit fruits or vegetables from the diet. d. Place a "No Visitors" sign on the door.

ANS: B The earliest sign of infection in a neutropenic patient is an elevation in temperature. Although unpeeled fresh fruits and vegetables should be avoided, fruits and vegetables that are peeled or cooked are acceptable. Injections may be required for administration of medications such as filgrastim (Neupogen). The number of visitors may be limited and visitors with communicable diseases should be avoided, but a "no visitors" policy is not needed

A 30-year-old man with acute myelogenous leukemia develops an absolute neutrophil count of 850/µL while receiving outpatient chemotherapy. Which action by the outpatient clinic nurse is most appropriate? a. Discuss the need for hospital admission to treat the neutropenia. b. Teach the patient to administer filgrastim (Neupogen) injections. c. Plan to discontinue the chemotherapy until the neutropenia resolves. d. Order a high-efficiency particulate air (HEPA) filter for the patient's home.

ANS: B The patient may be taught to self-administer filgrastim injections. Although chemotherapy may be stopped with severe neutropenia (neutrophil count less than 500/µL), administration of filgrastim usually allows the chemotherapy to continue. Patients with neutropenia are at higher risk for infection when exposed to other patients in the hospital. HEPA filters are expensive and are used in the hospital, where the number of pathogens is much higher than in the patient's home environment

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

ANS: B The patient should be seated with the feet flat on the floor. The BP is obtained in both arms, and the results of the two arms are not averaged. The patient does not need to be in the supine position. The cuff should be deflated at 2 to 3 mm Hg per second.

The nurse in the emergency department received change-of-shift report on four patients with hypertension. Which patient should the nurse assess first? a. 52-year-old with a BP of 212/90 who has intermittent claudication b. 43-year-old with a BP of 190/102 who is complaining of chest pain c. 50-year-old with a BP of 210/110 who has a creatinine of 1.5 mg/dL d. 48-year-old with a BP of 200/98 whose urine shows microalbuminuria

ANS: B The patient with chest pain may be experiencing acute myocardial infarction and rapid assessment and intervention is needed. The symptoms of the other patients also show target organ damage, but are not indicative of acute processes.

A patient is diagnosed with primary hypertension and asks the nurse what caused this condition. Which is the best response by the nurse? 1. "There is no one identifiable reason." 2. "Kidney disease is the most common reason." 3. "It is caused by a decrease in plasma renin levels." 4. "There is too much plaque in the blood vessels."

1. "There is no one identifiable reason." There is not one exact cause of primary hypertension; there are several contributing factors. Renal or kidney disease is a cause of secondary hypertension. An increase, not a decrease, in plasma renin levels is a contributing factor in the development of primary hypertension. Hypertension speeds up the process of atherosclerosis in the peripheral blood vessels. Text Reference - p. 712

A patient whose blood pressure is 200/120 mm Hg is diagnosed with hypertensive crisis. The patient receives a prescription for clonidine. The nurse instructs the patient to avoid engaging in hazardous activities like operating machinery. What is the reason for this instruction? 1. Clonidine causes drowsiness. 2. Clonidine causes orthostatic hypotension. 3. Clonidine causes a rapid decrease in BP. 4. Clonidine causes rebound hypertension

1. Clonidine causes drowsiness. Clonidine is an adrenergic inhibitor that reduces sympathetic outflow from the central nervous system. It lowers BP by reducing peripheral sympathetic tone, dilating the blood vessels, and decreasing the systemic vascular resistance. Drowsiness is a side effect of the drug, and the patient is advised to avoid engaging in hazardous activities, because this can increase the risk of injury. The drug also causes orthostatic hypotension, so the patient is advised to change position slowly. The drug does not cause a rapid decrease in BP. The drug can cause rebound hypertension if discontinued abruptly. Text Reference - p. 717

A nurse is monitoring the blood pressure (BP) of a patient visiting the health care facility. What should the nurse ensure when recording the BP? Select all that apply. 1. Ensure the patient has not exercised within 30 minutes. 2. Seat the patient and begin measurement. 3. Support the patient's arm at heart level. 4. Palpate the radial pulse for auscultatory measurement. 5. Deflate the cuff at the rate of 5 mm Hg/sec.

1. Ensure the patient has not exercised within 30 minutes. 3. Support the patient's arm at heart level. 4. Palpate the radial pulse for auscultatory measurement. The nurse should ensure that the patient has not exercised, smoked, or ingested caffeine within 30 minutes before measurement. The patient's arm should be supported at heart level. The radial pulse is palpated for auscultatory measurement. The nurse should begin measurement only after the patient has rested patiently for 5 minutes after sitting. The cuff should be deflated at a rate of 2 to 3 mm Hg/sec. Text Reference - p. 723

The nurse teaches a patient with hypertension that symptoms of uncontrolled hypertension may include which of the following? Select all that apply. 1. Fatigue 2. Dizziness 3. Palpitations 4. Shortness of breath 5. Cluster headaches

1. Fatigue 2. Dizziness 3. Palpitations Uncontrolled hypertension may result in fatigue, dizziness, and palpitations. Cluster headaches and shortness of breath do not occur with uncontrolled hypertension. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation. Text Reference - p. 713

A nurse works in a medical unit. The nurse has assessed the patients and planned care for them. Which activities can be delegated to unlicensed assistive personnel (UAP)? Select all that apply. 1. Report high or low BP readings to the registered nurse. 2. Make appropriate referrals to other health care professionals. 3. Teach patients about lifestyle management and medication use. 4. Check for postural changes in BP. 5. Assess patients for hypertension risk factors and develop risk modification plans.

1. Report high or low BP readings to the registered nurse. 4. Check for postural changes in BP. Reporting high or low BP readings and checking for postural changes in BP are repetitive activities and do not require nursing judgment. Therefore, these activities can be delegated to unlicensed assistive personnel. Making appropriate referrals requires understanding of the collaborative care and judgment regarding the requirement of the referrals; this activity cannot be delegated and is the role of a registered nurse. Patient education about lifestyle management and medication use requires sound knowledge; therefore, this activity should be performed by the nurse. Assessment and development of risk modification plans requires assessment and planning skills; this activity should not be delegated and should be performed by the nurse. Text Reference - p. 724

Which test result would indicate the presence of target organ damage resulting from uncontrolled hypertension? 1. Urine protein 3+ 2. Blood urea nitrogen (BUN) 18 mg/dL 3. Uric acid 8.2 mg/dL 4. Triglycerides 144 mg/dL

1. Urine protein 3+ Urine protein should not be present. This increased level indicates target organ damage to the kidneys. The BUN is normal, the elevated uric acid level indicates gout, and the triglyceride level is normal. Test-Taking Tip: Avoid taking a wild guess at an answer. However, should you feel insecure about a question, eliminate the alternatives that you believe are definitely incorrect, and reread the information given to make sure you understand the intent of the question. This approach increases your chances of randomly selecting the correct answer or getting a clearer understanding of what is being asked. Although there is no penalty for guessing on the NCLEX examination, the subsequent question will be based, to an extent, on the response you give to the question at hand; that is, if you answer a question incorrectly, the computer will adapt the next question accordingly based on your knowledge and skill performance on the examination up to that point. Text Reference - p. 714

In reviewing medication instructions with a patient prescribed lisinopril, the nurse should include which statement? 1. "You should not take this medication if you have asthma." 2. "You may develop a dry cough while taking this medication." 3. "Never take this medication on an empty stomach." 4. "Discontinue use of this medication if you develop a drop in your blood pressure."

2. "You may develop a dry cough while taking this medication." Lisinopril is an ACE-inhibitor. A common side effect is a dry cough. This medication is safe for use with asthma, can be taken on an empty stomach, and should not be discontinued unless instructed to do so by a health care provider. Text Reference - p. 719

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. Decreased systolic blood pressure, decreased diastolic blood pressure, increased pulse rate 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

The nurse is assessing a patient and auscultates a "swooshing" sound heard over the chest wall when the stethoscope is lifted just off of the chest. The nurse would document this finding as a(n): 1. Severe bruit 2. Atrial gallop 3. Grade VI murmur 4. Pericardial friction rub

3. Grade VI murmur A murmur is classified as turbulent blood flow, which produces the classic swooshing sound as it passes through the valve and is graded on a scale of I toVI, with VI being the loudest, heard when the stethoscope is not touching the chest wall. A bruit is auscultated over arteries. An atrial gallop is an extra heart sound and is not associated with turbulent blood flow. A pericardial friction rub is a scratching sound caused when inflamed surfaces of the pericardium move against each other, indicating cardiac inflammation. Text Reference - p. 726

When teaching how lisinopril will help lower the patient's blood pressure, which mechanism of action should the nurse use to explain it? 1. Blocks β-adrenergic effects 2. Relaxes arterial and venous smooth muscle 3. Inhibits conversion of angiotensin I to angiotensin II 4. Reduces sympathetic outflow from the central nervous system (CNS)

3. Inhibits conversion of angiotensin I to angiotensin II Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that inhibits the conversion of angiotensin I to angiotensin II, which reduces angiotensin II-mediated vasoconstriction and sodium and water retention. Beta blockers result in vasodilation and decreased heart rate. Direct vasodilators relax arterial and venous smooth muscle. Central acting α-adrenergic antagonists reduce sympathetic outflow from the CNS to produce vasodilation and decreased systemic vascular resistance (SVR) and blood pressure (BP). Test-Taking Tip: Do not read too much into the question or worry that it is a "trick." If you have nursing experience, ask yourself how a classmate who is inexperienced would answer this question from only the information provided in the textbooks or given in the lectures. Text Reference - p. 719

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. Lipid profile to provide information about the risk factor for HTN 5. Blood urea nitrogen (BUN) and serum creatinine levels to provide information on renal function 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

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. Serum creatinine of 2.6 mg/dL 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

Which test result would indicate the presence of target organ damage resulting from uncontrolled hypertension? 1. Check for history of depression. 2. Do not give with grapefruit juice. 3. Monitor for cardiac dysrhythmias. 4. Assess for orthostatic hypotension

4. Assess for orthostatic hypotension 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

A nurse is measuring the blood pressure (BP) of a 68-year-old patient. What intervention should the nurse perform for this patient? 1. Measure BP one hour after eating. 2. Inflate the cuff until the pulse disappears. 3. Recommend a BP goal of 120/80 mm Hg. 4. Check for an auscultatory gap

4. Check for an auscultatory gap The nurse measuring the BP of a 68-year-old patient should check for an auscultatory gap. Some elderly patients have a wide gap between the first Korotkoff sound and subsequent beats. Elderly patients experience a postprandial drop in BP; the greatest drop occurs approximately one hour after eating. The BP returns to preprandial levels three to four hours after eating. When measuring BP, the nurse should inflate the cuff 20 to 30 mm Hg after the radial pulse disappears. The recommended BP goal for this patient would be less than 140/90 mm Hg. Text Reference - p. 725

Which action will the nurse include in the plan of care for a 72-year-old woman admitted with multiple myeloma? a. Monitor fluid intake and output. b. Administer calcium supplements. c. Assess lymph nodes for enlargement. d. Limit weight bearing and ambulation.

A high fluid intake and urine output helps prevent the complications of kidney stones caused by hypercalcemia and renal failure caused by deposition of Bence-Jones protein in the renal tubules. Weight bearing and ambulation are encouraged to help bone retain calcium. Lymph nodes are not enlarged with multiple myeloma. Calcium supplements will further increase the patient's calcium level and are not used

Which menu choice indicates that the patient understands the nurse's teaching about best dietary choices for iron-deficiency anemia? a. Omelet and whole wheat toast b. Cantaloupe and cottage cheese c. Strawberry and banana fruit plate d. Cornmeal muffin and orange juice

ANS: A Eggs and whole grain breads are high in iron. The other choices are appropriate for other nutritional deficiencies but are not the best choice for a patient with iron-deficiency anemia

Which information obtained by the nurse assessing a patient admitted with multiple myeloma is most important to report to the health care provider? a. Serum calcium level is 15 mg/dL. b. Patient reports no stool for 5 days. c. Urine sample has Bence-Jones protein. d. Patient is complaining of severe back pain.

ANS: A Hypercalcemia may lead to complications such as dysrhythmias or seizures, and should be addressed quickly. The other patient findings will also be discussed with the health care provider, but are not life threatening

Which patient statement to the nurse indicates a need for additional instruction about taking oral ferrous sulfate? a. "I will call my health care provider if my stools turn black." b. "I will take a stool softener if I feel constipated occasionally." c. "I should take the iron with orange juice about an hour before eating." d. "I should increase my fluid and fiber intake while I am taking iron tablets."

ANS: A It is normal for the stools to appear black when a patient is taking iron, and the patient should not call the doctor about this. The other patient statements are correct

Which patient should the nurse assign as the roommate for a patient who has aplastic anemia? a. A patient with chronic heart failure b. A patient who has viral pneumonia c. A patient who has right leg cellulitis d. A patient with multiple abdominal drains

ANS: A Patients with aplastic anemia are at risk for infection because of the low white blood cell production associated with this type of anemia, so the nurse should avoid assigning a roommate with any possible infectious process

A 19-year-old woman with immune thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the health care provider before obtaining and administering platelets? a. The platelet count is 42,000/mL. b. Petechiae are present on the chest. c. Blood pressure (BP) is 94/56 mm Hg. d. Blood is oozing from the venipuncture site.

ANS: A Platelet transfusions are not usually indicated until the platelet count is below 10,000 to 20,000/mL unless the patient is actively bleeding. Therefore the nurse should clarify the order with the health care provider before giving the transfusion. The other data all indicate that bleeding caused by ITP may be occurring and that the platelet transfusion is appropriate

The charge nurse observes a new registered nurse (RN) 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 to a. increase the dietary intake of high-potassium foods. b. make an appointment with the dietitian for teaching. c. check the blood pressure (BP) at home at least once a day. d. move slowly when moving from lying to sitting to standing.

ANS: A The ACE inhibitors cause retention of potassium by the kidney, so hyperkalemia is a possible adverse effect. The other teaching by the new RN is appropriate for a patient with newly diagnosed hypertension who has just started therapy with enalapril.

The nurse caring for a patient with type A hemophilia being admitted to the hospital with severe pain and swelling in the right knee will a. immobilize the joint. b. apply heat to the knee. c. assist the patient with light weight bearing. d. perform passive range of motion to the knee.

ANS: A The initial action should be total rest of the knee to minimize bleeding. Ice packs are used to decrease bleeding. Range of motion (ROM) and weight-bearing exercise are contraindicated initially, but after the bleeding stops, ROM and physical therapy are started

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

ANS: A The initial nursing action should be assessment of the patient's baseline dietary intake through a thorough diet history. The other actions may be appropriate, but assessment of the patient's baseline should occur first.

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. 48-yr-old with a blood pressure of 160/92 mm Hg who reports chest pain b. 52-yr-old with a blood pressure of 198/90 mm Hg who has intermittent claudication c. 50-yr-old with a blood pressure of 190/104 mm Hg who has a creatinine of 1.7 mg/dL d. 43-yr-old with a blood pressure of 172/98 mm Hg whose urine shows microalbuminuria

ANS: A The patient with chest pain may be experiencing acute myocardial infarction and rapid assessment and intervention are needed. The symptoms of the other patients also show target organ damage but are not indicative of acute processes.

Which patient requires the most rapid assessment and care by the emergency department nurse? a. The patient with hemochromatosis who reports abdominal pain b. The patient with neutropenia who has a temperature of 101.8° F c. The patient with sickle cell anemia who has had nausea and diarrhea for 24 hours d. The patient with thrombocytopenia who has oozing after having a tooth extracted

ANS: B A neutropenic patient with a fever is assumed to have an infection and is at risk for rapidly developing sepsis. Rapid assessment, cultures, and initiation of antibiotic therapy are needed. The other patients also require rapid assessment and care but not as urgently as the neutropenic patient

The nurse has just finished teaching a hypertensive patient about the newly prescribed drug, ramipril (Altace). Which patient statement indicates that more teaching is needed? a. "The medication may not work well if I take aspirin." b. "I can expect some swelling around my lips and face." 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."

ANS: B Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an indication that the ACE inhibitor should be discontinued. The patient should be taught that if any swelling of the face or oral mucosa occurs, the health care provider should be immediately notified because this could be life threatening. The other patient statements indicate that the patient has an accurate understanding of ACE inhibitor therapy.

Which collaborative problem will the nurse include in a care plan for a patient admitted to the hospital with idiopathic aplastic anemia? a. Potential complication: seizures b. Potential complication: infection c. Potential complication: neurogenic shock d. Potential complication: pulmonary edema

ANS: B Because the patient with aplastic anemia has pancytopenia, the patient is at risk for infection and bleeding. There is no increased risk for seizures, neurogenic shock, or pulmonary edema

A routine complete blood count indicates that an active 80-year-old man may have myelodysplastic syndrome. The nurse will plan to teach the patient about a. blood transfusion b. bone marrow biopsy. c. filgrastim (Neupogen) administration. d. erythropoietin (Epogen) administration.

ANS: B Bone marrow biopsy is needed to make the diagnosis and determine the specific type of myelodysplastic syndrome. The other treatments may be necessary if there is progression of the myelodysplastic syndrome, but the initial action for this asymptomatic patient will be a bone marrow biopsy.

Which information obtained by the nurse caring for a patient with thrombocytopenia should be immediately communicated to the health care provider? a. The platelet count is 52,000/µL. b. The patient is difficult to arouse. c. There are purpura on the oral mucosa. d. There are large bruises on the patient's back.

ANS: B Difficulty in arousing the patient may indicate a cerebral hemorrhage, which is life threatening and requires immediate action. The other information should be documented and reported but would not be unusual in a patient with thrombocytopenia

Which assessment finding for a patient who is receiving IV furosemide (Lasix) to treat stage 2 hypertension is *most* important to report to the health care provider? a. Blood glucose level of 175 mg/dL b. Serum potassium level of 3.0 mEq/L c. Orthostatic systolic BP decrease of 12 mm Hg d. Most recent blood pressure (BP) reading of 168/94 mm Hg

ANS: B Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening dysrhythmias. The health care provider should be notified of the potassium level immediately and administration of potassium supplements initiated. The elevated blood glucose and BP also indicate a need for collaborative interventions but will not require action as urgently as the hypokalemia. An orthostatic drop of 12 mm Hg will require intervention only if the patient is symptomatic.

Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenic purpura (ITP)? a. Assign the patient to a private room. b. Avoid intramuscular (IM) injections. c. Use rinses rather than a soft toothbrush for oral care. d. Restrict activity to passive and active range of motion.

ANS: B IM or subcutaneous injections should be avoided because of the risk for bleeding. A soft toothbrush can be used for oral care. There is no need to restrict activity or place the patient in a private room

The nurse notes scleral jaundice in a patient being admitted with hemolytic anemia. The nurse will plan to check the laboratory results for the a. Schilling test. b. bilirubin level. c. stool occult blood test. d. gastric analysis testing.

ANS: B Jaundice is caused by the elevation of bilirubin level associated with red blood cell (RBC) hemolysis. The other tests would not be helpful in monitoring or treating a hemolytic anemia

A patient who is receiving methotrexate for severe rheumatoid arthritis develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of a. iron. b. folic acid. c. cobalamin (vitamin B12). d. ascorbic acid (vitamin C).

ANS: B Methotrexate use can lead to folic acid deficiency. Supplementation with oral folic acid supplements is the usual treatment. The other nutrients would not correct folic acid deficiency, although they would be used to treat other types of anemia

An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is to a. provide a diet high in vitamin K. b. alternate periods of rest and activity. c. teach the patient how to avoid injury. d. place the patient on protective isolation.

ANS: B Nursing care for patients with anemia should alternate periods of rest and activity to encourage activity without causing undue fatigue. There is no indication that the patient has a bleeding disorder, so a diet high in vitamin K or teaching about how to avoid injury is not needed. Protective isolation might be used for a patient with aplastic anemia, but it is not indicated for hemolytic anemia

It is important for the nurse providing care for a patient with sickle cell crisis to a. limit the patient's intake of oral and IV fluids. b. evaluate the effectiveness of opioid analgesics. c. encourage the patient to ambulate as much as tolerated. d. teach the patient about high-protein, high-calorie foods.

ANS: B Pain is the most common clinical manifestation of a crisis and usually requires large doses of continuous opioids for control. Fluid intake should be increased to reduce blood viscosity and improve perfusion. Rest is usually ordered to decrease metabolic requirements. Patients are instructed about the need for dietary folic acid, but high-protein, high-calorie diets are not emphasized

A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and nausea and has a blood pressure (BP) of 238/118 mm Hg. Which question should the nurse ask to follow up on these findings? a. "Have you recently taken any antihistamines?" b. "Have you consistently taken your medications?" c. "Did you take any acetaminophen (Tylenol) today?" d. "Have there been recent stressful events in your life?"

ANS: B Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do not increase BP. Stressful events will increase BP but not usually to the level seen in this patient.

A patient with a history of a transfusion-related acute lung injury (TRALI) is to receive a transfusion of packed red blood cells (PRBCs). Which action by the nurse will decrease the risk for TRALI for this patient? a. Infuse the PRBCs slowly over 4 hours. b. Transfuse only leukocyte-reduced PRBCs. c. Administer the scheduled diuretic before the transfusion. d. Give the PRN dose of antihistamine before the transfusion.

ANS: B TRALI is caused by a reaction between the donor and the patient leukocytes that causes pulmonary inflammation and capillary leaking. The other actions may help prevent respiratory problems caused by circulatory overload or by allergic reactions, but they will not prevent TRALI

Which blood pressure (BP) finding by the nurse indicates that no changes in therapy are needed for a 48-yr-old patient with newly diagnosed hypertension? a. 98/56 mm Hg c. 128/92 mm Hg b. 128/76 mm Hg d. 142/78 mm Hg

ANS: B The 8th Joint National Committee's recommended goal for antihypertensive therapy for a 30- to 59-yr-old patient with hypertension is a BP below 140/90 mm Hg. The BP of 98/56 mm Hg may indicate overtreatment of the hypertension and an increased risk for adverse drug effects. The other two blood pressures indicate a need for modifications in the patient's treatment.

A 28-year-old man with von Willebrand disease is admitted to the hospital for minor knee surgery. The nurse will review the coagulation survey to check the a. platelet count. b. bleeding time. c. thrombin time. d. prothrombin time.

ANS: B The bleeding time is affected by von Willebrand disease. Platelet count, prothrombin time, and thrombin time are normal in von Willebrand disease

Several patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first? a. 44-year-old with sickle cell anemia who says "my eyes always look sort of yellow" b. 23-year-old with no previous health problems who has a nontender lump in the axilla c. 50-year-old with early-stage chronic lymphocytic leukemia who reports chronic fatigue d. 19-year-old with hemophilia who wants to learn to self-administer factor VII replacement

ANS: B The patient's age and presence of a nontender axillary lump suggest possible lymphoma, which needs rapid diagnosis and treatment. The other patients have questions about treatment or symptoms that are consistent with their diagnosis but do not need to be seen urgently

The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a hypertensive emergency. Which finding is most important to report to the health care provider? a. Urine output over 8 hours is 200 mL less than the fluid intake. b. The patient is unable to move the left arm and leg when asked to do so. c. Tremors are noted in the fingers when the patient extends the arms. d. The patient complains of a severe headache with pain at level 8/10 (0 to 10 scale).

ANS: B The patient's 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. The other clinical manifestations also likely are caused by the hypertension and will require rapid nursing actions, but they do not require action as urgently as the neurologic changes.

The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a hypertensive emergency. Which finding is *most* important to report to the health care provider? a. Urine output over 8 hours is 250 mL less than 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 arms. d. The patient complains of a headache with pain at level 7 of 10 (0 to 10 scale).

ANS: B The patient's inability to move the left arm and leg indicates that a stroke may be occurring and will require immediate action to prevent further neurologic damage. The other clinical manifestations are also likely caused by the hypertension and will require rapid nursing actions, but they do not require action as urgently as the neurologic changes.

A patient with septicemia develops prolonged bleeding from venipuncture sites and blood in the stools. Which action is most important for the nurse to take? a. Avoid venipunctures. b. Notify the patient's physician. c. Apply sterile dressings to the sites. d. Give prescribed proton-pump inhibitors.

ANS: B The patient's new onset of bleeding and diagnosis of sepsis suggest that disseminated intravascular coagulation (DIC) may have developed, which will require collaborative actions such as diagnostic testing, blood product administration, and heparin administration. The other actions also are appropriate, but the most important action should be to notify the physician so that DIC treatment can be initiated rapidly

The nurse obtains the following information from a patient newly diagnosed with prehypertension. Which finding is *most* important to address with the patient? a. Low dietary fiber intake b. No regular physical exercise c. Drinks a beer with dinner every night d. Weight is 5 pounds above ideal weight

ANS: B The recommendations for preventing hypertension include exercising aerobically for 30 minutes most days of the week. A weight that is 5 pounds over the ideal body weight is not a risk factor for hypertension. The Dietary Approaches to Stop Hypertension (DASH) diet is high in fiber, but increasing fiber alone will not prevent hypertension from developing. The patient's alcohol intake is within guidelines and will not increase the hypertension risk.

The nurse obtains this information from a patient with prehypertension. Which finding is most important to address with the patient? a. Low dietary fiber intake b. No regular aerobic exercise c. Weight 5 pounds above ideal weight d. Drinks wine with dinner once a week

ANS: B The recommendations for preventing hypertension include exercising aerobically for 30 minutes most days of the week. A weight that is 5 pounds over the ideal body weight is not a risk factor for hypertension. The Dietary Approaches to Stop Hypertension (DASH) diet is high in fiber, but increasing fiber alone will not prevent hypertension from developing. The patient's alcohol intake will not increase the hypertension risk.

A 68-year-old woman with acute myelogenous leukemia (AML) asks the nurse whether the planned chemotherapy will be worth undergoing. Which response by the nurse is appropriate? a. "If you do not want to have chemotherapy, other treatment options include stem cell transplantation." b. "The side effects of chemotherapy are difficult, but AML frequently goes into remission with chemotherapy." c. "The decision about treatment is one that you and the doctor need to make rather than asking what I would do." d. "You don't need to make a decision about treatment right now because leukemias in adults tend to progress quite slowly."

ANS: B This response uses therapeutic communication by addressing the patient's question and giving accurate information. The other responses either give inaccurate information or fail to address the patient's question, which will discourage the patient from asking the nurse for information

The nurse is planning to administer a transfusion of packed red blood cells (PRBCs) to a patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse delegate to unlicensed assistive personnel (UAP)? a. Verify the patient identification (ID) according to hospital policy. b. Obtain the temperature, blood pressure, and pulse before the transfusion. c. Double-check the product numbers on the PRBCs with the patient ID band. d. Monitor the patient for shortness of breath or chest pain during the transfusion.

ANS: B UAP education includes measurement of vital signs. UAP would report the vital signs to the registered nurse (RN). The other actions require more education and a larger scope of practice and should be done by licensed nursing staff members

A 56-yr-old patient who has no previous history of hypertension or other health problems suddenly develops a blood pressure (BP) of 198/110 mm Hg. 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. diagnosis, treatment, and ongoing monitoring will be needed. d. there is an immediate danger of a stroke, requiring hospitalization.

ANS: C A sudden increase in BP in a patient older than age 50 years with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem. The BP will need treatment and ongoing monitoring. If the patient has no other risk factors, a stroke in the immediate future is unlikely. There is no indication that dietary salt or fat intake have contributed to this sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this BP to an acceptable level.

Which action for a patient with neutropenia is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Assessing the patient for signs and symptoms of infection b. Teaching the patient the purpose of neutropenic precautions c. Administering subcutaneous filgrastim (Neupogen) injection d. Developing a discharge teaching plan for the patient and family

ANS: C Administration of subcutaneous medications is included in LPN/LVN education and scope of practice. Patient education, assessment, and developing the plan of care require RN level education and scope of practice

When a patient with splenomegaly is scheduled for splenectomy, which action will the nurse include in the preoperative plan of care? a. Discourage deep breathing to reduce risk for splenic rupture. b. Teach the patient to use ibuprofen (Advil) for left upper quadrant pain. c. Schedule immunization with the pneumococcal vaccine (Pneumovax). d. Avoid the use of acetaminophen (Tylenol) for 2 weeks prior to surgery.

ANS: C Asplenic patients are at high risk for infection with Pneumococcus and immunization reduces this risk. There is no need to avoid acetaminophen use before surgery, but nonsteroidal antiinflammatory drugs (NSAIDs) may increase bleeding risk and should be avoided. The enlarged spleen may decrease respiratory depth and the patient should be encouraged to take deep breaths

A 52-year-old patient has a new diagnosis of pernicious anemia. The nurse determines that the patient understands the teaching about the disorder when the patient states, "I a. need to start eating more red meat and liver." b. will stop having a glass of wine with dinner." c. could choose nasal spray rather than injections of vitamin B12." d. will need to take a proton pump inhibitor like omeprazole (Prilosec)."

ANS: C Because pernicious anemia prevents the absorption of vitamin B12, this patient requires injections or intranasal administration of cobalamin. Alcohol use does not cause cobalamin deficiency. Proton pump inhibitors decrease the absorption of vitamin B12. Eating more foods rich in vitamin B12 is not helpful because the lack of intrinsic factor prevents absorption of the vitamin

Which instruction will the nurse plan to include in discharge teaching for the patient admitted with a sickle cell crisis? a. Take a daily multivitamin with iron. b. Limit fluids to 2 to 3 quarts per day. c. Avoid exposure to crowds when possible. d. Drink only two caffeinated beverages daily.

ANS: C Exposure to crowds increases the patient's risk for infection, the most common cause of sickle cell crisis. There is no restriction on caffeine use. Iron supplementation is generally not recommended. A high-fluid intake is recommended

Which action will be included in the plan of care when the nurse is caring for a patient who is receiving sodium nitroprusside (Nipride) to treat a hypertensive emergency? a. Organize nursing activities so that the patient has undisturbed sleep for 6 to 8 hours at night. b. Assist the patient up in the chair for meals to avoid complications associated with immobility. c. Use an automated noninvasive blood pressure machine to obtain frequent BP measurements. d. Place the patient on NPO status to prevent aspiration caused by nausea and the associated vomiting.

ANS: C Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV antihypertensive medications. This can be most easily accomplished with an automated BP machine or arterial line. The patient will require frequent assessments, so allowing 6 to 8 hours of undisturbed sleep is not appropriate. When patients are receiving IV vasodilators, bed rest is maintained to prevent decreased cerebral perfusion and fainting. There is no indication that this patient is nauseated or at risk for aspiration, so an NPO status is unnecessary.

A patient has been diagnosed with possible white coat hypertension. Which action will the nurse plan to take next? a. Schedule the patient for frequent 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. Teach the patient about ambulatory blood pressure monitoring.

ANS: C Having the patient self-monitor BPs at home will provide a reliable indication about whether the patient has hypertension. Frequent BP checks in the clinic are likely to be high in a patient with white coat hypertension. Ambulatory blood pressure monitoring may be used if the data from self-monitoring is unclear. Although elevated stress levels may contribute to hypertension, instructing the patient about this is unlikely to reduce BP.

Which information is *most* important for the nurse to include when teaching a patient with newly diagnosed hypertension? a. Most people are able to control BP through dietary changes. b. Annual BP checks are needed to monitor treatment effectiveness. c. Hypertension is usually asymptomatic until target organ damage occurs. d. Increasing physical activity alone controls blood pressure (BP) for most people.

ANS: C Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle changes (e.g., physical activity, dietary changes) are used to help manage BP, but drugs are needed for most patients. Home BP monitoring should be taught to the patient and findings checked by the health care provider frequently when starting treatment for hypertension and then every 3 months when stable.

Propranolol (Inderal) is prescribed for a patient diagnosed with hypertension. The nurse should consult with the health care provider before giving this drug when the patient reveals a history of a. daily alcohol use. c. reactive airway disease. b. peptic ulcer disease. d. myocardial infarction (MI).

ANS: C Nonselective b-blockers block b1- and b2-adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma. b-Blockers will have no effect on the patient's peptic ulcer disease or alcohol use. b-Blocker therapy is recommended after MI.

A 54-year-old woman with acute myelogenous leukemia (AML) is considering treatment with a hematopoietic stem cell transplant (HSCT). The best approach for the nurse to assist the patient with a treatment decision is to a. emphasize the positive outcomes of a bone marrow transplant. b. discuss the need for adequate insurance to cover post-HSCT care. c. ask the patient whether there are any questions or concerns about HSCT. d. explain that a cure is not possible with any other treatment except HSCT.

ANS: C Offering the patient an opportunity to ask questions or discuss concerns about HSCT will encourage the patient to voice concerns about this treatment and also will allow the nurse to assess whether the patient needs more information about the procedure. Treatment of AML using chemotherapy is another option for the patient. It is not appropriate for the nurse to ask the patient to consider insurance needs in making this decision

A patient with possible disseminated intravascular coagulation arrives in the emergency department with a blood pressure of 82/40, temperature 102° F (38.9° C), and severe back pain. Which physician order will the nurse implement first? a. Administer morphine sulfate 4 mg IV. b. Give acetaminophen (Tylenol) 650 mg. c. Infuse normal saline 500 mL over 30 minutes. d. Schedule complete blood count and coagulation studies.

ANS: C The patient's blood pressure indicates hypovolemia caused by blood loss and should be addressed immediately to improve perfusion to vital organs. The other actions also are appropriate and should be rapidly implemented, but improving perfusion is the priority for this patient

A patient has just been diagnosed with hypertension and has been started on captopril . Which information is *most* important to include when teaching the patient about this drug? a. Include high-potassium foods such as bananas in the diet. b. Increase fluid intake if dryness of the mouth is a problem. c. Change position slowly to help prevent dizziness and falls. d. Check blood pressure (BP) in both arms before taking the drug.

ANS: C 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. Increasing fluid intake may counteract the effect of the drug, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP should be taken in the nondominant arm by newly diagnosed patients in the morning, before taking the drug, and in the evening. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.

Which finding about a patient with polycythemia vera is most important for the nurse to report to the health care provider? a. Hematocrit 55% b. Presence of plethora c. Calf swelling and pain d. Platelet count 450,000/mL

ANS: C The calf swelling and pain suggest that the patient may have developed a deep vein thrombosis, which will require diagnosis and treatment to avoid complications such as pulmonary embolus. The other findings will also be reported to the health care provider but are expected in a patient with this diagnosis

Which action will the nurse include in the plan of care for a patient who has thalassemia major? a. Teach the patient to use iron supplements. b. Avoid the use of intramuscular injections. c. Administer iron chelation therapy as needed. d. Notify health care provider of hemoglobin 11g/dL.

ANS: C The frequent transfusions used to treat thalassemia major lead to iron toxicity in patients unless iron chelation therapy is consistently used. Iron supplementation is avoided in patients with thalassemia. There is no need to avoid intramuscular injections. The goal for patients with thalassemia major is to maintain a hemoglobin of 10 g/dL or greater

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 patient's pulse has dropped from 68 to 57 beats/min. b. The patient complains that the fingers and toes feel quite cold. c. The patient has developed wheezes throughout the lung fields. d. The patient's blood pressure (BP) reading is now 158/91 mm Hg.

ANS: C 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. The nurse should immediately obtain an O2 saturation measurement, apply supplemental O2, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes are associated with b-receptor blockade but do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated. However, this is not as urgently needed as addressing the bronchospasm.

A postoperative patient receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping the transfusion, what action should the nurse take? a. Draw blood for a new crossmatch. b. Send a urine specimen to the laboratory. c. Administer PRN acetaminophen (Tylenol). d. Give the PRN diphenhydramine (Benadryl).

ANS: C The patient's clinical manifestations are consistent with a febrile, nonhemolytic transfusion reaction. The transfusion should be stopped and antipyretics administered for the fever as ordered. A urine specimen is needed if an acute hemolytic reaction is suspected. Diphenhydramine (Benadryl) is used for allergic reactions. This type of reaction does not indicate incorrect crossmatching

A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when her platelet level drops to 110,000/µL. Which action will the nurse include in the plan of care? a. Use low-molecular-weight heparin (LMWH) only. b. Administer the warfarin (Coumadin) at the scheduled time. c. Teach the patient about the purpose of platelet transfusions. d. Discontinue heparin and flush intermittent IV lines using normal saline.

ANS: D All heparin is discontinued when the HIT is diagnosed. The patient should be instructed to never receive heparin or LMWH. Warfarin is usually not given until the platelet count has returned to 150,000/µL. The platelet count does not drop low enough in HIT for a platelet transfusion, and platelet transfusions increase the risk for thrombosis

Which statement by a patient indicates good understanding of the nurse's teaching about prevention of sickle cell crisis? a. "Home oxygen therapy is frequently used to decrease sickling." b. "There are no effective medications that can help prevent sickling." c. "Routine continuous dosage narcotics are prescribed to prevent a crisis." d. "Risk for a crisis is decreased by having an annual influenza vaccination."

ANS: D Because infection is the most common cause of a sickle cell crisis, influenza, Haemophilus influenzae, pneumococcal pneumonia, and hepatitis immunizations should be administered. Although continuous dose opioids and oxygen may be administered during a crisis, patients do not receive these therapies to prevent crisis. Hydroxyurea (Hydrea) is a medication used to decrease the number of sickle cell crises

The nurse is caring for a 70-yr-old patient who uses hydrochlorothiazide and enalapril (Norvasc) but whose self-monitored blood pressure (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 (Motrin) treat osteoarthritis.

ANS: D Because use of nonsteroidal antiinflammatory drugs (NSAIDs) can prevent adequate BP control, the patient may need to avoid the use of ibuprofen. A multivitamin tablet will help supply vitamin D, which may help lower BP. BP decreases while sleeping, so self-monitoring early in the morning will result in obtaining pressures that are at their lowest. The patient's alcohol intake is not excessive.

Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy? a. Platelet count b. Reticulocyte count c. Total lymphocyte count d. Absolute neutrophil count

ANS: D Filgrastim increases the neutrophil count and function in neutropenic patients. Although total lymphocyte, platelet, and reticulocyte counts also are important to monitor in this patient, the absolute neutrophil count is used to evaluate the effects of filgrastim

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 a hypertensive emergency? a. Organize nursing activities so that the patient has undisturbed sleep for 8 hours at night. b. Keep the patient NPO to prevent aspiration caused by nausea and possible vomiting. 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 measurements.

ANS: D Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV antihypertensive medications. This can be most easily accomplished with an automated BP machine or arterial line. The patient will require frequent assessments, so allowing 8 hours of undisturbed sleep is not reasonable. When patients are receiving IV vasodilators, bed rest is maintained to prevent decreased cerebral perfusion and fainting. There is no indication that this patient is nauseated or at risk for aspiration, so an NPO status is unnecessary.

Which action should the nurse take when giving the initial dose of oral labetalol to a patient with hypertension? a. Encourage the use of hard candy to prevent dry mouth. b. Teach the patient that headaches often occur with this drug. c. Instruct the patient to call for help if heart palpitations occur. d. Ask the patient to request assistance before getting out of bed.

ANS: D Labetalol decreases sympathetic nervous system activity by blocking both a and b adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension. Heart palpitations, dry mouth, dehydration, and headaches are possible side effects of other antihypertensives.

A patient who has non-Hodgkin's lymphoma is receiving combination treatment with rituximab (Rituxan) and chemotherapy. Which patient assessment finding requires the most rapid action by the nurse? a. Anorexia b. Vomiting c. Oral ulcers d. Lip swelling

ANS: D Lip swelling in angioedema may indicate a hypersensitivity reaction to the rituximab. The nurse should stop the infusion and further assess for anaphylaxis. The other findings may occur with chemotherapy, but are not immediately life threatening

A critical action by the nurse caring for a patient with an acute exacerbation of polycythemia vera is to a. place the patient on bed rest. b. administer iron supplements. c. avoid use of aspirin products. d. monitor fluid intake and output.

ANS: D Monitoring hydration status is important during an acute exacerbation because the patient is at risk for fluid overload or underhydration. Aspirin therapy is used to decrease risk for thrombosis. The patient should be encouraged to ambulate to prevent deep vein thrombosis (DVT). Iron is contraindicated in patients with polycythemia vera

Which laboratory result will the nurse expect to show a decreased value if a patient develops heparin-induced thrombocytopenia (HIT)? a. Prothrombin time b. Erythrocyte count c. Fibrinogen degradation products d. Activated partial thromboplastin time

ANS: D Platelet aggregation in HIT causes neutralization of heparin, so that the activated partial thromboplastin time will be shorter and more heparin will be needed to maintain therapeutic levels. The other data will not be affected by HIT

Following successful treatment of Hodgkin's lymphoma for a 55-year-old woman, which topic will the nurse include in patient teaching? a. Potential impact of chemotherapy treatment on fertility b. Application of soothing lotions to treat residual pruritus c. Use of maintenance chemotherapy to maintain remission d. Need for follow-up appointments to screen for malignancy

ANS: D The chemotherapy used in treating Hodgkin's lymphoma results in a high incidence of secondary malignancies; follow-up screening is needed. The fertility of a 55-year-old woman will not be impacted by chemotherapy. Maintenance chemotherapy is not used for Hodgkin's lymphoma. Pruritus is a clinical manifestation of lymphoma, but should not be a concern after treatment

A 62-year old man with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patient's laboratory findings to include a. a hematocrit (Hct) of 38%. b. an RBC count of 4,500,000/mL. c. normal red blood cell (RBC) indices. d. a hemoglobin (Hgb) of 8.6 g/dL (86 g/L).

ANS: D The patient's clinical manifestations indicate moderate anemia, which is consistent with a Hgb of 6 to 10 g/dL. The other values are all within the range of normal

A patient in the emergency department complains of back pain and difficulty breathing 15 minutes after a transfusion of packed red blood cells is started. The nurse's first action should be to a. administer oxygen therapy at a high flow rate. b. obtain a urine specimen to send to the laboratory. c. notify the health care provider about the symptoms. d. disconnect the transfusion and infuse normal saline.

ANS: D The patient's symptoms indicate a possible acute hemolytic reaction caused by the transfusion. The first action should be to disconnect the transfusion and infuse normal saline. The other actions also are needed but are not the highest priority

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

b

What is most organ damage in hypertension related to? a. Increased fluid pressure exerted against organ tissue b. Atherosclerotic changes in vessels that supply the organs c. Erosion and thinning of blood vessels from constant pressure d. Increased hydrostatic pressure causing leakage of plasma into organ interstitial spaces

b

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? 1. Do not stop taking abruptly. 2. Take initial doses at bedtime. 3. Monitor for peripheral edema. 4. Take with orange juice.

1. Do not stop taking abruptly. 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

A nurse provides education to a hypertensive patient related to lifestyle modifications to reduce cardiovascular risks associated with high blood pressure (BP). Which statement made by the patient indicates effective learning? Select all that apply. 1. "I should achieve and maintain a healthy weight." 2. "I can continue to smoke, because nicotine does not affect blood pressure." 3. "I should exercise for at least 30 minutes daily." 4. "I can have up to five alcoholic drinks per day." 5. "I should restrict my salt intake to less than 1500 mg/day."

1. "I should achieve and maintain a healthy weight." 3. "I should exercise for at least 30 minutes daily." 5. "I should restrict my salt intake to less than 1500 mg/day." Lifestyle modifications play a vital role in reducing blood pressure and cardiovascular risk. Overweight people are at higher risk of cardiovascular disease. A weight loss of 22 lb may decrease systolic blood pressure by approximately 5 to 20 mm Hg. Being physically active is essential to maintain good health. It decreases the cardiovascular risk of hypertension. Sodium reduction helps to control blood pressure. A hypertensive patient should lower salt intake to 1500 mg/day. The nicotine in tobacco causes vasoconstriction and increases blood pressure. Therefore, smokers who are hypertensive should stop smoking. Excessive alcohol consumption increases the risk of hypertension. Consuming three or more drinks per day increases the risk of cardiovascular disease and stroke. Text Reference - p. 715

The nurse is obtaining a health history from a patient with hypertension. Nonmodifiable risk factors for the development of hypertension include which of these? Select all that apply. 1. Age 65 years 2. Excessive dietary sodium 3. African American ethnicity 4. Excessive alcohol consumption 5. A family history of hypertension

1. Age 65 years 3. African American ethnicity 5. A family history of hypertension Nonmodifiable risk factors for hypertension include increasing age, African American ethnicity, and a family history of hypertension. Consumption of excessive dietary sodium and excessive alcohol consumption are considered modifiable risk factors. Text Reference - p. 713

The nurse is taking the blood pressure of an older patient and compares the result to the previous reading. The nurse observes that the systolic blood pressure of the previous reading was 30 mm Hg higher than the reading the nurse just obtained. Which of these is a possible explanation? 1. An aucultatory gap may be present. 2. The patient's hypertension is improving. 3. The equipment the nurse used is not working properly. 4. The patient was more relaxed with the most recent blood pressure measurement.

1. An aucultatory gap may be present. Careful technique is important in assessing blood pressure in older adults. Some older people have a wide gap between the first Korotkoff sound and subsequent beats. This is called the auscultatory gap. Failure to inflate the cuff high enough may result in underestimating systolic blood pressure. Text Reference - p. 725

The nurse is creating a plan of care for a patient with a new diagnosis of hypertension. Which is a potential nursing diagnosis for the patient taking antihypertensive medications? Select all that apply. 1. Anxiety 2. Constipation 3. Impaired memory 4. Sexual dysfunction 5. Urge urinary incontinence

1. Anxiety 4. Sexual dysfunction Nursing diagnoses associated with patients taking medications for hypertension include anxiety (related to complexity of management regimen) and sexual dysfunction (related to side effects of antihypertensive drugs). Constipation, impaired memory, and urge urinary incontinence are not side effects of antihypertensive drugs. Text Reference - p. 720

A nurse is caring for a patient admitted to the health care facility with acute ischemic stroke. The patient is receiving IV antihypertensive drugs. Which interventions should the nurse perform for this patient? Select all that apply. 1. Assess blood pressure (BP) and pulse every 30 minutes. 2. Titrate drug according to mean arterial pressure (MAP) or BP as prescribed. 3. Measure hourly urine output. 4. Provide assistance to get up as patient desires. 5. Perform frequent neurologic checks.

1. Assess blood pressure (BP) and pulse every 30 minutes. 2. Titrate drug according to mean arterial pressure (MAP) or BP as prescribed. 5. Perform frequent neurologic checks. Drugs should be titrated according to MAP or BP as prescribed. The nurse should measure hourly urine output to assess renal perfusion and should perform frequent neurologic checks. Antihypertensive IV drugs have a rapid onset of action; hence BP and pulse should be assessed every two to three minutes using a noninvasive BP machine. The patient should be restricted to bed; severe cerebral ischemia or fainting may result if the patient tries to get up. Text Reference - p. 272

The nurse providing dietary instruction to a patient with hypertension would advise the patient to cut down on the intake of which foods? Select all that apply. 1. Canned vegetables 2. Red meat 3. Baked chicken 4. Canned fruit 5. Processed cheeses

1. Canned vegetables 2. Red meat 5. Processed cheeses Foods high in fat and sodium—including canned vegetables, red meat, and processed cheeses—should be avoided by the patient with hypertension. Baked chicken and canned fruit are low in sodium and fat. Text Reference - p. 716

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. Chronic obstructive pulmonary disease (COPD) 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

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. Cough 3. Dizziness 4. Impotence 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. Test-Taking Tip: Avoid spending excessive time on any one question. Most questions can be answered in one to two minutes. Text Reference - p. 724

While obtaining subjective assessment data from a patient with hypertension, the nurse recognizes that a modifiable risk factor for the development of hypertension is a. a low-calcium diet. b. excessive alcohol intake. c. a family history of hypertension. d. consumption of a high-protein diet.

b

A nurse is preparing to measure the blood pressure of a patient who is lying down on a bed. What technique should the nurse use to ensure that the BP reading is accurate? 1. Measure the BP twice, waiting one minute between measurements. 2. Rest the patient's arms on the bed during the BP measurement. 3. Measure the BP in both arms and record the lowest reading. 4. Place the BP cuff on the forearm when measuring the BP.

1. Measure the BP twice, waiting one minute between measurements. When recording BP, two measurements should be taken one minute apart. This allows the blood to drain from the arm and prevents inaccurate readings. If the patient is in a lying down position, the arm should be placed on a pillow so that it is at the heart level. Atherosclerosis in the subclavian artery may result in a falsely low BP in the affected side; therefore, the arm which has the highest recording of the BP should be used for further measurements. The upper arm, not the forearm, is the preferred site of BP cuff placement due to its accuracy of recordings. Text Reference - p. 723

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. Rise slowly from a supine to sitting position. 3. Lie down or sit if dizziness occurs. 4. Do not stand still for prolonged periods. 5. Perform leg exercises to increase venous return. 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

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. Sexual dysfunction 3. Orthostatic hypotension 4. Frequent voiding and dry mouth 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 preparing a presentation on complications of hypertension. Which information would the nurse include? Select all that apply. 1. Stroke as a result of carotid artery atherosclerosis 2. Heart failure as a result of increased heart contractility 3. Blurred vision or loss of vision secondary to retinal damage 4. Right ventricular hypertrophy as a result of increased workload 5. Coronary artery disease caused by an increase in the elasticity of arterial walls

1. Stroke as a result of carotid artery atherosclerosis 3. Blurred vision or loss of vision secondary to retinal damage Embolic stroke may be a result of cerebral blood flow obstruction by a portion of atherosclerotic plaque or a blood clot formed in the carotid arteries. Hypertension leads to retinal damage that is manifested by blurred vision or loss of vision and retinal hemorrhage. Heart failure is a result of decreased heart contractility along with decreased stroke volume and cardiac output. Hypertension leads to increased cardiac workload that causes left ventricular hypertrophy. Coronary artery disease is caused by decreased elasticity of arterial walls and narrowing of the lumen. Text Reference - p. 713

A patient arrives at a medical clinic for a check-up. The patient's blood pressure (BP) is 150/94 mm Hg. All other assessment findings are within normal limits. The nurse reviews the patient's file from previous visits, and there is no history of elevated blood pressure. What could be the reason for a falsely high blood pressure? 1. The blood pressure cuff might have been too small. 2. There may be atherosclerosis in the subclavian artery. 3. The patient may have smoked the day before the BP measurement. 4. The patient may have engaged in strenuous exercises the day before the BP measurement.

1. The blood pressure cuff might have been too small. BP measurements should be performed using proper technique to get an accurate reading. BP measurements may be falsely high if the BP cuff is too small as it puts undue pressure on the artery. If the subclavian artery has atherosclerosis, the BP measurement would be falsely low. Smoking and engaging in strenuous exercise should be avoided 30 minutes before the BP measurement, because they can alter the measurement. Smoking or engaging in strenuous exercise one day before a BP measurement will not affect the readings. Text Reference - p. 723

The nurse records normal blood pressure (BP) for a patient with a family history of hypertension and diabetes. What should the nurse teach the patient to specifically address the risks of hypertension? Select all that apply. 1. Increase caloric intake. 2. Avoid foods high in sodium. 3. Reduce the use of tobacco products. 4. Take brisk walks. 5. Avoid overexertion with muscle-strengthening activities

2. Avoid foods high in sodium. 4. Take brisk walks. The nurse should teach the patient to adopt lifestyle changes, such as avoiding foods high in sodium and taking brisk walks. A decrease in caloric intake helps to reduce weight and prevent hypertension. The patient should completely avoid use of tobacco products, because the nicotine contained in tobacco causes vasoconstriction and increases BP. All adults should perform muscle-strengthening activities to maintain and increase endurance and strength of muscles. Text Reference - p. 716

The nurse is caring for a patient admitted with a history of hypertension. The patient's medication history includes hydrochlorothiazide daily for the past 10 years. Which parameter would indicate the optimal intended effect of this drug therapy? 1. Weight loss of 2 lb 2. Blood pressure 128/86 3. Absence of ankle edema 4. Output of 600 mL per eight hours

2. Blood pressure 128/86 Hydrochlorothiazide may be used alone as monotherapy to manage hypertension or in combination with other medications if not effective alone. After the first few weeks of therapy, the diuretic effect diminishes, but the antihypertensive effect remains. Because the patient has been taking this medication for 10 years, the most direct measurement of its intended effect would be the blood pressure. Text Reference - p. 717

A nurse is providing care for a patient who continues to experience hypertension despite taking a calcium channel blocker daily. A diuretic has been prescribed. How does a diuretic help control blood pressure? Select all that apply. 1. It causes vasodilation. 2. It reduces plasma volume. 3. It promotes sodium and water excretion. 4. It reduces the vascular response to catecholamines. 5. It prevents extracellular calcium from moving into the cells.

2. It reduces plasma volume. 3. It promotes sodium and water excretion. 4. It reduces the vascular response to catecholamines. Diuretics are an important component of BP treatment. Diuretics tend to reduce the plasma volume by promoting excretion of sodium and water. The net result is a reduction in the circulating volume, which causes a decrease in the BP. Diuretics also reduce the vascular response to catecholamines. The blood vessels do not constrict in response to catecholamines; as a result, the BP is reduced. Diuretics do not cause vasodilation or prevent the movement of extracellular calcium into the cells; these effects are brought about by calcium channel blockers. Text Reference - p. 720

The nurse is obtaining data from a patient who has been on medication for hypertension and diabetes for four years. The patient has been experiencing blurred vision due to retinal damage caused by hypertension. What are the other manifestations of target organ disease? Select all that apply. 1. Pneumonia 2. Nocturia 3. Aneurysm 4. Transient ischemic attack 5. Anemia

2. Nocturia 3. Aneurysm 4. Transient ischemic attack Hypertension affects the kidneys; the earliest manifestation of renal disease is nocturia. Hypertension speeds up the process of atherosclerosis in the peripheral blood vessels, leading to aneurysms. Adequate control of blood pressure (BP) reduces the risk of transient ischemic attack. Pneumonia and anemia are not manifestations of target organ disease. Text Reference - p. 714

When teaching a patient about dietary management of stage 1 hypertension, which instruction is most appropriate? 1. Restrict all caffeine 2. Restrict sodium intake 3. Increase protein intake 4. Use calcium supplements

2. Restrict sodium intake The patient should decrease intake of sodium. This will help to control hypertension, which can be aggravated by excessive salt intake, which in turn leads to fluid retention. Caffeine and protein intake do not affect hypertension. Calcium supplements are not recommended to lower blood pressure. Text Reference - p. 712

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 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. Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks "why," be sure the response you have chosen is a reason. If the question stem is singular, then be sure the option is singular, and the same for plural stems and plural responses. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer. Text Reference - p. 715

A patient has been asked to monitor blood pressure (BP) levels at home twice a day. What should the nurse teach the patient about measuring BP in the supine position? 1. Take at least two consecutive readings one after another. 2. Support the arm with a pillow during measurement. 3. Take the reading immediately after lying down. 4. Use the arm with the lowest BP for all future measurements.

2. Support the arm with a pillow during measurement. When measuring BP in a supine position, the patient should support the arm with a small pillow to raise the position of the hand to the level of the heart. Record the average pressure by taking two consecutive readings at least one minute apart; this allows the blood to drain from the arm and prevents inaccurate readings. The first reading should be taken after two to three minutes of rest in a supine position. If bilateral BP measurements are not equal, the patient should use the arm with the highest BP for all future measurements. 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. "Take this drug at bedtime because of the risk of orthostatic hypotension." 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. Test-Taking Tip: Relax during the last hour before an exam. Your brain needs some recovery time to function effectively. Text Reference - p. 723

The patient has chronic hypertension. Today the patient has gone to the emergency department and the patient's blood pressure has risen to 200/140. What is the priority assessment for the nurse to make? 1. Is the patient pregnant? 2.Does the patient need to urinate? 3. Does the patient have a headache or confusion? 4. Is the patient taking antiseizure medications as prescribed?

3. Does the patient have a headache or confusion? The nurse's priority assessments include neurologic deficits, retinal damage, heart failure, pulmonary edema, and renal failure. The headache or confusion could be seen with hypertensive encephalopathy, from increased cerebral capillary permeability leading to cerebral edema. Pregnancy can lead to secondary hypertension. Needing to urinate and taking antiseizure medication do not indicate a hypertensive emergency. Text Reference - p. 726

The nurse understands that catapres has which side effects? 1. Cough and confusion 2. Sweating and shaking 3. Dry mouth and sedation 4. Gynecomastia and dizziness

3. Dry mouth and sedation Dry mouth and sedation are side effects of central-acting alpha-adrenergic antagonists. Cough is a possible side effect of angiotensin-converting enzyme inhibitors. Confusion, sweating, and shaking are not common side effects for hypertension drug therapy. Gynecomastia is a side effect of aldosterone receptor blockers. Dizziness is a side effect for hypertension drug therapy; gynecomastia is not. Text Reference - p. 717

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 3. Expiratory wheezing 4. Blood sugar 217 mg/dL

3. Expiratory wheezing 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

A patient reports chest pain and is admitted to the emergency department. The patient is obese, smokes cigarettes, and drinks alcohol in moderate amounts. The patient had taken labetalol for high blood pressure (BP) for one week and then stopped taking the medication the morning of admission. The nurse recognizes that the probable reason for the patient's angina is what? 1. Leading a sedentary lifestyle after a lifetime of obesity 2. Smoking cigarettes 3. Stopping labetalol abruptly after a week of treatment 4. Alcohol consumption

3. Stopping labetalol abruptly after a week of treatment Labetalol is an alpha- and beta-adrenergic blocker and reduces BP by causing vasodilatation and a decrease in heart rate. The patient should not stop the drug abruptly, because it may precipitate angina and heart failure. Obesity, a sedentary lifestyle, smoking, and alcohol consumption are risk factors for cardiovascular disease but are unlikely to cause angina. Text Reference - p. 718

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. The patient who is complaining about severe headache and has a nose bleed 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

In reviewing medication instructions with a patient being discharged on antihypertensive medications, which statement would be most appropriate for the nurse to make when discussing guanethidine? 1. "A fast heart rate is a side effect to watch for while taking guanethidine." 2. "Stop the drug and notify your health care provider if you experience any nausea or vomiting." 3. "Because this drug may affect the lungs in large doses, it also may help your breathing." 4. "Make position changes slowly, especially when rising from lying down to a standing position."

4. "Make position changes slowly, especially when rising from lying down to a standing position." Guanethidine is a peripheral-acting α-adrenergic antagonist and can cause marked orthostatic hypotension. For this reason, the patient should be instructed to rise slowly, especially when moving from a recumbent to a standing position. Support stockings also may be helpful. Tachycardia or lung effects are not evident with guanethidine, nor are nausea and vomiting. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten. Text Reference - p. 718

A 65-year-old patient without any past medical problems has his or her blood pressure checked at a primary health care provider's office during an annual physical examination. The blood pressure (BP) reading is 158/92. The patient is asking the nurse who was checking the blood pressure: "Does this mean that I have hypertension?" What is the most appropriate answer from the nurse? 1. "Do not worry, everything is fine." 2. "It is a normal blood pressure reading for a person of your age." 3. "Yes, you have hypertension, because your blood pressure is over 140/90." 4. "You need to have a follow-up appointment to recheck your blood pressure."

4. "You need to have a follow-up appointment to recheck your blood pressure." The diagnosis of hypertension is made based on two or more elevated blood pressure readings. Considering the fact that the patient does not have any medical problems and that this reading is the first elevated blood pressure reading, a follow-up office visit is required. Providing false reassurance to the patient is leading to misinformation. For any person of age 18 and older, BP higher than 140/90 is considered elevated. Diagnosing the patient with a medical diagnosis is not within the nursing scope of practice and cannot be done based on one elevated BP reading. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. Text Reference - p. 715

The nurse is checking blood pressure for people at a health fair. Which patient is at higher risk to develop primary hypertension? 1. 65-year-old retired Caucasian with a body mass index (BMI) of 15 2. 60-year-old who has chronic pain caused by cancer 3. 45-year-old blue collar worker who smokes one pack of cigarettes per day 4. 59-year-old African American with a BMI of 35 who has a high stress job

4. 59-year-old African American with a BMI of 35 who has a high stress job The patient has four risk factors for primary hypertension: advanced age, African American race, morbid obesity with a BMI of 35, and a high level of stress. All of the other patients have fewer risk factors for primary hypertension: in the 45-year-old smoker, smoking is the only risk factor; in the 60-year-old with cancer, advanced age and pain are the only risk factors; and in the 65-year-old retiree, the only risk factor is advanced age. Text Reference - p. 713

The patient with osteoporosis and hypertension understands dietary teaching when the patient selects which meal for dinner? 1. Ham and Swiss cheese sandwich on whole-wheat bread, steamed broccoli, and an apple 2. Baked chicken with one cup of yogurt and steamed rice 3. A two-egg omelet with 2 oz. of American cheese, one slice of whole-wheat toast, and half a grapefruit 4. Baked salmon with one cup of spinach and steamed carrots

4. Baked salmon with one cup of spinach and steamed carrots The highest calcium content is present in the dinner containing salmon and spinach, also taking into account fat and sodium restrictions required to manage hypertension. Ham and cheese are both high in sodium and should be avoided in the patient with hypertension. Eggs are not a large source of calcium, and chicken, yogurt, and rice, although lower in sodium, do not have the highest calcium content. Text Reference - p. 716

Which item on the patient's dinner tray should not be taken in large quantities by the patient prescribed furosemide for hypertension? 1. Coffee 2. Ice cream 3. Grapefruit juice 4. Chicken noodle soup

4. Chicken noodle soup Furosemide, a diuretic, causes fluid loss to decrease blood pressure. Chicken noodle soup is high in sodium and may cause increased fluid retention, negating the effects of the medication and increasing the blood pressure. Ice cream, grapefruit juice, and coffee will not decrease the effectiveness of furosemide. Text Reference - p. 717

A nurse provides care to a patient who is admitted to an emergency department with hypertensive crisis. The patient had been taking sodium nitroprusside for the past three days. What is the reason that blood tests to assess thiocyanate levels are prescribed for this patient? 1. The patient may have very low BP due to the sodium nitroprusside. 2. The patient may have adverse effects on target organs. 3. The patient may have reduced excretion of sodium nitroprusside. 4. The patient may have toxic levels of sodium nitroprusside.

4. The patient may have toxic levels of sodium nitroprusside. Sodium nitroprusside causes arterial vasodilation and reduces systemic vascular resistance. This in turn decreases the blood pressure. Sodium nitroprusside is metabolized to cyanide and then to thiocyanate, which can reach lethal levels. Therefore, thiocyanate levels should be monitored in patients receiving the drug for more than three days or at doses greater than 4mcg/kg/min. In hypertensive crisis, the patient usually has very high BP despite the BP-lowering effect of sodium nitroprusside. Serum thiocyanate levels do not indicate adverse effects of hypertension on target organs or reduced excretion of sodium nitroprusside. Text Reference - p. 719

The nurse is reviewing the laboratory tests for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider? a. Serum creatinine of 2.6 mg/dL b. Serum potassium of 3.8 mEq/L c. Serum hemoglobin of 14.7 g/dL d. Blood glucose level of 98 mg/dL

ANS: A The elevated creatinine indicates renal damage caused by the hypertension. The other laboratory results are normal.

Which nursing action should the nurse take first in order to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes? a. Have the patient record dietary intake for 3 days. b. Give the patient a detailed list of low-sodium foods. c. Teach the patient about foods that are high in sodium. d. Help the patient make an appointment with a dietitian.

ANS: A The initial nursing action should be assessment of the patient's baseline dietary intake through a 3-day food diary. The other actions may be appropriate, but assessment of the patient's baseline should occur first.

Which assessment finding for a patient who is receiving furosemide (Lasix) to treat stage 2 hypertension is most important to report to the health care provider? a. Blood glucose level of 180 mg/dL b. Blood potassium level of 3.0 mEq/L c. Early morning BP reading of 164/96 mm Hg d. Orthostatic systolic BP decrease of 12 mm Hg

ANS: B Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening dysrhythmias. The health care provider should be notified of the potassium level immediately and administration of potassium supplements initiated. The elevated blood glucose and BP also indicate a need for collaborative interventions but will not require action as urgently as the hypokalemia. An orthostatic drop of 12 mm Hg is common and will require intervention only if the patient is symptomatic.

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 heart failure? a. 108/64 mm Hg b. 128/76 mm Hg c. 140/90 mm Hg d. 136/ 82 mm Hg

ANS: B The goal for antihypertensive therapy for a patient with hypertension and heart failure is a BP of <130/80 mm Hg. The BP of 108/64 may indicate overtreatment of the hypertension and an increased risk for adverse drug effects. The other two blood pressures indicate a need for modifications in the patient's treatment.

Which information should the nurse include when teaching a patient with newly diagnosed hypertension? a. Dietary sodium restriction will control BP for most patients. b. Most patients are able to control BP through lifestyle changes. c. Hypertension is usually asymptomatic until significant organ damage occurs. d. Annual BP checks are needed to monitor treatment effectiveness.

ANS: C Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle changes and sodium restriction are used to help manage blood pressure, but drugs are needed for most patients. BP should be checked by the health care provider every 3 to 6 months.

The RN is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside (Nipride). Which of the following nursing actions can the nurse delegate to an experienced LPN/LVN? a. Titrate nitroprusside to maintain BP at 160/100 mm Hg. b. Evaluate effectiveness of nitroprusside therapy on BP. c. Set up the automatic blood pressure machine to take BP every 15 minutes. d. Assess the patient's environment for adverse stimuli that might increase BP.

ANS: C LPN/LVN education and scope of practice include correct use of common equipment such as automatic blood pressure machines. The other actions require more nursing judgment and education and should be done by RNs.

After giving a patient the initial dose of oral labetalol (Normodyne) for treatment of hypertension, which action should the nurse take? a. Encourage oral fluids to prevent dry mouth or dehydration. 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.

ANS: C Labetalol decreases sympathetic nervous system activity by blocking both α- and β-adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension. Heart palpitations, dehydration, and headaches are possible side effects of other antihypertensives.

A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and has a BP of 240/118 mm Hg. Which question should the nurse ask first? a. Did you take any acetaminophen (Tylenol) today? b. Do you have any recent stressful events in your life? c. Have you been consistently taking your medications? d. Have you recently taken any antihistamine medications?

ANS: C Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do not increase BP. Stressful events will increase BP but not usually to the level seen in this patient.

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

ANS: C The ACE inhibitors cause retention of potassium by the kidney, so hyperkalemia is a possible adverse effect. The other teaching by the new RN is appropriate for a patient with newly diagnosed hypertension who has just started therapy with enalapril.

During change-of-shift report, the nurse obtains this information about a hypertensive patient who received the first dose of propranolol (Inderal) during the previous shift. Which information indicates that the patient needs immediate intervention? a. The patient's most recent BP reading is 156/94 mm Hg. b. The patient's pulse has dropped from 64 to 58 beats/minute. c. The patient has developed wheezes throughout the lung fields. d. The patient complains that the fingers and toes feel quite cold.

ANS: C The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective β-blockers) is occurring. The nurse should immediately obtain an oxygen saturation measurement, apply supplemental oxygen, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes are associated with β-receptor blockade but do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated; however, this is not as urgently needed as addressing the bronchospasm.

Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new patient? a. Obtain a BP reading in each arm and average the results. b. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second. c. Have the patient sit in a chair with the feet flat on the floor. d. Assist the patient to the supine position for BP measurements.

ANS: C The patient should be seated with the feet flat on the floor. The BP is obtained in both arms, but the results of the two arms are not averaged. The patient does not need to be in the supine position. The cuff should be deflated at 2 to 3 mm Hg per second.

A 52-year-old patient who has no previous history of hypertension or other health problems suddenly develops a BP of 188/106 mm Hg. 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. the dietary sodium and fat content should be decreased. c. there is an immediate danger of a stroke and hospitalization will be required. d. more diagnostic testing may be needed to determine the cause of the hypertension.

ANS: D 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. The BP will need rapid treatment and ongoing monitoring. If the patient has no other risk factors, a stroke in the immediate future is unlikely. There is no indication that dietary salt or fat intake have contributed to this sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this BP to an acceptable level.

The nurse has just finished teaching a hypertensive patient about the newly prescribed quinapril (Accupril). Which patient statement indicates that more teaching is needed? a. "The medication may not work as well if I take any aspirin." b. "The doctor may order a blood potassium level occasionally." c. "I will call the doctor if I notice that I have a frequent cough." d. "I won't worry if I have a little swelling around my lips and face."

ANS: D Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an indication that the ACE inhibitor should be discontinued. The patient should be taught that if any swelling of the face or oral mucosa occurs, the health care provider should be immediately notified because this could be life threatening. The other patient statements indicate that the patient has an accurate understanding of ACE inhibitor therapy.

When a patient with hypertension who has a new prescription for 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. Provide information about the use of multiple drugs to treat hypertension. b. Teach the patient about the reasons for a possible change in drug therapy. c. Remind the patient that lifestyle changes also are important in BP control. d. Question the patient about whether the medication is actually being taken.

ANS: D Since noncompliance with antihypertensive therapy is common, the nurse's initial action should be to determine whether the patient is taking the atenolol as prescribed. The other actions also may be implemented, but these would be done after assessing patient compliance with the prescribed therapy.

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 dietary protein. c. The patient has only one cup of coffee in the morning. d. The patient has a glass of low-fat milk with each meal.

ANS: D The Dietary Approaches to Stop Hypertension (DASH) recommendations for prevention of hypertension include increasing the intake of calcium-rich foods. Caffeine restriction and decreased protein intake are not included in the recommendations. Nuts are high in beneficial nutrients and 4 to 5 servings weekly are recommended in the DASH diet.

A patient has just been diagnosed with hypertension and has a new prescription for captopril (Capoten). Which information is important to include when teaching the patient? a. Check BP daily 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 position slowly to help prevent dizziness and falls.

ANS: D 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.The BP does not need to be checked at home by the patient before taking the medication. ** Increasing fluid intake may counteract the effect of the medication, and the patient is taught to use gum or hard candy to relieve dry mouth. ***Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.

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? a. Stenosis of the heart valves Incorrect b. Decreased adrenergic sensitivity c. Increased parasympathetic activity d. Loss of elasticity in arterial vessels

d

A patient with newly discovered high BP has an average reading of 158/98 mmHg after 3 months of exercise and diet modifications. Which management strategy will be a priority for this patient? a. Medication will be required because the BP is still not at goal b. BP monitoring should continue for another 3 months to confirm a diagnosis of hypertension c. Lifestyle changes are less important, since they were not effective, and medications will be started d. More vigorous changes in the patient's lifestyle are needed for a longer time before starting medications

a. Medication will be required because the BP is still not at goal

A patient with newly discovered high BP has an average reading of 158/98 mm Hg after 3 months of exercise and diet modifications. Which management strategy will be a priority for this patient? a. Medication will be required because the BP is still not at goal. b. BP monitoring should continue for another 3 months to confirm a diagnosis of hypertension. c. Lifestyle changes are less important, since they were not effective, and medications will be started. d. More vigorous changes in the patient's lifestyle are needed for a longer time before starting medications.

a

The nurse is providing care for a patient who has decreased cardiac output related to heart failure. What should the nurse recognize about cardiac output? a. Calculated by multiplying the patient's stroke volume by the heart rate b. The average amount of blood ejected during one complete cardiac cycle c. Determined by measuring the electrical activity of the heart and the patient's heart rate d. The patient's average resting heart rate multiplied by the patient's mean arterial blood pressure

a

Despite a high dosage, a male patient who is taking nifedipine (Procardia XL) for antihypertensive therapy continues to have blood pressures over 140/90 mmHg. 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. A long-acting calcium-channel blocker such as nifedipine causes vascular smooth muscle relaxation resulting in decreased SVR and arterial BP and related side effects. The patient data the nurse has about this patient is very limited, so the nurse needs to assess his adherence to therapy.

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. Hypertension is a major risk factor for the development of atherosclerosis by mechanisms not yet fully known. However, once atherosclerosis develops, it damages the walls of arteries and reduces circulation to target organs and tissues.

The nurse is caring for a patient with hypertension who is scheduled to receive a dose of esmolol (Brevibloc). The nurse should withhold the dose and consult the prescribing physician for which vital sign taken just before administration? a) Pulse 48 b) Respirations 24 c) Blood pressure 118/74 d) Oxygen saturation 93%

a) Pulse 48 Because esmolol is a β1-adrenergic blocking agent, it can cause hypotension and bradycardia as adverse effects. The nurse should withhold the dose and consult with the health care provider for parameters regarding pulse rate limits.

When caring for elderly patients with hypertension, which information should the nurse consider when planning care (select all that apply.)? 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

A patient is admitted to the hospital in hypertensive emergency (BP 244/142 mm Hg). Sodium nitroprusside is started to treat the elevated BP. Which management strategy(ies) would be most appropriate for this patient (select all that apply)? a. Measuring hourly urine output b. Decreasing the MAP by 50% within the first hour c. Continuous BP monitoring with an arterial line d. Maintaining bed rest and providing tranquilizers to lower the BP e. Assessing the patient for signs and symptoms of heart failure and changes in mental status

a, c, e

Which BP-regulating mechanism(s) can result in the development of hypertension if defective (select all that apply)? a. Release of norepinephrine b. Secretion of prostaglandins c. Stimulation of the sympathetic nervous system d. Stimulation of the parasympathetic nervous system e. Activation of the renin-angiotensin-aldosterone system

a, c, e

A patient is admitted to the hospital in hypertensive emergency (BP 244/142 mmHg). Sodium nitroprusside is started to treat the elevated BP. Which management strategy(ies) would be appropriate for this patient (select all that apply)? a. Measuring hourly urine output b. Decreasing the MAP by 50% within the first hour c. Continuous BP monitoring with an intraarterial line d. Maintaining bed rest and providing tranquilizers to lower the BP e. Assessing the patient for signs and symptoms of heart failure and changes in mental status

a,c, & e

What are nonmodifiable risk factors for primary hypertension (select all that apply)? a. Age b. Obesity c. Gender d. Genetic link e. Ethnicity

a,c,d,e Hypertension progresses with increasing age. It is more prevalent in men up to age 45 and above the age of 64 in women. African Americans have a higher incidence of hypertension than do white Americans. Children and siblings of patients with hypertension should be screened and taught about healthy lifestyles.

A 78-year-old patient is admitted with a BP of 180/98 mm Hg. Which age-related physical changes may contribute to this patient's hypertension (select all that apply)? a. Decreased renal function b. Increased adrenergic receptor sensitivity c. Increased baroreceptor reflexes d. Increased collagen and stiffness of the myocardium e. Increased peripheral vascular resistance f. Loss of elasticity in large arteries from arteriosclerosis

a,d,e,f The age-related changes that contribute to hypertension include decreased renal function, increased peripheral vascular resistance, increased collagen and stiffness of the myocardium, and decreased elasticity in large arteries from arteriosclerosis.

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.

What is the patient with primary hypertension likely to report? a. No symptoms b. Dyspnea on exertion c. Cardiac palpitations d. Dizziness and vertigo

a. Hypertension is often asymptomatic, especially if it is mild or moderate, and has been called the "silent killer."

During treatment of a patient with a BP of 222/148 mm Hg and confusion, nausea, and vomiting, the nurse initially titrates the medications to achieve which goal? a. Decrease the mean arterial pressure (MAP) to 129 mm Hg b. Lower the BP to the patient's normal within the second to third hour c. Reduce the systolic BP (SBP) to 158 mm Hg and the diastolic BP (DBP) to 111 mm Hg within the first 2 hours d. Decrease the SBP to 160 mm Hg and the DBP to between 100 and 110 mm Hg as quickly as possible

a. Initially the treatment goal in hypertensive emergencies is to reduce the mean arterial pressure (MAP) by no more than 20% to 25% in the first hour, with further gradual reduction over the next 24 hours. In this case the MAP is 172, so decreasing it by 25% equals 129. MAP = [(2 x diastolic)+systolic] / 3

A 42-year-old man has been diagnosed with primary hypertension with an average BP of 162/92 mm Hg on three consecutive clinic visits. What are four priority lifestyle modifications that should be explored in the initial treatment of the patient? a. b. c. d.

a. Dietary modifications to restrict sodium, cholesterol, and saturated fat; maintain intake of potassium, calcium, and magnesium; and promote weight reduction if overweight b. Daily moderate-intensity physical activity for at least 30 minutes on most days of the week c. Cessation of smoking (if a smoker) d. Moderation or cessation of alcohol intake; usually medications and monitor BP at home. Also, psychosocial risk factors must be addressed.

The nurse is caring for a patient admitted with a history of hypertension. The patient's medication history includes hydrochlorothiazide (Hydrodiuril) 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) Blood pressure 128/86 c) Absence of ankle edema d) Output of 600 mL per 8 hours

b) Blood pressure 128/86 Hydrochlorothiazide may be used alone as monotherapy to manage hypertension or in combination with other medications if not effective alone. After the first few weeks of therapy, the diuretic effect diminishes, but the antihypertensive effect remains. Since the patient has been taking this medication for 10 years, the most direct measurement of its intended effect would be the blood pressure.

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

b) Restrict sodium intake. The patient should decrease intake of sodium. This will help to control hypertension, which can be aggravated by excessive salt intake, which in turn leads to fluid retention. Caffeine and protein intake do not affect hypertension. Calcium supplements are not recommended to lower BP.

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 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 CVD risk. The other meats are lower in fat and are therefore acceptable in the diet.

When assessing the patient for orthostatic hypotension, after taking the blood pressure (BP) and pulse (P) in the supine position, what should the nurse do next? a) Repeat BP and P in this position. b) Take BP and P with patient sitting. c) Record the BP and P measurements. d) Take BP and P with patient standing.

b) Take BP and P with patient sitting. When assessing for orthostatic changes in BP after measuring BP in the supine position, the patient is placed in a sitting position and BP is measured within 1 to 2 minutes and then repositioned to the standing position with BP measured again, within 1 to 2 minutes. The results are then recorded with a decrease of 20 mm Hg or more in SBP, a decrease of 10 mm Hg or more in DBP, and/or an increase in pulse of greater than or equal to 20 beats/minute from supine to standing indicating orthostatic hypotension.

Which classification of drugs used to treat hypertension prevents the action of angiotensin II and promotes increased salt and water excretion? a. Thiazide diuretics b. Angiotensin II receptor blockers (ARBs) c. Direct vasodilators d. Angiotensin-converting enzyme (ACE) inhibitors

b. Angiotensin II receptor blockers (ARBs) prevent the action of angiotensin II and produce vasodilation and increased salt and water excretion.

The unit is very busy and short staffed. What could be delegated to the unlicensed assistive personnel (UAP)? a. Administer antihypertensive medications to stable patients. b. Obtain orthostatic blood pressure (BP) readings for older patients. c. Check BP readings for the patient receiving IV enalapril (Vasotec). d. Teach about home BP monitoring and use of automatic BP monitoring equipment

b. Unlicensed assistive personnel (UAP) may check postural changes in BP as directed. The licensed practical nurse (LPN) may administer antihypertensive medications to stable patients. The RN must monitor the patient receiving IV enalapril (Vasotec), as he or she is in a hypertensive crisis. The RN must also do the teaching related to home BP monitoring.

While obtaining subjective assessment date from a patient with hypertension, the nurse recognizes that a modifiable risk factor for the development of hypertension is: a. a low-calcium diet b. excessive alcohol consumption c. a family history of hypertension d. consumption of a high-protein diet

b. excessive alcohol consumption

The nurse teaches a 28-yr-old man newly diagnosed with hypertension about lifestyle modifications to reduce his blood pressure. 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 blood pressure by switching to smokeless tobacco." d. "Diet changes can be as effective as taking blood pressure medications.

c

How is secondary hypertension differentiated from primary hypertension? a. Has a more gradual onset than primary hypertension b. Does not cause the target organ damage that occurs with primary hypertension c. Has a specific cause, such as renal disease, that often can be treated by medicine or surgery d. Is caused by age-related changes in BP regulatory mechanisms in people over 65 years of age

c Secondary hypertension has an underlying cause that can often be treated, in contrast to primary or essential hypertension,which has no single known cause.

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 PO, the nurse assesses the patient carefully. Which adverse effect is this patient at risk for, given the patient's health history? a) Hypocapnia b) Tachycardia c) Bronchospasm d) Nausea and vomiting

c) Bronchospasm 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.

The patient has chronic hypertension. Today she has gone to the ED, and her blood pressure has risen to 200/140. What is the priority assessment for the nurse to make? 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? The nurse's priority assessments include neurologic deficits, retinal damage, heart failure, pulmonary edema, and renal failure. The headache or confusion could be seen with hypertensive encephalopathy from increased cerebral capillary permeability leading to cerebral edema. Pregnancy can lead to secondary hypertension. Needing to urinate and taking antiseizure medication do not support a hypertensive emergency.

When teaching how lisinopril (Zestril) will help lower the patient's blood pressure, which mechanism of action should the nurse use to explain it? a) Blocks β-adrenergic effects. b) Relaxes arterial and venous smooth muscle. c) Inhibits conversion of angiotensin I to angiotensin II. d) Reduces sympathetic outflow from central nervous system.

c) Inhibits conversion of angiotensin I to angiotensin II. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that inhibits the conversion of angiotensin I to angiotensin II, which reduces angiotensin II-mediated vasoconstriction and sodium and water retention. Beta blockers result in vasodilation and decreased heart rate. Direct vasodilators relax arterial and venous smooth muscle. Central acting α-adrenergic antagonists reduce sympathetic outflow from the CNS to produce vasodilation and decreased SVR and BP.

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

c) Serum creatinine of 2.6 mg/dL The normal serum creatinine level is 0.6-1.3 mg/dL. This elevated level indicates target organ damage to the kidneys. The other lab results are within normal limits.

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)? a) Lose weight. b) Limit nuts and seeds. c) Limit sodium and fat intake. d) Increase fruits and vegetables. e) Exercise 30 minutes most days.

c, d, & e Primary prevention of hypertension is to make lifestyle modifications that prevent or delay the increase in BP. Along with exercise for 30 minutes on most days, the 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. Nuts and seeds and dried beans are used for protein intake. Weight loss may or may not be necessary for the individual.

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)? a. Lose weight. b. Limit nuts and seeds. c. Limit sodium and fat intake. d. Increase fruits and vegetables. e. Exercise 30 minutes most days.

c, d, e

Which manifestation is an indication that a patient is having a hypertensive emergency? a. Symptoms of a stroke with an elevated BP b. A systolic BP >200 mm Hg and a diastolic BP >120 mm Hg c. A sudden rise in BP accompanied by neurologic impairment d. A severe elevation of BP that occurs over several days or weeks

c. Hypertensive emergency, a type of hypertensive crisis, is a situation that develops over hours or days in which a patient's BP is severely elevated with evidence of acute target organ disease (e.g., cerebrovascular, cardiovascular, renal, or retinal). The neurologic manifestations are often similar to the presentation of a stroke but do not show the focal or lateralizing symptoms of stroke.

The patient who is being admitted has had a history of uncontrolled hypertension. High SVR is most likely to cause damage to which organ? a. Brain b. Retina c. Heart d. Kidney

c. The increased systemic vascular resistance (SVR) of hypertension directly increases the workload of the heart and heart failure occurs when the heart can no longer pump effectively against the increased resistance.

A priority consideration in the management of the older adult with hypertension is to a. prevent primary hypertension from converting to secondary hypertension. b. recognize that the older adult is less likely to adhere to the drug therapy regimen than a younger adult. c. ensure that the patient receives larger initial doses of antihypertensive drugs because of impaired absorption. d. use careful technique in assessing the BP of the patient because of the possible presence of an auscultatory gap.

d

In teaching a patient with hypertension about controlling the illness, the nurse recognizes that a. all patients with elevated BP require medication. b. obese persons must achieve a normal weight to lower BP. c. it is not necessary to limit salt in the diet if taking a diuretic. d. lifestyle modifications are indicated for all persons with elevated BP.

d

In reviewing medication instructions with a patient being discharged on antihypertensive medications, which statement would be most appropriate for the nurse to make when discussing guanethidine (Ismelin)? a) "A fast heart rate is a side effect to watch for while taking guanethidine." b) "Stop the drug and notify your doctor if you experience any nausea or vomiting." c) "Because this drug may affect the lungs in large doses, it may also help your breathing." d) "Make position changes slowly, especially when rising from lying down to a standing position."

d) "Make position changes slowly, especially when rising from lying down to a standing position." Guanethidine is a peripheral-acting α-adrenergic antagonist and can cause marked orthostatic hypotension. For this reason, the patient should be instructed to rise slowly, especially when moving from a recumbent to a standing position. Support stockings may also be helpful. Tachycardia or lung effects are not evident with guanethidine.

What is included in the correct technique for BP measurements? a. Always take the BP in both arms. b. Position the patient supine for all readings. c. Place the cuff loosely around the upper arm. d. Take readings at least two times at least 1 minute apart.

d. Correct technique in measuring BP includes taking two or more readings at least 1 minute apart. Initially BP measurements should be taken in both arms to detect any differences. If there is a difference, the arm with the higher reading should be used for all subsequent BP readings. The patient may be supine or sitting. The important point is that the arm being used is at the heart level and the cuff needs to fit snugly.

What does the nursing responsibility in the management of the patient with hypertensive urgency often include? a. Monitoring hourly urine output for drug effectiveness b. Titrating IV drug dosages based on BP measurements every 2 to 3 minutes c. Providing continuous electrocardiographic (ECG) monitoring to detect side effects of the drugs d. Instructing the patient to follow up with a health care professional within 24 hours after outpatient treatment

d. Hypertensive urgencies are often treated with oral drugs on an outpatient basis but it is important for the patient to be seen by a health care professional within 24 hours to evaluate the effectiveness of the treatment. Hourly urine measurements, titration of IV drugs, and ECG monitoring are indicated for hypertensive emergencies.

In teaching a patient with hypertension about controlling the condition, the nurse recognizes that: a. all patients with elevated BP require medication b. obese persons must achieve a normal weight to lower BP c. It is not necessary to limit salt in the diet if taking a diuretic d. lifestyle modifications are indicated for all persons with elevated BP

d. lifestyle modifications are indicated for all persons with elevated BP

A major consideration in the management of the other adult with hypertension is to: a. prevent primary hypertension from converting to secondary hypertension b. recognize that the older adult is less likely to adhere to the drug therapy regimen than a younger adult c. ensure that the patient receives larger initial doses of antihypertensive drugs because of impaired absorption d. use careful technique in assessing the BP of the patient because of the possible presence of ab auscultatory gap

d. use careful technique in assessing the BP of the patient because of the possible presence of ab auscultatory gap