HTN & CAD quiz
The nurse on the intermediate care unit received change-of-shift report on four patients with hypertension. Which patient should the nurse assess first? 52-yr-old with a blood pressure of 198/90 mm Hg who has intermittent claudication 43-yr-old with a blood pressure of 172/98 mm Hg whose urine shows microalbuminuria 48-yr-old with a blood pressure of 160/92 mm Hg who reports chest pain 50-yr-old with a blood pressure of 190/104 mm Hg who has a creatinine of 1.7 mg/dL
48-yr-old with a blood pressure of 160/92 mm Hg who reports chest pain
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? The patient drinks low-fat milk with each meal. The patient has two cups of coffee in the morning. The patient restricts intake of chicken and fish. The patient avoids eating nuts or nut butters.
The pt drinks low-fat milk with each meal.
A patient with diabetes mellitus and chronic stable angina has a new order for captopril . The nurse should teach the patient that the primary purpose of captopril is to decrease the heart rate. reduce the frequency of chest pain. prevent changes in heart muscle. control blood glucose levels.
decrease in heart rate
Diltiazem (Cardizem) is ordered for a patient with newly diagnosed Prinzmetal's (variant) angina. When teaching the patient, the nurse will include the information that diltiazem will reduce heart palpitations. decrease coronary artery spasms. increase contractile force of the heart. prevent coronary artery plaque.
decreased coronary artery spasms
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 dietary sodium and fat content should be decreased. diagnosis, treatment, and ongoing monitoring will be needed. there is an immediate danger of a stroke, requiring hospitalization.
diagnosis, treatment, and ongoing monitoring will be needed
After reviewing information shown in the accompanying figure from the medical records of a 43-yr-old patient, which risk factor modification for coronary artery disease should the nurse include in patient teaching? Effect of weight loss on blood pressure Importance of daily physical activity Cardiac risk associated with previous tobacco use Dietary changes to improve lipid levels
dietary changes to improve lipid levels
When developing a teaching plan for a 61-yr-old patient with multiple risk factors for coronary artery disease (CAD), the nurse should focus primarily on the increased risk associated with the patient's gender. increased risk of cardiovascular disease as people age. family history of coronary artery disease. elevated low-density lipoprotein (LDL) level
elevated low-density liproprotein (LDL) level
Which information from a patient helps the nurse confirm the previous diagnosis of chronic stable angina? "The pain is level 3 to 5 (0 to 10 scale)." "The pain has gotten worse over the last week." "The pain goes away after a nitroglycerin tablet." "The pain wakes me up at night."
"the pain goes away after a nitroglycerin tablet."
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? 142/78 mm Hg 128/76 mm Hg 128/92 mm Hg 98/56 mm Hg
128/92 mm Hg
Which action should the nurse take when giving the initial dose of oral labetalol to a patient with hypertension? Encourage the use of hard candy to prevent dry mouth. Ask the patient to request assistance before getting out of bed. Instruct the patient to call for help if heart palpitations occur. Teach the patient that headaches often occur with this drug.
Ask the patient to request assistance before getting out of bed
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? Question the patient regarding any lifestyle changes made to help control BP. Ask the patient if the medication is being taken as prescribed. Tell the patient why a change in drug dosage is needed. Inform the patient that multiple drugs are often needed to treat hypertension.
Ask the pt if the medication is being taken as prescribed
Which nursing action should the nurse take first to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes? Teach the patient about foods that are high in potassium. Collect a detailed diet history. Provide a list of low-sodium foods. Help the patient make an appointment with a dietitian.
Collect a detailed diet history
A patient who has recently started taking pravastatin (Pravachol) and niacin reports several symptoms to the nurse. Which information is most important to communicate to the health care provider? Dizziness with rapid position changes Flushing and pruritus after taking the drugs Nausea when taking the drugs before meals Generalized muscle aches and pains
Generalized muscle aches and pains
Which action will the nurse in the hypertension clinic take to obtain an accurate baseline blood pressure (BP) for a new patient? Deflate the BP cuff at a rate of 5 to 10 mm Hg per second. Have the patient sit in a chair with the feet flat on the floor. Assist the patient to the supine position for BP measurements. Obtain two BP readings in the dominant arm and average the results.
Have the pt sit in a chair with the feet flat on the floor
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? "The doctor may order a blood potassium level occasionally." "I can expect some swelling around my lips and face." "I will call the doctor if I notice that I have a frequent cough." "The medication may not work well if I take aspirin."
"I can expect some swelling around my lips and face."
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? "Did you take any acetaminophen (Tylenol) today?" "Have you recently taken any antihistamines?" "Have you consistently taken your medications?" "Have there been recent stressful events in your life?"
"Have you consistently taken your medications?
Which statement made by a patient with coronary artery disease after the nurse has completed teaching about the therapeutic lifestyle changes (TLC) diet indicates that further teaching is needed? "I like salmon and I will plan to eat it more often." "I will switch from whole milk to 1% milk." "I will miss being able to eat peanut butter sandwiches." "I can have a glass of wine with dinner if I want one."
"I miss being able to eat peanut butter sandwiches."
In preparation for discharge, the nurse teaches a patient with chronic stable angina how to use the prescribed short-acting and long-acting nitrates. Which patient statement indicates that the teaching has been effective? "I will check my pulse rate before I take any nitroglycerin tablets." "I will put the nitroglycerin patch on as soon as I get any chest pain." "I will be sure to remove the nitroglycerin patch before taking any sublingual nitroglycerin." "I will stop what I am doing and sit down before I put the nitroglycerin under my tongue."
"I will stop what I am doing and sit down before I put the nitroglycerin under my tongue."
After the nurse teaches the patient about the use of carvedilol (Coreg) in preventing anginal episodes, which statement by a patient indicates that the teaching has been effective? "Carvedilol will increase the blood flow to my heart muscle." "It is important not to suddenly stop taking the carvedilol." "I can expect to feel short of breath when taking carvedilol." "Carvedilol will help my heart muscle work harder."
"It is important to not suddenly stop taking the carvedilol."
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? Blood glucose level of 175 mg/dL Orthostatic systolic BP decrease of 12 mm Hg Most recent blood pressure (BP) reading of 168/94 mm Hg Serum potassium level of 3.0 mEq/L
Blood glucose level of 175 mg/dL
A patient who has chest pain is admitted to the emergency department (ED), and all of the following are ordered. Which one should the nurse arrange to be completed first? Insertion of a peripheral IV Troponin level Chest x-ray Electrocardiogram (ECG)
Electrocardiogram (ECG)
Which information is most important for the nurse to include when teaching a patient with newly diagnosed hypertension? Increasing physical activity alone controls blood pressure (BP) for most people. Hypertension is usually asymptomatic until target organ damage occurs. Most people are able to control BP through dietary changes. Annual BP checks are needed to monitor treatment effectiveness.
Hypertension is usually asymptomatic until target organ damage occurs.
After the nurse has finished teaching a patient about the use of sublingual nitroglycerin (Nitrostat), which patient statement indicates that the teaching has been effective? "I can expect nausea as a side effect of nitroglycerin." "Nitroglycerin helps prevent a clot from forming and blocking blood flow to my heart." "I will call an ambulance if I still have pain after taking three nitroglycerin 5 minutes apart." "I should only take nitroglycerin when I have chest pain."
I will call an ambulance if I still have pain after taking three nitroglycerin 5 minutes apart
The nurse obtains the following information from a patient newly diagnosed with prehypertension. Which finding is most important to address with the patient? Low dietary fiber intake Drinks a beer with dinner every night No regular physical exercise Weight is 5 pounds above ideal weight
No regular physical exercise
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? Patient drinks wine three to four times a week. Patient uses ibuprofen (Motrin) treat osteoarthritis. Patient checks BP daily just after getting up. Patient takes a daily multivitamin tablet.
Patient uses ibeprofen (Motrin) treat osteoarthritis
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? Serum creatinine of 2.8 mg/dL Blood glucose level of 96 mg/dL Serum hemoglobin of 14.7 g/dL Serum potassium of 4.5 mEq/L
Serum creatinine of 2.8 mg/dL
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? Schedule the patient for regular blood pressure (BP) checks in the clinic. Inform the patient and caregiver that major dietary changes will be needed. Instruct the patient about the need to decrease stress levels. Teach the patient how to self-monitor and record BPs at home.
Teach the patient how to self-monitor and record BPs at home
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? The patient's blood pressure (BP) reading is now 158/91 mm Hg. The patient complains that the fingers and toes feel quite cold. The patient has developed wheezes throughout the lung fields. The patient's pulse has dropped from 68 to 57 beats/min.
The pt has developed wheezes throughout the lung fields.
The nurse suspects that the patient with stable angina is experiencing a side effect of the prescribed drug metoprolol (Lopressor) if the blood pressure is 90/54 mm Hg. patient complains about feeling anxious. patient is restless and agitated. heart monitor shows normal sinus rhythm.
blood pressure is 90/54 mm Hg
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? Increase fluid intake if dryness of the mouth is a problem. Change position slowly to help prevent dizziness and falls. Include high-potassium foods such as bananas in the diet. Check blood pressure (BP) in both arms before taking the drug.
change position slowly to help prevent dizziness and falls
Which nursing intervention is likely to be most effective when assisting the patient with coronary artery disease to make appropriate dietary changes? Inform the patient about a diet containing no saturated fat and minimal salt. Give the patient a list of low-sodium, low-cholesterol foods that should be included in the diet. Emphasize the increased risk for heart problems unless the patient makes the dietary changes. Help the patient modify favorite high-fat recipes by using monounsaturated oils.
help the pt modify favorite high-fat recipes by using monounsaturated oils
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 increase the dietary intake of high-potassium foods. move slowly when moving from lying to sitting to standing. check the blood pressure (BP) at home at least once a day.
increase the dietary intake of high-potassium foods.
Nadolol (Corgard) is prescribed for a patient with chronic stable angina and left ventricular dysfunction. To determine whether the drug is effective, the nurse will monitor for improvement in the strength of the distal pulses. participation in daily activities without chest pain. fewer complaints of having cold hands and feet. decreased blood pressure and heart rate.
participation in daily activities without chest pain
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 daily alcohol use. reactive airway disease. peptic ulcer disease. myocardial infarction (MI).
reactive airway disease
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? Use an automated noninvasive blood pressure machine to obtain frequent measurements. Organize nursing activities so that the patient has undisturbed sleep for 8 hours at night. Keep the patient NPO to prevent aspiration caused by nausea and possible vomiting. Assist the patient up in the chair for meals to avoid complications associated with immobility.
use an automated noninvasive blood pressure machine to obtain frequent measurements