Level 2: Topic 4

A nurse provides education to a patient with hypertension related to lifestyle modifications to reduce overall cardiovascular risk. Which statement made by the patient indicates effective learning? Select all that apply. 1. "I should exercise for at least 30 minutes daily." 2. "I should achieve and maintain a healthy weight." 3. "I should limit my alcohol intake to five drinks per day." 4. "I should restrict my salt intake to less than or equal to 1500 mg/day." 5. "I can continue to smoke because nicotine does not affect blood pressure."

1. "I should exercise for at least 30 minutes daily." 2. "I should achieve and maintain a healthy weight." 4. "I should restrict my salt intake to less than or equal to 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.

The nurse provides discharge teaching to a patient who is newly diagnosed with coronary artery disease (CAD). Which statement made by the patient indicates understanding of the dietary modifications that need to be implemented after discharge home? 1. "I will not eat bacon or any pork products." 2. "I will eat only fried eggs instead of boiled eggs." 3. "I may continue to enjoy French fries with hot dogs." 4. "I will drink no more than one glass of whole milk per day."

1. "I will not eat bacon or any pork products." Nutritional guidelines recommended for the patient with CAD include a low-cholesterol and low-fat diet; therefore the patient has to avoid bacon and any pork products. Egg yolk is high in cholesterol and the patient with CAD has to avoid fried food. French fries are high in fat because of their preparation process. Low-fat or nonfat milk is recommended for the patient with CAD.

Which statement by an 84-year-old patient with coronary artery disease (CAD) indicates understanding of discharge teaching about physical activity? 1. "I will use longer rest periods between exercise sessions." 2. "I can stop exercising as soon as my cardiac symptoms disappear." 3. "I should exercise outside all the time to achieve better results" 4. "I have to exercise for longer periods of time and more vigorously compared with younger people."

1. "I will use longer rest periods between exercise sessions." Older adults have to use longer rest periods between exercise sessions because of decreased endurance and ability to tolerate stress. Older adults have decreased sweating and, therefore, shouldn't exercise in hot temperatures. Older adults have to perform low-level activity exercise for longer periods of time. Elderly adults have to change their lifestyles to accommodate a physical activity program, even though they are more prone to make such changes during hospitalization or when experiencing symptoms of CAD.

What instruction should the nurse give to a patient to reduce the risk of coronary artery disease (CAD) by lowering LDL cholesterol? Select all that apply. 1. "Increase complex carbohydrates such as fruit." 2. "Increase fiber intake by eating food such as legumes." 3. "Choose foods made with whole grains such as brown rice." 4. "Avoid fatty fish such as tuna." 5. "Fat intake should be about 40% of total calories."

1. "Increase complex carbohydrates such as fruit." 2. "Increase fiber intake by eating food such as legumes." 3. "Choose foods made with whole grains such as brown rice." It is recommended to increase the intake of complex carbohydrates, fiber, and whole grains. The AHA recommends eating fatty fish twice a week. Fat intake should be about 25-35% of total daily calories.9

A patient is diagnosed with primary hypertension and asks the nurse what caused the condition. How should the nurse respond? 1. "There is no identified cause." 2. "Kidney disease is the most common cause." 3. "It is caused by a decrease in plasma renin levels." 4. "It is caused by too much plaque in the blood vessels."

1. "There is no identified cause." 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.

The nurse receives information about the assigned patients during shift report. Which patient should the nurse assess first? 1. A patient that reports a severe headache and that is vomiting 2. A patient that reports dizziness and whose blood pressure (BP) is 150/92 3. A patient with a hip fracture that reports a pain level of "2" on a 1 to 10 scale 4. A patient that received an angiotensin-converting enzyme (ACE) inhibitor 30 minutes previously reports fatigue

1. A patient that reports a severe headache and that is vomiting Severe headache and vomiting are signs of hypertensive crisis that is an emergency situation; therefore, the nurse must assess 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. A pain level of 2 on a scale of 1 to 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 an antihypertensive medication.

The nurse obtains a health history from a patient with primary hypertension and recognizes which nonmodifiable risk factors? 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.

The nurse is caring for a patient with a myocardial infarction. The health care provider prescribes an intravenous infusion of alteplase. What is the priority nursing intervention during the administration of this medication? 1. Assess neurologic status. 2. Observe for bleeding gums. 3. Monitor blood pressure for orthostatic changes. 4. Apply a pressure dressing to intravenous (IV) insertion site.

1. Assess neurologic status. Assessment for changes in neurologic status is the priority nursing intervention because this may indicate a cerebral bleed. Gingival or bleeding gums are expected with thrombolytic therapy and are controlled by applying ice packs. Application of a pressure dressing to the IV insertion site is not done until evidence of bleeding is noted. Monitoring blood pressure for orthostatic changes is necessary with the use of short-acting nitrates.

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 the medication abruptly. 2. Increase the intake of green leafy vegetables. 3. Take with orange juice to prevent hypokalemia. 4. Take a hot bath within one hour of the medication to promote vasodilation.

1. Do not stop taking the medication abruptly. Patients should not stop taking this medication abruptly because this may cause rebound hypertension. Beta blockers are not potassium wasting, so it is not necessary to take them with orange juice or to increase the intake of potassium-rich foods such as green leafy vegetables. The patient should be instructed to avoid hot baths within 3 hours of taking drugs that promote vasodilation; excessive hypotension may occur.

A nurse teaches a patient about strategies to prevent angina caused by coronary artery disease. The nurse tells the patient that if a heavy meal is eaten, to rest for 1 to 2 hours after the meal. What is the rationale for this instruction? 1. Eating a heavy meal would divert more blood to the gastrointestinal system. 2. Heavy meals cause obesity and increase the susceptibility to myocardial ischemia. 3. Eating a heavy meal can cause physical inactivity, which could precipitate angina. 4. Heavy meals cause excessive heat production, which leads to peripheral vasodilation.

1. Eating a heavy meal would divert more blood to the gastrointestinal system. The digestive system requires more blood supply for a longer period of time to digest heavy meals. Therefore blood is diverted to the gastrointestinal system, which causes reduced blood supply to the myocardium. Physical inactivity does not cause an anginal attack; angina can be precipitated by physical exertion. Eating heavy meals causes obesity in due course of time, and this increases the susceptibility of an individual to have coronary artery disease. This is not a valid reason here, because the patient already has coronary artery disease. Eating heavy meals does not cause peripheral pooling of blood.

A nurse assesses a patient whose angiogram revealed an 80% blockage of the left circumflex artery and 70% blockage of the right coronary artery. The patient does not show any symptoms of coronary ischemia. What is the most likely reason for this finding? 1. Formation of collateral circulation 2. Increased production of C-reactive proteins in the liver 3. Pulmonary artery supplies oxygenated blood to the heart 4. Lowering of low-density lipoprotein (LDL) levels in the body

1. Formation of collateral circulation Collateral circulation develops as an inherited predisposition to develop new blood vessels or in the presence of chronic ischemia. With sufficient collateral circulation, the heart may still receive an adequate amount of blood and oxygen; therefore the patient is asymptomatic. Lowering LDL levels does not prevent coronary ischemia in the patient whose myocardial blood supply is already compromised. The pulmonary artery consists of deoxygenated blood and does not supply blood to the coronary arteries unless there is a congenital anatomic variation. C-reactive proteins are inflammatory markers that are increased in patients with coronary artery disease. These are not associated with reducing coronary ischemia.

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 thickening of the capillary membranes, leading to hypoxia of organ systems. 3. Hypertension causes direct pressure on organs, resulting in necrosis and replacement of cells with scar tissue. 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.

The nurse is preparing discharge teaching for a patient with orthostatic hypotension and should include which instructions? Select all that apply. 1. Lie down or sit if dizziness occurs. 2. Avoid sleeping with the head elevated. 3. Do not stand still for prolonged periods. 4. Rise slowly from a supine to sitting position. 5. Perform leg exercises to increase venous return.

1. Lie down or sit if dizziness occurs. 3. Do not stand still for prolonged periods. 4. Rise slowly from a supine to sitting position. 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.

An elderly patient often experiences sudden dizziness when standing. The nurse should perform the steps of an assessment for orthostatic hypotension in what order? 1. Assist the patient to a sitting position with legs dangling. 2. Assist the patient to stand and measure blood pressure (BP) and heart rate (HR) within one to two minutes. 3. Measure blood pressure (BP) and heart rate (HR) in supine position after two to three minutes of rest. 4. Measure blood pressure (BP) and heart rate (HR) again within one to two minutes after sitting. 5. Evaluate the findings.

1. Measure blood pressure (BP) and heart rate (HR) in supine position after two to three minutes of rest. 2. Assist the patient to a sitting position with legs dangling. 3. Measure blood pressure (BP) and heart rate (HR) again within one to two minutes after sitting. 4. Assist the patient to stand and measure blood pressure (BP) and heart rate (HR) within one to two minutes. 5. Evaluate the findings. When assessing a patient for orthostatic or postural changes in BP and pulse, the nurse initially measures BP in supine position after two to three minutes of rest. BP and pulse are then measured one to two minutes after assisting the patient to a sitting position with legs dangling. Next, BP and pulse are assessed in the standing position after standing for one to two minutes. Finally, the findings should be evaluated to determine if orthostatic hypotension exists.

The nurse is caring for a patient with hypertension who is scheduled to receive a dose of esmolol. The nurse should withhold the dose and consult the prescribing health care provider for which vital sign taken just before administration? 1. Pulse 48 2. Respirations 24 3. Blood pressure 118/74 4. Oxygen saturation 93%

1. 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. Respirations, blood pressure, and oxygen saturation are not a source of concern in this case. Test-Taking Tip: Have confidence in your initial response to an item because it more than likely is the correct answer.

The nurse is describing the progressive development of coronary artery disease to a patient with coronary artery disease (CAD). The nurse recalls that the stages of development occurs in what order? 1. Thrombus formation occurs. 2. Collateral circulation is formed; new blood circulation routes are created or utilized. 3. Fibrous plaque narrows the vessel lumen. 4. Streaks of fat develop within the smooth muscle cells.

1. Streaks of fat develop within the smooth muscle cells. 2. Fibrous plaque narrows the vessel lumen. 3. Thrombus formation occurs. 4. Collateral circulation is formed; new blood circulation routes are created or utilized. The development stages of CAD are the fatty streaks stage, fibrous plaque stage, and, finally, the complicated lesion stage. If the disease progresses far enough, collateral circulation increases, although this is not considered a formal developmental stage of CAD. In CAD, elevated levels of low-density lipoproteins cause the transport of cholesterol and other lipids into injured arterial intima (fatty streaks stage). Once there, the lipids and fibrous tissues form a plaque, which narrows the vessel lumen and causes a reduction of blood flow to the cardiac muscle (fibrous plaque stage). This ischemia of the cardiac muscle can lead to the development of angina (complicated lesion stage). Plaque forms in lesions in the arteries. If the blockage of coronary arteries occurs slowly over time, there is a chance of collateral circulation occurring, in which new routes of blood circulation are formed to bypass blockages.

A patient undergoes routine blood pressure (BP) monitoring. What actions should the nurse take when obtaining the BP measurement? Select all that apply. 1. Support the patient's arm at heart level. 2. Deflate the cuff at a rate of 5-10 mm Hg/sec. 3. Average two or more readings, taken at intervals of at least 1 minute. 4. Ensure the patient has not exercised within 30 minutes before measurement. 5. Take the measurement immediately after placing the patient in the seated position.

1. Support the patient's arm at heart level. 3. Average two or more readings, taken at intervals of at least 1 minute. 4. Ensure the patient has not exercised within 30 minutes before 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 nurse should average two or more readings (taken at intervals of at least 1 minute). The nurse should obtain additional readings if the first two readings differ by more than 5 mm Hg. 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.

When providing nutritional counseling for patients at risk for coronary artery disease (CAD), which dietary selections should the nurse encourage them to include in their meal-planning? Select all that apply. 1. Tofu 2. Walnuts 3. Flaxseed 4. Whole milk 5. Orange juice

1. Tofu 2. Walnuts 3. Flaxseed Tofu, walnuts, and flaxseed are all rich in omega-3 fatty acids, which have been shown to reduce the risks associated with CAD when consumed regularly. Whole milk and orange juice have no benefits for CAD.

The nurse assesses an older patient for risk factors for coronary artery disease (CAD). What question should the nurse ask the patient? 1. What is your BMI number? 2. Did you receive a pneumococcal vaccine? 3. When did you last have a bowel movement? 4. Did you travel abroad within the last 12 months?

1. What is your BMI number? Risk for CAD increases with obesity, which is defined as a BMI more than 30 kg/m2. Constipation is not a risk factor for CAD. Traveling abroad to underdeveloped countries is a risk factor for infectious disease, but not for CAD. Pneumococcal vaccine protects the elderly patient from pneumonia, but not from CAD.

The community health nurse is planning health promotion teaching targeted at preventing coronary artery disease (CAD). Which population has the highest incidence of CAD? 1. White male 2. Hispanic male 3. African American male 4. Native American female

1. White male The incidence of CAD and myocardial infarction (MI) is highest among white, middle-aged men. Hispanic individuals have lower rates of CAD than non-Hispanic whites or African Americans. African Americans have an earlier age of onset and more severe CAD than whites and more than twice the mortality rate of whites of the same age. Native Americans have increased mortality in 35-year-old and under people, and have major modifiable risk factors, such as diabetes.

A nurse provides discharge teaching to a patient prescribed nitroglycerin sublingual tablets for the treatment of chronic stable angina. Which statement made by the patient indicates the need for further teaching? 1. "The sublingual tablets will expire six months from the time the bottle is opened." 2. "I will put the bottle in my front or back pant pockets before I leave the house." 3. "I can use this medication before exercising to prevent angina from occurring." 4. "Possible side effects include a warm feeling, headache, or lightheadedness. Sublingual nitroglycerin should not be stored in pant pockets because body heat can cause degradation of the nitroglycerin tablets. Flushing (warm feeling), headache, or dizziness (lightheadedness) may occur following sublingual nitroglycerin administration. Sublingual nitroglycerin can be used prophylactically before starting an activity that is known to cause an anginal attack. Sublingual nitroglycerin tablets tend to lose potency once the bottle has been opened; therefore it should be replaced every six months.

2. "I will put the bottle in my front or back pant pockets before I leave the house."

A nurse provides discharge teaching to a patient prescribed nitroglycerin sublingual tablets for the treatment of chronic stable angina. Which statement made by the patient indicates the need for further teaching? 1. "The sublingual tablets will expire six months from the time the bottle is opened." 2. "I will put the bottle in my front or back pant pockets before I leave the house." 3. "I can use this medication before exercising to prevent angina from occurring." 4. "Possible side effects include a warm feeling, headache, or lightheadedness.

2. "I will put the bottle in my front or back pant pockets before I leave the house." Sublingual nitroglycerin should not be stored in pant pockets because body heat can cause degradation of the nitroglycerin tablets. Flushing (warm feeling), headache, or dizziness (lightheadedness) may occur following sublingual nitroglycerin administration. Sublingual nitroglycerin can be used prophylactically before starting an activity that is known to cause an anginal attack. Sublingual nitroglycerin tablets tend to lose potency once the bottle has been opened; therefore it should be replaced every six months.

The nurse teaches a student nurse about acute pericarditis. Which statement made by the student nurse indicates effective learning? 1. "I should massage the patient in the chest region to relieve symptoms." 2. "The patient's chest pain can be relieved by sitting in the forward position." 3. "Acute pericarditis should be treated immediately by intravenous heparin." 4. "Treatment of acute pericarditis involves mitral valve repair or replacement."

2. "The patient's chest pain can be relieved by sitting in the forward position." Acute pericarditis is an inflammation of the pericardium that may occur within two to three days of acute myocardial infarction. The patient's chest pain is relieved after sitting in the forward position. The pain may return after a change in position or inspiration. Massaging the chest region may aggravate the symptoms. Intravenous heparin is given to a patient with an unstable thrombus or coronary artery spasm. Papillary muscle dysfunction treatment involves mitral valve repair or replacement. Acute pericarditis treatment involves nonsteroidal anti-inflammatory agents, aspirin, and corticosteroids.

A nurse who is preparing a patient for cardiac catheterization should perform a baseline assessment of vital signs, pulse oximetry, and heart and lung sounds. What other vital assessment should the nurse include? 1. Anemia 2. Allergies 3. Dysrhythmia 4. Mental status

2. Allergies Before performing a cardiac catheterization, the nurse should assess the patient for an allergy to contrast medium, which would have an immediate adverse effect on the patient receiving this procedure. Anemia, dysrhythmia, and change in mental status present less immediate complications during a cardiac catheterization procedure.

The nurse is preparing to administer atenolol to a patient with hypertension. The medication has what mechanism of action that makes it beneficial to a patient with this diagnosis? 1. Activates dopamine receptors 2. Blocks β-adrenergic receptors 3. Relaxes arterial and venous smooth muscles 4. Reduces conversion of angiotensin I to angiotensin II

2. Blocks β-adrenergic receptors Atenolol is a cardioselective β-adrenergic blocker that reduces blood pressure. It also reduces cardiac output and reduces sympathetic vasoconstrictor tone. It also decreases renin secretion by kidneys. Fenoldopam, a direct vasodilator, activates dopamine receptors, resulting in systemic and renal vasodilation. Angiotensin-converting enzyme inhibitors inhibit ACE, reducing conversion of angiotensin I to angiotensin II. Nitroglycerin is a direct vasodilator, which relaxes arterial and venous smooth muscle, reducing preload and SVR.

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.

The nurse provides information to a patient about preventing coronary artery disease (CAD) by maintaining healthy serum low-density lipoproteins (LDL) and high-density lipoprotein (HDL) levels. The nurse should include what goals? 1. Decreased LDLs; decreased HDLs 2. Decreased LDLs; increased HDLs 3. Increased LDLs; increased HDLs 4. Increased LDLs; decreased HDLs

2. Decreased LDLs; increased HDLs Low-density lipoproteins (LDLs) contain more cholesterol than any other lipoprotein and have an attraction to arterial walls, whereas high-density lipoproteins carry lipids away from the arteries to the liver for metabolism and prevent lipid accumulation within the arterial walls. Therefore increasing high-density lipoprotein (HDL) levels and decreasing low-density lipoprotein (LDL) levels are most helpful in lose should not advise the patient to decrease high-density lipoproteins or increase low-density lipoprotein levels, because these actions would be counterproductive.

The nurse is reviewing a patient's lipid profile results. Which level increases the patient's risk of coronary artery disease (CAD)? 1. Decreased triglycerides 2. Elevated low-density lipoproteins (LDL) 3. Elevated high-density lipoproteins (HDL) 4. Decreased very-low-density lipoproteins (VLDL)

2. Elevated low-density lipoproteins (LDL) Elevated LDLs contain more cholesterol than any of the other lipoproteins and have an affinity for arterial walls. Elevated LDL levels correlate most closely with an increased incidence of atherosclerosis and CAD. Elevated HDL, decreased triglycerides, and VLDL are all negative risk factors for CAD.

A nurse is caring for a patient with a history of chronic stable angina that reports chest pain. What is a characteristic of pain related to this type of angina? 1. It generally lasts longer than 15 to 20 minutes. 2. It will be relieved by rest, nitroglycerin, or both. 3. It is frequently associated with vomiting and extreme fatigue. 4. It indicates that irreversible myocardial damage is occurring.

2. It will be relieved by rest, nitroglycerin, or both. Chronic stable angina is characterized by intermittent chest pain, often described as pressure or tightness that occurs over a period of time in the same pattern, onset, and intensity. It commonly subsides when precipitating factors have stopped and the patient is at rest or with the use of nitroglycerin. The pain usually lasts just 5 to 15 minutes and does not always indicate irreversible myocardial damage. Vomiting and extreme fatigue are symptoms of myocardial infarction and are not commonly seen in chronic stable angina.

The nurse recognizes indications of unstable angina if a patient experiences what symptoms? 1. Dyspnea, hyperglycemia, and polyuria 2. Nausea, indigestion, and shortness of breath 3. Peripheral edema and decreased urinary output 4. Confusion, dysrhythmias, and difficulty breathing

2. Nausea, indigestion, and shortness of breath A patient experiencing fatigue, indigestion, and shortness of breath may be experiencing an unstable anginal attack. A patient experiencing dyspnea, hyperglycemia and polyuria may have diabetes. A patient with peripheral edema and a decreased urine output may have right ventricular dysfunction or heart failure due to UA or coronary artery disease. Altered mental status (confusion), difficulty in breathing, dizziness, and dysrhythmias are observed in elder patients with UA. Test-Taking Tip: A patient should never neglect any signs of myocardial infarction. Educating the public, especially females, is important, to identify the complications early.

When teaching a patient about dietary management of stage 1 hypertension, which instruction is important for the nurse to provide? 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.

When caring for a patient admitted with poorly controlled hypertension, the nurse identifies that which laboratory test result indicates the presence of target organ damage? 1. Serum uric acid of 3.8 mg/dL 2. Serum creatinine of 2.6 mg/dL 3. Serum potassium of 3.5 mEq/L 4. Blood urea nitrogen (BUN) of 15 mg/dL

2. 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.

A patient receives instructions about monitoring the blood pressure (BP) levels at home. What should the nurse teach the patient about measuring the BP in a supine position? 1. Take the reading immediately after lying down. 2. Support the arm with a pillow during measurement. 3. Take at least two consecutive readings one after another. 4. Use the arm with the lower 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.

A patient with chronic hypertension is admitted to the emergency department with a sudden rise in blood pressure (BP). What is the priority question for the nurse to ask the patient? 1. "Are you pregnant?" 2. "Do you need to urinate?" 3. "Do you have a headache or confusion?" 4. "Are you taking antiseizure medications as prescribed?"

3. "Do you 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.

What instruction should the nurse give to the patient who is predisposed to coronary artery disease (CAD)? Select all that apply. 1. "Avoid consuming tofu." 2. "Drink whole or 2% milk." 3. "Limit concentrated fruit juice." 4. "Decrease the intake of beans." 5. "Choose foods such as buckwheat and oats."

3. "Limit concentrated fruit juice." 5. "Choose foods such as buckwheat and oats." Concentrated fruit juices are high in added sugar and should be limited. Buckwheat and oats are made whole grain and are recommended. Beans are a good source of fiber and are recommended. The AHA recommends eating tofu because it contains alpha-linolenic acid, which becomes omega-3 fatty acid in the body. Patients should select fat free or low fat dairy products.

The nurse teaches a student nurse about diagnostic studies used for acute coronary syndrome. Which statement made by the student nurse indicates effective learning? 1. "A nitroprusside stress echocardiogram is used for patients with acute pericarditis." 2. "A pathogenic Q wave is always present in the electrocardiogram (ECG) of patients with unstable angina." 3. "Serum cardiac markers are proteins that are released from necrotic heart muscle." 4. "Coronary angiography is the only way to confirm the diagnosis of unstable angina."

3. "Serum cardiac markers are proteins that are released from necrotic heart muscle." Serum cardiac markers such as myoglobin, creatine kinase, cardiac-specific troponin I (cTnI), and cardiac-specific troponin T (cTnT) are released in patients with myocardial infarction (MI) into the blood from necrotic heart muscle. These markers are important to diagnose MI. A patient with a pathologic Q wave and ST-elevated MI has prolonged coronary occlusion because the MI evolves with time. Pharmacologic stress echocardiogram testing with dobutamine, dipyridamole, or adenosine simulates the effects of exercise and is performed on patients who are unable to exercise or have abnormal, nondiagnostic baseline echocardiograms. A coronary angiography is used for patients with stable or high-risk unstable angina.

The patient is diagnosed with stage 1 hypertension. The nurse understands that this correlates with which systolic blood pressure measurement? 1. 130mm Hg 2. 139mm Hg 3. 142mm Hg 4. 162mm Hg

3. 142mm Hg Stage 1 hypertension is defined as a systolic blood pressure of 140 to 150 or a diastolic blood pressure of 90 to 99 mm Hg. Systolic blood pressures of 130 and 139 are defined as prehypertension. A systolic blood pressure of 162/92 mm Hg is categorized as stage 2 hypertension.

The rupture of plaque in the artery occurs in which stage of the pathogenesis of arterial disease? 1. Fatty streak 2. Fibrous plaque 3. Complicated lesion 4. Chronic endothelial injury

3. Complicated lesion The rupture of plaque in the artery occurs when the lesion is complicated. The plaque ruptures, and thrombus formation occurs, as does further narrowing or total occlusion of the vessel. Fibrous plaque occurs when collagen covers the fatty streak, narrowing the artery, thus reducing the blood flow. When the fatty streak forms, lipids accumulate and migrate into the smooth muscle cells. Chronic endothelial injury occurs secondary to exposure of toxins, infections, and certain disease processes.

The nurse suspects that a patient is experiencing postural hypotension. The nurse recalls that the hypotension occurs when there are what changes in the blood pressure (BP) and heart rate (HR)? 1. Increased systolic BP and/or decreased HR 2. Increased diastolic BP and/or decreased HR 3. Decreased systolic BP, decreased diastolic BP, and/or increased HR 4. Decreased systolic BP, increased diastolic BP, and no change in HR

3. Decreased systolic BP, decreased diastolic BP, and/or increased HR 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.

The nurse assesses a patient with papillary muscle dysfunction. Which observation supports the patient's diagnosis? 1. Crackles 2. S3 heart sound 3. Murmur at the cardiac apex 4. Deep sound noted while auscultating at the lower sternal border

3. Murmur at the cardiac apex Papillary muscle dysfunction occurs if the papillary muscles attached to the mitral valves are involved in infarction. A patient may have papillary muscle infraction if a murmur is heard upon auscultation at the cardiac apex. The presence of crackles of breath sounds and S3 and S4 sounds of the heart indicate heart failure. The deep sound heard at the lower left sternal border upon auscultation indicates acute pericarditis.

A patient is hospitalized with uncontrolled hypertension. The nurse anticipates that which diagnostic study will be prescribed? 1. Cardiac MRI 2. Thyroid function tests 3. Ophthalmic examination 4. Computerized tomography (CT) scan of the head

3. Ophthalmic examination An ophthalmic exam is performed to assess the appearance of the retina. It can provide important information about the severity and duration of hypertension. A cardiac MRI, a CT of the head, or thyroid function tests will not provide useful information about hypertension.

Which is a characteristic of a complicated lesion? 1. Formation of a fibrous plaque 2. Lipid-filled smooth muscle cells 3. Platelet aggregation and adhesion 4. Transport of lipids into arterial intima

3. Platelet aggregation and adhesion A complicated lesion is characterized by accumulation of platelets leading to thrombus formation. Formation of a fibrous plaque is the beginning of progressive changes in the endothelium of the arterial wall. It is called the fibrous plaque stage. Fatty streaks are the earliest lesions of atherosclerosis and are characterized by lipid-filled smooth muscle cells. Transport of lipids into the arterial intima occurs in the fibrous plaque stage.

A nurse reviews a patient's medical history and identifies which findings as major modifiable risk factors? Select all that apply. 1. Age 2. Gender 3. Tobacco use 4. BP 150/92 mm Hg 5. Genetic predisposition 6. Cholesterol 180 mg/dL 7. Waist circumference 42 inches

3. Tobacco use 4. BP 150/92 mm Hg 7. Waist circumference 42 inches Major modifiable risk factors include BP > 140/90 mm Hg, tobacco use, and waist circumference > 40 inches in men and > 35 inches in women. Age, genetic predisposition, and gender are nonmodifiable. A total cholesterol level > 200 mg/dL is a risk factor.

When advising an obese patient about ways to prevent coronary artery disease (CAD), the nurse suggests using tofu instead of chicken when making food dishes. Which reason led the nurse to make this suggestion? Select all that apply. 1. Tofu has a high salt content. 2. Tofu has very low fiber content. 3. Tofu is a good source of alpha-linolenic acid. 4. Tofu increases the triglyceride levels in the body. 5. Tofu increases omega-3 fatty acid levels in the body.

3. Tofu is a good source of alpha-linolenic acid. 5. Tofu increases omega-3 fatty acid levels in the body. The American Heart Association recommends consuming tofu and other soybean products because they are rich sources of alpha-linolenic acid. Alpha-linolenic acid is converted to omega-3 fatty acids, which reduce the risk of coronary artery disease by lowering the triglyceride levels in the body. A diet high in salt may increase blood pressure, which could make an individual more susceptible to developing coronary artery disease. A high-fiber diet is preferred to prevent coronary artery disease because fiber is known to reduce total cholesterol and low-density lipoprotein levels. Increased triglyceride levels make an individual more susceptible to atherosclerosis.

Which suggestion is most important for the nurse to provide to a patient with a waist circumference of 42 inches? 1. "Check your blood pressure regularly." 2. "Check your blood glucose levels regularly." 3. "Consume saturated fats for health reasons." 4. "Exercise regularly to maintain an ideal body weight."

4. "Exercise regularly to maintain an ideal body weight." Obesity is described as a waist circumference of more than 40 inches for men and more than 35 inches for women. The patient should be advised to exercise regularly to achieve an ideal body weight. The patient does not have high blood pressure, so it is not necessary to check it regularly; it is only advisable to eliminate other risk factors. High blood glucose levels increase the risk of developing coronary heart disease, but do not help maintain ideal body weight. The patient should be advised not to consume saturated fats, because they may lead to additional weight gain and coronary artery disease (CAD).

The nurse provides information to a patient about ways to decrease risk factors for coronary artery disease (CAD). Which statement by the patient indicates understanding of the teaching? 1. "I will add weightlifting to my daily exercise program." 2. "I will change my diet to increase my intake of saturated fats." 3. "I need to switch to smokeless tobacco instead of smoking cigarettes." 4. "I will change my lifestyle to alter patterns that add to my stress."

4. "I will change my lifestyle to alter patterns that add to my stress." Health-promoting behaviors for those at risk for CAD include: improving physical activity such as brisk walking (three to four miles/hour for at least 30 minutes five or more times a week); reducing total fat and saturated fat intake; stopping all tobacco use, and altering patterns that are conducive to stress.

The nurse provides education to a 68-year-old patient who is experiencing orthostatic hypotension. Which statement made by the patient indicates the need for further teaching? 1. "I should change positions slowly, so I do not become lightheaded." 2. "I should continue to limit my salt intake, which helps prevent high blood pressure." 3. "This may be caused by dehydration, so perhaps I should increase my fluid intake." 4. "This may be caused by my blood pressure medications, which I should stop taking immediately."

4. "This may be caused by my blood pressure medications, which I should stop taking immediately." Blood pressure medications may contribute to orthostatic hypotension; however, medications should not be discontinued unless advised by the health care provider. Changing positions slowly and limitation of salt intake are all correct ways to promote cardiovascular health and safety associated with the hypotension. Dehydration is a common cause of orthostatic hypotension and should be addressed.

The nurse is providing care to a patient with chronic stable angina that is scheduled for a cardiac catheterization. What finding associated with myocardial ischemia could be obtained by this diagnostic procedure? 1. ST segment depression 2. Cardiac enlargement 3. Abnormal cardiac wall motion 4. 70% block in right coronary artery

4. 70% block in right coronary artery Cardiac catheterization is an invasive diagnostic procedure to find out the location and severity of blockages in the coronary circulation. ST segment depression is an important diagnostic finding for the presence of myocardial ischemia, which is obtained by electrocardiography (ECG). Cardiac enlargement is a sign of heart failure that can be seen on an x-ray. Echocardiography is used to detect the presence of abnormal wall motion due to myocardial ischemia.

When evaluating a patient's knowledge regarding a low-sodium, low-fat cardiac diet, the nurse recognizes additional teaching is needed when the patient selects which food item? 1. Baked flounder 2. Angel food cake 3. Baked potato with margarine 4. Canned chicken noodle soup

4. Canned chicken noodle soup Canned soups are very high in sodium content. Patients need to be taught to read food labels for sodium and fat content. Baked flounder, angel food cake, and baked potato with margarine are all low in sodium and low in fat and would be appropriate for this diet.

A patient that takes digoxin daily is being treated for hyperlipidemia. The nurse should question a prescription for what lipid-lowering drug that the patient is scheduled to take? 1. Niacin 2. Icosapent 3. Atorvastatin 4. Cholestyramine

4. Cholestyramine Fibric acid derivatives, such as cholestyramine, interfere with the absorption of many drugs including digoxin. Icosapent ethyl is an omega-3 fatty acid. Niacin is in the broad category name of niacin. Atorvastatin is an HMG-CaA reductase inhibitor (statin).

To reduce a patient's risk of coronary artery disease (CAD), the nurse recognizes that dietary teaching is needed when the patient's high density lipoprotein (HDL) and low-density lipoprotein (LDL) profile reveals what two abnormal results? 1. Increased HDLs; increased LDLs 2. Decreased HDLs; decreased LDLs 3. Increased HDLs; decreased LDLs 4. Decreased HDLs; increased LDLs

4. Decreased HDLs; increased LDLs The risk of CAD is associated with increased LDLs (> 160 mg/dL) and decreased HDLs (< 40 mg/dL).

What is an appropriate nursing intervention for a patient who smokes cigarettes and is predisposed to developing coronary artery disease? 1. Recommend smokeless tobacco. 2. Encourage the use of filtered cigarettes. 3. Suggest smoking low nicotine cigarettes. 4. Discuss medication to assist with smoking cessation.

4. Discuss medication to assist with smoking cessation. The patient must be encouraged to quit smoking. Smoking cessation medications such as bupropion can be used to prevent the withdrawal symptoms of nicotine. Even if the patient is using smokeless tobacco, the risk of developing coronary artery disease is the same. Changing to filtered cigarettes does not affect the risk of developing coronary artery disease. Changing from high-nicotine to low-nicotine cigarettes also does not affect the risk of getting coronary heart disease.

A patient recently diagnosed with coronary artery disease (CAD) asks the nurse: "What caused my problem?" The nurse responds that the CAD was most likely caused by what? 1. Orthostatic hypotension 2. Low oxygen saturation of the blood 3. The heart's inability to pump effectively 4. Fatty deposits on the walls of the coronary arteries

4. Fatty deposits on the walls of the coronary arteries The major cause of CAD is atherosclerosis, which is manifested by fatty deposits on the walls of coronary arteries. Decrease in pumping action of the heart will result in congestive heart failure (CHF). Low oxygen saturation of the blood is a result of respiratory problems. Hypertension, not orthostatic hypotension, will predispose a patient to development of CAD.

A patient survived an episode of sudden cardiac death (SCD) and is recovering in the intensive care unit (ICU). The nurse anticipates which intervention to prevent a recurrence? 1. Drug therapy with beta-blocker 2. Coronary artery bypass graft (CABG) 3. Percutaneous coronary intervention (PCI) 4. Implantable cardioverter-defibrillator (ICD)

4. Implantable cardioverter-defibrillator (ICD) The most common approach to preventing a recurrence is the use of an ICD. It has been shown that an ICD improves survival compared with drug therapy alone. Drug therapy and a PCI will not prevent a recurrence of SCD. A coronary artery bypass graft is not necessary.

A patient with Prinzmetal's angina who takes a short-acting nitrate reports feeling dizzy while changing positions. What prescription does the nurse anticipate? 1. Esmolol 2. Morphine sulfate 3. Intravenous heparin 4. Intravenous fluid bolus

4. Intravenous fluid bolus Prinzmetal's angina is treated with short-acting nitrates, such as nitroglycerin. Orthostatic hypotension is a common side effect of nitroglycerin because of the depletion of body fluid volume. Therefore the patient must be administered intravenous fluid bolus. Beta blockers such as esmolol can lead to hypotension, which may further worsen the patient's condition. Intravenous heparin is administered to a patient undergoing thrombolytic therapy; heparin is not suggested for a patient with Prinzmetal's angina. Morphine sulfate is the drug of choice for chest pain during angina that is unrelieved by nitroglycerin.

A patient is classified as having stage 2 hypertension on the basis of the blood pressure recorded. The nurse notes that the primary goal of therapy for the patient is to normalize the blood pressure. What should be the patient's target blood pressure? Incorrect1. 130/80 mm Hg 2. 140/90 mm Hg 3. 150/90 mm Hg 4. Less than 120/80 mm Hg

4. Less than 120/80 mm Hg The nurse's goal is to normalize the blood pressure (BP) of this patient. Therefore, the target blood pressure would be 120/80 mm Hg, which is a normal BP. If the patient has a blood pressure within 140 to 159/90 to 99 mm Hg range, then the patient has stage 1 hypertension. This can be controlled by drugs and lifestyle modifications. If the BP of the patient is within 120 to 139/80 to 89 mm Hg, then the patient has prehypertension. Lifestyle modifications are required for this patient to normalize the blood pressure. Blood pressure of 150/90 is indicative of stage 2 hypertension.

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

4. 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.

The nurse presents information to a group of nursing students about cultural and ethnic health disparities related to hypertension. What should the nurse include in the education about Mexican Americans, when comparing them to the white and African American populations? 1. Mexican Americans have higher rates of blood pressure control. 2. Mexican Americans are more likely to receive treatment for hypertension. 3. Mexican Americans have the highest prevalence of hypertension in the world. 4. Mexican Americans have lower levels of awareness of hypertension and its treatment.

4. Mexican Americans have lower levels of awareness of hypertension and its treatment. Mexican Americans have lower levels of awareness of hypertension and its treatment than do whites and African Americans. Mexican Americans are less likely to receive treatment for hypertension, and they have lower rates of blood pressure control. African Americans have the highest prevalence of hypertension in the world.

A patient who has received a maximum dose of nitroglycerin continues to report chest pain. What is the next medication that the nurse should administer to the patient? 1. Esmolol 2. Docusate 3. Ticagrelor 4. Morphine sulfate

4. Morphine sulfate Morphine sulfate is the drug of choice for a patient with unrelieved chest pain even after the administration of nitroglycerin. Esmolol is a beta blocker used to slow down the heart during minimally invasive direct coronary artery bypass (MIDCAB). Docusate is a stool softener that facilitates bowel movements. Ticagrelor is used in dual antiplatelet therapy on a patient with ongoing angina and negative cardiac markers.

The nurse is assessing a patient for orthostatic hypotension. First, the nurse measures the blood pressure (BP) and heart rate (HR) with the patient in the supine position. What is the next nursing action? 1. Repeat BP and HR in the supine position. 2. Ask the patient to sit or stand and then measure the BP and HR within 15 minutes. 3. Move the patient to a standing position and immediately measure the BP and HR. 4. Move the patient to a sitting position and measure the BP and HR again within 1 to 2 minutes.

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

A nurse is counseling a patient about dietary supplements normally used for the prevention and treatment of cardiovascular disease. Which supplement has strong scientific evidence for its use? 1. Melatonin 2. Green tea 3. Glucosamine 4. Omega-3 fatty acids

4. Omega-3 fatty acids There is strong scientific evidence for the use of omega-3 fatty acids in the treatment and prevention of hypertension, hypertriglyceridemia, and cardiovascular disease. Melatonin, green tea, and glucosamine are not indicated for prevention and treatment of cardiovascular disease. There is unclear scientific evidence for the use of green tea in the treatment of high cholesterol.

After reviewing the medical records of four patients, the nurse identifies that which patient is at the highest risk of developing coronary artery disease (CAD)? 1. Patient A: 43-year-old nonsmoking African American male 2. Patient B: 26-year-old Hispanic male that smokes one pack of cigarettes per day 3. Patient C: 49-year-old Caucasian male with a blood pressure 139/82 mm Hg 4. Patient D: 72-year-old African American female with a cholesterol level of 300 mg/dL

4. Patient D: 72-year-old African American female with a cholesterol level of 300 mg/dL Multiple risk factors increase the risk of CAD. Patient D has three risk factors: age over 55, African American ethnic background, and cholesterol level greater than 240 mg/dL. Patient A has two risk factors: middle age and male gender. Patient B has two risk factors for CAD: male gender and smoking. Patient C has two risk factors (age and gender) because the blood pressure is classified as prehypertension.