Perfusion EAQ - HTN, PE, DVT, and Anemia
Which statement by the student nurse demonstrates correct understanding of anemia related to chronic disease? "Red blood cells (RBCs) are normal in size and color; however, the number of cells produced is decreased." "RBC indices are usually low, indicating a need for oral iron supplementation." "Administration of vitamins B 12 and folate will help treat this type of longterm anemia." "This is the mildest form of anemia and is easily corrected through administration of blood products.
"Red blood cells (RBCs) are normal in size and color; however, the number of cells produced is decreased." Rationale: Anemia of chronic disease results in a decrease in the production of RBCs in response to chronic inflammation; the RBCs are normal size, shape, and color. RBC indices such as mean corpuscular volume and mean hemoglobin concentration are usually normal. Administration of folate or B 12 will not correct the anemia, because these levels are generally within normal limits. This form of anemia can be very severe, and treatment is directed at the identification and management of the underlying cause.
Which instruction would the nurse give an unlicensed assistive personnel (UAP) to perform while caring for a client prescribed captopril? Select all that apply. One, some, or all responses may be correct. Obtain blood pressure. Measure intake and output. Weigh the client every morning. Notify the nurse if the client has a dry cough. Assist the client to change positions slowly
ALL THE ABOVE Rationale: ACE inhibitors such as captopril are prescribed for the management of hypertension, heart failure, and diabetic nephropathy. The nurse would ask the UAP caring for a client taking captopril to perform several tasks. The UAP would obtain the client's blood pressure. The UAP would also measure the client's intake and output as well as obtain a daily weight in the morning. This data would help the nurse determine the client's fluid volume status and is an important component of heart failure management. The UAP would be aware that a dry cough is a common side effect of ACE inhibitors. Because of the blood pressure-lowering effects of this medication, the nurse would instruct the UAP to assist the client to make sure the client changes positions slowly.
Which action would help prevent venous thrombosis in a client during the perioperative period? Select all that apply. One, some, or all responses may be correct. Administer subcutaneous heparin injections. Give intravenous thrombolytic medications. Assist the client to don antiembolism stockings. ' Apply pneumatic compression devices to the legs. Remind the client about the importance of bed rest.
Administer subcutaneous heparin injections. Assist the client to don antiembolism stockings. ' Apply pneumatic compression devices to the legs. Rationale: Actions that help prevent postoperative venous thrombosis include administration of anticoagulant medications such as heparin, use of anti-embolism stockings, and use of pneumatic compression devices. Thrombolytic medications dissolve clots rather than prevent them and are typically not used for venous thrombosis because of the high bleeding risk associated with their use. Bed rest leads to venous stasis of blood and increases venous thrombosis risk.
Which condition can be prevented when a client with chronic kidney disease receives medication to manage anemia? Uremic frost Chronic fatigue Tubular necrosis Dependent edema
Chronic fatigue Rationale: Kidney failure results in impaired erythropoietin production, which causes anemia and chronic fatigue; treating the anemia will help in managing the fatigue. Uremic frost results because urea compounds and other waste products of metabolism that are not excreted by the kidneys are brought to the skin by small, superficial capillaries and are excreted and deposited on the skin. Tubular necrosis is a pathological condition of the kidneys that can lead to kidney failure. The anemia and dependent edema associated with kidney failure are not interrelated.
Which topic would be the most important to include in teaching when an obese client receives a diagnosis of high blood pressure? Causes of hypertension Symptoms of hypertension Effect of weight loss in hypertension Effect of lowering alcohol intake in hypertension
Effect of weight loss in hypertension Rationale: Weight loss is among the most powerful lifestyle modifications in lowering blood pressure. Because teaching should be individualized to the client, the effect of weight loss would be emphasized for this obese client. The other topics might also be addressed, but they are not as specific to the client. Causes of hypertension would be discussed, but with an emphasis on the effect of high weight in causing high blood pressure. Symptoms of hypertension (such as headaches and nose bleeds) would be discussed, but many clients do not have symptoms until they develop cardiovascular complications of hypertension. Limiting alcohol intake to 2 drinks a day for men and 1 drink per day for women and smaller men is recommended, but there is no indication that this client has a high alcohol intake.
Which action describes a therapeutic effect of atenolol? Heart rate decreases Blood pressure increases Bronchospasm is relieved Pulse oximetry is relieved
Heart rate decreases Rationale: Atenolol, a beta-blocker, slows the rate of sinoatrial (SA) node discharge and atrioventricular (AV) node conduction, thus decreasing the heart rate; it prevents angina by decreasing the cardiac workload and myocardial oxygen consumption. Blood pressure is not increased and may be decreased. Atenolol may promote bronchospasm, not relieve it. Atenolol does not directly affect gas exchange in the lungs to promote improving oxygenation.
Which information obtained by the nurse about a client would represent a risk factor for the client's admission diagnosis of hypertension? Select all that apply. One, some, or all responses may be correct. Daily use of 1 aspirin Occasional cocaine use Reduced hemoglobin level African American/Black heritage Increased high-density lipoprotein (HDL)
Occasional cocaine use African American/Black heritage Rationale: Cocaine is a stimulant that causes tachycardia and hypertension. Hypertension is more prevalent in African Americans/Blacks in the United States. Aspirin decreases platelet aggregation, thus reducing the risk for cardiovascular disease, but does not affect blood pressure. Lowered hemoglobin may increase the heart rate, not the blood pressure. Increased HDL reduces the risk for cardiovascular disease, and it does not affect hypertension.
Based upon the provided data, which client would the nurse suspect of having hypertension? Client A: cardiac output dec., Peripheral resistantce normal, Hematocrit dec. Client B: Cardiac output inc., Peripheral resistantce inc., Hematocrit inc. Client C:Cardiac output dec., Peripheral resistantce normal, Hematocrit normal Client D: Cardiac output normal, Peripheral resistantce inc., Hematocrit normal
Client B Rationale: The blood pressure (BP) in a client rises when the client's cardiac output, peripheral resistance, and hematocrit are increased. Because all of these parameters are increased in client B, then that client is suspected of having hypertension. The BP falls when cardiac output is decreased. So, clients A and C may be at risk of hypotension. Client D's cardiac output may not be at risk of hypertension.
Which drug action will the nurse include when describing the purpose of heparin in a client who develops thrombophlebitis in the right calf and is prescribed bed rest and initiated on an intravenous (IV) infusion of heparin? It prevents extension of the clot. It reduces the size of the thrombus. It dissolves the blood clot in the vein. It facilitates absorption of red blood cells.
It prevents extension of the clot. Rationale: Heparin interferes with activation of prothrombin to thrombin and inhibits aggregation of platelets. Heparin does not reduce the size of a thrombus. Heparin does not dissolve blood clots in the veins. Heparin does not facilitate the absorption of red blood cells.
Which assessment finding indicates a need for the nurse to consult with the health care provider before administering the prescribed metoprolol to a client with stable angina? Blood pressure 142/90 mm Hg Report of chest pain when walking Sinus bradycardia, rate 54 on monitor Large Q waves on the electrocardiogram
Sinus bradycardia, rate 54 on monitor Rationale: Because beta blockers such as metoprolol decrease heart rate, the nurse would communicate with the health care provider before giving metoprolol to a client with a slow heart rate. Administration of metoprolol to a client with a mildly elevated blood pressure is appropriate, because beta blockers lower blood pressure. Chest pain with exertion indicates possible myocardial ischemia and metoprolol will decrease cardiac oxygen demand and ischemia. Large Q waves on the electrocardiogram indicate that the client may have a history of myocardial infarction and metoprolol is appropriate to prevent further ischemia.
A pregnant client with a history of hypertension is treated with an angiotensin-converting enzyme (ACE) inhibitor. For which teratogenic effect of ACE inhibitors would the neonate be at risk? Growth delay Skull hypoplasia Neural tube defects Central nervous system defects
Skull hypoplasia Rationale: The use of ACE inhibitors in the second and third trimesters of pregnancy may cause skull hypoplasia in the newborn. Antiseizure medications may cause neural tube defects and growth delays in the newborn. Warfarin may cause skeletal and central nervous system defects in the newborn.
Which response would the nurse make to a 30-year-old client diagnosed with hyperlipidemia and hypertension who asks the nurse to explain why treatment is important, stating "I feel fine, so I don't really see the need to make any changes."? "Both high blood pressure and high cholesterol contribute to development of heart disease." "Lifestyle adaptations alone will be adequate as long as you continue to be asymptomatic." "Usually someone with these diagnoses will have symptoms of heart disease already." "You should discuss your questions about medical problems with the health care provider.
"Both high blood pressure and high cholesterol contribute to development of heart disease." Rationale: Because cardiac risk factors are cumulative in their effect on the development of coronary artery disease, treatment of both risk factors is advised before development of symptoms. Although lifestyle adaptations are an initial action in management of hypertension and hyperlipidemia, treatment with medications is also frequently required. The majority of young adults with hypertension and hyperlipidemia are asymptomatic. Although the health care provider will certainly answer questions, the nurse is also responsible for teaching clients about how to manage cardiac risk factors.
Which question would the nurse ask before administering an adrenergic agonist to a client with increased intraocular pressure "Do you take antidepressants?" "Do you have any respiratory disorders?" "Do you wear eyeglasses?" "Do you have allergies to sulfonamides?
"Do you take antidepressants?" Rationale: Clients prescribed adrenergic agonists should be asked whether they are taking any antidepressants, such as phenazoline, because these medications increase blood pressure, as do the adrenergic agonists; hence, this may lead to a hypertensive crisis. Clients prescribed beta-adrenergic blockers should be asked about any respiratory disorders, such as asthma because the medication causes constriction of pulmonary smooth muscle, which may lead to narrowing of the airway. While asking about contact lenses is appropriate, this is not the priority for adrenergic agonists; discoloration of the lens is not a critical as hypertensive crisis. Carbonic anhydrase inhibitors are similar to sulfonamides. They should not be prescribed to clients who are allergic to sulfonamides.
Which instruction is beneficial for an aging Black client with hypertension? "Check the pulse daily." "Have an annual urinalysis." "Record blood pressure weekly." "Visit an ophthalmologist monthly.
"Have an annual urinalysis." Rationale: Blacks have 20% less blood flow to the kidneys because of high sodium consumption. This causes anatomical changes in the blood vessels, thereby increasing the risk of kidney failure. Instructing the client with hypertension to have an annual urine examination would be beneficial. If the client has protein in the urine, this is a sign of high blood pressure and can signify kidney damage. Checking the pulse daily poses no harm to the individual but does not determine if the client has hypertension. Recording the blood pressure weekly is not often enough to identify hypertension. The client's blood pressure should be taken at least daily to determine if the client has problems. If the client has an eye-related problem, visiting an ophthalmologist should be suggested, but it is usually not monthly.
The nurse manager teaches the licensed practical nurse (LPN) the evidence-based practice regarding use of normal saline and low-dose heparin flush solutions for capped intravenous catheters. Which statement by the LPN indicates understanding of the content? Select all that apply. One, some, or all responses may be correct. "The use of small doses of heparin is safe." "The use of heparin flushes disappeared in the late 1990s." "The use of high doses of heparin solutions is not recommended for adults." "The use of heparin in peripheral intravenous catheters is recommended in neonates." "The catheters flushed with normal saline have shorter life spans than heparin-flushed catheters.
"The use of heparin flushes disappeared in the late 1990s." "The use of high doses of heparin solutions is not recommended for adults." Rationale: Although some organizations continued to use heparin flushes for a number of years, their use became less common and mostly disappeared in the late 1990s. It is not safe to use high doses of heparin in adults because of serious adverse events. Based on research, the use of normal saline flushes is now standard practice for flushing peripheral intravenous catheters. The use of heparin in peripheral intravenous catheters is not recommended in neonates. Research also shows that catheters flushed with normal saline lasted significantly longer than heparin-flushed catheters.
The registered nurse is teaching a nursing student about monoamine oxidase inhibitors (MAOIs). Which statement made by the student indicates the need for further teaching? Select all that apply. One, some, or all responses may be correct. 'Isocarboxazid is a selective MAO-B inhibitor.' 'MAO inhibitors are prescribed as adjunct to diphenhydramine.' 'Hypertensive crisis is a reported adverse effect of MAO inhibitors.' 'MAO inhibitors are prescribed to clients with Parkinson disease.' 'Interaction of sympathomimetic medications with MAO inhibitors may cause hypertensive crisis.'
'Isocarboxazid is a selective MAO-B inhibitor.' 'MAO inhibitors are prescribed as adjunct to diphenhydramine.' Rationale: Selegiline is a selective MAO-B inhibitor, whereas isocarboxazid is a non-selective MAO-A and MAO-B inhibitor. MAO inhibitors may be contraindicated in clients on diphenhydramine and cetirizine, as they may aggravate depression of the central nervous system. Hypertensive crisis is an adverse effect of MAO inhibitors. They can be prescribed to clients with Parkinson disease. Hypertensive crisis occurs when the sympathomimetic medications are taken with MAO inhibitors.
Which clinical finding enables the nurse to conclude that the heparin therapy is effective in a client who has atrial fibrillation with rapid ventricular response and is started on a continuous heparin infusion? Atrial fibrillation converts to a sinus rhythm. The heart rate is stabilized at 70 to 90 beats per minute. The international normalized ratio (INR) is within normal range. An activated partial thromboplastin time (aPTT) is twice the usual value.
An activated partial thromboplastin time (aPTT) is twice the usual value. Rationale: Heparin is an anticoagulant administered to clients with atrial fibrillation to prevent formation of mural thrombi. The desired anticoagulant effect is achieved when the activated partial thromboplastin time is 1.5 to 2 times normal. Medications other than heparin are administered to convert the rhythm and control the rate. The INR is not used to determine heparin effectiveness.
Which is the best action for the nurse to take when a client with hypertension tells the nurse, "I took the blood pressure pills for a few weeks, but I didn't feel any different, so I decided I'd only take them when I feel sick." ? Educate the client about the complications associated with high blood pressure. Ask the client questions to determine the current understanding of high blood pressure. Emphasize the importance of taking blood pressure medications now to continue to feel well. Show the client the current blood pressure and compare that with normal blood pressure levels.
Ask the client questions to determine the current understanding of high blood pressure. Rationale: Further assessment of the client's understanding of hypertension and treatment is important before the nurse can develop an effective plan to change the client's behavior. Education about complications of hypertension may be helpful, but first the nurse needs to know what the client already understands about the long-term effects of high blood pressure. An emphasis on taking medications now to ensure future health may be appropriate for this client, but further assessment is needed before using this strategy. Many clients may respond to actually seeing the difference between their blood pressures and the expected normals, but more information about the client's knowledge is needed to know if this will be a useful strategy for this client.
Which prescribed action would the nurse take first when a client who is admitted to the emergency department with a blood pressure of 240/150 mm Hg reports severe headache, blurred vision, and swelling of the ankles? Obtain a glucose blood sample. Collect urine and blood samples. Assess the client's pulse and respirations. Determine the amount of ankle edema.
Assess the client's pulse and respirations. Rationale: Baseline pulse and respiratory rates are needed rapidly to help detect complications of hypertension such as heart failure and dysrhythmias. Because changes in glucose level are not likely to have caused the client's current hypertension, checking the glucose level is not needed immediately. Collecting urine and blood samples is not the priority at this time; this may be done later. The nurse will need to assess and document the amount of ankle edema, but this is not a life-threatening symptom.
Which laboratory result will be important for the nurse to review when a client is admitted to the hospital with a long history of uncontrolled hypertension? Blood glucose level White blood cell count Blood urea nitrogen Lactic dehydrogenase
Blood urea nitrogen Rationale: Hypertension leads to changes in renal blood flow and eventually to decreased renal function, which is tested with blood urea nitrogen levels. All of the other results would also be reviewed by the nurse, but they are not associated with complications of hypertension. Changes in blood glucose level are not associated with hypertension, although if the client also has diabetes then there will be more risk for kidney disease. White blood cell count is not affected by hypertension, but it would be assessed for any possible infectious or inflammatory process. Lactic dehydrogenase is an enzyme associated with multiple other diagnoses, but it is not affected by hypertension.
Which action would the nurse take next when a 78-year-old client comes to the health clinic presenting with fatigue, and laboratory results indicate a hematocrit of 32% (0.32) and hemoglobin of 10.5 g/dL (105 mmol/L)? Conduct a complete nutritional assessment of the client. Plan to teach the client about taking daily iron supplements. Schedule the client to return to have the test repeated in 3 months. Explain that mild anemia is an expected response to the aging process
Conduct a complete nutritional assessment of the client. Rationale: A nutritional assessment starts the investigation for the cause of the client's anemia. Although anemia may be caused by iron deficiency, more assessments and testing are needed to establish the etiology of anemia for this client. The client may need to have results repeated in about 3 months, but this will depend on the etiology of the anemia and the treatments that are prescribed. Although mild anemia may occur with aging because of chronic illness, anemia is not considered to be part of the normal aging process and normal hemoglobin and hematocrit values do not change with aging
The nurse identifies which anticoagulant medications as safe to administer during pregnancy for treatment of thrombophlebitis? Select all that apply. One, some, or all responses may be correct. Heparin Warfarin Enoxaparin Clopidogrel Acetylsalicylic acid
Heparin Enoxaparin Rationale: Heparin may be used during pregnancy because it does not cross the placental barrier and will not cause hemorrhage in the fetus. Enoxaparin does not cross the placental barrier (formerly classified for pregnancy as category B). Warfarin crosses the placental barrier, causing hemorrhage in the fetus. Clopidogrel is a platelet aggregation inhibitor. It is not used for thrombophlebitis; it is used to reduce the risk of brain attack, transient ischemic attack, unstable angina, and myocardial infarction. Acetylsalicylic acid is a platelet aggregation inhibitor and is not recommended during pregnancy (formerly classified as category D).
Which nursing intervention will be implemented when the health care provider prescribes verapamil to be administered intravenously to a 70- year-old client with hypertension? Monitor the electrocardiogram for reflex tachycardia. Keep the client in bed for an hour after giving the medication. Dilute the dose in 50 mL of normal saline and administer it over 15 minutes. Assess the client for wheezes and history of asthma before administering the medication.
Keep the client in bed for an hour after giving the medication. Rationale: Hypotension is a common side effect of intravenously administered verapamil. Keeping the client in bed for an hour after administration provides for the safety of the client. Verapamil slows cardiac conduction as well as causing arterial dilation, so reflex tachycardia does not occur. Reflex tachycardia does occur with the dihydropyridine calcium channel blockers such as nifedipine. Verapamil should be administered undiluted when given intravenously. It is administered over 2 minutes for adults and over 3 minutes for older adults. Asthma history and wheezing would be assessed before administration of beta-receptor blockers, whereas heart rate and blood pressure would be checked before giving calcium channel blockers.
Which treatment would the nurse anticipate when caring for an infant with heart failure? Open heart surgery Cardiac stress test Aggressive intravenous fluid infusions Medications that are prescribed for both children and adults
Medications that are prescribed for both children and adults Rationale: Because the mechanism of heart failure is the same in children and adults, the same medications (e.g., cardiac glycosides, angiotensin-converting enzyme [ACE] inhibitors, and diuretics) are used, although the dosage will be adjusted for the infant and for the child. Open heart surgery may or may not be necessary; other treatments may be successful. A cardiac stress test is not an anticipated treatment for an infant. Also, a stress test is a diagnostic test, not a treatment. Aggressive fluid infusions are usually not prescribed for clients in heart failure. Excessive fluid increases the workload of the heart.
Which prescription by the health care provider would the nurse question when caring for a client who is hospitalized for an acute myocardial infarction? Long-acting beta blocker Daily low-dose aspirin tablet H 1 blocker to reduce gastric acid secretions Rectal suppository as needed for constipation
Rectal suppository as needed for constipation Rationale: Rectal stimulation can stimulate the vagus nerve and cause bradycardia and is avoided in clients who have had myocardial infarction. Long-acting beta blockers are commonly prescribed after myocardial infarction to prevent cardiac remodeling and heart failure. Low-dose aspirin is typically prescribed to clients with coronary artery disease or myocardial infarction to prevent new coronary artery thrombus from forming. H 1 blockers are frequently prescribed to hospitalized clients to prevent formation of stress-related gastric ulcers.
Which action would the nurse take after obtaining client blood pressures of 172/104 mm Hg and 164/98 mm Hg during a blood pressure screening? Provide health teaching about a low-sodium diet. Call the paramedics for transport to the hospital. Suggest ways to decrease the client's stress level. Refer the client to a primary health care provider.
Refer the client to a primary health care provider. Rationale: According to the current hypertension guidelines, both of these readings indicate hypertension and thus require further evaluation by a health care provider. Teaching about a low-sodium diet is an inadequate intervention for this client's hypertension. Because the client is asymptomatic, there is no need for transport to a hospital. Although reduction of stress may affect blood pressure, the client's hypertension will require further evaluation by a health care provider.
A 3-year-old child is admitted to the pediatric unit with a hemoglobin level of 6.4 g/dL (64 mmol/L). Which would the nurse's priority assessment be? Manifestations of shock Increased white blood cell count (WBC) Presence of hemoglobinuria Signs of cardiac decompensation
Signs of cardiac decompensation Rationale: Cardiac decompensation results because the heart attempts to maintain tissue oxygenation by increasing its workload. Shock occurs with hemorrhage because the body does not have time to adapt to the sudden loss of blood. With chronic anemia, compensatory mechanisms take over. An increased WBC count indicates infection; however, the data do not indicate the presence of an infection. Hemoglobin in the urine suggests hemolytic anemia. Although it is important to determine the cause of the anemia, this is not the priority.
After consistently obtaining a blood pressure of 140/76 mm Hg for a client, which stage of hypertension will the nurse document? Normal Elevated Stage 1 Stage 2
Stage 2 Rationale: According to the current American College of Cardiology guidelines, systolic blood pressure greater than or equal to 140 mm Hg is classified as stage 2 hypertension. Although the diastolic pressure of 76 mm Hg is normal, elevation of either the systolic or diastolic pressure results in a hypertension diagnosis. Normal blood pressure would be less than 120/80 mm Hg. Systolic pressures between 120 to 129 mm Hg and a diastolic pressure less than 80 mm Hg would be classified as elevated blood pressure. Stage 1 hypertension would be documented for systolic pressures between 130 to 139 mm Hg or diastolic between 80 to 89 mm Hg. Hypertensive crisis would be diagnosed for systolic pressures over 180 mm Hg and/or diastolic pressures over 120 mm Hg.
Which effect would the nurse anticipate after captopril is prescribed for a client? Increased urine output Decreased anxiety Improved sleep Decreased blood pressure
Decreasesd blood pressure Rationale: Captopril is an angiotensin-converting enzyme (ACE) inhibitor antihypertensive. It does not have diuretic, sedative, or hypnotic properties. Diuretics promote fluid excretion. Sedatives reduce muscle tension and anxiety. Hypnotics promote sleep.
Which finding indicates that a client's kidney transplant is successful Increased specific gravity Correction of hypotension Elevated serum potassium Decreasing serum creatinine
Decreasing serum creatinine Rationale As the transplanted organ functions, nitrogenous wastes are eliminated, lowering the serum creatinine. As more urine is produced by the transplanted kidney, the specific gravity and concentration of the urine will decrease. With end-stage renal disease,fluid retention causes hypertension; there should be a correction of hypertension, not hypotension. After the transplant, the serum potassium should correct to within expected limits for an adult
Sildenafil is prescribed for a man with erectile dysfunction. Which side effects of this medication would the nurse mention in teaching? Select all that apply. One, some, or all responses may be correct. Flushing Headache Dyspepsia Constipation Hypertension
Flushing Headache Dyspepsia Rationale: Flushing is a common central nervous system response to sildenafil. Headache is a common central nervous system response to sildenafil. Dyspepsia is a common gastrointestinal response to sildenafil. Diarrhea, not constipation, is a common gastrointestinal response to sildenafil. Hypotension, not hypertension, is a cardiovascular response to sildenafil. It should not be taken with antihypertensives and nitrates because medication interactions can precipitate cardiovascular collapse.
Which action would the nurse perform first when prioritizing care for a hypertensive client? Administer oxygen (O 2). Monitor the blood pressure (BP). Assess for a severe headache. Place the client in a semi-Fowler position.
Assess for a severe headache. Rationale: The client should be assessed for the presence of a severe headache to determine the presence of systemic complications related to the hypertension. O 2 administration depends on the condition of the client and the O 2 saturation level. The BP is monitored every 5 to 15 minutes. Placing the client in a semi-Fowler position should be followed during care for a hypertensive client.
Which clinical finding would the nurse expect for a client with hypertensive emergency? Increased urine output Severe pounding headache Heart rate 110 beats/minute Weak and thready radial pulses
Severe pounding headache Rationale: Hypertensive emergency often causes hypertensive encephalopathy because of increased cerebral capillary permeability, leading to severe headache, nausea, vomiting, and confusion or coma. Increased urine output would not be expected because acute kidney injury can occur with hypertensive emergency. Tachycardia is not typically seen with hypertensive emergency; high blood pressure can lead to bradycardia because of increased pressure on the carotid sinus and bodies. Radial pulses would be bounding with hypertensive emergency.
Which medication is a beta-adrenergic blocker used to reduce intraocular pressure? Timolol Travoprost Carbachol Apraclonidine
Timolol Rationale: Glaucoma is manifested by increased intraocular pressure. Timolol is a betaadrenergic blocker used in the treatment of glaucoma. Travoprost is a prostaglandin agonist, and apraclonidine is an adrenergic agonist used in the treatment of glaucoma. Carbachol is a cholinergic agonist used to treat glaucoma.
Which medication is often contraindicated when taking warfarin? Atenolol Ferrous sulfate Chlorpromazine Acetylsalicylic acid
Acetylsalicylic acid Rationale: Acetylsalicylic acid can cause decreased platelet aggregation, increasing the risk for undesired bleeding that may occur with the administration of anticoagulants. It should not be administered unless specifically prescribed, usually by a cardiologist or other specialist, to manage serious risks of thrombosis. Atenolol is a beta-blocker that reduces blood pressure; it does not affect bleeding. Ferrous sulfate does not affect warfarin; it is used for red blood cell synthesis. Chlorpromazine is a neuroleptic; it does not affect bleeding.
Which medication would a nurse conclude is the cause of a decreased heart rate in a client receiving a cardiac glycoside, a diuretic, an angiotensin-converting enzyme (ACE) inhibitor, and a vasodilator? Diuretic Vasodilator ACE inhibitor Cardiac glycoside
Cardiac glycoside Rationale: A cardiac glycoside such as digoxin decreases the conduction speed within the myocardium and slows the heart rate. The primary effect of a diuretic is on the kidneys, not the heart; it may reduce the blood pressure, not the heart rate. A vasodilator can cause tachycardia, not bradycardia, which is an adverse effect. ACE inhibitors act on the renin-angiotensin system and are not associated with decreased heart rates.
Which response indicates that a beta blocker prescribed for persistent ventricular tachycardia is working effectively? Decreased anxiety Reduced chest pain Decreased heart rate Increased blood pressure
Decreased heart rate Rationale: A decreased heart rate is the expected response to a beta blocker. Beta blockers inhibit the activity of the sympathetic nervous system and of adrenergic hormones, decreasing the heart rate, conduction velocity, and workload of the heart. A beta blocker is not an anxiolytic and does not reduce anxiety. A beta blocker is not an analgesic and does not reduce chest pain. Beta blockers reduce blood pressure.
Which symptoms would the nurse expect in a 3-year-old child with mild iron-deficiency anemia and fatigue? Cold, clammy skin Increased pulse rate Increased blood pressure Cyanosis of the nail beds
Increased pulse rate Rationale: Increased pulse rate (tachycardia) occurs as the body tries to compensate for the hypoxia resulting from mild iron-deficiency anemia. Severe anemia, however, can manifest as pale, cool, and clammy skin. Increased blood pressure is not a response associated with anemia. Cyanosis of the nail beds is a sign of carbon monoxide poisoning.
Which client would the nurse identify as being at greatest risk for a hypertensive disorder of pregnancy? Obese primigravida 31-year-old multipara Multipara with more than six previous pregnancies Primigravida who took oral contraceptives within 3 months of conception
Obese primigravida Rationale: A first pregnancy and obesity are both documented risk factors for hypertensive disorders of pregnancy. The risk for a hypertensive disorder of pregnancy increases when the client is younger than 20 years of age or older than 35 years of age. Grand multipara status and oral contraceptive use during the first 3 months of pregnancy are not known risk factors.
Which medication will the nurse be prepared to administer to a client admitted to the hospital with a diagnosis of deep vein thrombosis who is prescribed intravenous (IV) heparin sodium if the client experiences excessive bleeding? Vitamin K Oprelvekin Warfarin sodium Protamine sulfate
Protamine sulfate Rationale: Protamine sulfate binds with heparin sodium to form a physiologically inert complex; it corrects clotting deficits. Vitamin K counteracts the effects of medications like warfarin sodium. Oprelvekin is a thrombopoietic growth factor that stimulates the production of platelets. It would not be appropriate for emergency management. Warfarin sodium is an oral anticoagulant that interferes with the synthesis of prothrombin.
Which instruction would the nurse include when preparing discharge instructions for a client who will take enalapril for hypertension? "Change to a standing position slowly." "This may color your urine green." ' "The medication may cause a sore throat for the first few days." "Schedule blood tests weekly for the first 2 months."
"Change to a standing position slowly." Rationale: Enalapril is classified as an angiotensin-converting enzyme (ACE) inhibitor. Like many antihypertensives, it can cause orthostatic hypotension. Clients should be advised to change positions slowly to minimize this effect. This medication does not alter the color of urine or cause a sore throat the first few days of treatment. Presently, there are no guidelines that suggest blood tests are required weekly for the first 2 months.
Which client seen at a health fair will be most at risk for hypertension? 23-year-old white man 44-year-old white woman 50-year-old Mexican-American woman 62-year-old African American man
62-year-old African American man Rationale: African Americans have the highest risk for hypertension; before the age of 45, men are at higher risk than women. A 23-year-old white man would be a low risk for hypertension. A 44-year-old white woman would be a somewhat higher risk, but still much less than an African American man or woman. Mexican-American clients are less likely to seek treatment for hypertension, but they are not at higher risk than African Americans.
Which laboratory value would the nurse use to determine whether a client is receiving a therapeutic dose of intravenous heparin? International normalized ratio (INR) is between 2 and 3 Prothrombin time (PT) is 2.5 times the control value Activated partial thromboplastin time (APTT) is 70 seconds Activated clotting time (ACT) is in the range of 70 to 120 seconds
Activated partial thromboplastin time (APTT) is 70 seconds Rationale: When a client is receiving intravenous heparin, the APTT should be 1.5 to 2 times the normal APTT of 40 seconds, or 60 to 80 seconds. INR and PT are used to evaluate therapeutic levels of warfarin. The ACT is not commonly used for monitoring of heparin, but ACT increases to a range of 150 to 200 seconds when heparin reaches therapeutic levels.
Which antihypertensive medication class would the nurse identify as the likely cause of the cough in a client taking multiple medications for hypertension who develops a persistent, hacking cough? Thiazide diuretics Calcium channel blockers Direct renin inhibitors Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin-converting enzyme (ACE) inhibitors Rationale: The ACE breaks down kinins. When ACE is inhibited, the increase of kinins in the lung can cause bronchial irritation, leading to the common adverse effect sometimes referred to as an ACE cough. A cough is not a side effect of thiazide diuretics, calcium channel blockers, or direct renin inhibitors.
Which technique will the nurse employ to prevent excessive bruising when administering subcutaneous heparin? Administer the injection via the Z-track technique. Avoid massaging the injection site after the injection. Use 2 mL of sterile normal saline to dilute the heparin. Inject the medication into the vastus lateralis muscle in the thigh
Avoid massaging the injection site after the injection. Rationale: The site of the injection should not be massaged to avoid dispersion of the heparin around the site and subsequent bleeding into the area. The Z-track technique and the intramuscular route are not used with heparin; subcutaneous injection and intravenous administration are the routes appropriate for heparin administration. The medication should be injected into the subcutaneous tissue slowly, not quickly. Diluting heparin with normal saline is unnecessary. Generally, heparin is provided by the pharmacy department in single-dose syringes.
Which angiotensin-converting enzyme inhibitor (ACE inhibitor) is appropriate for a client with liver dysfunction? Select all that apply. One, some, or all responses may be correct. Ramipril Enalapril Quinapril Captopril Lisinopril
Captopril Lisinopril Rationale:Captopril and Lisinopril are the best choices for someone with liver dysfunction because they are the only two ACE inhibitors that are not inactive in the administered form and then are metabolized to the active form once they are in the body, usually by the liver. Ramipril, Enalapril, Quinapril, and Benazepril are not good choices for the client with liver dysfunction.
Which information will the nurse include when teaching a client with hypertension about metoprolol? Do not abruptly discontinue the medication. Consume alcoholic beverages in moderation. Report a heart rate of less than 70 beats per minute. Increase the medication dosage if chest pain occurs
Do not abruptly discontinue the medication. Rationale: Abrupt discontinuation of metoprolol may cause rebound hypertension and an acute myocardial infarction. Alcohol is contraindicated for clients taking beta-adrenergic blockers such as metoprolol. The pulse rate can go lower than 70 beats per minute as long as the client is asymptomatic. Clients should never increase medications without medical direction.
A client develops a deep vein thrombophlebitis in her leg 3 weeks after giving birth and is admitted for anticoagulant therapy. The nurse would anticipate developing a teaching plan for which anticoagulant? Heparin Warfarin Clopidogrel Enoxaparin
Hepatrin Rationale:Heparin is the medication of choice during the acute phase of a deep vein thrombosis; it prevents conversion of fibrinogen to fibrin and of prothrombin to thrombin. Warfarin, a long-acting oral anticoagulant, is started after the acute stage has subsided; it is continued for 2 to 3 months. Clopidogrel is a platelet aggregate inhibitor and is used to reduce the risk of a brain attack. A low-molecular-weight heparin (e.g., enoxaparin) is not administered during the acute stage; it may be administered later to prevent future deep vein thromboses.
Which abnormal laboratory value will the nurse expect when caring for a client with iron-deficiency anemia? Macrocytic red blood cells (RBCs) Thrombocytopenia Decreased folate levels Increased total iron-binding capacity (TIBC)
Increased total iron-binding capacity (TIBC) Rationale: TIBC may be elevated from 350 to 500 mcg/dL (82 µmol/L) (expected range is 250-460 mcg/dL [45-82 mcmol/L]) because more iron is being used to attempt to make more RBCs and less iron is bound to proteins that transport iron in the circulation. Iron deficiency causes microcytic RBCs. Platelet count is not decreased with iron-deficiency anemia. Folate deficiency would cause folate deficiency anemia, a macrocytic anemia.
Which manifestation would the nurse assess for in a client with a blood pressure of 190/94 who reports minimal urinary output despite adequate fluid intake? Thirst Weight gain Urinary retention Urinary hesitancy
Weight gain Rationale: If urine is not being produced in the presence of an average daily intake, fluid will be retained and reflected in weight gain. One liter of fluid weighs 2.2 pounds (1 kg). Excess fluid contributes to an increase in circulating blood volume, causing hypertension. Thirst is associated with dehydration, not hypertension and oliguria. Urinary retention is unrelated to hypertension. Urinary retention is the inability to empty the bladder. Urinary hesitancy is an involuntary delay in initiating urination and is unrelated to hypertension and oliguria.
