Chapter 19: Care of Patients with Hypertension and Peripheral Vascular Disease My Nursing Test Banks

Chapter 19: Care of Patients with Hypertension and Peripheral Vascular Disease

MULTIPLE CHOICE

1. Hypertension is diagnosed by the finding of a blood pressure reading greater than:

a.

120/80 twice, 2 weeks apart.

b.

140/90 twice, 2 weeks apart.

c.

120/80 on 3 consecutive days.

d.

140/90 every day for a week.

ANS: B

A diagnosis of hypertension is made if the systolic pressure is equal to or greater than 140 mm Hg and the diastolic pressure is equal to or greater than 90 mm Hg at least twice on two different occasions 2 weeks apart.

DIF: Cognitive Level: Comprehension REF: 398 OBJ: 10 (theory)

TOP: Hypertension: Diagnosis KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

2. Because of reduced sensitivity of the baroreceptors in the older adult who is also on a diuretic, the nurse instructs the patient to:

a.

walk for 20 minutes a day.

b.

reduce sodium in the diet.

c.

sit on the side of the bed before standing.

d.

use a walker for all ambulation.

ANS: C

Reduced sensitivity of the baroreceptors along with taking a diuretic predisposes the older adult to orthostatic hypotension; therefore, the nurse should caution the patient to change postures slowly to prevent becoming faint and falling.

DIF: Cognitive Level: Application REF: 400 | Elder Care Points

OBJ: 5 (clinical) TOP: Orthostatic Hypotension

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

3. The home health nurse is alarmed that the hypertensive patients blood pressure has risen to 200/160, but he denies any discomfort. The nurse interprets these assessments as being indicative of:

a.

malignant hypertension.

b.

hypertensive crisis.

c.

essential hypertension.

d.

secondary hypertension.

ANS: A

The diastolic pressure rising to readings between 140 and 170 and the patient being asymptomatic indicate malignant hypertension.

DIF: Cognitive Level: Comprehension REF: 401 OBJ: 3 (theory)

TOP: Malignant Hypertension KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. The nurse adds an intervention to the care plan of a patient who has just been prescribed a thiazide diuretic, which is to increase:

a.

intake of foods containing potassium.

b.

carbohydrates in the diet.

c.

foods high in sodium.

d.

fluid intake.

ANS: A

The thiazide diuretics are potent diuretics that flush out water, sodium, and potassium quickly. Potassium should be replaced, if not by prescription of oral potassium salts, then by modifying the diet.

DIF: Cognitive Level: Application REF: 402 | Table 19-3

OBJ: 3 (theory) TOP: Thiazide Diuretics

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

5. The patient has been prescribed a low-sodium diet. Which food omissions from the diet will indicate the patient has an adequate understanding of the recommended diet?

a.

Fresh spinach

b.

Hot dogs

c.

Pasta

d.

Grapefruit

ANS: B

Hot dogs and all other processed meats contain large amounts of sodium. Fresh fruits, vegetables, and pasta are allowed on a low-sodium diet.

DIF: Cognitive Level: Application REF: 405 | Nutrition Considerations

OBJ: 3 (theory) TOP: Low-Sodium Diet

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

6. The patient is instructed that the most common and effective antiplatelet aggregation agent is:

a.

warfarin.

b.

aspirin.

c.

alteplase (Activase).

d.

reteplase (Retavase).

ANS: B

Aspirin is the most common and effective antiplatelet agent.

DIF: Cognitive Level: Knowledge REF: 409 OBJ: 9 (theory)

TOP: Antiplatelet Therapy KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

7. The patient scheduled for a percutaneous angioplasty (PTA) is instructed that a ________ is left in the artery to keep it patent.

a.

bolus of alteplase

b.

dose of reteplase

c.

stent

d.

graft

ANS: C

A stent is left in the vessel after the angioplasty to keep the vessel open.

DIF: Cognitive Level: Knowledge REF: 409 OBJ: 10 (theory)

TOP: PTA: Stents KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

8. The nurse is providing patient teaching to a pregnant patient who works as a cashier in a grocery store. Which suggestion by the nurse will help most in preventing varicose veins?

a.

Add vitamin C to diet.

b.

March in place while standing at the counter.

c.

Avoid tight support hose.

d.

Wear supportive shoes.

ANS: B

Marching in place or any leg exercises will help blood flow in the lower limbs and prevent varicose veins. Support hose are very beneficial. Supportive shoes and vitamin C do not prevent venous congestion.

DIF: Cognitive Level: Analysis REF: 416 OBJ: 5 (clinical)

TOP: Varicose Veins: Prevention KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

9. An 86-year-old patient asks why her ankles have a brownish discoloration and the skin looks so thick. Which is the most accurate response by the nurse?

a.

The valves in the vessels in your legs arent working as well as they used to, which causes the discoloration and thickening of your skin.

b.

You probably arent getting enough iron in your diet. We should talk to your doctor about adding an iron supplement.

c.

How many years have you smoked? Nicotine will cause these changes in your skin.

d.

These are just normal changes seen in most elderly people.

ANS: A

Hemosiderin leaks out of the trapped red blood cells in the dilated vessels of the feet and ankles and stains the skin of people with venous insufficiency. In addition, fibrous tissue replaces subcutaneous tissue around the ankles and causes the skin to become thick and hardened. Iron and nicotine do not play a role in these skin changes with venous insufficiency, and these are not normal changes associated with aging.

DIF: Cognitive Level: Analysis REF: 420-421 OBJ: 3 (theory)

TOP: Signs of Chronic Venous Insufficiency: Hemosiderin

KEY: Nursing Process Step: Intervention

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. The nurse is planning the care for a patient who is to have a saphenous vein stripping. What will be the priority intervention?

a.

Bed rest and leg elevation for the first 12 to 24 hours

b.

Assessing the need for significant pain relief

c.

Massaging the legs to stimulate sluggish circulation

d.

Elevating the legs to prevent hematoma

ANS: A

Bed rest with leg elevation the first night after surgery is the standard of care. The legs are wrapped with Ace bandages to prevent hematomas and stimulate sluggish circulation. There is only minimal discomfort. Legs should not be massaged in any patient undergoing vein stripping.

DIF: Cognitive Level: Application REF: 420 OBJ: 10 (theory)

TOP: Vein Stripping for Varicosities KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

11. The 75-year-old diabetic patient has an inflamed area at the shin caused by scratching. Which intervention should the nurse perform first?

a.

Record the skin break.

b.

Apply antibiotic ointment.

c.

Wrap with an ACE bandage.

d.

Cover with clear occlusive dressing.

ANS: D

Covering the area with a clear dressing protects the area from further scratching and becoming infected. The skin break should be recorded and the primary care provider notified of the area and the immediate action taken. The nurse cannot apply antibiotic ointment or an ACE bandage without an order, and neither of these interventions is warranted in this situation.

DIF: Cognitive Level: Application REF: 421 OBJ: 2 (theory)

TOP: PVD: Skin Care KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

12. The Unna paste boot is wrapped in a variety of directions to make the most of muscular action. These dressings are usually changed:

a.

twice a day.

b.

once a day.

c.

every 2 to 3 days.

d.

twice a month.

ANS: C

Compression dressings are changed every 2 to 3 days.

DIF: Cognitive Level: Comprehension REF: 421-422 OBJ: 8 (theory)

TOP: Venous Insufficiency: Compression Dressings

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

13. The nurse assessing a patient with a deep venous thrombosis (DVT) becomes concerned when the patient demonstrates which sign or symptom?

a.

Hematuria

b.

Tingling in the limbs

c.

Hematemesis

d.

Hemoptysis

ANS: D

Development of embolisms are of primary concern for the patient with a DVT. Coughing of rust-colored sputum is the cardinal sign of a pulmonary embolus, which is a medical emergency.

DIF: Cognitive Level: Application REF: 416 | Clinical Cues

OBJ: 2 (clinical) TOP: Pulmonary Embolus: Signs

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

14. The patient with a deep venous thrombosis is on a protocol of IV urokinase. The nurse clarifies that this drug will:

a.

reduce the threat of pulmonary embolus.

b.

dissolve the clot.

c.

prevent platelet aggregation.

d.

reduce inflammation and pain.

ANS: B

Urokinase is given IV to dissolve the clot. The patient is very carefully monitored for bleeding.

DIF: Cognitive Level: Comprehension REF: 416 OBJ: 9 (theory)

TOP: DVT Treatment: Streptokinase KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

15. The patient who is on daily doses of warfarin is instructed in the use of a coagulation monitoring device. The patient is taught that the device will monitor which blood clotting time?

a.

PT

b.

PTT

c.

INR

d.

ACT

ANS: C

A coagulation monitoring device measures the INR level for clotting time for a person on therapeutic doses of warfarin.

DIF: Cognitive Level: Comprehension REF: 423 OBJ: 9 (clinical)

TOP: INR Standard KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

16. The student nurse is planning a presentation on hypertension to present in a community setting. Which group of individuals should the student identify as having the highest incidence of hypertension?

a.

Muslims

b.

African Americans

c.

Whites

d.

Latinos

ANS: B

African Americans have a higher incidence of hypertension than any other minority group or whites.

DIF: Cognitive Level: Comprehension REF: 400 | Cultural Considerations

OBJ: 1 (clinical) TOP: Hypertension

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

17. The nurse is caring for a patient diagnosed with an abdominal aortic aneurysm. The patient is complaining of intense abdominal pain and lightheadedness. The patients blood pressure has dropped and pulse is rising. What is the priority nursing intervention?

a.

Monitor the patients blood pressure every 15 minutes.

b.

Contact the physician immediately.

c.

Notify the patients family of the change in condition.

d.

Instruct the patient to inform you if the pain intensifies.

ANS: B

The patient is most likely experiencing a ruptured aneurysm, which is a medical emergency requiring surgical repair; therefore, the physician should be contacted immediately. The vital signs may need to be measured more often than every 15 minutes. Notifying the family is not the priority intervention. Ongoing assessment of pain should continue.

DIF: Cognitive Level: Analysis REF: 411 OBJ: 6 (theory)

TOP: Aneurysm KEY: Nursing Process Step: Intervention

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

18. The nurse is initiating the care plan for a patient with peripheral arterial disease, who complains of pain in the lower extremities at a 3/10, has a 0.5 cm 1 cm ulcer on the left lower leg, and the lower legs are shiny and hairless bilaterally. What is the priority nursing diagnosis?

a.

Injury related to loss of peripheral circulation

b.

Acute pain related to ischemia to lower extremities

c.

Impaired skin integrity related to ulcer on lower extremity

d.

Deficient knowledge related to management of medical condition

ANS: C

Impaired skin integrity is the priority diagnosis in this situation. Acute pain is a nursing diagnosis, but the pain is 3/10 so it is not the priority since there is an open wound. Injury and deficient knowledge could be problems, but there is not enough information to support these diagnoses.

DIF: Cognitive Level: Analysis REF: 410 OBJ: 9 (theory)

TOP: Arterial Ulcer KEY: Nursing Process Step: Diagnosis

MSC: NCLEX: Health Promotion and Maintenance

MULTIPLE RESPONSE

19. The nurse cautions the patient with uncontrolled hypertension that the consequences of the disease will include: (Select all that apply.)

a.

threat of a stroke.

b.

possible kidney failure.

c.

risk for heart attack.

d.

probability of congestive heart failure.

e.

development of DVT.

ANS: A, B, C, D

DVT is not usually the result of hypertension. All other options are possible complications of uncontrolled hypertension.

DIF: Cognitive Level: Application REF: 406 | Patient Teaching

OBJ: 6 (theory) TOP: Hypertension: Complications

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

20. Peripheral vascular disease (PVD) is characterized by: (Select all that apply.)

a.

narrowing of arteries.

b.

obstruction of veins.

c.

involvement of all extremities only.

d.

defective valve function.

e.

production of thrombophlebitis.

ANS: A, B, D, E

PVD usually only involves the lower extremities. All other options are the symptoms of PVD.

DIF: Cognitive Level: Comprehension REF: 406 | 408 | Table 19-4

OBJ: 6 (theory) TOP: PVD: Characteristics

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

21. The nurse outlines methods of prevention of peripheral vascular disease (PVD), which include: (Select all that apply.)

a.

relieving stress.

b.

controlling diabetes.

c.

maintaining appropriate weight.

d.

routinely exercising.

e.

stopping smoking.

ANS: A, B, C, D, E

All strategies are supportive of the prevention of PVD.

DIF: Cognitive Level: Knowledge REF: 406 OBJ: 5 (theory)

TOP: PVD: Prevention KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

22. The nurse in a long-term care facility designs a teaching program for the residents to help prevent peripheral vascular disease (PVD) caused by age-related changes, which include: (Select all that apply.)

a.

decreasing blood viscosity.

b.

loss of elasticity in vessel walls.

c.

atherosclerotic vessels.

d.

sedentary practices.

e.

weakened leg muscles.

ANS: B, C, D, E

Increasing age causes blood viscosity to increase. All other options are age-related changes that can lead to PVD in the elderly.

DIF: Cognitive Level: Application REF: 400 | 419 | Elder Care Points

OBJ: 2 (clinical) TOP: PVD: Prevention

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

23. The nurse anticipates that the patient with venous insufficiency will need an intervention for: (Select all that apply.)

a.

assessment for phlebitis.

b.

elevating feet to reduce edema.

c.

NSAIDs for pain control.

d.

strategies to decrease itching.

e.

approach to regular exercise.

ANS: A, B, D, E

NSAIDs may interact with other medications used for venous insufficiency and may not be strong enough to control the pain associated with venous insufficiency. All other options are appropriate interventions to meet the needs of a patient with PVD.

DIF: Cognitive Level: Comprehension REF: 420-421 OBJ: 3 (clinical)

TOP: PVD: Basic Care KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

24. The nurse instructs that the 6 Ps of arterial disease include: (Select all that apply.)

a.

pain.

b.

paresthesia.

c.

putrefaction.

d.

pooling.

e.

pallor.

ANS: A, B, E

The classic 6 Ps of arterial disease are pain, pulselessness, poikilothermia (coldness), pallor, paresthesias, and paralysis.

DIF: Cognitive Level: Comprehension REF: 408 OBJ: 3 (clinical)

TOP: 6 Ps of Arterial Disease KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

25. The nurse plans to enhance blood flow in the 80-year-old long-term care facility resident by interventions such as: (Select all that apply.)

a.

using lap throws or light blankets over legs while sitting.

b.

elevating legs with knee gatch.

c.

encouraging walking.

d.

coaching isometric exercises.

e.

keeping environment warm.

ANS: A, C, D, E

Using the knee gatch is contraindicated in people with PVD as it increases pressure on the posterior knee. All other options aid in enhancing blood flow.

DIF: Cognitive Level: Application REF: 400 | 410 | 419 | Elder Care Points

OBJ: 3 (clinical) TOP: PVD: Maintenance

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

26. The nurse is caring for a patient with Raynauds disease who is employed as a construction worker, has hypertension, and smokes 1/2 to 1 pack of cigarettes per day. What teaching points should the nurse include in discharge instructions? (Select all that apply.)

a.

Wear gloves during cool weather.

b.

Drink plenty of warm beverages, such as coffee.

c.

Insulated socks are advisable when working in cool weather.

d.

Attend a smoking program.

e.

Wear gloves when handling hot objects at work.

ANS: A, C, D, E

The patient with Raynauds disease should avoid cold temperatures when possible. Since this patients job may expose him to cold temperatures, it is important that he wear gloves and insulated socks when working in cold temperatures. Smoking increases vasoconstriction, which is detrimental to both hypertension and Raynauds. Sensation in the fingers is often affected so gloves should be worn when handling hot objects in order to prevent burns. Caffeine should be avoided as it causes vasoconstriction.

DIF: Cognitive Level: Application REF: 413-414 OBJ: 7 (theory)

TOP: Raynauds Disease KEY: Nursing Process Step: Intervention

MSC: NCLEX: Health Promotion and Maintenance

COMPLETION

27. The patient who has a history of smoking and alcohol abuse is most likely to develop __________ hypertension.

ANS:

secondary

Secondary hypertension results from other conditions or lifestyle choices. Primary hypertension is idiopathic or familial.

DIF: Cognitive Level: Comprehension REF: 399 OBJ: 1 (theory)

TOP: Hypertension KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

One comment

Leave a Reply