Chapter 22. Nursing Care of Patients With Hypertension My Nursing Test Banks

Chapter 22. Nursing Care of Patients With Hypertension

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. A patient on antihypertensive medication has no insurance, three children, and reports feeling great and exercising daily. What should the nurse include in this patients teaching plan to promote compliance?
a. Encourage increased rest periods.
b. Provide names of support groups.
c. Refer the patient for financial assistance.
d. Schedule an annual physical examination.
____ 2. A patients current blood pressure reading is 144/94 mm Hg. A reading of 150/96 mm Hg was obtained on a prior occasion. Which type of hypertension should the nurse recognize that this patient is experiencing?
a. Prehypertension
b. Stage 1
c. Stage 2
d. Hypertensive emergency
____ 3. The nurse is caring for a patient who is prescribed a thiazide diuretic. What instructions should the nurse provide this patient who reports fatigue due to sleep deprivation?
a. Make position changes quickly.
b. Take your medication early in the day.
c. Take your medication before bedtime.
d. Empty your bladder after the first dose.
____ 4. The nurse is measuring blood pressures during a screening clinic. Which participant statement indicates that teaching about blood pressure has been effective?
a. My blood pressure is 118/68, which is normal.
b. I need to keep my blood pressure around 130/90.
c. Since my blood pressure is 148/94, Im considered to have prehypertension.
d. My blood pressure is 158/88, so I should have it checked at least twice a year.
____ 5. The nurse is measuring blood pressures during a screening clinic. For which blood pressure reading should the nurse instruct a patient to have follow-up in one year?
a. 108/80 mm Hg
b. 132/88 mm Hg
c. 148/94 mm Hg
d. 159/88 mm Hg
____ 6. The nurse is measuring blood pressures during a screening clinic. Which recommended follow-up time frame should the nurse suggest to a patient for a blood pressure reading of 118/72 mm Hg?
a. 1 month
b. 2 months
c. l year
d. 2 years
____ 7. The nurse measures a blood pressure of 166/100 mm Hg on a participant of a screening clinic. Which follow-up should the nurse recommend to this participant?
a. 1 month
b. 2 months
c. 12 months
d. 24 months
____ 8. The nurse is planning care for patients with hypertension. Which ethnic group should the nurse understand is most sensitive to the effects of the beta blocker propranolol (Inderal)?
a. Chinese
b. Koreans
c. African Americans
d. Japanese Americans
____ 9. The nurse is planning care for a group of patients. Which individual should the nurse identify as being at the highest risk for developing hypertension?
a. A 60-year-old Japanese American man
b. A 56-year-old African American woman
c. A 45-year-old female tourist from China
d. A 51-year-old man who recently emigrated from Korea
____ 10. A patient asks the nurse what the doctor meant by the phrase, hypertensive emergency. Which explanation should the nurse provide?
a. It means that youve had a small stroke.
b. It refers to an episode of very high blood pressure.
c. Its when the heart is failing to pump blood effectively.
d. It means the heart has become hyperactive and is beating too fast.
____ 11. The nurse is monitoring a patient with a hypertensive urgency. Which manifestation should the nurse expect to find?
a. Muscle weakness
b. Urinary retention
c. Severe headaches
d. Irregular heartbeats
____ 12. The nurse is reinforcing teaching for a patient with hypertension. If a patient states, I understand that if I do not eat or cook with salt, my hypertension will go away. What is the nurses best response?
a. Reducing salt in the diet increases blood pressure.
b. Patients who take diuretics do not need to reduce their salt intake.
c. Excessive salt intake is responsible for most types of hypertension.
d. Some patients blood pressure may not respond to salt restriction alone.
____ 13. The nurse is reinforcing teaching for a patient with hypertension. Which activity should the nurse include to help control hypertension?
a. Walk regularly.
b. Begin yoga weekly.
c. Begin a weight-lifting program.
d. Perform stretching exercises daily.
____ 14. The nurse is reinforcing teaching provided to a patient who has been taught ways to decrease blood pressure. Which patient statement indicates a need for further teaching?
a. I eat fried foods three times a week.
b. I dont add salt to my food anymore.
c. I walk my dog for 30 minutes every day.
d. I take high blood pressure medication daily.
____ 15. A patient is prescribed furosemide (Lasix) for hypertension and heart failure. Which statement should the nurse use to explain the purpose of this medication to the patient?
a. The medication vasodilates the arterioles so the heart doesnt have to pump as often.
b. Furosemide increases cardiac output so workload is decreased and the heart pumps more effectively.
c. By removing excess water, blood pressure and then cardiac workload are lowered so the heart doesnt work so hard.
d. Furosemide increases the blood flow to the kidneys so the normal renin-angiotensin cycle is optimized and blood pressure is lowered.
____ 16. The nurse is caring for a patient who is receiving furosemide (Lasix) for treatment of hypertension. Which laboratory test should the nurse carefully monitor?
a. Glucose
b. Potassium
c. Cholesterol
d. Hemoglobin
____ 17. The nurse provides dietary teaching to a patient who is prescribed bumetanide (Bumex). Which food should the patient name as important to ingest while taking this medication?
a. Radish
b. Lettuce
c. Broccoli
d. Cucumber
____ 18. The nurse is obtaining a health history from an individual at a blood pressure screening clinic. Which information in the patients history should the nurse identify as a modifiable risk factor for hypertension?
a. Age 57
b. Male gender
c. Cigarette smoking
d. Family history of hypertension
____ 19. The nurse is measuring blood pressures at a screening clinic. For which blood pressure reading should the nurse provide the patient with instructions for follow-up in 2 months?
a. 130/72 mm Hg
b. 148/96 mm Hg
c. 164/100 mm Hg
d. 184/110 mm Hg
____ 20. The nurse is reinforcing teaching provided to a patient on the pathophysiology of hypertension. Which patient statement indicates understanding of this teaching?
a. High blood pressure can cause serious problems.
b. Hypertension is diagnosed with one high reading.
c. High blood pressure has specific detectable symptoms.
d. Most people have high blood pressure for brief periods.
____ 21. The nurse obtains a blood pressure reading from a patient who is being treated with lifestyle modifications and drug therapy for stage 1 hypertension. Which reading indicates that the treatment is having the desired effect?
a. 88/42 mm Hg
b. 126/70 mm Hg
c. 138/94 mm Hg
d. 144/86 mm Hg
____ 22. A patient who has unsuccessfully implemented lifestyle modifications for high blood pressure asks what else can be done. What should the nurse respond to this patient?
a. You should get more rest.
b. You should decrease your exercise plan.
c. You should consider more strenuous exercise.
d. Your doctor may discuss medication with you.
____ 23. The nurse is caring for a patient who has possible kidney damage from high blood pressure. Which action should the nurse take?
a. Monitor glucose.
b. Encourage fluids.
c. Monitor urine color.
d. Review creatinine level.
____ 24. The nurse is reinforcing teaching provided to a patient with hypertension. Which food should the nurse include if the patient is prescribed a diet low in cholesterol and saturated fat?
a. Fried fish
b. Hamburger
c. Chopped steak
d. Grilled chicken
____ 25. A patient with a history of hypertension used to take prescribed antihypertensive medication for headaches however stopped when the headaches disappeared. Now the patients blood pressure is 198/110 mm Hg. What should the nurse emphasize when teaching this patient?
a. Symptoms are always present.
b. Symptoms may not always be present.
c. Symptoms occur only with malignant hypertension.
d. Symptoms occur only when there is an impending stroke.
____ 26. The nurse is contributing to the plan of care for a 76-year-old patient with hypertension. Which guideline should be used when following physician orders to treat elevated blood pressure?
a. Increase heart rate slowly.
b. Increase heart rate rapidly.
c. Reduce blood pressure slowly.
d. Reduce blood pressure quickly.
____ 27. The nurse is caring for a patient with stage 1 hypertension. Which medication should the nurse expect to be prescribed for this patient?
a. Verapamil (Calan)
b. Minoxidil (Loniten)
c. Diltiazem (Cardizem)
d. Hydrochlorothiazide (HydroDIURIL)
____ 28. A patient with essential hypertension asks the nurse to explain the cause for the disorder. What should the nurse respond to the patient?
a. The cause is unknown.
b. A pheochromocytoma causes it.
c. Each person has a different cause.
d. A coarctation of the aorta causes it.
____ 29. The nurse is contributing to a teaching session about hypertension. Which patient should the nurse identify as having the greatest risk for hypertension?
a. A 43-year-old married mother of three teenagers
b. A 40-year-old man whose brother has hypertension
c. A 35-year-old male construction worker who smokes
d. A 34-year-old single female who is an administrative assistant
____ 30. The nurse is reinforcing teaching provided to a patient about the complications of hypertension. Which organ should the patient state is at risk of damage from hypertension?
a. Eyes
b. Liver
c. Lungs
d. Stomach
____ 31. The nurse determines that teaching provided to a patient about the medication bumetanide (Bumex) was not effective. What did the patient say that caused the nurse to come to this conclusion?
a. I will rise slowly.
b. I should limit my potassium intake.
c. The medication will make me urinate.
d. I will take the medication when I am awake.
____ 32. A patient with mild hypertension is prescribed spironolactone (Aldactone). Which patient statement indicates that teaching about this medication was effective?
a. I will use gum or hard candy to help dry my mouth.
b. I will change from a supine to sitting or standing position quickly.
c. I will use sunscreen and protective clothing to avoid photosensitivity.
d. I will avoid potassium-rich foods such as bananas and take medication after meals.
____ 33. The nurse caring for a patient with newly diagnosed mild hypertension. Which medications should the nurse expect to be ordered for this patient?
a. Prazosin (Minipress)
b. Clonidine (Catapres)
c. Reserpine (Serpalan)
d. Hydrochlorothiazide (HydroDIURIL)
____ 34. The nurse is caring for a patient in hypertensive emergency. What should the nurse expect to be the goal when treatment is provided for this patient?
a. Increase urine output
b. Negate the impact of sodium in the body
c. Ensure an adequate potassium blood level
d. Reduce blood pressure by 25% in one hour
____ 35. A patient with hypertension has been following the Mediterranean diet however blood pressure has not been any lower. What additional information should the nurse obtain from the patient?
a. Amount of exercise each day
b. Ounces of water ingested each day
c. Total hours of sleep obtaining each night
d. Intake of recommended servings of red meat
____ 36. The nurse becomes concerned that a male patients blood pressure is 168/98 mm Hg after 6 months on antihypertensive medication. What question should the nurse ask after measuring this blood pressure?
a. Is the patient taking the medication?
b. What is the volume of alcohol ingested each day?
c. Which pharmacy is filling the prescribed medications?
d. How many hours of sleep does the patient receive each night?
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

____ 37. The nurse is contributing to the teaching plan for a patient taking antihypertensives to control blood pressure who is on a 2000-calorie DASH diet. What should be included in the teaching about this diet? (Select all that apply.)
a. Eat four or five servings of vegetables a day.
b. Include four to five servings of grains each day.
c. Consume four or five servings of fruit each day.
d. Eat four or five servings of nuts, seeds, and legumes each day.
e. Eat two or fewer servings of lean meat, poultry, or fish each day.
f. Consume two to three servings of low-fat or nonfat dairy products.
____ 38. The nurse is contributing to a staff education program about hypertension. Which factors should be included as possibly playing a role in the development of hypertension? (Select all that apply.)
a. Changes in kidney function
b. Increases in aldosterone levels
c. Increased baroreceptor sensitivity
d. Sympathetic nervous system overstimulation
e. Increased stretching ability of the blood vessels
f. Increased arteriolar premature ventricular contraction
____ 39. The nurse reinforced teaching provided to a patient about complications of hypertension. Which organs if identified by a patient indicate correct understanding of the organs most likely to be damaged from uncontrolled hypertension? (Select all that apply.)
a. Eyes
b. Brain
c. Heart
d. Liver
e. Lungs
f. Kidneys
____ 40. The infection control nurse observes a nurse on a cardiac unit. Which actions by the nurse would require intervention by the infection control nurse? (Select all that apply.)
a. Wipes stethoscope with a soft cloth before each patient use
b. Carries stethoscope in a laboratory coat pocket when not in use
c. Performs hand hygiene before and after contact with each patient
d. Leaves a thermometer in the room of a patient on contact precautions
e. Takes own stethoscope into the room of a patient on contact precautions
f. Uses a stethoscope and blood pressure cuff supplied in the patients room
____ 41. The nurse is preparing to measure a patients blood pressure. What should the nurse do to ensure that the reading obtained is accurate? (Select all that apply.)
a. The patient is seated.
b. The patients arm is at the level of the heart.
c. The patients arm is lowered towards the floor.
d. The patients arm is elevated towards the head.
e. The patient is standing against the examination table.
____ 42. A patient is being considered for medication therapy to treat high blood pressure. Prior to beginning medication, the nurse should prepare to schedule the patient for which diagnostic tests? (Select all that apply.)
a. Hematocrit
b. Electrocardiogram
c. Liver function tests
d. Blood glucose level
e. Cholesterol and triglycerides
____ 43. After completing a family history, the nurse is concerned that a patient is at risk for developing high blood pressure. What information did the nurse obtain to come to this conclusion? (Select all that apply.)
a. Brother has renal calculi.
b. Mother had type 2 diabetes mellitus.
c. Sister diagnosed with multiple sclerosis.
d. Father died with morbid obesity at age 55.
e. First cousin experienced retinal detachment.

Chapter 22. Nursing Care of Patients With Hypertension
Answer Section

MULTIPLE CHOICE

1. ANS: C
The nurse should refer the patient for financial assistance. If the patient cannot afford the medication, it will not be taken in spite of any teaching that is done. A. B. D. Rest, support groups, and annual physical examinations will not improve compliance with this patients teaching plan.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level: Application

2. ANS: B
Stage 1 hypertension is 140 to 159/90 to 99 mm Hg. A. Prehypertension is 120 to 139/80 to 89 mm Hg. C. Stage 2 hypertension is greater than 160/100 mm Hg. D. Hypertensive emergency is a sustained increase in blood pressure despite measures to reduce the level.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

3. ANS: B
If the patients lifestyle is to sleep at night and the medication is taken later in the day, it can interfere with sleep due to the need to void. So, the medication should be taken early in the day for this patient. A. Position changes should be made slowly to reduce the risk of orthostatic hypotension. C. Taking the medication before bedtime can increase sleep deprivation. D. There is no reason for the patient to empty the bladder after the first dose of the medication.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

4. ANS: A
Normal blood pressure is less than 120/80 mm Hg. B. A blood pressure of 130/90 is considered as being prehypertension. C. D. Readings of 148/94 and 158/88 are considered stage 1 hypertension and should be evaluated every 2 months with possible treatment of medication.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

5. ANS: B
The pressure of 132/88 mm Hg is prehypertension and requires a 1-year follow-up. A. The reading of 108/80 mm Hg is normal blood pressure. C. D. The readings of 148/94 and 159/88 require a 2-month follow-up.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

6. ANS: D
This is a normal blood pressure and requires a 2-year follow-up. A. B. C. Follow-up of 1 month, 2 months, or 1 year are not necessary for a normal blood pressure.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

7. ANS: A
A blood pressure of 166/100 mm Hg is stage 2 hypertension and requires a 1-month follow-up. B. C. D. Waiting for 2 months, 12 months or 24 months would be too long for the patient with stage 2 hypertension.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

8. ANS: C
Hypertension among African Americans is usually caused by increased renin activity resulting in greater sodium and fluid retention. African Americans respond better to diuretics such as furosemide (Lasix) than to beta blockers such as propranolol (Inderal). A. Chinese people are more sensitive than Caucasians to the effects of propranolol on heart rate and blood pressure, requiring only half the blood level of European Americans to achieve a therapeutic effect. Propranolol is eliminated from the bodies of many Chinese people at double the rate of European Americans. They are more likely to suffer fatigue as a side effect. The nurse must carefully monitor the Chinese patient for therapeutic and side effects. B. D. There is no information to suggest that individuals of Korean or Japanese descent cannot take propranolol (Inderal).

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

9. ANS: B
Hypertension continues to be the most serious health problem for African Americans in the United States. A. C. D. Hypertension is not as serious of a health problem in individuals from Japan, China, or Korea.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

10. ANS: B
Hypertensive emergency is a severe type of hypertension, characterized by elevations in systolic blood pressure (SBP) greater than 180 mm Hg and diastolic blood pressure (DBP) greater than 120 which are complicated by risk for or progression of target organ dysfunction. A. A hypertensive emergency is not a small stroke. C. This does not mean that the heart if failing to pump blood effectively. D. This does not mean that the heart is hyperactive and beating too fast.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

11. ANS: C
The patient with hypertensive urgency may experience severe headaches, nosebleeds, shortness of breath, and severe anxiety. A. B. D. Muscle weakness, urinary retention, and irregular heartbeats are not manifestations of hypertensive urgency.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

12. ANS: D
The nurse should explain that some patients blood pressure may not respond to salt restriction alone, so it is important to follow prescribed therapy. A. B. C. These statements are not necessarily true for all people.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

13. ANS: A
Exercise can help control hypertension. Aerobic exercise is recommended. B. C. D. Yoga, weight lifting, and stretching exercises will not necessarily help to lower the blood pressure.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

14. ANS: A
Fried foods should be reduced to decrease saturated fat intake. B. C. D. These statements indicate teaching about ways to control blood pressure were effective.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis | Integrated Processes: Teaching and Learning | Question to Guide Your Learning: 4

15. ANS: C
Furosemide (Lasix) acts on the ascending loop of Henle in the kidney to cause sodium and water loss. This will reduce the cardiac workload caused by the heart failure. A. Furosemide is not a vasodilator. B. Furosemide does not increase cardiac output. D. Furosemide does not impact the blood flow to the kidney.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

16. ANS: B
Since furosemide (Lasix) causes loss of potassium, potassium levels should be monitored and potassium held, if low. Supplemental potassium is usually given with Lasix. A. C. D. Furosemide (Lasix) does not influence glucose, cholesterol, or hemoglobin levels.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

17. ANS: C
Since bumetanide (Bumex) causes potassium loss, broccoli should be included in the diet. A. B. D. Radishes, lettuce, and cucumbers are not identified as being foods high in potassium.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Analysis

18. ANS: C
Modifiable risk factors are those that can be changed and include blood glucose levels, activity levels, smoking, and salt and alcohol intake. A. B. D. Age, gender, and family history are non-modifiable risk factors or those that cannot be changed.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

19. ANS: B
148/96 mm Hg requires a 2-month follow-up. A. A reading of 130/72 mm Hg requires a 1-year follow-up. C. A reading of 164/100 mm Hg requires a 1-month follow-up. D. A reading of 184/110 mm Hg requires immediate follow-up.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

20. ANS: A
Hypertension is referred to as the silent killer as it can cause serious problems. D. High blood pressure is a lifelong condition. B. The average of at least two or more readings on different dates is needed to diagnose hypertension. C. Hypertension may have no symptoms.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

21. ANS: B
Goals of therapeutic interventions are less than 140/90 mmHg, or less than 130/80 mm Hg for those with diabetes or chronic kidney disease. A. A reading of 88/42 mm Hg is too low. C. D. Readings of 138/94 mm Hg and 144/86 mm Hg are higher than the goal.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

22. ANS: D
The no- or low-risk hypertensive patients therapy begins with lifestyle modifications. If lifestyle modification alone does not result in a blood pressure at the target goal, then drug therapy is recommended. A. Rest is not going to reduce the patients blood pressure. B. Exercise is helpful to reduce blood pressure. C. Strenuous exercise is not recommended for anyone with high blood pressure.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

23. ANS: D
Creatinine is a measurement of kidney function. With kidney damage, the creatinine level will be elevated. A. Glucose level is not altered with kidney function. B. Fluids will not reduce the amount of kidney damage. C. Urine color is not going to be influenced by kidney function or damage.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

24. ANS: D
Grilled chicken is low in fat and cholesterol. A. B. C. Fried fish, hamburger, and chopped steak are high in fat and cholesterol.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

25. ANS: B
In hypertension, symptoms may not always be present. That is why hypertension is referred to as the silent killer. A. The symptoms are not always present. C. Symptoms can appear with all types of hypertension. D. The presence of symptoms does not mean that a stroke is pending.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

26. ANS: C
Since older adults may be more sensitive to medications, they should be monitored carefully for adverse effects. The blood pressure should be reduced slowly to prevent complications such as stroke. A. B. Medication to treat high blood pressure does not affect the heart rate. D. Reducing blood pressure quickly could cause adverse effects.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

27. ANS: D
For most patients with hypertension, initial drug therapy should be thiazide-type diuretics such as hydrochlorothiazide. A. B. C. These medications are not appropriate for the patient with stage 1 hypertension.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

28. ANS: A
Primary or essential hypertension is the chronic elevation of blood pressure from an unknown cause. B. Pheochromocytoma does not cause essential hypertension. C. Essential hypertension does not mean that every person has a different cause. D. Coarctation of the aorta does not cause essential hypertension.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential| Cognitive Level: Application

29. ANS: B
Non-modifiable risk factorsthose that cannot be changedinclude a family history of hypertension, age, ethnicity, and diabetes mellitus. A. C. D. These individuals have risk factors that can be modified and reduce the risk of developing hypertension.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

30. ANS: A
Most signs and symptoms of hypertension stem from long-term damaging effects on the large and small blood vessels of the heart, kidneys, brain, and eyes. B. C. D. Damage from hypertension is not expected to occur to the liver, lungs, or stomach.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

31. ANS: B
Since bumex causes loss of potassium, potassium levels should be monitored and potassium held, if low. Supplemental potassium is usually given so potassium intake should not be limited. A. C. D. These statements indicate that teaching about the medication was effective.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Analysis

32. ANS: D
Spironolactone (Aldactone) is a potassium-sparing diuretic, so further potassium intake is not needed and can result in hyperkalemia. The patient should avoid potassium-rich foods such as bananas. A. B. C. These actions are not necessarily required when taking this medication.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Analysis

33. ANS: D
For initial drug therapy a thiazide diuretic, ACE inhibitor, ARB, or CCB is recommended. A. B. C. These medications are not recommended for initial drug therapy.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

34. ANS: D
In some cases of hypertensive emergency, blood pressure may need to be reduced by 25% within 1 hour. A. B. C. The goals of therapy for the patient in hypertensive emergency are not to increase urine output, negate the impact of sodium in the body, or to ensure an adequate potassium blood level.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

35. ANS: A
The lifestyle interventions to reduce cardiovascular risk from hypertension recommend following a Mediterranean or diet with fruits, vegetables, whole grains, nuts, low fat dairy, poultry, fish and non-tropical vegetable oils; and participating in 40 minutes of moderate to vigorous aerobic activity 3-4 times weekly. The nurse needs to learn if the patient is getting the recommended amount of physical activity. B. C. Water and sleep are not recommendations for following the Mediterranean diet. D. Red meat is not recommended on the Mediterranean diet.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

36. ANS: A
Antihypertensive medications can have unpleasant side effects. For the male patient, erectile dysfunction might occur and the patient may choose to stop the medication. The nurse needs to find out if the patient is taking the medication. B. C. D. These questions do not focus on why the patients blood pressure continues to be elevated after taking medication for 6 months.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

MULTIPLE RESPONSE

37. ANS: A, C, E, F
The patient should be instructed to eat four or five servings of vegetables a day; two or fewer servings of lean meat, poultry, or fish each day; four or five servings of fruit each day; and two to three servings of low-fat or nonfat dairy products. D. The patient should be instructed to consume four or five servings of nuts, seeds, and legumes a week. B. The patient should be instructed to consume seven to eight servings of grains each day.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application

38. ANS: A, B, C, D, F
Changes in kidney function, aldosterone levels, baroreceptor sensitivity, sympathetic nervous system overstimulation, and increased arteriolar premature ventricular contraction may play a role in hypertension. E. Increased stretching ability of the blood vessels would result in decreased blood pressure.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

39. ANS: A, B, C, F
Most signs and symptoms of hypertension stem from long-term damaging effects on the large and small blood vessels of the heart, kidneys, brain, and eyes. D. E. Hypertension is not known to damage the liver or lungs.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

40. ANS: A, E
The nurse should not wipe the stethoscope with a cloth before use or use own stethoscope for a patient on contact precautions. B. C. D. F. Stethoscopes become contaminated with patient use. To protect patients, stethoscopes should be cleansed with ethanol-based cleanser or isopropyl alcohol pads as frequently between each patient use as hands are washed. Patients with contact precautions/isolation should have dedicated equipment in the room.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentSafety and Infection Control | Cognitive Level: Analysis

41. ANS: A, B
It is essential to take blood pressure readings correctly for accurate readings. The patient should be in a seated position and the arm supported at heart level. B. C. D. The arm should be at the level of the heart for an accurate reading. E. The patient should be seated for an accurate reading.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

42. ANS: A, B, D, E
It is recommended that patients undergo various routine tests to identify damage to organs or blood vessels before beginning therapy for high blood pressure. These tests help determine if target-organ damage has been caused by elevated blood pressure and include electrocardiogram (ECG), blood glucose level, hematocrit, and cholesterol and triglyceride levels. C. Liver function tests are not routinely completed before beginning medication therapy for high blood pressure.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

43. ANS: B, D
The risk of developing hypertension with a family history of diabetes and obesity is greater than when there is no family history. A. C. E. A family history of renal calculi, multiple sclerosis, and retinal detachment does not increase the patients risk of developing high blood pressure.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

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