Chapter 25 My Nursing Test Banks

 

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E
Chapter 25

Question 1

Type: MCSA

The patient receives hydrochlorothiazide (HydroDIURIL). He tells the nurse he is urinating a lot and questions how this drug affects his blood pressure. What is the best response by the nurse?

1. Hydrochlorothiazide (HydroDIURIL) enhances kidney function causing you to urinate more and that decreases your blood pressure.

2. Hydrochlorothiazide (HydroDIURIL) decreases the fluid in your bloodstream and this lowers your blood pressure.

3. Hydrochlorothiazide (HydroDIURIL) dilates your blood vessels so you urinate more and your blood pressure decreases.

4. Hydrochlorothiazide (HydroDIURIL) increases your heart rate; this pumps blood faster to your kidneys so you urinate more and your blood pressure decreases.

Correct Answer: 2

Rationale 1: Blood volume is one of the three factors influencing blood pressure. Diuretics like hydrochlorothiazide (HydroDIURIL) decrease blood pressure by decreasing total blood volume. Hydrochlorothiazide (HydroDIURIL) does not increase heart rate. Hydrochlorothiazide (HydroDIURIL) does not dilate blood vessels. Hydrochlorothiazide (HydroDIURIL) does not enhance kidney function.

Rationale 2: Blood volume is one of the three factors influencing blood pressure. Diuretics like hydrochlorothiazide (HydroDIURIL) decrease blood pressure by decreasing total blood volume. Hydrochlorothiazide (HydroDIURIL) does not increase heart rate. Hydrochlorothiazide (HydroDIURIL) does not dilate blood vessels. Hydrochlorothiazide (HydroDIURIL) does not enhance kidney function.

Rationale 3: Blood volume is one of the three factors influencing blood pressure. Diuretics like hydrochlorothiazide (HydroDIURIL) decrease blood pressure by decreasing total blood volume. Hydrochlorothiazide (HydroDIURIL) does not increase heart rate. Hydrochlorothiazide (HydroDIURIL) does not dilate blood vessels. Hydrochlorothiazide (HydroDIURIL) does not enhance kidney function.

Rationale 4: Blood volume is one of the three factors influencing blood pressure. Diuretics like hydrochlorothiazide (HydroDIURIL) decrease blood pressure by decreasing total blood volume. Hydrochlorothiazide (HydroDIURIL) does not increase heart rate. Hydrochlorothiazide (HydroDIURIL) does not dilate blood vessels. Hydrochlorothiazide (HydroDIURIL) does not enhance kidney function.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 25-3

Question 2

Type: MCMA

The nurse is conducting the initial group education session for patients who have hypertension. What is the most important information to include?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Blood pressures tend to decrease as people age, due to decreased blood volume.

2. The aorta has sensors that help regulate blood pressure.

3. Anger can result in hypertension.

4. The vasomotor center, located in the limbic system of the brain, helps regulate blood pressure.

5. Hypertension is diagnosed when the blood pressure is greater than 145/95 mmHg.

Correct Answer: 2,3

Rationale 1: Anger and stress can cause blood pressure to rise. The aorta and internal carotid artery have baroreceptors that sense changes in pressure in blood vessels and chemoreceptors that detect oxygen, carbon dioxide, and pH levels. According to JNC-7, a person is considered to have hypertension when sustained blood pressure is 139/89 mmHg. The vasomotor center is located in the medulla oblongata. Blood pressures tend to rise as people age.

Rationale 2: Anger and stress can cause blood pressure to rise. The aorta and internal carotid artery have baroreceptors that sense changes in pressure in blood vessels and chemoreceptors that detect oxygen, carbon dioxide, and pH levels. According to JNC-7, a person is considered to have hypertension when sustained blood pressure is 139/89 mmHg. The vasomotor center is located in the medulla oblongata. Blood pressures tend to rise as people age.

Rationale 3: Anger and stress can cause blood pressure to rise. The aorta and internal carotid artery have baroreceptors that sense changes in pressure in blood vessels and chemoreceptors that detect oxygen, carbon dioxide, and pH levels. According to JNC-7, a person is considered to have hypertension when sustained blood pressure is 139/89 mmHg. The vasomotor center is located in the medulla oblongata. Blood pressures tend to rise as people age.

Rationale 4: Anger and stress can cause blood pressure to rise. The aorta and internal carotid artery have baroreceptors that sense changes in pressure in blood vessels and chemoreceptors that detect oxygen, carbon dioxide, and pH levels. According to JNC-7, a person is considered to have hypertension when sustained blood pressure is 139/89 mmHg. The vasomotor center is located in the medulla oblongata. Blood pressures tend to rise as people age.

Rationale 5: Anger and stress can cause blood pressure to rise. The aorta and internal carotid artery have baroreceptors that sense changes in pressure in blood vessels and chemoreceptors that detect oxygen, carbon dioxide, and pH levels. According to JNC-7, a person is considered to have hypertension when sustained blood pressure is 139/89 mmHg. The vasomotor center is located in the medulla oblongata. Blood pressures tend to rise as people age.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 25-4

Question 3

Type: MCSA

The patient has a blood pressure reading of 126/84 mmHg. She asks the nurse if she has high blood pressure. What is the best response by the nurse?

1. You have prehypertension, but it isnt really serious.

2. You have prehypertension; lets discuss your lifestyle.

3. You have prehypertension; unfortunately, this will progress to hypertension.

4. You have prehypertension, and must begin medication.

Correct Answer: 2

Rationale 1: According to JNC-7, prehypertension includes individuals with systolic readings of 120 to 130 mmHg or diastolic readings of 80 to 89 mmHg. Prehypertension should be initially treated by modification in lifestyle. Initiation of medication is incorrect because prehypertension is initially treated with lifestyle modifications. Hypertension is incorrect because many individuals can treat prehypertension with lifestyle modifications and will never progress to hypertension. Prehypertension is always serious and requires lifestyle modifications.

Rationale 2: According to JNC-7, prehypertension includes individuals with systolic readings of 120 to 130 mmHg or diastolic readings of 80 to 89 mmHg. Prehypertension should be initially treated by modification in lifestyle. Initiation of medication is incorrect because prehypertension is initially treated with lifestyle modifications. Hypertension is incorrect because many individuals can treat prehypertension with lifestyle modifications and will never progress to hypertension. Prehypertension is always serious and requires lifestyle modifications.

Rationale 3: According to JNC-7, prehypertension includes individuals with systolic readings of 120 to 130 mmHg or diastolic readings of 80 to 89 mmHg. Prehypertension should be initially treated by modification in lifestyle. Initiation of medication is incorrect because prehypertension is initially treated with lifestyle modifications. Hypertension is incorrect because many individuals can treat prehypertension with lifestyle modifications and will never progress to hypertension. Prehypertension is always serious and requires lifestyle modifications.

Rationale 4: According to JNC-7, prehypertension includes individuals with systolic readings of 120 to 130 mmHg or diastolic readings of 80 to 89 mmHg. Prehypertension should be initially treated by modification in lifestyle. Initiation of medication is incorrect because prehypertension is initially treated with lifestyle modifications. Hypertension is incorrect because many individuals can treat prehypertension with lifestyle modifications and will never progress to hypertension. Prehypertension is always serious and requires lifestyle modifications.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 25-1

Question 4

Type: MCMA

The patient has been recently diagnosed with hypertension with a sustained blood pressure of 144/90 mmHg. The patient is concerned about effects on the body. What effects of hypertension on the body will the nurse include in her education of this patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Kidney damage

2. Stroke

3. Liver failure

4. Heart failure

5. Blindness

Correct Answer: 1,2,4,5

Rationale 1: The four target organs most commonly affected by hypertension are the heart, kidneys, brain, and retina. Liver failure is not commonly associated with hypertension.

Rationale 2: The four target organs most commonly affected by hypertension are the heart, kidneys, brain, and retina. Liver failure is not commonly associated with hypertension.

Rationale 3: The four target organs most commonly affected by hypertension are the heart, kidneys, brain, and retina. Liver failure is not commonly associated with hypertension.

Rationale 4: The four target organs most commonly affected by hypertension are the heart, kidneys, brain, and retina. Liver failure is not commonly associated with hypertension.

Rationale 5: The four target organs most commonly affected by hypertension are the heart, kidneys, brain, and retina. Liver failure is not commonly associated with hypertension.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 25-2

Question 5

Type: MCSA

The patient has been recently diagnosed with hypertension. Assessment data includes
Wt: 200 pounds
Ht: 5 4
Diet: Mostly starches
Alcohol intake: 3 beers/week
Stressors: Works 60 hours/week
In planning care with this patient, what is the priority outcome?

1. Patient will eliminate alcohol from the diet.

2. Patient will decrease stress by limiting work to 40 hours/week.

3. Patient will balance diet according to the food pyramid.

4. Patient will achieve and maintain optimum weight.

Correct Answer: 4

Rationale 1: Achieving and maintaining optimum weight is of greatest importance when a patient has hypertension. For obese patients, a 10 to 20 pound weight loss can produce a measurable change in blood pressure. A balanced diet is important, but not the priority outcome. Decreasing stress is important, but not the priority outcome. Eliminating alcohol is important, but not the priority outcome.

Rationale 2: Achieving and maintaining optimum weight is of greatest importance when a patient has hypertension. For obese patients, a 10 to 20 pound weight loss can produce a measurable change in blood pressure. A balanced diet is important, but not the priority outcome. Decreasing stress is important, but not the priority outcome. Eliminating alcohol is important, but not the priority outcome.

Rationale 3: Achieving and maintaining optimum weight is of greatest importance when a patient has hypertension. For obese patients, a 10 to 20 pound weight loss can produce a measurable change in blood pressure. A balanced diet is important, but not the priority outcome. Decreasing stress is important, but not the priority outcome. Eliminating alcohol is important, but not the priority outcome.

Rationale 4: Achieving and maintaining optimum weight is of greatest importance when a patient has hypertension. For obese patients, a 10 to 20 pound weight loss can produce a measurable change in blood pressure. A balanced diet is important, but not the priority outcome. Decreasing stress is important, but not the priority outcome. Eliminating alcohol is important, but not the priority outcome.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 25-5

Question 6

Type: MCSA

The patient is receiving hydrochlorothiazide (HydroDIURIL) as well as digoxin (Lanoxin). Which lab result would the nurse recognize as most significant?

1. ALT level of 35 units/L

2. Sodium level of 140 mEq/L

3. Potassium level of 2.9 mEq/L

4. BUN level of 20 mg/dl

Correct Answer: 3

Rationale 1: Hypokalemia caused by hydrochlorothiazide (HydroDIURIL) may increase digoxin (Lanoxin) toxicity. The normal range for potassium is 3.5 to 5.2 mEq/L. The concern is hypokalemia, not sodium levels; this sodium level is within normal range. The concern is hypokalemia, not liver damage, and this ALT level is within normal range. The concern is hypokalemia, not kidney function, and this BUN is within normal range.

Rationale 2: Hypokalemia caused by hydrochlorothiazide (HydroDIURIL) may increase digoxin (Lanoxin) toxicity. The normal range for potassium is 3.5 to 5.2 mEq/L. The concern is hypokalemia, not sodium levels; this sodium level is within normal range. The concern is hypokalemia, not liver damage, and this ALT level is within normal range. The concern is hypokalemia, not kidney function, and this BUN is within normal range.

Rationale 3: Hypokalemia caused by hydrochlorothiazide (HydroDIURIL) may increase digoxin (Lanoxin) toxicity. The normal range for potassium is 3.5 to 5.2 mEq/L. The concern is hypokalemia, not sodium levels; this sodium level is within normal range. The concern is hypokalemia, not liver damage, and this ALT level is within normal range. The concern is hypokalemia, not kidney function, and this BUN is within normal range.

Rationale 4: Hypokalemia caused by hydrochlorothiazide (HydroDIURIL) may increase digoxin (Lanoxin) toxicity. The normal range for potassium is 3.5 to 5.2 mEq/L. The concern is hypokalemia, not sodium levels; this sodium level is within normal range. The concern is hypokalemia, not liver damage, and this ALT level is within normal range. The concern is hypokalemia, not kidney function, and this BUN is within normal range.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 25-8

Question 7

Type: MCSA

The patient with hypertension is receiving nefedipine (Procardia XL). The nurse determines that the patient needs additional medication education when the patient selects which menu for breakfast?

1. Whole-wheat pancakes with syrup, and bacon, oatmeal, and orange juice

2. Eggs, whole-wheat toast with butter, Lucky Charms cereal, milk, and grapefruit juice

3. Eggs and sausage, a biscuit with margarine, coffee with cream, and cranberry juice

4. Egg and cheese omelet, tea with sugar and lemon, hash brown potatoes, and prune juice

Correct Answer: 2

Rationale 1: Grapefruit juice in combination with a sustained-release calcium channel blocker could result in rapid toxic overdose, which is a medical emergency. There is no fooddrug interaction with calcium channel blockers and whole-wheat pancakes with syrup, and bacon, oatmeal, and orange juice. There is no fooddrug interaction with calcium channel blockers and eggs, sausage, a biscuit with margarine, and cranberry juice. There is no fooddrug interaction with calcium channel blockers and egg and cheese omelet, tea with sugar and lemon, hash brown potatoes, and prune juice.

Rationale 2: Grapefruit juice in combination with a sustained-release calcium channel blocker could result in rapid toxic overdose, which is a medical emergency. There is no fooddrug interaction with calcium channel blockers and whole-wheat pancakes with syrup, and bacon, oatmeal, and orange juice. There is no fooddrug interaction with calcium channel blockers and eggs, sausage, a biscuit with margarine, and cranberry juice. There is no fooddrug interaction with calcium channel blockers and egg and cheese omelet, tea with sugar and lemon, hash brown potatoes, and prune juice.

Rationale 3: Grapefruit juice in combination with a sustained-release calcium channel blocker could result in rapid toxic overdose, which is a medical emergency. There is no fooddrug interaction with calcium channel blockers and whole-wheat pancakes with syrup, and bacon, oatmeal, and orange juice. There is no fooddrug interaction with calcium channel blockers and eggs, sausage, a biscuit with margarine, and cranberry juice. There is no fooddrug interaction with calcium channel blockers and egg and cheese omelet, tea with sugar and lemon, hash brown potatoes, and prune juice.

Rationale 4: Grapefruit juice in combination with a sustained-release calcium channel blocker could result in rapid toxic overdose, which is a medical emergency. There is no fooddrug interaction with calcium channel blockers and whole-wheat pancakes with syrup, and bacon, oatmeal, and orange juice. There is no fooddrug interaction with calcium channel blockers and eggs, sausage, a biscuit with margarine, and cranberry juice. There is no fooddrug interaction with calcium channel blockers and egg and cheese omelet, tea with sugar and lemon, hash brown potatoes, and prune juice.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 25-7

Question 8

Type: MCSA

The nurse is taking the initial history of a patient admitted to the hospital for hypertension. The physician has ordered a beta-adrenergic blocker. Which statement by the patient does the nurse recognize as most significant?

1. I dont handle stress well; I have a lot of diarrhea.

2. When I have a migraine headache, I need to have the room darkened.

3. My father died of a heart attack when he was 48-years-old.

4. I have always had problems with my asthma.

Correct Answer: 4

Rationale 1: With increased doses, beta-adrenergic blockers can slow the heart rate and cause bronchoconstriction. They should be used with caution in patients with asthma. Beta-adrenergic blockers do not affect migraine headaches. Having a father who died of a heart attack when he was young is significant, but has no correlation to this patient and use of beta-adrenergic blockers. There is no correlation between increased stress, diarrhea, and beta-adrenergic blockers.

Rationale 2: With increased doses, beta-adrenergic blockers can slow the heart rate and cause bronchoconstriction. They should be used with caution in patients with asthma. Beta-adrenergic blockers do not affect migraine headaches. Having a father who died of a heart attack when he was young is significant, but has no correlation to this patient and use of beta-adrenergic blockers. There is no correlation between increased stress, diarrhea, and beta-adrenergic blockers.

Rationale 3: With increased doses, beta-adrenergic blockers can slow the heart rate and cause bronchoconstriction. They should be used with caution in patients with asthma. Beta-adrenergic blockers do not affect migraine headaches. Having a father who died of a heart attack when he was young is significant, but has no correlation to this patient and use of beta-adrenergic blockers. There is no correlation between increased stress, diarrhea, and beta-adrenergic blockers.

Rationale 4: With increased doses, beta-adrenergic blockers can slow the heart rate and cause bronchoconstriction. They should be used with caution in patients with asthma. Beta-adrenergic blockers do not affect migraine headaches. Having a father who died of a heart attack when he was young is significant, but has no correlation to this patient and use of beta-adrenergic blockers. There is no correlation between increased stress, diarrhea, and beta-adrenergic blockers.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 25-9

Question 9

Type: MCSA

What is a priority nursing intervention for a patient who has just begun antihypertensive treatment with enalapril (Vasotec)?

1. Monitor the patient for headaches.

2. Take the patients blood pressure.

3. Order a sodium-restricted diet for the patient.

4. Review the patients lab results for hypokalemia.

Correct Answer: 2

Rationale 1: Enalapril (Vasotec) may produce a first-dose phenomenon resulting in profound hypotension, which may result in syncope. Enalapril (Vasotec) is more likely to cause hyperkalemia, not hypokalemia. Enalapril (Vasotec) does not affect sodium levels. Although headache is a side effect, it is not as big a priority as profound hypotension.

Rationale 2: Enalapril (Vasotec) may produce a first-dose phenomenon resulting in profound hypotension, which may result in syncope. Enalapril (Vasotec) is more likely to cause hyperkalemia, not hypokalemia. Enalapril (Vasotec) does not affect sodium levels. Although headache is a side effect, it is not as big a priority as profound hypotension.

Rationale 3: Enalapril (Vasotec) may produce a first-dose phenomenon resulting in profound hypotension, which may result in syncope. Enalapril (Vasotec) is more likely to cause hyperkalemia, not hypokalemia. Enalapril (Vasotec) does not affect sodium levels. Although headache is a side effect, it is not as big a priority as profound hypotension.

Rationale 4: Enalapril (Vasotec) may produce a first-dose phenomenon resulting in profound hypotension, which may result in syncope. Enalapril (Vasotec) is more likely to cause hyperkalemia, not hypokalemia. Enalapril (Vasotec) does not affect sodium levels. Although headache is a side effect, it is not as big a priority as profound hypotension.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 25-8

Question 10

Type: MCSA

The patient comes to the emergency department with a blood pressure of 200/120 mmHg. The physician orders hydralazine (Apresoline) IV. What will the nurses priority assessment include?

1. Hypotension and bradycardia

2. Hypotension and hyperthermia

3. Hypotension and tachycardia

4. Hypotension and tachypnea

Correct Answer: 3

Rationale 1: Direct vasodilators produce reflex tachycardia, a compensatory response to the sudden decrease in blood pressure caused by the drug. Direct vasodilators produce hypotension and tachycardia, not bradycardia. Direct vasodilators do not affect body temperature. Direct vasodilators do not affect respiratory rate.

Rationale 2: Direct vasodilators produce reflex tachycardia, a compensatory response to the sudden decrease in blood pressure caused by the drug. Direct vasodilators produce hypotension and tachycardia, not bradycardia. Direct vasodilators do not affect body temperature. Direct vasodilators do not affect respiratory rate.

Rationale 3: Direct vasodilators produce reflex tachycardia, a compensatory response to the sudden decrease in blood pressure caused by the drug. Direct vasodilators produce hypotension and tachycardia, not bradycardia. Direct vasodilators do not affect body temperature. Direct vasodilators do not affect respiratory rate.

Rationale 4: Direct vasodilators produce reflex tachycardia, a compensatory response to the sudden decrease in blood pressure caused by the drug. Direct vasodilators produce hypotension and tachycardia, not bradycardia. Direct vasodilators do not affect body temperature. Direct vasodilators do not affect respiratory rate.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 25-6

Question 11

Type: MCSA

The nurse completed medication education with the patient who receives hydrochlorothiazide (HydroDIURIL). The nurse determines that teaching has been effective when the patient makes which statement?

1. I really need to avoid grapefruit juice when I take this medication.

2. I need to avoid salt substitutes and potassium-rich foods.

3. I take my medication early in the morning.

4. If I develop a cough, I should call my doctor.

Correct Answer: 3

Rationale 1: Taking hydrochlorothiazide (HydroDIURIL) early in the day will help prevent nocturia. Hydrochlorothiazide (HydroDIURIL) is a potassium-excreting diuretic and potassium supplementation is often necessary. Development of a cough occurs with ACE Inhibitors, not diuretics. Grapefruit juice inhibits the metabolism of the calcium channel blockers.

Rationale 2: Taking hydrochlorothiazide (HydroDIURIL) early in the day will help prevent nocturia. Hydrochlorothiazide (HydroDIURIL) is a potassium-excreting diuretic and potassium supplementation is often necessary. Development of a cough occurs with ACE Inhibitors, not diuretics. Grapefruit juice inhibits the metabolism of the calcium channel blockers.

Rationale 3: Taking hydrochlorothiazide (HydroDIURIL) early in the day will help prevent nocturia. Hydrochlorothiazide (HydroDIURIL) is a potassium-excreting diuretic and potassium supplementation is often necessary. Development of a cough occurs with ACE Inhibitors, not diuretics. Grapefruit juice inhibits the metabolism of the calcium channel blockers.

Rationale 4: Taking hydrochlorothiazide (HydroDIURIL) early in the day will help prevent nocturia. Hydrochlorothiazide (HydroDIURIL) is a potassium-excreting diuretic and potassium supplementation is often necessary. Development of a cough occurs with ACE Inhibitors, not diuretics. Grapefruit juice inhibits the metabolism of the calcium channel blockers.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 25-7

Question 12

Type: MCSA

The nurse is teaching the patient about lifestyle modifications to help manage the patients hypertension. The nurse determines that teaching has been effective when the patient makes which statement?

1. I need to get started on my medications right away.

2. My father had hypertension, did nothing, and lived to be 90-years-old.

3. I know I need to give up my cigarettes and alcohol.

4. I wont be able to run in the marathon race anymore.

Correct Answer: 3

Rationale 1: Limiting intake of alcohol and discontinuing tobacco products are important nonpharmacological methods for controlling hypertension. Implementing lifestyle modifications may eliminate the need for pharmacotherapy, so the patient may not have to take medication right away. Increasing physical activity is an important lifestyle modification for controlling hypertension. The fact that the patients father had hypertension and lived to be 90-years-old does not mean that the patient will have the same experience; the patient is in denial.

Rationale 2: Limiting intake of alcohol and discontinuing tobacco products are important nonpharmacological methods for controlling hypertension. Implementing lifestyle modifications may eliminate the need for pharmacotherapy, so the patient may not have to take medication right away. Increasing physical activity is an important lifestyle modification for controlling hypertension. The fact that the patients father had hypertension and lived to be 90-years-old does not mean that the patient will have the same experience; the patient is in denial.

Rationale 3: Limiting intake of alcohol and discontinuing tobacco products are important nonpharmacological methods for controlling hypertension. Implementing lifestyle modifications may eliminate the need for pharmacotherapy, so the patient may not have to take medication right away. Increasing physical activity is an important lifestyle modification for controlling hypertension. The fact that the patients father had hypertension and lived to be 90-years-old does not mean that the patient will have the same experience; the patient is in denial.

Rationale 4: Limiting intake of alcohol and discontinuing tobacco products are important nonpharmacological methods for controlling hypertension. Implementing lifestyle modifications may eliminate the need for pharmacotherapy, so the patient may not have to take medication right away. Increasing physical activity is an important lifestyle modification for controlling hypertension. The fact that the patients father had hypertension and lived to be 90-years-old does not mean that the patient will have the same experience; the patient is in denial.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 25-5

Question 13

Type: MCSA

The patient has a nighttime cough related to taking enalapril (Vasotec). What is the best nursing intervention to promote rest in this patient?

1. Have the patient sit up at an 80-degree angle in a comfortable chair at night.

2. Contact the physician for an order for a cough-suppressant medication.

3. Have the patient sleep on two or three pillows at night.

4. Contact the physician for an order for a sedative-hypnotic medication.

Correct Answer: 3

Rationale 1: The patient should sleep with the head elevated if a cough becomes troublesome when in supine position. An ACEI-induced cough will not be relieved by cough medication. Sitting up at an 80-degree angle would be effective, but would be too uncomfortable for the patient. A sedative-hypnotic medication would put the patient to sleep, but it does nothing to address the patients cough.

Rationale 2: The patient should sleep with the head elevated if a cough becomes troublesome when in supine position. An ACEI-induced cough will not be relieved by cough medication. Sitting up at an 80-degree angle would be effective, but would be too uncomfortable for the patient. A sedative-hypnotic medication would put the patient to sleep, but it does nothing to address the patients cough.

Rationale 3: The patient should sleep with the head elevated if a cough becomes troublesome when in supine position. An ACEI-induced cough will not be relieved by cough medication. Sitting up at an 80-degree angle would be effective, but would be too uncomfortable for the patient. A sedative-hypnotic medication would put the patient to sleep, but it does nothing to address the patients cough.

Rationale 4: The patient should sleep with the head elevated if a cough becomes troublesome when in supine position. An ACEI-induced cough will not be relieved by cough medication. Sitting up at an 80-degree angle would be effective, but would be too uncomfortable for the patient. A sedative-hypnotic medication would put the patient to sleep, but it does nothing to address the patients cough.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 25-8

Question 14

Type: MCSA

The patient with hypertension has experienced heart failure. The nurse notes that the patient is receiving nefedipine (Procardia). What is a priority assessment for the nurse?

1. Review recent lab results for hypokalemia.

2. Assess urinary output.

3. Assess level of orientation.

4. Auscultate breath sounds for crackles.

Correct Answer: 4

Rationale 1: Some calcium channel blockers can reduce myocardial contractility and can worsen heart failure. Crackles in the lungs can indicate pulmonary edema which could indicate heart failure. Calcium channel blockers do not cause hypokalemia. Level of orientation may be decreased with heart failure, but it is not a priority assessment at this time. Urinary output may be decreased with heart failure, but it is not a priority assessment at this time.

Rationale 2: Some calcium channel blockers can reduce myocardial contractility and can worsen heart failure. Crackles in the lungs can indicate pulmonary edema which could indicate heart failure. Calcium channel blockers do not cause hypokalemia. Level of orientation may be decreased with heart failure, but it is not a priority assessment at this time. Urinary output may be decreased with heart failure, but it is not a priority assessment at this time.

Rationale 3: Some calcium channel blockers can reduce myocardial contractility and can worsen heart failure. Crackles in the lungs can indicate pulmonary edema which could indicate heart failure. Calcium channel blockers do not cause hypokalemia. Level of orientation may be decreased with heart failure, but it is not a priority assessment at this time. Urinary output may be decreased with heart failure, but it is not a priority assessment at this time.

Rationale 4: Some calcium channel blockers can reduce myocardial contractility and can worsen heart failure. Crackles in the lungs can indicate pulmonary edema which could indicate heart failure. Calcium channel blockers do not cause hypokalemia. Level of orientation may be decreased with heart failure, but it is not a priority assessment at this time. Urinary output may be decreased with heart failure, but it is not a priority assessment at this time.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 25-9

Question 15

Type: MCSA

The patient is receiving doxazosin (Cardura) for hypertension. He asks the nurse how the medication works. What is the nurses best response?

1. It works by causing your kidneys to excrete more urine.

2. It works by making your heart work more efficiently.

3. It works by making your blood vessels expand.

4. It works by decreasing the release of your stress hormones.

Correct Answer: 3

Rationale 1: Doxazosin (Cardura) is selective for blocking alpha1-receptors in vascular smooth muscle, which results in dilation of arteries and veins. Excreting more urine is an effect of diuretic medications. Increasing the efficiency of the heart is not an effect of doxazosin (Cardura). Decreasing the release of stress hormones is not an effect of doxazosin (Cardura).

Rationale 2: Doxazosin (Cardura) is selective for blocking alpha1-receptors in vascular smooth muscle, which results in dilation of arteries and veins. Excreting more urine is an effect of diuretic medications. Increasing the efficiency of the heart is not an effect of doxazosin (Cardura). Decreasing the release of stress hormones is not an effect of doxazosin (Cardura).

Rationale 3: Doxazosin (Cardura) is selective for blocking alpha1-receptors in vascular smooth muscle, which results in dilation of arteries and veins. Excreting more urine is an effect of diuretic medications. Increasing the efficiency of the heart is not an effect of doxazosin (Cardura). Decreasing the release of stress hormones is not an effect of doxazosin (Cardura).

Rationale 4: Doxazosin (Cardura) is selective for blocking alpha1-receptors in vascular smooth muscle, which results in dilation of arteries and veins. Excreting more urine is an effect of diuretic medications. Increasing the efficiency of the heart is not an effect of doxazosin (Cardura). Decreasing the release of stress hormones is not an effect of doxazosin (Cardura).

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts:

Learning Outcome: 25-8

Question 16

Type: MCSA

According to the JNC-7, a patient with a blood pressure of 144/82 would be classified as

1. prehypertensive.

2. stage 2 hypertensive.

3. normal.

4. stage 1 hypertensive.

Correct Answer: 4

Rationale 1: A systolic blood pressure of 140159 indicates stage 1 hypertension. Since the diastolic is in a class lower than stage 1, the patient is classified as stage 1 hypertensive.

Rationale 2: A systolic blood pressure of 140159 indicates stage 1 hypertension. Since the diastolic is in a class lower than stage 1, the patient is classified as stage 1 hypertensive.

Rationale 3: A systolic blood pressure of 140159 indicates stage 1 hypertension. Since the diastolic is in a class lower than stage 1, the patient is classified as stage 1 hypertensive.

Rationale 4: A systolic blood pressure of 140159 indicates stage 1 hypertension. Since the diastolic is in a class lower than stage 1, the patient is classified as stage 1 hypertensive.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 25-1

Question 17

Type: MCSA

Which of the following lists include the three factors that make up blood pressure?

1. Blood volume, heart rate, and stroke volume

2. Cardiac output, blood volume, and peripheral vascular resistance

3. Age, weight, and race

4. Body mass index, diet, and genetics

Correct Answer: 2

Rationale 1: Although many factors can contribute to blood pressure, such as diet and weight, it is a persons cardiac output, blood volume, and peripheral vascular resistance that create the pressure.

Rationale 2: Although many factors can contribute to blood pressure, such as diet and weight, it is a persons cardiac output, blood volume, and peripheral vascular resistance that create the pressure.

Rationale 3: Although many factors can contribute to blood pressure, such as diet and weight, it is a persons cardiac output, blood volume, and peripheral vascular resistance that create the pressure.

Rationale 4: Although many factors can contribute to blood pressure, such as diet and weight, it is a persons cardiac output, blood volume, and peripheral vascular resistance that create the pressure.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 25-3

Question 18

Type: MCSA

Diuretics are often used to lower blood pressure. Which factor do they affect most?

1. Cardiac output

2. Blood volume

3. Heart rate

4. Peripheral vascular resistance

Correct Answer: 2

Rationale 1: Diuretics cause fluid loss through urination. The decrease in blood volume lowers blood pressure.

Rationale 2: Diuretics cause fluid loss through urination. The decrease in blood volume lowers blood pressure.

Rationale 3: Diuretics cause fluid loss through urination. The decrease in blood volume lowers blood pressure.

Rationale 4: Diuretics cause fluid loss through urination. The decrease in blood volume lowers blood pressure.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 25-6

Question 19

Type: MCSA

Changes in which of the following would be sensed by baroreceptors and relayed to the vasomotor center?

1. Oxygenation

2. Blood pressure

3. Carbon dioxide

4. Blood pH

Correct Answer: 2

Rationale 1: Baroreceptors sense and relay changes in blood pressure. Chemoreceptors recognize levels of oxygen, carbon dioxide, and pH levels.

Rationale 2: Baroreceptors sense and relay changes in blood pressure. Chemoreceptors recognize levels of oxygen, carbon dioxide, and pH levels.

Rationale 3: Baroreceptors sense and relay changes in blood pressure. Chemoreceptors recognize levels of oxygen, carbon dioxide, and pH levels.

Rationale 4: Baroreceptors sense and relay changes in blood pressure. Chemoreceptors recognize levels of oxygen, carbon dioxide, and pH levels.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 25-4

Question 20

Type: MCSA

Which statement is accurate in regard to secondary hypertension?

1. There is no known cause.

2. It can result from chronic renal impairment.

3. It is also known as idiopathic.

4. It accounts for 90% of all hypertensive cases.

Correct Answer: 2

Rationale 1: Secondary hypertension has an identifiable cause, and accounts for 10% of all cases. Primary hypertension is known as idiopathic, and has no known cause.

Rationale 2: Secondary hypertension has an identifiable cause, and accounts for 10% of all cases. Primary hypertension is known as idiopathic, and has no known cause.

Rationale 3: Secondary hypertension has an identifiable cause, and accounts for 10% of all cases. Primary hypertension is known as idiopathic, and has no known cause.

Rationale 4: Secondary hypertension has an identifiable cause, and accounts for 10% of all cases. Primary hypertension is known as idiopathic, and has no known cause.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 25-1

Question 21

Type: MCSA

Which of the following interventions would be indicated and take highest priority for a smoking 30-year-old female with a BMI of 20 and a blood pressure of 137/88?

1. Smoking-cessation program

2. Diuretic therapy

3. Weight-loss program

4. Stress management

Correct Answer: 1

Rationale 1: Although weight management is very important, this patient has a normal body mass index of 20. Therefore, smoking is the priority. This patient is not necessarily a candidate for drug therapy, given that she is in the prehypertension class. There is nothing provided in the question that indicates the woman is suffering from stress.

Rationale 2: Although weight management is very important, this patient has a normal body mass index of 20. Therefore, smoking is the priority. This patient is not necessarily a candidate for drug therapy, given that she is in the prehypertension class. There is nothing provided in the question that indicates the woman is suffering from stress.

Rationale 3: Although weight management is very important, this patient has a normal body mass index of 20. Therefore, smoking is the priority. This patient is not necessarily a candidate for drug therapy, given that she is in the prehypertension class. There is nothing provided in the question that indicates the woman is suffering from stress.

Rationale 4: Although weight management is very important, this patient has a normal body mass index of 20. Therefore, smoking is the priority. This patient is not necessarily a candidate for drug therapy, given that she is in the prehypertension class. There is nothing provided in the question that indicates the woman is suffering from stress.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 25-5 and 25-6

Question 22

Type: MCSA

Which laboratory test would be the priority for a hypertensive patient taking a thiazide diuretic?

1. Magnesium

2. Calcium

3. Chloride

4. Potassium

Correct Answer: 4

Rationale 1: Sodium and potassium are the electrolytes of most concern. A patient on thiazide diuretics should be monitored for hypokalemia.

Rationale 2: Sodium and potassium are the electrolytes of most concern. A patient on thiazide diuretics should be monitored for hypokalemia.

Rationale 3: Sodium and potassium are the electrolytes of most concern. A patient on thiazide diuretics should be monitored for hypokalemia.

Rationale 4: Sodium and potassium are the electrolytes of most concern. A patient on thiazide diuretics should be monitored for hypokalemia.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 25-8

Question 23

Type: MCSA

A hypertensive female patient being treated with which of the following would be of primary concern if she became pregnant?

1. Enalapril (Vasotec)

2. Potassium supplement

3. Doxazosin (Cardura)

4. Hydrochlorothiazide (HCTZ)

Correct Answer: 1

Rationale 1: Enalapril is a Pregnancy Category D drug that has a higher fetal risk than do the other drugs listed.

Rationale 2: Enalapril is a Pregnancy Category D drug that has a higher fetal risk than do the other drugs listed.

Rationale 3: Enalapril is a Pregnancy Category D drug that has a higher fetal risk than do the other drugs listed.

Rationale 4: Enalapril is a Pregnancy Category D drug that has a higher fetal risk than do the other drugs listed.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 25-7

Question 24

Type: SEQ

The nurse is discussing the long-term consequences of uncontrolled hypertension with a group of patients with prehypertension. Place in order the pathological changes that occur as a result of uncontrolled hypertension.

Standard Text: Click and drag the options below to move them up or down.

Correct Answer:

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 25-2

Question 25

Type: MCMA

The nurse is educating a patient whose blood pressure is 140/90 mmHg on ways to lower blood pressure and avoid hypertension. Which lifestyle choices may eliminate the need for pharmacotherapy in this patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Increasing intake of wine

2. Restricting salt intake

3. Increasing intake of red meat

4. Increasing activity

5. Stopping smoking

Correct Answer: 2,4,5

Rationale 1: Increasing the intake of alcohol, including wine, is not a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. The patient should be encouraged to decrease the intake of alcohol.

Rationale 2: Restricting sodium intake is a positive lifestyle change associated with the nonpharmacologic treatment of hypertension.

Rationale 3: Increasing the intake of saturated fat is not a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. The patient should be encouraged to decrease the intake of red meat and other sources of saturated fat.

Rationale 4: Increased activity, especially aerobic activity, is a positive lifestyle change associated with the nonpharmacologic treatment of hypertension.

Rationale 5: Eliminating tobacco products is a positive lifestyle change associated with the nonpharmacologic treatment of hypertension.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 25-3

Question 26

Type: MCMA

The nurse is educating a patient who has been diagnosed with hypertension and explains that the criteria that will be used to determine medication management include the patients

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. risk factors.

2. comorbid medical conditions.

3. age.

4. degree of blood pressure elevation.

5. occupational status.

Correct Answer: 1,2,4

Rationale 1: The patients risk factors guide the pharmacotherapy of hypertension.

Rationale 2: The patients comorbid medical conditions guide the pharmacotherapy of hypertension.

Rationale 3: The patients age is not a factor in the pharmacotherapy of hypertension.

Rationale 4: The patients degree of hypertension guides the pharmacotherapy of hypertension.

Rationale 5: The patients current occupation is not a factor in the pharmacotherapy of hypertension.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 25-4

Question 27

Type: MCMA

The nurse is caring for an African American male who has just been diagnosed with hypertension. The nurse anticipates that this patient will be started on which medications?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. A thiazide diuretic

2. A calcium channel blocker

3. An ACE inhibitor

4. A beta-adrenergic antagonist

5. An angiotensin-II receptor blocker

Correct Answer: 1,2

Rationale 1: Thiazide diuretics seem to provide the greatest blood pressure reduction in this population.

Rationale 2: Calcium channel blockers seem to provide the greatest blood pressure reduction in this population.

Rationale 3: Monotherapy with ACE inhibitors does not reduce blood pressure as effectively in African Americans as in other groups.

Rationale 4: Monotherapy with beta-adrenergic antagonists does not reduce blood pressure as effectively in African Americans as in other groups.

Rationale 5: Monotherapy with angiotensin-II receptor blockers does not reduce blood pressure as effectively in African Americans as in other groups.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 25-4

Question 28

Type: MCMA

A patient is newly diagnosed with hypertension and diabetes. Which classes of drugs are likely to be prescribed?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. ACE inhibitors

2. Beta blockers

3. Thiazide diuretics

4. Calcium channel blockers

5. Angiotensin receptor blockers (ARBs)

Correct Answer: 1,5

Rationale 1: ACE inhibitors protect the kidneys in patients with diabetes. JNC VI recommends that patients with other compelling factors be given an antihypertensive that also treats the other factors.

Rationale 2: Beta blockers treat hypertension but do not help diabetes and can mask signs of hypoglycemia.

Rationale 3: Thiazide diuretics treat hypertension, but do not help diabetes.

Rationale 4: Calcium channel blockers treat hypertension, but do not help diabetes.

Rationale 5: ARBs protect the kidneys in patients with diabetes. JNC VI recommends that patients with other compelling factors be given an antihypertensive that also treats the other factors.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 25-5

Question 29

Type: MCMA

The nurse is caring for a patient recently diagnosed with hypertension. The patient asks what medications may be used to treat the condition. The nurse begins by discussing the primary antihypertensive agents, which include

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. diuretics.

2. angiotensin-II receptor blockers (ARBs).

3. beta-adrenergic antagonists.

4. direct-acting vasodilators.

5. peripheral adrenergic antagonists.

Correct Answer: 1,2,3

Rationale 1: Diuretics are considered a primary antihypertensive agent and should be discussed with this patient.

Rationale 2: ARBs are considered a primary antihypertensive agent and should be discussed with this patient.

Rationale 3: Beta-adrenergic antagonists are considered a primary antihypertensive agent and should be discussed with this patient.

Rationale 4: Direct-acting vasodilators are considered an alternative antihypertensive medication and are prescribed only when first-line agents do not produce a satisfactory response.

Rationale 5: Peripheral adrenergic antagonists are considered an alternative antihypertensive medication and are prescribed only when first-line agents do not produce a satisfactory response.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 25-5

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E

Copyright 2014 by Pearson Education, Inc.

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