Chapter 28Hypertension: Nursing Management My Nursing Test Banks

Chapter 28Hypertension: Nursing Management

MULTIPLE CHOICE

1.Which of the following should the nurse instruct a client who is newly diagnosed with hypertension?

1.

It is a lifelong process.

2.

It can be managed easily.

3.

It is a short-term problem.

4.

It happens only in the very poor and treatment is expensive.

ANS: 1

Treatment of hypertension is a lifelong process. It requires lifestyle modification and occurs in all racial and economical groups. Hypertension can either be easy or difficult to manage.

PTS: 1 DIF: Apply REF: Introduction

2.A client is diagnosed with isolated systolic hypertension. The nurse realizes that this diagnosis means the client is experiencing a systolic pressure:

1.

greater than 140 mmHg and a diastolic pressure greater than 90 mmHg.

2.

greater than 90 mmHg and a diastolic pressure greater than 60 mmHg.

3.

greater than 140 mmHg and a diastolic pressure lower than 90 mmHg.

4.

lower than 140 mmHg and a diastolic pressure greater than 90 mmHg.

ANS: 3

The likelihood of developing isolated systolic hypertension is greater with age and is confirmed with a systolic pressure greater than 140 mmHg while the diastolic pressure remains less than 90 mmHg.

PTS: 1 DIF: Analyze REF: Hypertension: Nonmodifiable Risk Factors

3.The nurse is instructing a client on the impact of cigarette smoking and the development of hypertension. Which of the following would not be appropriate for the nurse to include in these instructions?

1.

Tobacco damages the lining of the artery walls.

2.

Tobacco temporarily constricts blood vessels, increasing pulse and blood pressure.

3.

Tobacco thins the blood and makes the person at risk for bleeding.

4.

Carbon monoxide in tobacco smoke replaces the oxygen in the blood, forcing the heart to work harder to supply oxygen.

ANS: 3

Tobacco and smoking have been shown to increase heart rate and blood pressure because of vasoconstriction and the accumulation of plaque on the artery walls. Because of the replacement of oxygen with carbon monoxide from tobacco smoke, the heart has to work harder to supply oxygen to the organs. There is no evidence that smoking thins the blood and causes bleeding.

PTS: 1 DIF: Apply REF: Hypertension: Modifiable Risk Factors

4.The nurse is assessing a clients pulse pressure. His blood pressure reading is 130/82 mmHg. Which of the following is the correct pulse pressure?

1.

40

2.

48

3.

130

4.

82

ANS: 2

The pulse pressure is the difference between the systolic and diastolic pressure: 130 82 = 48. The other choices represent miscalculations or not understanding the correct way to calculate pulse pressure.

PTS: 1 DIF: Apply REF: Hypertension: Pathophysiology

5.A client is surprised to learn that she has high blood pressure. Which of the following should the nurse assess in this client? The presence or occurrence of:

1.

nausea.

2.

pain.

3.

headache.

4.

fear.

ANS: 3

With very elevated blood pressure, headache is the most commonly reported symptom. Although pain and nausea may be reported, they are not the most common. Fear is not commonly associated with hypertension though it may occur with an onset of pain or nausea.

PTS:1DIF:Apply

REF: Hypertension: Assessment with Clinical Manifestations

6.A clients blood pressure has been measured at 130/86 mmHg on two separate occasions. The nurse realizes this clients blood pressure reading would be categorized as being:

1.

normal.

2.

prehypertension.

3.

stage 1 hypertension.

4.

stage 2 hypertension.

ANS: 2

Prehypertension is a new designation used to identify individuals at high risk for the development of hypertension. Systolic blood pressure of 120 to 139 and diastolic blood pressure of 80 to 90 are values for prehypertension. A normal blood pressure is less than or equal to 120 mmHg systolic and less than or equal to 80 mmHg diastolic. Stage 1 hypertension is a systolic blood pressure between 140 to 159 and a diastolic pressure between 90 to 99. Stage 2 hypertension is a systolic reading greater than or equal to 160 and a diastolic pressure of greater than or equal to 100 mmHg.

PTS:1DIF:Analyze

REF:Table 28-6 JNC VII Classification of Blood Pressure in Adults

7.The nurse uses a blood pressure cuff that is too small for the circumference of the clients arm. How will this size of blood pressure cuff affect the clients blood pressure measurement?

1.

Falsely low

2.

Falsely high

3.

Not clearly heard

4.

More time consuming

ANS: 2

The blood pressure cuff must be the appropriate size to get an accurate reading. A cuff that is too small could result in a falsely high reading. A blood pressure cuff that is too large could result in a falsely low reading. The cuff size may not affect the nurses ability to hear the blood pressure sounds. An incorrect blood pressure cuff size will not be more time consuming to use.

PTS:1DIF:Analyze

REF:Table 28-2 Factors Causing False Blood Pressure Readings

8.A client diagnosed with hypertension should be instructed by the nurse to avoid which of the following foods?

1.

Cold cuts

2.

Bananas

3.

Milk

4.

Oatmeal

ANS: 1

Cold cuts are processed meats that are usually high in sodium and may cause water retention and an increase in blood pressure. The rest of the foods really have no effect on blood pressure.

PTS:1DIF:Apply

REF: Hypertension: Planning and Implementation: Evidence-Based Care

9.A client is instructed to reduce his intake of daily sodium intake so that the total amount is what his body needs. The nurse should instruct the client to reduce sodium intake to:

1.

500 mg a day.

2.

1000 mg a day.

3.

2500 mg a day.

4.

4500 mg a day.

ANS: 1

A human body needs about 500 mg of sodium each day. The average intake of sodium for individuals in the United States is between 4000 to 6000 mg a day.

PTS:1DIF:Apply

REF: Hypertension: Planning and Implementation: Evidence-Based Care

10.A client asks the nurse why she should be concerned about the amount of sodium in ice cream. Which of the following should the nurse respond to this client?

1.

Sodium is used to enhance the flavor.

2.

Sodium is used to emulsify the ice cream.

3.

Sodium is used to prevent mold.

4.

Sodium is used as a preservative.

ANS: 2

Sodium is used in ice cream as an emulsifier. Sodium in canned or processed foods is used to enhance flavor. Sodium is used to prevent mold in cheese, breads, and cakes. Sodium is used as a preservative in cured meats and sausages.

PTS: 1 DIF: Apply REF: Table 28-6 Sodium-Based Food Additives

11.Which of the following should the nurse instruct a client who desires to reduce his blood pressure through increasing physical activity?

1.

Regular exercise can lower the blood pressure by 5 to 10 mmHg.

2.

Regular exercise must be done 7 days a week.

3.

Regular exercise has to be done for at least 2 hours each day.

4.

Regular exercise is the participation in aerobic activities.

ANS: 1

Regular exercise can lower blood pressure by 5 to 10 mmHg. Regular exercise should be done 5 days a week for 60 minutes or 20 minutes of vigorous exercise at least 3 times a week to be effective. Regular exercise includes aerobic activity, flexibility, and strengthening exercises.

PTS:1DIF:Apply

REF: Hypertension: Planning and Implementation: Evidence-Based Care

12.A client is prescribed Spironolactone (Aldactone) for blood pressure control. Which of the following should the nurse assess in this client as a potential side effect?

1.

Hypokalemia

2.

Hyperkalemia

3.

Hyponatremia

4.

Hypernatremia

ANS: 2

Spironolactone (Aldactone) is a potassium-sparing diuretic. Side effects include hyperkalemia. Hypokalemia and hyponatremia are side effects of the thiazide diuretics. Hypernatremia is not a known side effect of any antihypertensive medication.

PTS:1DIF:Apply

REF: Table 28-9 Pharmacologic Management of Hypertension

13.A client is prescribed an ACE inhibitor for management of hypertension. Which of the following side effects should the nurse instruct the client as being expected with this medication?

1.

Tachycardia

2.

Constipation

3.

Bizarre dreams

4.

Persistent dry cough

ANS: 4

One side effect of ACE inhibitors that is expected with this medication is a persistent dry cough. Tachycardia, constipation, and bizarre dreams are not side effects associated with ACE inhibitors.

PTS:1DIF:Apply

REF: Table 28-9 Pharmacologic Management of Hypertension

MULTIPLE RESPONSE

1.The nurse is considering the risk factors for a clients development of primary hypertension. Which of the following would be considered nonmodifiable risk factors for the client? (Select all that apply.)

1.

Age

2.

Stress

3.

Gender

4.

Ethnicity

5.

Regular exercise

6.

Limits fat and salt in diet

ANS: 1, 3, 4

Nonmodifiable risk factors are those thing we cannot change or control, such as age, gender, and ethnicity. Stress, exercise, and diet are considered modifiable risk factors or those the client can control.

PTS: 1 DIF: Analyze REF: Hypertension: Risk Factors

2.Which of the following should the nurse tell a client when instructing on ways to reduce the risk factors for hypertension? (Select all that apply.)

1.

Smoking

2.

Diet

3.

Exercise

4.

Family history

5.

Race

6.

Stress

ANS: 1, 2, 3, 6

Modifiable risk factors can be changed or modified to help control hypertension. Smoking, diet, stress, and exercise can be changed to affect blood pressure. Persons with more risk factors have a greater chance of having hypertension during their lives. Family history and race cannot be modified.

PTS: 1 DIF: Apply REF: Hypertension: Risk Factors

3.Which of the following assessment questions would be appropriate for the nurse to use when assessing a client for hypertension? (Select all that apply.)

1.

Do you consume alcohol products? How much? How long?

2.

Do you use nicotine products? How much? How long?

3.

Do you experience nosebleeds?

4.

Do you get hungry at night?

5.

Do you experience cold sweats?

6.

Do you experience headaches?

ANS: 1, 2, 3, 6

The nurse will often ask the client questions about risks of hypertension. Asking about alcohol and nicotine product use will tell you about increased risk factors. Nosebleeds and headaches are often associated with hypertension. Although cold sweats and hunger are symptoms a patient may report, they are not indicative of hypertension.

PTS: 1 DIF: Apply REF: Box 28-2 Hypertension Assessment

4.The blood pressure measurement for a client is very different from the one that was assessed a few hours previously. The nurse should suspect that the blood pressure measurement is false when which of the following is assessed in the client?

1.

Client needs to void.

2.

Client smoked a cigarette 10 minutes prior to the measurement.

3.

The examination room is very warm.

4.

Doors are slamming and children are crying in the environment.

5.

Client just had lunch.

6.

Client slept for 8 hours the previous night.

ANS: 1, 2, 3, 4

Factors that cause false blood pressure readings include anxiety, full urinary bladder, excessively warm room, recent tobacco use, and loud or repetitive noises. Eating a meal or having 8 hours of sleep are not known to cause a false blood pressure reading.

PTS:1DIF:Analyze

REF:Table 28-2 Factors Causing False Blood Pressure Readings

5.A client is planning to use nicotine gum to aid with cigarette cessation. Which of the following should the nurse instruct the client as adverse effects of using nicotine gum? (Select all that apply.)

1.

Rapid heart rate may result.

2.

Mild headaches can occur.

3.

A sore mouth and throat are possible.

4.

Abnormal dreams are common.

5.

Pruritis is possible.

6.

Nausea can occur.

ANS: 1, 2, 3, 6

Adverse effects associated with the use of nicotine chewing gum include tachycardia, mild headache, sore mouth and throat, and nausea. Abnormal dreams and pruritis are adverse effects of nicotine patches, nicotine nasal spray, and nicotine inhalers.

PTS: 1 DIF: Apply REF: Table 28-7 Medications for Smoking Cessation

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