Hypertension NCLEX Questions

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s646680Preview Hypertension PEARLS - Essential H...Teacher 46 terms SmartyPANCEPreview Diabetes Mellitus NCLEX Style Ques...Teacher 36 terms ssandholmPreview Hypert 23 terms kma A client with newly diagnosed hypertension asks what she can do to decrease the risk for related cardiovascular problems. Which of the following risk factors is modifiable by the client?

a) Impaired renal function

b) Dyslipidemia

c) Age

d) Family history

Dyslipidemia Correct

Explanation: Page 862

Age, family history, and impaired renal function are risk factors for cardiovascular disease related to hypertension that the client cannot change.Obesity, inactivity, and disylipidemia are risk factors that the client can improve through diet, exercise, and other healthy lifestyle changes.A patient is admitted to the intensive care unit (ICU) with a diagnosis of hypertension emergency/crisis. The patient's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV Nitropress (nitroprusside). Upon assessment, which of the following patient findings requires immediate intervention by the nurse?

a) Nausea and severe headache

b) Chest pain score of 3/10 (on a scale of 1 to 10)

c) Urine output of 40 cc/mL over the last hour

d) Left arm numbness and weakness

Left arm numbness and weakness

Explanation: Page 873

Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. The finding of left arm numbness and weakness may indicate the patient is experiencing neurological symptoms associated with an ischemic stroke because of the severely elevated BP and requires immediate interventions. A urine output of 40 mL/h is within normal limits. The other findings are likely caused by the hypertension and require intervention, but they do not require action as urgently as the neurologic changes.

Hypertension is defined as "sustained elevations in systolic or diastolic blood pressures that exceed prehypertension levels." What are some of the consequences of hypertension that make it such a health menace in the United States?

a) Cerebrovascular accident

b) Cardiac failure

c) Renal disease

d) All options are correct.

All options are correct.Correct

Explanation: Page 862

Healthcare professionals have revised guidelines for identifying hypertension because hypertension places people at risk for heart disease, heart failure, stroke, and kidney disease.A 35-year-old female patient has been diagnosed with hypertension. The patient is a stock broker, smokes daily, and is also a diabetic. During a follow-up appointment, the patient states that she finds it cumbersome and time consuming to visit the doctor regularly just to check her blood pressure (BP). As the nurse, which of the following aspects of patient teaching would you recommend?

a) Purchasing a self-monitoring BP cuff

b) Advising a smoking cessation

c) Discussing methods for stress reduction

d) Administering glycemic control

Correct response: Purchasing a self-monitoring BP cuff

Explanation: Page 871

Because this patient finds it time consuming to visit the doctor just for a blood pressure reading, as the nurse, you can suggest the use of an automatic cuff at a local pharmacy, or purchasing a self-monitoring cuff. Discussing methods for stress reduction, advising a smoking cessation, and administering glycemic control would constitute patient education in managing hypertension.When treating hypertensive emergencies, the nurse identifies the most appropriate route of administration for antihypertensive agents as being which of the following?

a) Sublingual

b) Continuous IV infusion

c) Oral

d) Intramuscular

Correct response: Continuous IV infusion

Explanation: Page 873

The medications of choice in hypertensive emergencies are best managed through the continuous IV infusion of a short-acting titratable antihypertensive agent. The nurse avoids the sublingual and IM routes as their absorption and dynamics are unpredictable. The oral route would not have as quick an onset as a continuous IV infusion.

A nurse is caring for a client with hypertension. The physician orders furosemide (lasix) 2 mg/kg to be given intravenously. The client weighs 24 kg. The medication comes in a single-use vial that contains 40 mg in 4 mL (10 mg/mL). How much will the nurse draw up for this client's dose?

• 0.24 mL
• 4.8 mL
• 2.4 mL
• 0.48 mL

4.8 mL Correct

Explanation:

The formula is as follows: 24Kg X 2 mg = 48 mg total dose 48 mg / 10mg/mL = 4.8 mL amount to be drawn up Officially, hypertension is diagnosed when the patient demonstrates a systolic blood pressure greater than ______ mm Hg and a diastolic blood pressure greater than _____ mm Hg over a sustained period.

• 120, 70
• 140, 90
• 130, 80
• 110, 60

140, 90

Correct

Explanation: Page 862

According to the categories of blood pressure levels established by the JNC VI, stage 1 hypertension is demonstrated by a systolic pressure of 140 to 159, or a diastolic pressure of 90 to 99. Pressure of 130 systolic and 80 diastolic falls within the normal range for an adult. Pressure of 110 systolic and 60 diastolic falls within the normal range for an adult. Pressure of 120 systolic and 70 diastolic falls within the normal range for an adult.A patient is being treated for hypertensive emergency. When treating this patient, the priority goal is to lower the mean blood pressure (BP) by which percentage in the first hour?

• 45%
• 35%
• 40%

d) Up to 25%

Up to 25%

Explanation: Page 873

The therapeutic goals are reduction of the mean BP by up to 25% within the first hour of treatment, a further reduction to a goal pressure of about 160/100 mm Hg over a period of 2 to 6 hours, and then a more gradual reduction in pressure to the target goal over a period of days.

The nurse is caring for an elderly client with a diagnosis of hypertension, who is taking several antihypertensive medications. Which saftey precaution is the nurse most likely to reinforce?

a) Being sure to keep follow-up appointments

b) Walking as far as the client is able every day

c) Eating extra potassium due to loss of potassium related to medications

d) Changing positions slowly related to possible hypotension

Correct response: Changing positions slowly related to possible hypotension

Explanation: Page 872

The elderly have impaired cardiovascular reflexes and thus are more sensitive to the extracellular volume depletion caused by diuretics and to the sympathetic inhibition caused by adrenergic antagonists. The nurse teaches clients to change positions slowly when moving from a lying or sitting position to a standing position. This will help prevent falls. Eating extra potassium is not a good idea if taking a potassium-sparing diuretic.The other choices are good teaching points, but not necessarily safety precautions.A nurse is teaching about lifestyle modifications to a group of clients with known hypertension. Which of the following statements would the nurse include in the education session?

a) Limit alcohol consumption to no more that 3 drinks per day.

b) Maintain a waist circumference of 45 (men) and 40 (women) inches or less.

c) Engage in aerobic activity at least 30 minutes/day most days of the week.

d) Maintain a body mass index between 30 and 35.

Engage in aerobic activity at least 30 minutes/day most days of the week.Correct

Explanation: Page 865

Recommmended lifestye modifications to prevent and manage hypertension include maintaining a normal body mass index (about 24; greater than 25 is considered overweight), maintaining a waist circumference of less than 40 inches for men and 35 inches for women, limiting alcohol intake to no more than 2 drinks for men and 1 drink for women per day, and engaging in aerobic activity at least 30 minutes per day most days of the week.A nurse is providing education about lifestyle modifications to a group of clients who have been newly diagnosed with hypertension. The nurse

would include all the following statesments except:

a) Maintain a waist circumference of 40 (men) and 35 (women) inches or less.

b) Engage in aerobic activity at least 30 minutes/day most days of the week.

c) Maintain a normal body mass index of about 24.

d) Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women.

Limit alcohol consumption to no more that 3 drinks per day for men and 2 drinks per day for women.

Explanation: Page 865 table 31-2

Recommmended lifestye modifications to prevent and manage hypertension include maintaining a normal body mass index (about 24; greater than 25 is considered overweight), maintaining a waist circumference of less than 40 inches for men and 35 inches for women, limiting alcohol intake per day to no more than 2 drinks for men and 1 drink for women, and engaging in aerobic activity at least 30 minutes per day most days of the week.