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32 - TB- Test Bank Ch 32
Medical Surgical 1 (Chamberlain University)
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Chapter 32: Hypertension
Harding: Lewis’s Medical-Surgical Nursing, 11th Edition
MULTIPLE CHOICE
1. Which action should the nurse in the hypertension clinic take to obtain an accurate baseline
blood pressure (BP) for a new patient?
a. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second.
b. Have the patient sit in a chair with the feet flat on the floor.
c. Assist the patient to the supine position for BP measurements.
d. Obtain two BP readings in the dominant arm and average the results.
ANS: B
The patient should be seated with the feet flat on the floor. The BP is obtained in both arms,
and the results of the two arms are not averaged. The patient does not need to be in the supine
position. The cuff should be deflated at 2 to 3 mm Hg per second.
DIF: Cognitive Level: Understand (comprehension)
TOP: Nursing Process: Assessment
MSC: NCLEX: Health Promotion and Maintenance
2. The nurse obtains the following information from a patient newly diagnosed with elevated
blood pressure. Which finding is most important to address with the patient?
a. Low dietary fiber intake
b. No regular physical exercise
c. Drinks a beer with dinner every night
d. Weight is 5 pounds above ideal weight
ANS: B
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The recommendations for preventing hypertension include exercising aerobically for 30
minutes most days of the week. A weight that is 5 pounds over the ideal body weight is not a
risk factor for hypertension. The Dietary Approaches to Stop Hypertension (DASH) diet is
high in fiber but increasing fiber alone will not prevent hypertension from developing. The
patient’s alcohol intake is within guidelines and will not increase the hypertension risk.
DIF: Cognitive Level: Analyze (analysis)
MSC: NCLEX: Health Promotion and Maintenance
TOP: Nursing Process: Planning
3. Which action should the nurse take when giving the first dose of oral labetalol to a patient
with hypertension?
a. Encourage the use of hard candy to prevent dry mouth.
b. Teach the patient that headaches often occur with this drug.
c. Instruct the patient to call for help if heart palpitations occur.
d. Ask the patient to request assistance before getting out of bed.
ANS: D
Labetalol decreases sympathetic nervous system activity by blocking both - and
-adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause
severe orthostatic hypotension. Heart palpitations, dry mouth, dehydration, and headaches are
possible side effects of other antihypertensives.
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DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
4. After the nurse teaches the patient with stage 1 hypertension about diet modifications, which
diet choice indicates that the teaching has been most effective?
a. The patient avoids eating nuts or nut butters.
b. The patient restricts intake of chicken and fish.
c. The patient drinks low-fat milk with each meal.
d. The patient has two cups of coffee in the morning.
ANS: C
For the prevention of hypertension, the Dietary Approaches to Stop Hypertension (DASH)
recommendations include increasing the intake of calcium-rich foods. Caffeine restriction and
decreased protein intake are not part of the recommendations. Nuts are high in beneficial
nutrients and 4 to 5 servings weekly are recommended in the DASH diet.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
5. A patient diagnosed with hypertension has been prescribed captopril. Which information is
most important to teach the patient about this drug?
a. Include high-potassium foods such as bananas in the diet.
b. Increase fluid intake if dryness of the mouth is a problem.
c. Change position slowly to help prevent dizziness and falls.
d. Check the blood pressure in both arms before taking the drug.
ANS: C
The angiotensin-converting enzyme
inhibitors
cause orthostatic hypotension, and
NURSI(ACE)
NGTB.C
OMto often
patients should be taught to change
position
slowly
allow the vascular system time to
compensate for the position change. Increasing fluid intake may counteract the effect of the
drug. The patient is taught to use gum or hard candy to relieve dry mouth. The BP should be
taken in the nondominant arm by newly diagnosed patients in the morning, before taking the
drug, and in the evening. Because ACE inhibitors cause potassium retention, increased intake
of high-potassium foods is inappropriate.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
6. Propranolol (Inderal) is prescribed for a patient diagnosed with hypertension. The nurse
should consult with the health care provider before giving this drug when the patient reveals a
history of:
a. asthma.
b. daily alcohol use.
c. peptic ulcer disease.
d. myocardial infarction (MI).
ANS: A
Nonselective -blockers block 1- and 2-adrenergic receptors and can cause bronchospasm,
especially in patients with a history of asthma. -Blockers will have no effect on the patient’s
peptic ulcer disease or alcohol use. -Blocker therapy is recommended after MI.
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DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
7. A 62-yr-old patient who has no history of hypertension or other health problems suddenly
develops a blood pressure (BP) of 198/110 mm Hg. After reconfirming the BP, it is
appropriate for the nurse to tell the patient that:
a. a BP recheck should be scheduled in a few weeks.
b. dietary sodium and fat content should be decreased.
c. diagnosis, treatment, and monitoring will be needed.
d. there is danger of a stroke, requiring hospitalization.
ANS: C
A sudden increase in BP in a patient older than age 50 years with no hypertension history or
risk factors indicates that the hypertension may be secondary to some other problem. The BP
will need treatment and ongoing monitoring. If the patient has no other risk factors, a stroke in
the immediate future is unlikely. There is no indication that dietary salt or fat intake have
contributed to this sudden increase in BP. Reducing intake of salt and fat alone will not be
adequate to reduce this BP to an acceptable level.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
8. Which action will be included in the plan of care for a patient who is receiving nicardipine
(Cardene) to treat a hypertensive emergency?
a. Keep the patient NPO to prevent aspiration caused by nausea and possible
vomiting.
b. Organize nursing activities so that the patient has 8 hours of undisturbed sleep at
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night.
c. Assist the patient up in the chair for meals to avoid complications associated with
immobility.
d. Use an automated noninvasive blood pressure machine to obtain frequent
measurements.
ANS: D
Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV
antihypertensive medications. This can be most easily accomplished with an automated BP
machine or arterial line. The patient will require frequent assessments, so allowing 8 hours of
undisturbed sleep is not reasonable. When patients are receiving IV vasodilators, bed rest is
maintained to prevent decreased cerebral perfusion and fainting. There is no indication that
this patient is nauseated or at risk for aspiration, so an NPO status is unnecessary.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
9. The nurse has just finished teaching a hypertensive patient about a newly prescribed drug,
ramipril (Altace). Which patient statement indicates that more teaching is needed?
a. “The medication may not work well if I take aspirin.”
b. “I can expect some swelling around my lips and face.”
c. “The doctor may order a blood potassium level occasionally.”
d. “I will call the doctor if I notice that I have a frequent cough.”
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ANS: B
Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an
indication that the ACE inhibitor should be discontinued. The patient should be taught that if
any swelling of the face or oral mucosa occurs, the health care provider should be
immediately notified because this could be life threatening. The other patient statements
indicate that the patient has an accurate understanding of ACE inhibitor therapy.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
10. During change-of-shift report, the nurse obtains the following information about a
hypertensive patient who received the first dose of nadolol (Corgard) during the previous
shift. Which information indicates that the patient needs immediate intervention?
a. The patient’s pulse has dropped from 68 to 57 beats/min.
b. The patient reports that the fingers and toes feel quite cold.
c. The patient has developed wheezes throughout the lung fields.
d. The patient’s blood pressure (BP) reading is now 158/92 mm Hg.
ANS: C
The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a
common adverse effect of the noncardioselective -blockers) is occurring. The nurse should
immediately obtain an O2 saturation measurement, apply supplemental O2, and notify the
health care provider. The mild decrease in heart rate and cold fingers and toes are associated
with -receptor blockade but do not require any change in therapy. The BP reading may
indicate that a change in medication type or dose may be indicated. However, this is not as
urgently needed as addressing the bronchospasm.
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S N
DIF: Cognitive Level: Analyze U
(analysis)
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Evaluation
11. An older patient has been diagnosed with possible white coat hypertension. Which planned
action by the nurse addresses that suspected cause of the hypertension?
a. Instruct the patient about the need to decrease stress levels.
b. Teach the patient how to self-monitor and record BPs at home.
c. Tell the patient and caregiver that major dietary changes are needed.
d. Schedule the patient for regular blood pressure (BP) checks in the clinic.
ANS: B
In the phenomenon of “white coat” hypertension, patients have elevated BP readings in a
clinical setting and normal readings when BP is measured elsewhere. Having the patient
self-monitor BPs at home will provide a reliable indication about whether the patient has
hypertension. Regular BP checks in the clinic are likely to be high in a patient with white coat
hypertension. There is no evidence that this patient has elevated stress levels or a poor diet,
and those factors do not cause white coat hypertension.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
12. Which blood pressure (BP) finding by the nurse indicates that no changes in therapy are
needed for a 48-yr-old patient with newly diagnosed hypertension?
a. 98/56 mm Hg
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
b. 128/76 mm Hg
c. 128/92 mm Hg
d. 142/78 mm Hg
ANS: B
The 8th Joint National Committee’s recommended goal for antihypertensive therapy for a 30to 59-yr-old patient with hypertension is a BP below 130/80 mm Hg. The BP of 98/56 mm Hg
may indicate overtreatment of the hypertension and an increased risk for adverse drug effects.
The other two blood pressures indicate a need for modifications in the patient’s treatment.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
13. Which information is most important for the nurse to include when teaching a patient newly
diagnosed with hypertension?
a. Most people are able to control BP through dietary changes.
b. Annual BP checks are needed to monitor treatment effectiveness.
c. Hypertension is usually asymptomatic until target organ damage occurs.
d. Increasing physical activity controls blood pressure (BP) for most people.
ANS: C
Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle
changes (e.g., physical activity, dietary changes) are used to help manage BP, but drugs are
needed for most patients. Home BP monitoring should be taught to the patient and findings
checked by the health care provider frequently when starting treatment for hypertension and
then every 3 months when stable.
DIF: Cognitive Level: Apply N
(application)
URSINGMSC:
TB.C
OM
TOP: Nursing Process: Implementation
NCLEX: Physiological Integrity
14. The nurse on the intermediate care unit received change-of-shift report on four patients with
hypertension. Which patient should the nurse assess first?
a. 48-yr-old with a blood pressure of 160/92 mm Hg who reports chest pain
b. 52-yr-old with a blood pressure of 198/90 mm Hg who has intermittent
claudication
c. 50-yr-old with a blood pressure of 190/104 mm Hg who has a creatinine of 1.7
mg/dL
d. 43-yr-old with a blood pressure of 172/98 mm Hg whose urine shows
microalbuminuria.
ANS: A
The patient with chest pain may be experiencing acute myocardial infarction and rapid
assessment and intervention are needed. Intermittent claudication, elevated creatinine, and
microalbuminuria show target organ damage but do not indicate acute processes.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization | Special Questions: Multiple Patients
TOP: Nursing Process: Assessment
MSC: NCLEX: Safe and Effective Care Environment
15. The nurse is reviewing the laboratory test results for a patient who has recently been
diagnosed with hypertension. Which result is most important to communicate to the health
care provider?
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a.
b.
c.
d.
Serum creatinine of 2.8 mg/dL
Serum potassium of 4.5 mEq/L
Serum hemoglobin of 14.7 g/dL
Blood glucose level of 96 mg/dL
ANS: A
The elevated serum creatinine indicates renal damage caused by the hypertension. The other
laboratory results are normal.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
16. A patient with a history of hypertension treated with a diuretic and an angiotensin-converting
enzyme (ACE) inhibitor arrives in the emergency department. The patient reports a severe
headache and nausea and has a blood pressure (BP) of 238/118 mm Hg. Which question
should the nurse ask to follow up on these findings?
a. “Have you recently taken any antihistamines?”
b. “Have you consistently taken your medications?”
c. “Did you take any acetaminophen (Tylenol) today?”
d. “Have there been recent stressful events in your life?”
ANS: B
Sudden withdrawal of antihypertensive medications can cause rebound hypertension and
hypertensive crisis. Although many over-the-counter medications can cause hypertension,
antihistamines and acetaminophen do not increase BP. Stressful events will increase BP but
not usually to the level seen in this patient.
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DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
17. The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a
hypertensive emergency. Which finding is most important to report to the health care
provider?
a. Urine output over 8 hours is 250 mL less than the fluid intake.
b. The patient cannot move the left arm and leg when asked to do so.
c. Tremors are noted in the fingers when the patient extends the arms.
d. The patient reports a headache with pain at level 7 of 10 (0 to 10 scale).
ANS: B
The patient’s inability to move the left arm and leg indicates that a stroke may be occurring
and will require immediate action to prevent further neurologic damage. The other clinical
manifestations are also likely caused by the hypertension and will require rapid nursing
actions, but they do not require action as urgently as the neurologic changes.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
18. A patient with hypertension who has just started taking atenolol (Tenormin) returns to the
health clinic after 2 weeks for a follow-up visit. The blood pressure (BP) is unchanged from
the previous visit. Which action should the nurse take first?
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a.
b.
c.
d.
Tell the patient why a change in drug dosage is needed.
Ask the patient if the medication is being taken as prescribed.
Review with the patient any lifestyle changes made to help control BP.
Teach the patient that multiple drugs are often needed to treat hypertension.
ANS: B
Because nonadherence with antihypertensive therapy is common, the nurse’s initial action
should be to determine whether the patient is taking the atenolol as prescribed. The other
actions also may be implemented, but these would be done after assessing patient adherence
with the prescribed therapy.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
19. The registered nurse (RN) is caring for a patient with a hypertensive crisis who is receiving
sodium nitroprusside. Which nursing action can the nurse delegate to an experienced licensed
practical/vocational nurse (LPN/VN)?
a. Evaluate effectiveness of nitroprusside therapy on blood pressure (BP).
b. Assess the patient’s environment for adverse stimuli that might increase BP.
c. Titrate nitroprusside to decrease mean arterial pressure (MAP) to 115 mm Hg.
d. Set up the automatic noninvasive BP machine to take readings every 15 minutes.
ANS: D
LPN/VN education and scope of practice include the correct use of common equipment such
as automatic noninvasive blood pressure machines. Assessment, evaluation, and medication
titration require advanced nursing judgment and education, and should be done by RNs.
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DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Delegation
TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
20. The charge nurse observes a new registered nurse (RN) doing discharge teaching for a patient
with hypertension who has a new prescription for enalapril (Vasotec). Which statement by the
new nurse to the patient would require the charge nurse’s intervention?
a. “Make an appointment with the dietitian for teaching.”
b. “Increase your dietary intake of high-potassium foods.”
c. “Check your blood pressure at home at least once a day.”
d. “Move slowly when moving from lying to sitting to standing.”
ANS: B
The ACE inhibitors cause retention of potassium by the kidney, so hyperkalemia is a possible
adverse effect. The other teaching by the new RN is appropriate for a patient with newly
diagnosed hypertension who has just started therapy with enalapril.
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Delegation
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
21. Which assessment finding for a patient receiving IV furosemide (Lasix) to treat stage 2
hypertension is most important to report to the health care provider?
a. Blood glucose level of 175 mg/dL
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b. Serum potassium level of 3.0 mEq/L
c. Orthostatic systolic BP decrease of 12 mm Hg
d. Current blood pressure (BP) reading of 168/94 mm Hg
ANS: B
Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening
dysrhythmias. The health care provider should be notified of the potassium level immediately
and administration of potassium supplements initiated. The elevated blood glucose and BP
also need collaborative intervention but will not require action as urgently as the hypokalemia.
An orthostatic drop of 12 mm Hg will require intervention only if the patient is symptomatic.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
22. Which action should the nurse take first to assist a patient with newly diagnosed stage 1
hypertension in making needed dietary changes?
Collect a detailed diet history.
Provide a list of low-sodium foods.
Help the patient make an appointment with a dietitian.
Teach the patient about foods that are high in potassium.
a.
b.
c.
d.
ANS: A
The initial nursing action should be assessment of the patient’s baseline dietary intake through
a thorough diet history. The other actions may be appropriate, but assessment of the patient’s
baseline should occur first.
DIF: Cognitive Level: Analyze
(analysis)
NU
RSINGTB.COM
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
23. The nurse is caring for a 70-yr-old patient who takes hydrochlorothiazide and enalapril
(Norvasc). The patient’s blood pressure (BP) continues to be high. Which patient information
may indicate a need for a change?
a. Patient takes a daily multivitamin tablet.
b. Patient uses ibuprofen to treat osteoarthritis.
c. Patient checks BP daily just after getting up.
d. Patient drinks wine three to four times a week.
ANS: B
Because use of nonsteroidal antiinflammatory drugs (NSAIDs) can prevent adequate BP
control, the patient may need to avoid the use of ibuprofen. A multivitamin tablet will help
supply vitamin D, which may help lower BP. BP decreases while sleeping, so self-monitoring
early in the morning will result in obtaining pressures that are at their lowest. The patient’s
alcohol intake is not excessive.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
SHORT ANSWER
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
1. The nurse obtains a blood pressure of 172/82 mm Hg for a patient. What is the patient’s mean
arterial pressure (MAP)?
ANS:
112 mm Hg
MAP = (SBP + 2 DBP)/3
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
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