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Mid-Term Review Questions Chapter 26  You are leading an…

Mid-Term Review Questions

Chapter 26 

You are leading an educational discussion on childhood hypertension at a local school board meeting. A particular focus of the discussion is the promotion of nonpharmacologic treatment measures. Which of the following methods is appropriate for managing hypertension in children?

Promotion of exercise

Prevention of obesity                                                                                        

Reduction of dietary sodium

All the above

 

A community health nurse is facilitating a health promotion session to a group of seniors. Which topic related to hypertension is most important to include in the information?

 Hypertension will increase the risk of cancer.

An increase is sodium is recommended with hypertension.

Exercise will increase the risk of hypertension.

Hypertension will increase the risk of heart disease.

 

When providing dietary instruction on a low-sodium diet, which dietary choice is most appropriate for a client with hypertension?

 Hot dog, baked beans, and Cole slaw

Grilled hamburger, French fries, and cola drink

Grilled chicken, green salad, and apple

Ham sandwich, potato chips, and cookie

 

 

 

4.  The nurse is teaching a client about hypertension. Nonpharmacologic methods to decrease blood pressure would include which?

weight loss and decreased salt intake.

decreased water intake and decreased potassium intake.

increased exercise activity and fat intake.

stress reduction techniques and high fat intake.

 

5.  What should a client with newly diagnosed hypertension be counseled to do? 

Select all that apply.

Lose weight

Stop smoking

Reduce stress

Decrease exercise

Increase sodium intake

 

6.  An adult client recently diagnosed with hypertension has begun combination therapy. Which client statement would suggest a need for further health education?

“I’m going to make up a schedule for checking my blood pressure on a regular basis.”

“I’ll only need to take these drugs on days when my blood pressure is particularly high.”

“My wife and I are thinking of ways that we can cut down the amount of salt in our diet.”

“I’ve made plans with my best friend to start going for walks in the morning four times a week.”

 

 

 

 

7.  The goal of therapy for a client taking antihypertensive medication is to maintain:

compliance.

the blood pressure within normal limits.

a fluid volume balance.

homeostasis.

 

8.  The nurse should inform the client of the possibility of developing what common adverse effect of captopril therapy?

rhinitis

dry cough

photosensitivity

rash to the trunk and extremities

 

9.  The nurse would encourage clients with prehypertension to follow what type of diet?

High-sodium diet

DASH diet

Restricted-calorie diet

High-protein diet

 

10.  A patient who is prescribed losartan for hypertension has stopped taking the drug immediately after experiencing adverse effects. Which of the following may result when antihypertensives are abruptly discontinued?

Breathing difficulty

Rebound hypertension

Orthostatic hypotension

Anginal attack

11.  A client with a blood pressure of 165/95 mm Hg would be classified in which stage of hypertension?

Stage 2

Stage 1

Prehypertension

Normotensive

 

12.  A staff nurse on a renal unit knows that most patients require treatment for hypertensive disease. What would the nurse expect to assess prior to the beginning of antihypertensive treatment?

A temporary increase in renal function

A sustained increase in renal dysfunction

Baseline renal function

A sustained decrease in renal function

 

13.  A client prescribed a potassium-sparing diuretic is at a risk for developing which electrolyte imbalance?

 hypernatremia

 hyponatremia

 hypokalemia

 hyperkalemia

 

 

 

 

 

 

14.  An older adult client who resides in a care facility has been prescribed antihypertensives for the first time following many years of generally good health. When administering the first dose of the prescribed antihypertensive medication to an older adult, the nurse should recognize the related risk to which possible side effect?

 falls

 Infection

 acute confusion

 impaired oxygenation

 

15.  A client prescribed ramipril earlier in the week states, “Now I have a nagging, dry cough.” How should the nurse best follow up the client’s statement?

Inform the client that the drug should be immediately discontinued.

Inform the client that this is an adverse effect of the medication that may lead to pneumonitis.

Explain why it will be necessary to obtain a sputum sample.

Explain that drugs like ramipril often cause a cough.

 

16.  The client is diagnosed with primary hypertension. The nurse is educating a client about dietary changes that help decrease blood pressure. Which menu selection indicates the need for further client education?

Salad with a grilled chicken; unsweetened tea

Baked fish, broccoli, and oranges

Ham sandwich with mustard, carrots and cheesy dip

Turkey sandwich on whole wheat with lettuce and tomato; sweetened tea

 

 

 

17.  What statement should underlie the nurse’s response when asked if ACE inhibitor therapy can be continued during pregnancy?

Since ACE inhibitors cross the placenta, dosage during pregnancy should be reduced.

ACE inhibitors are contraindicated during pregnancy because they are teratogenic.

ACE inhibitors will exacerbate the fluid overload that commonly accompanies pregnancy.

There is no research to support discontinuation of ACE inhibitor therapy during pregnancy.

 

18.  A group of students are reviewing the various antihypertensive agents. The students demonstrate understanding of the information when they identify what as an example of an angiotensin II receptor blocker?

Moexipril

Losartan

Minoxidil

Amlodipine

 

19.  A patient has been advised to use a transdermal patch of clonidine for hypertension. For which of the following time periods should the nurse ensure that the patch is intact?

For one week

For two weeks

For three weeks

For four weeks

 

 

 

 

 

20.  A client is prescribed aliskiren. The nurse would monitor the laboratory test results of which electrolyte closely?

Potassium

Sodium

Magnesium

Chloride

 

21.  The nurse provides drug teaching to the client prescribed captopril. What statement made by the client does the nurse interpret to mean teaching has been effective?

“I will monitor the effectiveness by watching for any symptoms of hypertension.”

“I will call my doctor if I bruise easily or become extremely tired.”

“I’ll take the drug in the morning so that I don’t have to go to the bathroom often at night.”

“I will increase my intake of foods high in potassium, such as bananas.”

 

22.  A 42-year-old client is seen by the health care provider for follow-up for diabetic nephropathy. The provider prescribed losartan for the treatment of this condition because the medication has been shown to reduce the rate of end-stage renal disease. Which drug class does this drug belong to?

Antihyperlipidemic drugs

Calcium channel blockers

Selective aldosterone blockers

Angiotensin II receptor blockers

 

23.  How is hypertension defined with regard to blood pressure readings?

systolic pressure above 140 mm Hg or diastolic pressure above 90 mm Hg

systolic pressure above 160 mm Hg or diastolic pressure above 110 mm Hg

systolic pressure above 130 mm Hg or diastolic pressure above 88 mm Hg

systolic pressure above 150 mm Hg or diastolic pressure above 100 mm Hg

24.  A client develops primary hypertension and asks the nurse, “How long will I need to receive therapy?” The nurse responds based on the understanding that therapy would be required for how long?

Lifelong

Until blood pressure is 120/80 mmHg

One year

5 years

 

25.  A nurse is caring for a client who has been diagnosed with primary hypertension. What nursing interventions should be included in the teaching plan? Select all that apply.

Regular aerobic exercise

Diet with more fruits and vegetables

Decreased alcohol consumption

Smoking cessation

Focus on finding a different job

 

26.  The client has been started on an ACE inhibitor for hypertension. The client also takes spironolactone (Aldactone) daily. The nurse would evaluate the client for which of the following?

Hyperkalemia

Hypokalemia

Hypercalcemia

Hypocalcemia

 

 

 

 

27.  A client, diagnosed with left-sided heart failure, should be taught to recognize the signs and symptoms of the onset of what classic manifestation of this condition?

pulmonary edema

venous ulcers

chest pain

palpitations

 

28.  A nurse is caring for a client experiencing a hypertensive emergency. If blood pressure is not lowered immediately, what can occur? (Select all that apply.)

Damage to the heart

Damage to the kidneys

Damage to the gall bladder

Damage to the pancreas

Damage to the eyes

 

27, The female client states that her father has had high blood pressure all of his life and he is healthy. She does not understand why the care provider has prescribed medication for her blood pressure. What is the nurse’s best response?

“Maybe you do not need medication with your history.”

“With high blood pressure, blood vessels may be damaged and that can cause heart and kidney disease.”

“The effects of high blood pressure are different for different people.”

“We always treat high blood pressure with medicine to prevent further damage to your body.”

 

 

 

28.  A client has come to the clinic for the past 7 months with elevated blood pressure. The client has now been prescribed three different antihypertensives as well as a diuretic. The nurse knows that what other factors may be contributing to the client’s consistent hypertension? (Select all that apply.)

Meditation

Walking program

Nasal decongestant

Herbal supplement

OTC appetite suppressant

 

29.    Which risk factors increase a client’s risk for the development of hypertension? Select all that apply:

advancing age

family history

Caucasian race

cigarette smoking

chronic alcohol consumption

 

30.       Which risk factors increase a client’s risk for the development of hypertension? Select all that apply:

advancing age

family history

Caucasian race

cigarette smoking

chronic alcohol consumption

 

 

31.  Which antihypertensive medication can be administered by transdermal patch?

amlodipine

candesartan

enalapril

clonidine

 

32.  Mr. Zee is being discharged home after treatment for a myocardial infarction. During the hospital stay he was also diagnosed with uncomplicated diabetes mellitus type 2 and hypertension. The health care provider has prescribed several new drugs, one of which is captopril. What instruction is important to include in the teaching plan regarding captopril administration?

Discontinue drug if persistent dry cough occurs.

Avoid dairy products.

Avoid potassium supplements.

Implement a low-carbohydrate diet as part of your weight loss program.

 

33.      A client does not want to take medication to treat existing hypertension if it can be avoided. The client asks the nurse whether any other options are available? What lifestyle changes should the nurse recommend? Select all that apply.

“Increase the amount of exercise that you do.”

“Eliminate all salt from your diet.”

“Lose some weight, if possible.”

Try meditation, if it’s something you’re interested in.”

“Reduce your overall intake of fluids.”

 

 

 

 

34.       When educating a group of nursing students on the mechanism of action of angiotensin converting enzyme inhibitor (ACEI) drugs, the nurse identifies what as the action brought about by aldosterone?

Inhibits renin secretion.

Causes sodium and water retention.

Causes excess potassium retention.

Promotes angiotensin I conversion.

 

35.  After reviewing the various antihypertensive agents, a group of students demonstrate the need for additional teaching when they identify which agent as a calcium channel blocker?

Valsartan

Nicardipine

Diltiazem

Verapamil

 

36.  A group of students are reviewing the various antihypertensive agents available. The students demonstrate understanding of the information when they identify which agent as an example of a renin inhibitor?

Mecamylamine

Aliskiren

Candesartan

Captopril

 

 

 

 

 

37.  The nurse is caring for a client with hypertension who is preparing to be discharged from the hospital after suffering a myocardial infarction. What drug would both treat the client’s hypertension and reduce myocardial oxygen consumption?

Captopril

Losartan

Diltiazem

Nitroprusside

 

38.  The client presents to the health care provider with a new onset of bradycardia. The nurse recognizes that which antihypertensive can cause bradycardia?

 Labetalol

 Clonidine

 Enalapril

 Diltiazem

 

39.  A 77-year-old patient has a long-standing history of hypertension, a health problem that is being treated with metoprolol and a thiazide diuretic. Before administering the 8 AM dose of these medications, what assessments should the nurse perform and document? (Select all that apply.)

Respiratory rate

Oxygen saturation

Temperature

Heart rate

Blood pressure

 

 

 

 

40.       A 77-year-old patient has a long-standing history of hypertension, a health problem that is being treated with metoprolol and a thiazide diuretic. Before administering the 8 AM dose of these medications, what assessments should the nurse perform and document? (Select all that apply.)

Respiratory rate

Oxygen saturation

Temperature

Heart rate

Blood pressure

 

41.  A male client’s friend tells him to stop taking his metoprolol because he read that it causes cancer. The nurse encourages the client to consult his prescriber because abrupt withdrawal from the drug may cause what effect?

Postural hypotension and falls

Bradycardia

Exacerbation of his angina

 Atrial dysrhythmias

 

42.       A client with a long history of hypertension has just been prescribed an alpha1-adrenergic receptor blocker. To reduce this client’s risk of orthostatic hypotension and falls, the nurse should encourage the client to implement what intervention?

Take the medication at bedtime.

Take the medication at bedtime.

Take the medication with a high-fat meal.

Take the medication with a high-fat meal.

Increase fluid intake for 48 hours before taking the first dose.

Increase fluid intake for 48 hours before taking the first dose.

Start with a low dose and increase gradually over 2 to 3 weeks.

Start with a low dose and increase gradually over 2 to 3 weeks.

Increase fluid intake for 48 hours before taking the first dose.

Start with a low dose and increase gradually over 2 to 3 weeks.

Start with a low dose and increase gradually over 2 to 3 weeks.

 

43        Which of the following steps are involved in the proper administration of a Catapes-TTS patch? Select all that apply:

A new patch is applied daily.

If the patch loosens, a new patch should be applied.

The use of the adhesive overlay is not necessary.

A different body area should be selected for each application.

The patch should be applied to a hairless area.

 

44. Which event occurs in a client diagnosed with hypertension?

The kidneys excrete more fluid in response to increased blood pressure.

Fluid loss increases blood volume in the client with hypertension.

Decreased blood volume increases blood pressure.

Cardiac output increases and in turn causes an increase in blood pressure.

 

Chapter 27

45.       The nurse is visiting the home of a client who is prescribed antidysrhythmic medication. The nurse will teach the client to report which possible adverse effect?

 Increased energy

Improved functional status

Dizziness

Improved mentation

46.       Which would the nurse explain is the pacemaker of the heart?

SA node

AV node

Bundle of His

Purkinje fibers

 

47.       A patient, admitted to a health care facility with cardiac arrhythmia, is prescribed propranolol. Which factor should the nurse closely monitor as a part of the ongoing assessment during the therapy? 

Pulse rate

Tendon reflexes

Hydration

Visual acuity

 

48.       The client receiving propranolol (Inderal) at home for management of a ventricular dysrhythmia should monitor which parameter?

 Fluid intake

Blood pressure daily

Daily exercise

Pulse once a week

 

49.       A client diagnosed with heart disease is prescribed an antiarrhythmic drug. Further teaching is needed when the client makes which statement?

“I will take my medication at the prescribed time.”

“I need to call my primary care provider before taking any herbal supplements.”

“I can check the drug label about taking the medicine with food.”

“I know I must take my medication every day for my heartbeat to be fixed.”

 

50.       The nurse is administering lidocaine to a client with ventricular tachycardia. The nurse will need to observe for adverse effects, including

hyperthermia.

hypotension.

hypertension.

dysphagia.

 

51.       The nurse is preparing discharge teaching for a client prescribed chronic antiarrhythmic medication therapy. Which signs/symptoms should be reported to the health care provider immediately? (Select all that apply.)

Chest pain

Dyspnea

Nausea

Heart palpations

Diarrhea

 

52.       A 70-year-old woman with a history of atrial fibrillation takes digoxin and verapamil to control her health problem. Verapamil achieves a therapeutic effect by:

blocking adrenergic receptors and producing antisympathetic effects.

inhibiting the movement of calcium ions across the cardiac muscle cell membrane.

decreasing sodium and potassium conduction.

weakening diastolic depolarization and the action potential duration.

 

 

53.       A client has been declared “brain dead”. The family asks the nurse to explain why their loved one’s heart continues to beat in spite of the damage to the brain. The nurse should provide what explanation to the family?

The heart beats in response to impulses that are generated by specialized cells located in the heart not the brain.

When the brain is unable to trigger the heart to beat, the sinoatrial (SA) node in the heart assumes that role.

 The inability to control the heart is not among the losses associated with “brain death”.

The heart will eventually stop beating as the losses associated with “brain death” become more extensive.

 

54.       You are teaching a client how to follow his antidysrhythmic drug regimen. Which of the following should you advise the client to report as a possible adverse effect of his therapy?

Diarrhea

Gastric upset

Syncope

Dry mouth

 

55.       A client is prescribed propranolol (Inderal). Which condition in the client’s history may affect the treatment regimen?

Nausea

Diarrhea

Dizziness

Elevated glucose

 

 

 

56.       An adult client with a long-standing dysrhythmia has been taking oral propranolol for the last several months, resulting in acceptable symptom control. What is a priority teaching point for the nurse to communicate to this client?

the need to measure the radial pulse for 1 minute prior to each dose of propranolol

the importance of not stopping the medication abruptly

the need to avoid taking over-the-counter antacids

the need to limit intake of high-potassium foods

 

57.       An adult client with a long-standing dysrhythmia has been taking oral propranolol for the last several months, resulting in acceptable symptom control. What is a priority teaching point for the nurse to communicate to this client?

the need to measure the radial pulse for 1 minute prior to each dose of propranolol

the importance of not stopping the medication abruptly

the need to avoid taking over-the-counter antacids

the need to limit intake of high-potassium foods

 

58.       An adult client with a long-standing dysrhythmia has been taking oral propranolol for the last several months, resulting in acceptable symptom control. What is a priority teaching point for the nurse to communicate to this client?

the need to measure the radial pulse for 1 minute prior to each dose of propranolol

the importance of not stopping the medication abruptly

the need to avoid taking over-the-counter antacids

the need to limit intake of high-potassium foods

 

 

 

 

 

59.       Which assessment would be considered a priority for a client receiving amiodarone?

urine outputs

heart rate checks

lung sounds

muscle rigidity

 

60.       The teaching plan for a client taking amiodarone should include which instruction?

Take this medication with grapefruit juice for optimal absorption.

Use a reliable form of birth control while taking this medication.

Urinary retention is common and no need for concern.

Drowsiness is common but will not interfere with any of your usual activities.

 

61.       A 92-year-old male client is being sent home on disopyramide (Norpace) for a ventricular arrhythmia. The client asks why he must continue to take this drug. The nurse’s best response would be that a ventricular arrhythmia may:

lead to the formation of clots in the legs.

result in the atria beating independently.

result in death.

cause edema in the extremities.

62.       The nurse is assessing a client and suspects that the client is experiencing a dysrhythmia. What client assessments would support this condition? (Select all that apply.)

Polyuria

Hypotension

Mental confusion

Shortness of breath

Leg pain

63.       Quinidine is prescribed to a patient with cardiac arrhythmia. When documenting the patient’s drug history, the nurse inquires about the concomitant use of any other drug. Which drug when given concomitantly may cause an increase in serum Quinidine levels?

Cimetidine

Barbiturates

Hydantoins

Nifedipine

 

64.       A clinic nurse is following a 62-year-old woman who is taking quinidine for a cardiac arrhythmia. What nursing action will address the most common adverse effects of quinidine therapy?

Monitor the client for facial erythema

Monitor the client’s level of consciousness

Monitor normal serum calcium levels

Monitor the client for signs and symptoms of GI upset

 

65.       The nurse is teaching a male client who is receiving quinidine about foods to avoid. The client demonstrates the need for additional teaching when he identifies the need to avoid:

Citrus juices

Antacids

Milk

Apple juice

 

66.       Arrhythmia may be triggered by which of the following? Select all that apply:

emotional stress

Heart disease

Electrolyte imbalance

Diabetes

Hypoxia

 

67.       Arrhythmia may be triggered by which of the following? Select all that apply:

Emotional stress

Heart disease

Electrolyte imbalance

Diabetes

Hypoxia

 

68.       Before the administration of any anti-arrhythmic, what should the nurse’s pre-assessment of the client’s general condition include? (Select all that apply.)

Skin color

Blood glucose

Input and output

Orientation

Level of consciousness

 

69.       Mr. Green is prescribed amiodarone for the treatment of ventricular tachycardia. The nurse teaches him about the importance of follow-up care and routine testing that will need to be done secondary to the side effects of this medication. What testing will the patient require on a routine basis to monitor for side effects of the medication?

Pulmonary function testing to assess lung function

Amiodarone blood level determinations to assess for toxicity

Echocardiography to evaluate ejection fraction

Electrocardiography to assess cardiac rhythm

 

70.       A client should be instructed to take sublingual NTG how often if he experiences chest pain?

Every 1 minute times 3

Every 2 minutes times 5

Every 5 minutes times 3

Every 10 minutes times 5

 

71.       The nurse is caring for a client with angina who has been prescribed nitroglycerin. What health teaching about the client’s lifestyle should the nurse provide?

“It’s important not to take nitroglycerin unless you’re actually experiencing chest pain.”

“It’s best to eliminate or reduce your intake of alcoholic beverages.”

“Avoid drinking grapefruit juice because it will interfere with how your body processes nitroglycerin.”

“Make sure that you’re able to get at least 6 hours of sleep each night, if possible.”

 

72.       The chest pain and pressure a client experiences during an anginal attack is caused by which of the following?

decreased oxygen supply to the heart.

increased oxygen supply to the heart.

vasodilation of the arteries around the heart.

decreased workload on the heart.

 

73.       The nurse is preparing to administer sublingual nitroglycerin to a client for the first time. What effect might the client experience right after administration?

Nervousness or paresthesia

Throbbing headache or dizziness

Drowsiness or blurred vision

Tinnitus or diplopia.

74.       An asthmatic client on a beta blocker should be observed for which adverse reaction?

Bronchospasm

Hypoglycemia

Pleural effusion

Pneumonia

 

75.       A nurse is caring for a 59-year-old client who has been prescribed nitroglycerin to control angina. Which adverse effect might the nurse observe in this client?

Hypokalemia

Renal insufficiency

Hypotension

Sedation

 

76.       When describing the possible adverse effects associated with nitroglycerin, what would the nurse include?

Dizziness

Hypertension

Chills

Constipation

 

77.       Which statement by the client would lead the nurse to believe that the client has understood the teaching about angina?

“I will not exercise because it precipitates angina.”

“As long as I take the medicine, I can maintain my lifestyle.”

“There is no correlation between my hypertension and angina.”

“Heavy meals and cigarette smoking can precipitate an angina attack.”

 

78.       The 47-year-old client is experiencing chest pain and has taken three sublingual nitroglycerin tablets, but the pain remains. What should the client do next?

Have someone take him to the emergency department.

Take another nitroglycerin and call 911.

Call 911.

Notify his healthcare provider.