DeanArtSeaLion27
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.
