Chapter 18: Care of Patients with Hypertension and Peripheral Vascular Disease deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition

MULTIPLE CHOICE 1. Which blood pressure findings constitute a diagnosis of hypertension? a. 120/80 2, 2 weeks apart b. 140/90 2, 2 weeks apart c. 120/80 on 3 consecutive days d. 140/90 every day for a week ANS: B A diagnosis of hypertension is made if the systolic pressure is equal to or greater than 140 mm Hg and the diastolic pressure is equal to or greater than 90 mm Hg at least twice on two different occasions 2 weeks apart. PTS: 1 DIF: Cognitive Level: Comprehension REF: 396 OBJ: 10 (theory) TOP: Hypertension: Diagnosis KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 2. The nurse is educating an older adult patient who is taking antihypertensives with diuretics. Which informationregarding safety precautions is most important for the nurse to include? a. Consider purchasing a home blood pressure monitor. b. Limit sodium intake in the diet. c. Sit on the side of the bed before standing. d. Keep an updated list of all medications. ANS: C Age-related changes (reduced baroreceptor sensitivity) and risk for fluid shifts related to diuretics predispose the older adult patient to orthostatic hypotension. In order to prevent falls, the patient should change positions slowly and cautiously, like taking time to sit on the edge of the bed before standing. While purchasing a home blood pressure monitor, limiting sodium in the diet, and keeping an updated list of medications may assist with management of hypertension, fall prevention and safety are most important for the older adult patient. PTS: 1 DIF: Cognitive Level: Analysis REF: 398, Older Adult Care Points OBJ: 5 (clinical) TOP: Orthostatic Hypotension KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control 3. The home health nurse is caring for a patient with a blood pressure reading of 200/160. The patient denies any discomfort. The nurse should immediately contact the health care provider to report that the patient is experiencing which problem? a. Primary hypertension b. Hypertensive crisis c. Essential hypertension d. Secondary hypertension ANS: B The diastolic pressure rising to readings between 140 and 170 and the patient being asymptomatic indicates hypertensive crisis. PTS:1 DIF: Cognitive Level: Comprehension REF: 402 OBJ:3 (theory) TOP: Malignant Hypertension KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The nurse is caring for a patient who has a new prescription for a loop diuretic. Which nutritional intervention is most important for the nurse to add to the care plan? a. Increase intake of leafy green vegetables. b. Increase intake of bananas and potatoes. c. Avoid foods like canned soups and hot dogs. d. Limit caffeine intake. ANS: B Loop diuretics are potent, potassium-wasting diuretics. After talking with the health care provider, the patient should recommend that the patient increase intake of potassium-rich foods like bananas and potatoes to offset potassium depletion from the diuretic. Leafy green vegetables are rich in vitamin K and may increase clotting times. Sodium-rich foods like canned soups and hot dogs should be avoided to prevent excess water retention, but this intervention does not address the risk for potassium depletion with loop diuretics. Caffeine is a stimulant that causes vasoconstriction and may increase blood pressure. While avoiding caffeine may improve blood pressure, this intervention does not address the risk of potassium depletion with a loop diuretic. PTS:1 DIF: Cognitive Level: Analysis REF: 403 OBJ:3 (theory) TOP: Loop Diuretics KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 5. The patient has been prescribed a low-sodium diet. Which food choice indicates that the patient requires additional teaching? a. Fresh spinach b. Pickles c. Whole-grain pasta d. Grapefruit