MSN 277 EXAM 2023/2024 VERIFIED QUESTION AND ANSWERS WITH VERIFIED RATIONALES LATEST UPDATE GUARANTEED PASS

MSN 277 EXAM 2023/2024 VERIFIED QUESTION AND ANSWERS WITH VERIFIED RATIONALES LATEST UPDATE GUARANTEED PASS The nurse is assessing a patien t 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 200 mL less than the fluid intake. b. The patient is unable to m ove 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 complains of a severe headache with pain at level 8/10 (0 to 10 scale). ANS: B The patients inability to move the left arm a nd leg indicates that a hemorrhagic stroke may be occurring and will require immediate action to prevent further neurologic damage. The other clinical manifestations also likely are caused by the hypertension and will require rapid nursing actions, but the y do not require action as urgently as the neurologic changes. When a patient with hypertension who has a new prescription for atenolol (Tenormin) returns to the health clinic after 2 weeks for a follow -up visit, the BP is unchanged from the previous visit . Which action should the nurse take first? a. Provide information about the use of multiple drugs to treat hypertension. b. Teach the patient about the reasons for a possible change in drug therapy. c. Remind the patient that lifestyle changes also are i mportant in BP control. d. Question the patient about whether the medication is actually being taken. ANS: D Since noncompliance with antihypertensive therapy is common, the nurses initial action should be to determine whether the patient is taking the ate nolol as prescribed. The other actions also may be implemented, but these would be done after assessing patient compliance with the prescribed therapy. The RN is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside (Nipride ). Which of the following nursing actions can the nurse delegate to an experienced LPN/LVN? a. Titrate nitroprusside to maintain BP at 160/100 mm Hg. b. Evaluate effectiveness of nitroprusside therapy on BP. c. Set up the automatic blood pressure machine to take BP every 15 minutes. d. Assess the patients environment for adverse stimuli that might increase BP. ANS: C LPN/LVN education and scope of practice include correct use of common equipment such as automatic blood pressure machines. The other actions require more nursing judgment and education and should be done by RNs. The charge nurse observes a new RN doing discharge teaching for a hypertensive patient who has a new prescription for enalapril (Vasotec). The charge nurse will need to intervene if the new RN tells the patient to a. check the BP with a home BP monitor every day. b. move slowly when moving from lying to standing. c. increase the dietary intake of high -potassium foods. d. make an appointment with the dietitian for teaching. ANS: C The AC E 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. Which assess ment finding for a patient who is receiving furosemide (Lasix) to treat stage 2 hypertension is most important to report to the health care provider? a. Blood glucose level of 180 mg/dL b. Blood potassium level of 3.0 mEq/L c. Early morning BP reading of 164/96 mm Hg d. Orthostatic systolic BP decrease of 12 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 b lood glucose and BP also indicate a need for collaborative interventions but will not require action as urgently as the hypokalemia. An orthostatic drop of 12 mm Hg is common and will require intervention only if the patient is symptomatic. Which nursing a ction should the nurse take first in order to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes? a. Have the patient record dietary intake for 3 days. b. Give the patient a detailed list of low -sodium foods. c. Te ach the patient about foods that are high in sodium. d. Help the patient make an appointment with a dietitian. ANS: A The initial nursing action should be assessment of the patients baseline dietary intake through a 3-day food diary. The other actions may be appropriate, but assessment of the patients baseline should occur first. The nurse obtains a blood pressure of 180/75 mm Hg for a patient. What is the patients mean arterial pressure (MAP)? ____________________ ANS: 110 MAP = (SBP + 2 DBP)/3 During ass essment of a 72 -year-old with ankle swelling, the nurse notes jugular venous distention (JVD) with the head of the patients bed elevated 45 degrees. The nurse knows this finding indicates a. decreased fluid volume. b. jugular vein atherosclerosis. c. elev ated right atrial pressure. d. incompetent jugular vein valves. ANS: C The jugular veins empty into the superior vena cava and then into the right atrium, so JVD with the patient sitting at a 45 -degree angle reflects elevated right atrial pressure. JVD is an indicator of excessive fluid volume (increased preload), not decreased fluid volume. JVD is not caused by incompetent jugular vein valves or atherosclerosis. The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. When evaluating the patient response to the medications, the best indicator that the treatment has been effective is a. weight loss of 2 pounds overnight. b. hourly urine output g reater than 60 mL. c. reduction in patient complaints of chest pain. d. decreased dyspnea with the head of bed at 30 degrees. ANS: D Because the patients major clinical manifestation of ADHF is orthopnea (caused by the presence of fluid in the alveoli), the best indicator that the medications are effective is a decrease in dyspnea with the head of the bed at 30 degrees. The other assess ment data also may indicate that diuresis or improvement in cardiac output has occurred but are not as specific to evaluating this patients response. Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 38%? a. Need to participate in an aerobic exercise program several times weekly b. Use of salt substitutes to replace table salt when cooking and at the table c. Importance of making a yearly appointment with the primary care provider d. Benefits and side effects of angiotensin -converting enzyme (ACE) inhibitors ANS: D Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new patient? a. Obtain a BP reading in each arm and average the results. b. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second. c. Have the patient sit in a chair with the feet flat on the floor. d. Assist the patient to the supine position for BP measurements. ANS: C The patient should be seated with the feet flat on the floor. The BP is obtained in both arms, but 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. The nurse obtains this information from a patient with prehypertension. Which finding is most important to address with the patient? a. Low dietary fiber intake b. No regular aerobic exercise c. Weight 5 pounds above ideal weight d. Drinks wine with dinner once a week ANS: B 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 (DA SH) diet is high in fiber, but increasing fiber alone will not prevent hypertension from developing. The patients alcohol intake will not increase the hypertension risk. After giving a patient the initial dose of oral labetalol (Normodyne) for treatment of hypertension, which action should the nurse take? a. Encourage oral fluids to prevent dry mouth or dehydration. b. Instruct the patient to ask for help if heart palpitations occur. c. Ask the patient to request assistance when getting out of bed. d. Teach the patient that headaches may occur with this medication. ANS: C 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 orthostati c hypotension. Heart palpitations, dehydration, and headaches are possible side effects of other antihypertensives.