Chapter 38: Hypertension Nursing School Test Banks

Chapter 38: Hypertension
Linton: Introduction to Medical-Surgical Nursing, 6th Edition

MULTIPLE CHOICE

1. A patient inquires if his blood pressure is normal. What is the nurses most accurate response regarding the definition of normal blood pressure?
a. Less than 144/90 mm Hg
b. Less than 138/86 mm Hg
c. Less than126/82 mm Hg
d. Less than 120/80mm Hg
ANS: D
Normal blood pressure is defined as a systolic pressure of less than 120 mm Hg and a diastolic blood pressure of less than 80 mm Hg.

DIF: Cognitive Level: Knowledge REF: p. 770 OBJ: 1
TOP: Normal Blood Pressure KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

2. An obese African American man reports that he smokes. How should the nurse stage this patients hypertension?
a. Grade A
b. Grade B
c. Grade C
d. Grade D
ANS: B
Criteria for grade B are that the patient has more than one risk factor (African American, obese, smoker), with no target organ damage and no clinical cardiovascular problems. Criteria for grade A indicate that no risks have been assessed, and the criteria for grade C include target organ damage and clinical cardiovascular disease or diabetes mellitus.

DIF: Cognitive Level: Application REF: p. 770 OBJ: 3
TOP: Staging of Hypertension KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

3. Which is true regarding hypertension in older adults?
a. It is age related.
b. It is unavoidable.
c. It is progressively disabling.
d. It improves with treatment.
ANS: D
Older adults with hypertension have good results with aggressive therapy, although the age-related changes cannot be avoided.

DIF: Cognitive Level: Comprehension REF: p. 771 OBJ: 3
TOP: Hypertension and Older Adults KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

4. A patient is being evaluated every week for possible hypertension and is classified as prehypertensive. Which assessment would support this conclusion?
a. Blood pressure reading over 120/80 mm Hg for two consecutive visits
b. Blood pressure reading over 130/85 mm Hg for over 2 months
c. Blood pressure reading over 140/95 mm Hg for 2 months
d. Blood pressure reading over 144/100 mm Hg at one visit
ANS: A
Prehypertension is diagnosed after two readings of over 120/80 mm Hg. The readings of 135/85 mm Hg for 2 months is longer than the diagnostic criteria require. Blood pressures consistently over 140/90 mm Hg are classified as hypertension.

DIF: Cognitive Level: Comprehension REF: p. 770 OBJ: 3
TOP: Risk Factors for Hypertension KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

5. A patient with hypertension reports the symptom of headache. How do headaches related to hypertension characteristically occur?
a. Frontal in the afternoon
b. Temporal on exertion
c. Occipital on arising
d. Frontal at night
ANS: C
Hypertension occipital headaches occur on awakening.

DIF: Cognitive Level: Comprehension REF: p. 772 OBJ: 3
TOP: Symptoms of Hypertension KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

6. What does treatment for essential hypertension focus on?
a. Daily medication with mild diuretics
b. Low-dose vasodilators
c. Reduction of modifiable risks
d. Combination of vasodilators and diuretics
ANS: C
The therapeutic approach to essential hypertension is a nonpharmacologic treatment. The treatment plan is to identify and reduce the modifiable risks, which include weight loss, dietary changes, and increased exercise.

DIF: Cognitive Level: Comprehension REF: p. 773-774 OBJ: 1 | 6
TOP: Pathophysiology of Hypertension KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

7. What is the focus of treatment for secondary hypertension?
a. Smoking cessation program
b. Strenuous exercise program
c. Weight-loss program designed to reduce weight rapidly
d. Specific etiologic disease
ANS: D
Secondary hypertension has an identifiable cause. Treating the cause is the focus of care for secondary hypertension.

DIF: Cognitive Level: Comprehension REF: p. 773 | p. 778
OBJ: 1 | 6 TOP: Hypertension Treatment
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

8. What do blood pressure readings need to exceed for a patient to be diagnosed with hypertension?
a. 120/80 mm Hg
b. 130/90 mm Hg
c. 140/90 mm Hg
d. 150/100 mm Hg
ANS: C
The official diagnosis of hypertension is dependent on a period of observation during which the BP is consistently higher than 140/90 mm Hg.

DIF: Cognitive Level: Comprehension REF: p. 773 OBJ: 5
TOP: Parameters for Hypertension KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

9. A patient is taking hydrochlorothiazide (HydroDIURIL) for hypertension. When providing dietary teaching what should the nurse encourage the patient to increase the intake of?
a. Bananas
b. Apple juice
c. Sugar-free foods
d. Low-fat milk
ANS: A
Diuretics reduce fluid volume and can cause hypokalemia. Encourage foods high in potassium, such as bananas and orange juice.

DIF: Cognitive Level: Comprehension REF: p. 776 OBJ: 4
TOP: Drug Therapy for Hypertension KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

10. An obese 38-year-old African American patient with diabetes is being evaluated for the use of propranolol (Inderal) in controlling hypertension. What is a contraindication for the use of propranolol (Inderal) in this patient?
a. Race
b. Age
c. Diabetes
d. Weight
ANS: C
Hypoglycemia can occur with this medication and places those with diabetes at high risk for adverse effects.

DIF: Cognitive Level: Application REF: p. 777 OBJ: 4
TOP: Drug Therapy for Hypertension KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

11. An 89-year-old patient is taking an antihypertensive medication. What should the nurse include when providing home care teaching?
a. Get up out of bed slowly.
b. Take hot baths.
c. Report sexual dysfunction immediately.
d. Stop taking the drug if side effects occur.
ANS: A
Patients taking antihypertensive medications should get up slowly to prevent falling. They should avoid hot baths because they promote vasodilatation, and they should never stop the drug abruptly. Sexual dysfunction is a possible side effect, but it does not have to be reported immediately.

DIF: Cognitive Level: Application REF: p. 775 OBJ: 4
TOP: Drug Therapy in Hypertension KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

12. What should a nurse instruct a patient who has been started on verapamil (Calan) for elevated blood pressure to monitor?
a. Urine output
b. Pulse
c. Stool for blood
d. Edema
ANS: B
Verapamil (Calan) is a calcium channel blocker and most often causes bradycardia.

DIF: Cognitive Level: Application REF: p. 775 OBJ: 4
TOP: Drug Therapy in Hypertension KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

13. A patient is prescribed an angiotensin-converting enzyme (ACE) inhibitor, enalapril (Vasotec). What is an appropriate instruction for the nurse to provide?
a. Monitor potassium intake.
b. Report asthma symptoms.
c. Return for follow-up visits.
d. Assess blood sugar closely.
ANS: C
ACE inhibitors can cause neutropenia or other blood dyscrasias, and follow-up with blood assessments should be periodically performed.

DIF: Cognitive Level: Application REF: p. 777 OBJ: 4
TOP: Drug Therapy in Hypertension KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

14. An 87-year-old patient is taking furosemide (Lasix) for elevated blood pressure. What should the nurse know that older patients are at risk for?
a. Falls
b. Hypokalemia
c. Reflex tachycardia
d. Neutropenia
ANS: B
Older adults are at greater risk for side effects, especially hypokalemia.

DIF: Cognitive Level: Comprehension REF: p. 776 OBJ: 4
TOP: Drug Therapy in Hypertension KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

15. A nurse is providing patient education regarding a low-sodium diet. In addition to the use of spices, what should the nurse recommend to help decrease sodium in the diet?
a. Catsup
b. Garlic
c. Soy sauce
d. Cheese
ANS: B
Spices, garlic, and onions are good substitutes for sodium as flavorings. Catsup, soy sauce, and cheese all have large amounts of sodium.

DIF: Cognitive Level: Comprehension REF: p. 781 OBJ: 4
TOP: Sodium-Free Seasoning KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

16. Which lifestyle change has the greatest effect on reducing hypertension?
a. Sodium restriction
b. Reduction in alcohol consumption
c. Daily aerobic exercise
d. Weight reduction
ANS: D
Weight reduction has the greatest effect on reducing hypertension.

DIF: Cognitive Level: Comprehension REF: p. 774 OBJ: 3
TOP: Blood Pressure Screening KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

17. A nurse is educating a group of patients regarding Dietary Approaches to Stop Hypertension (DASH) diet. What recommendation should the nurse include as a source of protein and fat?
a. Lean red meat
b. Whole grains
c. Low fiber
d. Sugar
ANS: B
The DASH diet uses whole grains as a source of protein and fat.

DIF: Cognitive Level: Comprehension REF: p. 780 OBJ: 6
TOP: DASH Diet KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

18. Which antihypertensive medication is contraindicated in patients who have chronic obstructive pulmonary disease (COPD) and asthma?
a. Propranolol (Inderal): beta-adrenergic receptor blocker
b. Hydrochlorothiazide (HydroDIURIL): diuretic
c. Diltiazem (Cardizem): calcium antagonist
d. Captopril (Capoten): ACE inhibitor
ANS: A
Beta-blocking adrenergic agents block stimulation of catecholamine receptors and cause bronchoconstriction.

DIF: Cognitive Level: Comprehension REF: p. 776 OBJ: 4
TOP: Drug Therapy in Hypertension KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

19. A nurse is caring for a patient who is taking antihypertensive therapy. The patient reports fatigue and has a pulse of 54 beats/min. Which medication administered is most likely the cause of these symptoms?
a. Diltiazem (Cardizem)
b. Furosemide (Lasix)
c. Hydrochlorothiazide (HydroDIURIL)
d. Methyldopa (Aldomet)
ANS: A
Calcium channel blockers such as diltiazem and verapamil can cause bradycardia because conduction is slowed in the heart. These drugs also reduce stroke volume and cardiac output, which may result in fatigue.

DIF: Cognitive Level: Application REF: p. 775 | p. 777
OBJ: 4 TOP: Drug Therapy for Hypertension
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

20. What should a nurse include when developing a teaching plan for a patient with hypertension?
a. Stop medications if side effects occur.
b. Maintain a diet high in unsaturated fat.
c. Advise no further visits if no other symptoms occur.
d. Encourage relaxation techniques.
ANS: D
Patients with hypertension should never stop medications without discussing it with their physicians. A diet low in saturated and unsaturated fat should be followed. Visits to monitor blood pressure should continue because hypertension is often asymptomatic. Stress can aggravate hypertension; stress management or relaxation strategies should be implemented.

DIF: Cognitive Level: Application REF: p. 779 OBJ: 7
TOP: Care Plan for Hypertension KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

21. A patient reports drowsiness after initiating atenolol (Tenormin) for the treatment of hypertension. What is the nurses best response when educating this patient about atenolol (Tenormin)?
a. Take the medication at bedtime.
b. Reduce the dose of the medication until the desired effect occurs.
c. Avoid activities that require alertness.
d. Talk to the physician because drowsiness is not an anticipated side effect.
ANS: A
Sedation is an expected side effect of atenolol. This medication can be taken daily at bedtime. Doses should not be changed without talking to the physician. Activities requiring that the patient be alert should be postponed until later in the day.

DIF: Cognitive Level: Application REF: p. 775 OBJ: 4
TOP: Drug Therapy and Hypertension KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

22. A patient taking methyldopa (Aldomet) for hypertension reports to the emergency department with a severe headache, blurred vision, and a blood pressure reading of 200/94 mm Hg. What should the nurse suspect is happening to this patient?
a. Hyperglycemia
b. Ineffective coping with sedation
c. Abrupt cessation of medication
d. Sexual dysfunction
ANS: C
Abruptly stopping antihypertensive medications can result in a hypertensive crisis. The patients presenting symptoms may include rebound hypertension and reports of confusion, nausea, restlessness, headache, and vision abnormalities.

DIF: Cognitive Level: Application REF: p. 777-778 OBJ: 7
TOP: Drug Therapy and Hypertension KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

23. Which patient is at the highest risk for malignant hypertension?
a. White postmenopausal women
b. Obese Asians
c. Young African American adults
d. Older Latino men
ANS: C
Malignant hypertension occurs suddenly and usually exhibits a diastolic blood pressure higher than 140 mm Hg. It most commonly occurs in young African American adults.

DIF: Cognitive Level: Comprehension REF: p. 782 OBJ: 5
TOP: Hypertensive Crisis KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

24. A patient with hypertension comes to the emergency department and is experiencing nausea and vomiting and is restless and confused. Vital signs are assessed at blood pressure, 220/130 mm Hg; pulse, 120 beats/min; and respirations, 32 breaths/min. What should the nurse conclude the patient is experiencing based on these assessments?
a. Hypertension crisis from the cessation of a drug
b. Stroke from increased blood pressure
c. Adverse drug reaction
d. Onset of diabetes
ANS: A
Patients with a hypertensive crisis usually experience nausea and vomiting, headache, and elevated vital signs because of an abrupt cessation of the hypertensive drug.

DIF: Cognitive Level: Analysis REF: p. 782 OBJ: 6
TOP: Care of the Patient in Hypertensive Crisis
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

25. What should be the nursing priority when caring for a patient with a hypertensive crisis?
a. Suctioning secretions
b. Monitoring for seizure activity
c. Monitoring fluid volume
d. Preventing hyperthermia
ANS: B
The care of a patient with hypertensive crisis focuses on monitoring for seizure activity and level of consciousness, which would suggest the occurrence of a stroke.

DIF: Cognitive Level: Application REF: p. 782-783 OBJ: 6
TOP: Care of Patient with Hypertensive Crisis
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

MULTIPLE RESPONSE

26. What are the advantages of hydrochlorothiazide (HydroDIURIL)? (Select all that apply.)
a. Is potassium sparing
b. Is effective for African Americans
c. Consistently controls blood pressure
d. Has no side effects
e. Decreases heart rate
ANS: B, C
Hydrochlorothiazide is a potassium-sparing diuretic that provides consistent blood pressure control and is effective for African Americans. It does have side effects, however, and does nothing to decrease heart rate directly.

DIF: Cognitive Level: Knowledge REF: p. 774 OBJ: 4
TOP: Diuretic Drugs KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

27. A nurse is providing care to a patient diagnosed with essential hypertension. What should the nurse know is included in a first-line therapeutic approach to lowering this patients blood pressure? (Select all that apply.)
a. Smoking cessation
b. Beta-blockers
c. Exercise programs
d. Weight loss
e. Decreased sodium intake
ANS: A, C, D, E
The first methodology is a nonpharmacologic approach, using lifestyle changes rather than drugs.

DIF: Cognitive Level: Comprehension REF: p. 773 OBJ: 3
TOP: Essential Hypertension Therapy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

28. Which conditions are considered potential causes of secondary hypertension? (Select all that apply.)
a. Renal disease
b. Coarctation of the aorta
c. Colon cancer
d. Increased intracranial pressure (ICP)
e. Rheumatoid arthritis
ANS: A, B, D
Renal disorders, constriction or stiffening of the aorta, and conditions that result in ICP are common causes of secondary hypertension.

DIF: Cognitive Level: Knowledge REF: p. 778 OBJ: 3
TOP: Secondary Hypertension KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

COMPLETION

29. A nurse explains that the force against which the left ventricle must work to force the blood into the circulation is called _____.

ANS:
peripheral vascular resistance
Peripheral vascular resistance is the pressure against which the left ventricle must work to put blood in the circulating volume.

DIF: Cognitive Level: Knowledge REF: p. 770-771 OBJ: 2
TOP: Peripheral Vascular Resistance KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

OTHER

30. A nurse explains that hypertension occurs when a chain reaction of events takes place: (Place the following options in the appropriate sequence. Separate letters by a comma and space as follows: A, B, C, D.)
A. Ephedrine constricts vessels and increases the heart rate.
B. Renin constricts vessels and decreases the blood flow to the kidneys.
C. Angiotensin constricts vessels in response to renin.
D. Norepinephrine constricts vessels, increasing peripheral vascular resistance.
E. The adrenal cortex produces aldosterone, causing fluids and sodium to be retained.

ANS:
D, A, B, C, E
The sequence is that norepinephrine, in response to the sympathetic nervous system, constricts vessels, causing an increase in peripheral vascular resistance; epinephrine constricts vessels and increases the heart rate; and renin is released because of the reduced blood flow to the kidneys, which stimulates the production of an angiotensin. Angiotensin stimulates the adrenal cortex to excrete aldosterone, causing retention of fluid and sodium.

DIF: Cognitive Level: Comprehension REF: p. 771 OBJ: 2
TOP: Pathophysiologic Sequence of Hypertension
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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