NURS 360(MEDICAL SURGICAL NURSING) MIDTERM EXAM 2023(100% CORRECT WITH RATIONALE) TOP PRIORITY EXAM

Chapter 31: Assessment and Management of Patients With Hypertension Question 1 A 55-year-old black male is found to have a blood pressure of 150/90 mm Hg during a work-site health screening. What should the nurse do? Correct response: • Recommend he have his blood pressure rechecked within 2 weeks. Explanation: The nurse should recommend the client have his blood pressure rechecked within 2 weeks because a blood pressure of 150/90 mm Hg isn't considered normal. One year is too long to wait. The client need not see his physician yet. Question 2 A nurse is caring for a client with hypertension. The physician orders furosemide (lasix) 2 mg/kg to be given intravenously. The client weighs 24 kg. The medication comes in a single-use vial that contains 40 mg in 4 mL (10 mg/mL). How much will the nurse draw up for this client's dose? Correct response: • 4.8 mL Explanation: The formula is as follows: 24Kg X 2 mg = 48 mg total dose 48 mg / 10mg/mL = 4.8 mL amount to be drawn up Question 3 A 77-year-old client has newly diagnosed stage 2 hypertension. The physician has prescribed a thiazide and an angio-converting enzyme inhibitor. About what is the nurse most concerned? Correct response: • Postural hypotension and resulting injury Explanation: Antihypertensive medication can cause hypotension, especially postural hypotension that may result in injury. Rebound hypertension occurs when antihypertensive medication is stopped abruptly. Sexual dysfunction may occur, especially with beta blockers, but other medications are available should this problem ensue. This is not immediately a priority concern. Antihypertensive medications do not usually cause postural hypertension. Question 4 A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. Which of the following are risk factors for cardiovascular problems in clients with hypertension? Choose all that apply. Correct response: • Smoking • Diabetes mellitus • Physical inactivity Explanation: Risk factors for cardiovascular problems in clients with hypertension include smoking, dyslipidemia, diabetes mellitus, impaired renal function, obesity, physical inactivity, age, and family history. Question 5 The nurse is caring for an 82-year-old male client who has come to the clinic for a yearly physical. When assessing the client, the nurse notes the blood pressure (BP) is 140/93. The nurse knows that in older clients what happens that may elevate the systolic BP? Correct response: • Loss of arterial elasticity Explanation: In older clients, systolic BP may be elevated because of loss of arterial elasticity (arteriosclerosis). Systolic BP would not become elevated by a decrease in blood volume, an increase in calcium intake, or a decrease in cardiac output. Question 6 A client, newly admitted to the nursing unit, has a primary diagnosis of renal failure. When assessing the client, the nurse notes a blood pressure (BP) of 180/100. The nurse knows that this is what kind of hypertension? Correct response: • Secondary Explanation: Secondary hypertension is elevated BP that results from or is secondary to some other disorder. This type of hypertension is not primary, essential, or malignant. Question 7 An African American client at the clinic has just been diagnosed with essential hypertension. The client tells the nurse that they do not take medicine. What would the nurse tell the client is the most serious consequence of chronic hypertension? Correct response: • Death Explanation: Consequences are life-threatening when the BP in the vascular system becomes extremely elevated. Some arterial blood vessels already may have ruptured or will soon. Retinal hemorrhages can lead to blindness. A stroke occurs if vessels in the brain rupture and bleed. If an aneurysm has developed in the aorta from chronic hypertension, it may burst and cause hemorrhage and shock. Cardiac effects include left ventricular failure with pulmonary edema or MI. Renal failure also may be forthcoming if the pressure is not reduced. Question 8 The nurse is caring for a client who is prescribed diuretic medication for the treatment of hypertension. The nurse recognizes that which of the following medications conserves potassium? Correct response: • Spironolactone (Aldactone) Explanation: Aldactone is known as a potassium-sparing diuretic. Lasix causes loss of potassium from the body. Diuril causes mild hypokalemia. Hygroton causes mild hypokalemia. Question 9