Medical-Surgical Nursing In Canada
Chapter 35- edition 3
A new patient is seen at an outpatient clinic for a routine health examination. During the
patient's initial visit, which technique would the nurse use to assess the patient's blood
pressure (BP)?
a. Have the patient sit with the arm supported at heart level, and measure the BP in
each arm first.
b. Average all the BP readings obtained in both arms to establish a baseline BP for the
patient.
c. Measure the first BP with the patient lying supine, and repeat the measurement in 5
minutes in the opposite arm.
d. Take additional measurements if there is a difference of more than 10 mm Hg
between the first and second BP readings. - ANS>>ANS: A
To obtain the baseline BP, the patient's arm should be at the level of the heart. The BP
is obtained in both arms; if there is a difference, the arm with the higher pressure should
be used to monitor BP.
REF: page 885, Table 35-13
The nurse assesses the risk factors for hypertension in a patient with high normal BP.
Which risk factor would the nurse identify from the health history and advise the patient
to change, in order to prevent hypertension?
a. Little or no regular exercise
b. No use of relaxation techniques
c. High dietary intake of simple sugars
d. Drinking wine with dinner once a week - ANS>>ANS: A
The recommendations for preventing hypertension include exercising aerobically for 30
minutes most days of the week.
REF: page 873, Table 35-3
The nurse measures the BP of a 78-year-old patient and finds it to be 168/86 mm Hg in
both arms. What will the nurse include in the teaching plan for this patient?
a. Increased BP is a normal finding in older adults.
b. Prehypertension indicates the need for lifestyle changes.
c. It is important to address the increased BP.
d. A high probability of kidney and heart disease exists. - ANS>>ANS: C
Although an increase in systolic BP (SBP) is a common finding in older adults, the
recommendations for treating elevated BP are unchanged. An SBP of >140 mm Hg is a
more important cardiovascular risk factor than diastolic BP (DBP) in individuals older
than 50. The diagnosis of prehypertension indicates a systolic BP between 120 and 139
mm Hg and a DBP between 80 and 89 mm Hg.
REF: page 884, Table 35-11
, Why should the nurse teach a patient who is taking labetalol (Normodyne) for treatment
of hypertension to change position slowly?
a. The medication blocks the vasoconstrictive and sodium-retaining properties initiated
by the presence of angiotensin.
b. The medication paralyzes the smooth muscle of blood vessels, and they cannot
constrict in response to sympathetic stimulation.
c. The medication blocks the normal sympathetic nervous system response to position
changes in vasoconstriction and increased heart rate.
d. The medication blocks the movement of calcium into the cardiac cells, and cardiac
output cannot increase in response to decreased BP. - ANS>>ANS: C
Labetalol decreases sympathetic nervous system activity by blocking both - and -
adrenergic receptors, leading to vasodilation and a decrease in heart rate, which lower
BP.
REF: page 881, Table 35-8
A patient with hypertension asks the nurse why lifestyle changes are needed when the
patient has no symptoms from the high BP. Which response is most likely to improve
patient's compliance with therapy?
a. "High BP damages the blood vessels, leading to risk for heart attack, stroke, and
kidney failure."
b. "High BP increases blood flow to the kidneys, leading to increased workload for the
renal system."
c. "High BP may not cause any problems for some people but does cause symptoms in
many others."
d. High BP is probably causing the damage, but the patient does not recognize that they
are occurring. - ANS>>ANS: A
Teaching the patient that hypertension can damage blood vessels and eventually
causes severe health problems is most likely to improve patient compliance with
needed lifestyle changes.
REF: page 873
During assessment of a patient who has stage 2 hypertension, the nurse recognizes
that it is common for the patient to experience which of the following?
a. Nosebleeds
b. No symptoms
c. Blurred vision
d. Dyspnea on exertion - ANS>>ANS: B
Hypertension is largely asymptomatic until damage to target organs has occurred.
REF: page 873
The nurse teaches the patient with stage 1 hypertension about diet modifications that
should be implemented to manage BP. Which diet choice indicates that the teaching
has been effective?
a. The patient has a glass of low-fat milk with each meal.
b. The patient has only one cup of coffee in the morning.
c. The patient restricts intake of dietary protein.
Chapter 35- edition 3
A new patient is seen at an outpatient clinic for a routine health examination. During the
patient's initial visit, which technique would the nurse use to assess the patient's blood
pressure (BP)?
a. Have the patient sit with the arm supported at heart level, and measure the BP in
each arm first.
b. Average all the BP readings obtained in both arms to establish a baseline BP for the
patient.
c. Measure the first BP with the patient lying supine, and repeat the measurement in 5
minutes in the opposite arm.
d. Take additional measurements if there is a difference of more than 10 mm Hg
between the first and second BP readings. - ANS>>ANS: A
To obtain the baseline BP, the patient's arm should be at the level of the heart. The BP
is obtained in both arms; if there is a difference, the arm with the higher pressure should
be used to monitor BP.
REF: page 885, Table 35-13
The nurse assesses the risk factors for hypertension in a patient with high normal BP.
Which risk factor would the nurse identify from the health history and advise the patient
to change, in order to prevent hypertension?
a. Little or no regular exercise
b. No use of relaxation techniques
c. High dietary intake of simple sugars
d. Drinking wine with dinner once a week - ANS>>ANS: A
The recommendations for preventing hypertension include exercising aerobically for 30
minutes most days of the week.
REF: page 873, Table 35-3
The nurse measures the BP of a 78-year-old patient and finds it to be 168/86 mm Hg in
both arms. What will the nurse include in the teaching plan for this patient?
a. Increased BP is a normal finding in older adults.
b. Prehypertension indicates the need for lifestyle changes.
c. It is important to address the increased BP.
d. A high probability of kidney and heart disease exists. - ANS>>ANS: C
Although an increase in systolic BP (SBP) is a common finding in older adults, the
recommendations for treating elevated BP are unchanged. An SBP of >140 mm Hg is a
more important cardiovascular risk factor than diastolic BP (DBP) in individuals older
than 50. The diagnosis of prehypertension indicates a systolic BP between 120 and 139
mm Hg and a DBP between 80 and 89 mm Hg.
REF: page 884, Table 35-11
, Why should the nurse teach a patient who is taking labetalol (Normodyne) for treatment
of hypertension to change position slowly?
a. The medication blocks the vasoconstrictive and sodium-retaining properties initiated
by the presence of angiotensin.
b. The medication paralyzes the smooth muscle of blood vessels, and they cannot
constrict in response to sympathetic stimulation.
c. The medication blocks the normal sympathetic nervous system response to position
changes in vasoconstriction and increased heart rate.
d. The medication blocks the movement of calcium into the cardiac cells, and cardiac
output cannot increase in response to decreased BP. - ANS>>ANS: C
Labetalol decreases sympathetic nervous system activity by blocking both - and -
adrenergic receptors, leading to vasodilation and a decrease in heart rate, which lower
BP.
REF: page 881, Table 35-8
A patient with hypertension asks the nurse why lifestyle changes are needed when the
patient has no symptoms from the high BP. Which response is most likely to improve
patient's compliance with therapy?
a. "High BP damages the blood vessels, leading to risk for heart attack, stroke, and
kidney failure."
b. "High BP increases blood flow to the kidneys, leading to increased workload for the
renal system."
c. "High BP may not cause any problems for some people but does cause symptoms in
many others."
d. High BP is probably causing the damage, but the patient does not recognize that they
are occurring. - ANS>>ANS: A
Teaching the patient that hypertension can damage blood vessels and eventually
causes severe health problems is most likely to improve patient compliance with
needed lifestyle changes.
REF: page 873
During assessment of a patient who has stage 2 hypertension, the nurse recognizes
that it is common for the patient to experience which of the following?
a. Nosebleeds
b. No symptoms
c. Blurred vision
d. Dyspnea on exertion - ANS>>ANS: B
Hypertension is largely asymptomatic until damage to target organs has occurred.
REF: page 873
The nurse teaches the patient with stage 1 hypertension about diet modifications that
should be implemented to manage BP. Which diet choice indicates that the teaching
has been effective?
a. The patient has a glass of low-fat milk with each meal.
b. The patient has only one cup of coffee in the morning.
c. The patient restricts intake of dietary protein.
