N2 Test HTN - Cardiac - Pharm

1. A new patient is seen at an outpatient clinic for a routine health examination. During the patient’s initial visit, one technique the nurse uses to assess the patient’s blood pressure involves
a. having the patient sit with the arm supported at heart level and measuring the blood pressure in each arm first.
b. averaging all the blood pressure readings obtained in both arms to establish a baseline blood pressure for the patient.
c. measuring the first blood pressure with the patient lying supine and repeating the measurement in 5 minutes in the opposite arm.
d. taking additional measurements if there is more than a 10 mm Hg difference between the first and second blood pressure readings.

ANS: A

2. The nurse assesses the risk factors for hypertension in a patient with high normal blood pressure. A risk factor that the nurse identified from the health history and advises the patient to change to prevent hypertension is
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 A

3. The nurse teaches a patient who is taking labetalol (Normodyne) for treatment of hypertension to change position slowly because this drug
a. blocks the vasoconstrictive and sodium-retaining properties initiated by the presence of angiotensin.
b. paralyzes the smooth muscle of blood vessels and they cannot constrict in response to sympathetic stimulation.
c. blocks the normal sympathetic nervous system response to position changes of vasoconstriction and increased heart rate.
d. blocks the movement of calcium into the cardiac cells and cardiac output cannot increase in response to decreased blood pressure.

ANS C

4. The nurse teaches a patient with hypertension that uncontrolled hypertension may damage organs in the body primarily by
a. promoting atherosclerosis and damage of the walls of the arteries.
b. thickening capillary membranes, leading to hypoxia of organ systems.
c. causing direct pressure on organs, resulting in necrosis and replacement of cells with scar tissue.
d. increasing the viscosity of the blood, contributing to intravascular coagulation and necrosis of tissue distal to occlusions.

ANS: A

5. While caring for a patient with angina, the nurse plans interventions that decrease myocardial oxygen demand and promote coronary blood flow. Appropriate interventions are those that primarily prevent
a. coronary artery spasms.
b. an increase in heart rate.
c. a decreased blood volume.
d. disruption of circadian rhythms.

ANS: B

6. A 45-year-old man is admitted to the emergency room after developing severe chest pain while raking leaves. On admission he has midchest dullness and a normal ECG. The physician schedules the patient for cardiac catheterization with coronary angiography and possible percutaneous coronary intervention (PCI). The nurse prepares the patient for the procedure by explaining that, in his case, it is used to
a. determine whether there are any structural defects in the walls or chambers of his heart.
b. determine whether any obstructions are present in his coronary arteries and to test for an allergy to thrombolytic agents.
c. measure the amount of blood being pumped from his heart with each contraction to determine whether there is heart damage.
d. visualize any blockages in the coronary arteries and, if necessary, to dilate an obstructed artery with the use of a small balloon.

ANS: D

7. A patient admitted to the coronary care unit (CCU) with a myocardial infarction has physician’s orders for continuous amiodarone infusion, intravenous nitroglycerin, and morphine sulfate 2 mg IV every 5 minutes until there is relief of pain, in addition to standard CCU protocol. The patient is having frequent, multifocal premature ventricular contractions (PVCs) and tells the nurse that the pain is worse than he has ever had and asks if he is going to die. On admission to the CCU, the nurse identifies as a priority the nursing diagnosis of
a. acute pain related to myocardial ischemia.
b. anxiety related to perceived threat of death.
c. decreased cardiac output related to cardiogenic shock.
d. activity intolerance related to decreased cardiac output.

ANS: B

8. A patient with a history of chronic congestive heart failure is hospitalized with severe dyspnea and a dry, hacking cough. She has pitting edema in both ankles, and her vital signs are blood pressure 170/100, pulse 92, and respirations 28. The nurse recognizes that the patient’s symptoms indicate
a. the venous return to the heart is impaired, causing a decrease in cardiac output.
b. there is impaired emptying of both the right and left ventricles, with low forward blood flow.
c. the right side of the heart is failing to pump enough blood to the lungs to provide systemic oxygenation.
d. the myocardium is not receiving enough blood supply through the coronary arteries to meet its oxygen demand.

ANS: B

9. The nurse monitors a patient receiving IV furosemide (Lasix) and enalapril (Vasotec) 5 mg po bid for an acute exacerbation of congestive heart failure. The nurse determines that the treatment is effective upon finding
a. a weight loss of 2 pounds.
b. an increase in urinary output.
c. a decrease in systolic blood pressure.
d. fewer crackles upon lung auscultation.

ANS: D

10. Intravenous nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the initial administration of the drug, the nurse monitors the patient for
a. bradycardia.
b. hypotension.
c. cyanide toxicity.
d. ventricular arrhythmias.

ANS: B