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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. W...

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  • 23 augustus 2023
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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

, The nurse is caring for a patient with systolic blood pressure of 135 mm Hg. This
finding would be classified as which of the following?
Correct response:

• Prehypertension

Explanation:

A systolic blood pressure of 135 mm Hg is classified as prehypertension. A systolic
BP of less than 120 mm Hg is normal. A systolic BP of 140 to 159 mm Hg is stage I
hypertension. A systolic BP of greater than or equal to 160 is classified as stage II
hypertension.

Question 10
A patient with long-standing hypertension is admitted to the hospital with
hypertensive urgency. The physician orders a chest x-ray, which reveals an enlarged
heart. What diagnostic test does the nurse anticipate preparing the patient for to
determine left ventricular enlargement?
Correct response:

• Echocardiography

Explanation:

Left ventricular hypertrophy can be assessed by echocardiography, but not by any
of the other measures listed.



Question 1
A community health nurse is screening for hypertension. Which of the following
clients would the nurse focus on most intensively?
Correct response:


• A middle-aged African-American man

Explanation:

African Americans have the highest prevalence of hypertension. The other choices
all have a lower incidence of hypertension, so the nurse should pay greatest
attention to the middle-aged African-American man.

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