NUR 325 Exam 3 New Latest Version Updated 2024-2025
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Correct Answers
When caring for elderly patients with hypertension, which information should the nurse consider when
planning care (select all that apply.)? ----------- Correct Answer ---------- Systolic blood pressure increases
with age and patients older than age 60 years should be maintained below 150/90 mm Hg. Older patients
have significantly higher blood pressure readings when taken by health care providers (white coat
syndrome). Older patients experience orthostatic hypotension related to dehydration, reduced
compensatory mechanisms, and medications. One hour after eating, many older patients experience a
drop in blood pressure. Lower doses of medications may be needed to control blood pressures in older
adults related to decreased absorption rates and excretion ability.
A diabetic patient has proliferative retinopathy, nephropathy, and peripheral neuropathy. What should the
nurse teach this patient about exercise? ----------- Correct Answer ---------- "Swimming or water aerobics
30 minutes each day would be the safest exercise routine for you."
Exercise is not contraindicated for this client, but modifications are necessary to prevent further injury.
Swimming or water aerobics provides support for the joints and muscles while increasing the uptake of
glucose and promoting cardiovascular health. Jogging, vigorous exercise, or no exercise would increase
the pathologies of this patient.
A nures is caring for an older adult clients who has COPD with pneumonia. The nurse should monitor the
client for which of the following acid-base imbalances?
a. Respiratory alkalosis
b. Respiratory acidosis
c. Metabolic alkalosis
d. Metabolic acidosis ----------- Correct Answer ------------ B (Respiratory acidosis is a common
complication of COPD. This complication occurs because clients who have COPD are unable to exhale
carbon dioxide due to a loss of elastic recoil in the lungs.)
A nurse is providing instructions about pursed-lip breathing for a client who has COPD with emphysema.
The nurse should explain that this breathing technique accomplishes which of the following?
a. Increases oxygen intake
b. Promotes CO2 elimination
c. Uses intercostal muscles
d. Strengthens the diaphragm ----------- Correct Answer ------------ B (The client who has COPD with
emphysema should use pursed-lip breathing when experiencing dyspnea. This is one of the simplest ways
to control dyspnea. It slows the client's pace of breathing, making each breath more effective. Pursed-lip
breathing releases trapped air in the lungs and prolongs exhalation to slow the breathing rate. This
improved breathing pattern moves CO2 out of the lungs more efficiently.)
A nurse on a medical-surgical unit is caring for a client who is postoperative following a hip replacement
surgery. The client reports feeling apprehensive and restless. which of the following findings should the
nurse recognize as an indication of pulmonary embolism?
a. Sudden onset of dyspnea
,b. Tracheal deviation
c. Bradycardia
d. Difficulty swallowing ----------- Correct Answer ------------ A (Dyspnea occurs due to reduced blood
flow to the lungs. Tachycardia is a clinical manifestation of pulmonary embolism.)
A nurse is planning care for a client who has COPD and is malnourished. Which of the following
recommendations to promote nutritional intake should the nurse include in the plan?
a. Eat high calorie foods first.
b. Increase intake of water at meal times
c. Perform ative ROM exercises before meals
d. Keep saltine crackers nearby for snacking ----------- Correct Answer ------------ A (A client who has
COPD often experiences early satiety. Therefore, the client should eat calorie-dense foods first. The client
should limit intake of water at mealtimes to reduce the felling of early satiety. The client should rest
before meals to decrease dyspnea while eating. The client should keep foods on hand for snacking, but
should avoid dry and salty foods, which can place the client at risk for aspiration and make the client's
mouth dry.)
The nurse teaches which action to the diabetic client who self-injects insulin to prevent local irritation at
the injection site? ----------- Correct Answer ---------- Allow the insulin to warm to room temperature
before injecting it.
Cold insulin from the refrigerator is the most common cause of irritation. Aspiration of insulin is not
recommended; massaging the site can cause irritation; and a 1-inch needle is the improper size for insulin
injections.
The nurse admits a 73-y/o male patient with dementia for treatment of uncontrolled hypertension. The
nurse will closely monitor for hypokalemia if the patient receives which medication? ----------- Correct
Answer ---------- Bumetanide (Bumex)
Bumetanide is a loop diuretic. Hypokalemia is a common adverse effect of this medication. Amiloride is a
potassium-sparing diuretic. Spironolactone is an aldosterone-receptor blocker. Hyperkalemia is an
adverse effect of both amiloride and spironolactone. Clonidine is a central-acting α-adrenergic antagonist
and does not cause electrolyte abnormalities.
The nurse is caring for a patient admitted with chronic obstructive pulmonary disease (COPD), angina,
and hypertension. Before administering the prescribed daily dose of atenolol 100 mg PO, the nurse
assesses the patient carefully. Which adverse effect is this patient at risk for given the patient's health
history? ----------- Correct Answer ---------- Bronchospasm
Atenolol is a cardioselective β1-adrenergic blocker that reduces blood pressure and could affect the β2-
receptors in the lungs with larger doses or with drug accumulation. Although the risk of bronchospasm is
less with cardioselective β-blockers than nonselective β-blockers, atenolol should be used cautiously in
patients with COPD.
The nurse is caring for a patient with hypertension who is scheduled to receive a dose of metoprolol
(Lopressor). The nurse should withhold the dose and consult the prescribing physician for which vital
sign taken just before administration? ----------- Correct Answer ---------- Pulse 48 beats/min
Because metoprolol is a β1-adrenergic blocking agent, it can cause hypotension and bradycardia as
adverse effects. The nurse should withhold the dose and consult with the health care provider for
parameters regarding pulse rate limits.
When teaching a patient about dietary management of stage 1 hypertension, which instruction is most
,appropriate? ----------- Correct Answer ---------- Restrict sodium intake.
The patient should decrease intake of sodium. This will help to control hypertension, which can be
aggravated by excessive salt intake, which in turn leads to fluid retention. Protein intake does not affect
hypertension. Calcium supplements are not recommended to lower blood pressure.
The nurse is teaching a women's group about prevention of hypertension. What information should be
included in the teaching for all the women (select all that apply.)? ----------- Correct Answer ----------
Primary prevention of hypertension is to make lifestyle modifications that prevent or delay the increase in
BP. Along with exercise for 30 minutes on most days, the DASH eating plan is a healthy way to lower BP
by limiting sodium and fat intake, increasing fruits and vegetables, and increasing nutrients that are
associated with lowering BP. Nuts and seeds and dried beans are used for protein intake. Weight loss may
or may not be necessary for the individual.
A patient with a history of chronic hypertension is being evaluated in the emergency department for a
blood pressure of 200/140 mm Hg. Which patient assessment question is the priority? ----------- Correct
Answer ---------- Does the patient have a headache or confusion?
The nurse's priority assessments include neurologic deficits, retinal damage, heart failure, pulmonary
edema, and renal failure. The headache or confusion could be seen with hypertensive encephalopathy
from increased cerebral capillary permeability leading to cerebral edema. In addition, headache or
confusion could represent signs and symptoms of a hemorrhagic stroke. Pregnancy can lead to secondary
hypertension. Needing to urinate and taking antiseizure medication do not support a hypertensive
emergency.
A 67-yr-old woman with hypertension is admitted to the emergency department with a blood pressure of
234/148 mm Hg and was started on nitroprusside (Nitropress). After one hour of treatment, the mean
arterial blood pressure (MAP) is 55 mm Hg. Which nursing action is a priority? ----------- Correct Answer
---------- Stop the nitroprusside infusion and assess the patient for potential complications.
Nitroprusside is a potent vasodilator medication. A blood pressure of 234/118 mm Hg would have a
calculated MAP of 177 mm Hg. Subtracting 25% (or 44 mm Hg) = 133 mm Hg. The initial treatment goal
is to decrease MAP by no more than 25% within minutes to 1 hour. For this patient, the goal MAP would
be approximately 133 mm Hg. Minimal MAP required to perfuse organs is around 60 to 65 mm Hg.
Lowering the blood pressure too rapidly may decrease cerebral, coronary, or renal perfusion and could
precipitate a stroke, myocardial infarction, or renal failure. The priority is to stop the nitroprusside
infusion and then use fluids only if necessary to support restoration of MAP
A 44-yr-old man is diagnosed with hypertension and receives a prescription for benazepril (Lotensin).
After providing instruction, which statement by the patient indicates correct understanding? -----------
Correct Answer ---------- "If I develop a dry cough while taking this medication, I should notify my
doctor."
Benazepril is an angiotensin-converting enzyme inhibitor. The medication inhibits breakdown of
bradykinin, which may cause a dry, hacking cough. Other adverse effects include hyperkalemia. Swelling
in the face could indicate angioedema and should be reported immediately to the prescriber. Patients
taking drug therapy for hypertension should also attempt lifestyle modifications to lower blood pressure
such as a reduced-sodium diet.
The UAP is taking orthostatic vital signs. In the supine position, the blood pressure (BP) is 130/80 mm
Hg, and the heart rate (HR) is 80 beats/min. In the sitting position, the BP is 140/80, and the HR is 90
beats/min. Which action should the nurse instruct the UAP to take next? ----------- Correct Answer --------
-- Take BP and HR with patient standing.
, The vital signs taken do not reflect orthostatic changes, so the UAP will continue with the measurements
while the patient is standing. There is no need to repeat or delay the readings. The patient does not need to
return to the supine positon. When assessing for orthostatic changes, the UAP will take the BP and pulse
in the supine position, then place the patient in a sitting position for 1 to 2 minutes and repeat the
readings, and then reposition to the standing position for 1 to 2 minutes and repeat the readings. Results
consistent with orthostatic changes would have a decrease of 20 mm Hg or more in systolic BP, a
decrease of 10 mm Hg or more in diastolic BP, and/or an increase in HR of greater than or equal to 20
beats/min with position changes.
Despite a high dosage, a male patient who is taking nifedipine (Procardia XL) for antihypertensive
therapy continues to have blood pressures over 140/90 mm Hg. What should the nurse do next? -----------
Correct Answer ---------- Assess his adherence to therapy.
A long-acting calcium-channel blocker such as nifedipine causes vascular smooth muscle relaxation,
resulting in decreased systemic vascular resistance and arterial blood pressure and related side effects.
The patient data the nurse has about this patient is very limited, so the nurse needs to begin by assessing
adherence to therapy.
The nurse teaches a patient with hypertension that uncontrolled hypertension may damage organs in the
body primarily by which mechanism? ----------- Correct Answer ---------- Hypertension promotes
atherosclerosis and damage to the walls of the arteries.
Hypertension is a major risk factor for the development of atherosclerosis by mechanisms not yet fully
known. However, when atherosclerosis develops, it damages the walls of arteries and reduces circulation
to target organs and tissues.
The nurse is caring for a patient admitted with a history of hypertension. The patient's medication history
includes hydrochlorothiazide daily for the past 10 years. Which parameter would indicate the optimal
intended effect of this drug therapy? ----------- Correct Answer ---------- BP 128/86 mm Hg
Hydrochlorothiazide may be used alone as monotherapy to manage hypertension or in combination with
other medications if not effective alone. After the first few weeks of therapy, the diuretic effect
diminishes, but the antihypertensive effect remains. Because the patient has been taking this medication
for 10 years, the most direct measurement of its intended effect would be the blood pressure.
The nurse teaches a 28-yr-old man newly diagnosed with hypertension about lifestyle modifications to
reduce his blood pressure. Which patient statement requires reinforcement of teaching? ----------- Correct
Answer ---------- "I can lower my blood pressure by switching to smokeless tobacco."
Nicotine contained in tobacco products (smoking and chew) cause vasoconstriction and increase blood
pressure. Persons with hypertension should restrict sodium to 1500 mg/day by avoiding foods high in
sodium and not adding salt in preparation of food or at meals. Weight loss can decrease blood pressure
between 5 to 20 mm Hg. Following dietary recommendations (e.g., the DASH diet) lowers blood
pressure, and these decreases compare with those achieved with blood pressure-lowering medication
In caring for a patient admitted with poorly controlled hypertension, which laboratory test result should
the nurse understand as indicating the presence of target organ damage? ----------- Correct Answer ---------
- Serum creatinine of 2.6 mg/dL
The normal serum creatinine level is 0.6 to 1.3 mg/dL. This elevated level indicates target organ damage
to the kidneys. The other laboratory results are within normal limits.
