Question 1

A patient is admitted to the outpatient diagnostic unit for further testing to identify the cause of the uncontrolled secondary hypertension. In preparation, the nurse should anticipate that which of the following diagnostic procedures will provide the most definitive diagnosis?

Accepted Answer

A)   Routine ultrasound of kidney
B)   Renal arteriography
C)   Echocardiography
D)   Serum creatinine level B

Question 2

A physiotherapist is measuring the lying, sitting, and standing blood pressure of a patient who has been admitted to hospital following a syncopal episode and recent falls. Which of the following facts about the patient best relates to these health problems?

Accepted Answer

A)   The patient is male and has a history of hypertension.
B)   The patient's cardiac ejection fraction was 40% during his last echocardiogram.
C)   The patient has a history of acute and chronic renal failure.
D)   The client is 89 years old and takes a diuretic medication for his congestive heart failure. D

Question 3

A formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks' gestation. Her blood pressure is 154/110 mm Hg, and she has proteinuria. What other lab tests should be ordered for her?

Accepted Answer

A)   Plasma angiotensin I and II and renin
B)   Urinary sodium and potassium
C)   Platelet count, serum creatinine, and liver enzymes
D)   Urinary catecholamines and metabolites C

Question 4

During a prenatal education class, an expectant mother tells the group about a friend whose blood pressure became so high during pregnancy that she had to be admitted to hospital. Which of the following statements should the nurse include in response to this?

Accepted Answer

A)   "A large increase in blood pressure is a normal part of the changes in blood circulation that accompany pregnancy."
B)   "By avoiding salt, staying active, and minimizing weight gain, you can prevent this during your pregnancy."
C)   "Essentially, experts don't really know why so many pregnant women develop high blood pressure."
D)   "I'm sure this was hard for your friend, but rest assured that it won't affect your baby even if it affects you."

Question 5

The nurse practitioner working in an overnight sleep lab is assessing and diagnosing patients with sleep apnea. During this diagnostic procedure, the nurse notes that a patient's blood pressure is 162/97. The nurse explains this connection to the patient based on which of the following pathophysiological principles?

Accepted Answer

A)   During apneic periods, the patient experiences hypoxemia that stimulates chemoreceptors to induce vasoconstriction.
B)   When the patient starts to snore, his epiglottis is closed over the trachea.
C)   When the airway is obstructed, specialized cells located in the back of the throat send signals to the kidney to increase pulse rate.
D)   When airways are obstructed, the body will retain extracellular fluid so that this fluid can be shifted to intravascular space to increase volume.

Question 6

An autopsy is being performed on a 44-year-old female who died unexpectedly of heart failure. Which of the following components of the pathologist's report is most suggestive of a possible history of poorly controlled blood pressure?

Accepted Answer

A)   "Scarring of the urethra suggestive of recurrent urinary tract infections is evident."
B)   "Bilateral renal hypertrophy is noted."
C)   "Vessel wall changes suggestive of venous stasis are evident."
D)   "Arterial sclerosis of subcortical brain regions is noted."

Question 7

A group of novice nursing students are learning how to manually measure a client's blood pressure using a stethoscope and sphygmomanometer. Which of the following statements by students would the instructor most likely need to correct?

Accepted Answer

A)   "I'll inflate the cuff around 30 mm Hg above the point at which I can't palpate the client's pulse."
B)   "If my client's arm is too big for the cuff, I'm going to get a BP reading that's artificially low."
C)   "The accuracy of the whole process depends on my ability to clearly hear the Korotkoff sounds with the bell of my stethoscope."
D)   "With practice, my measurement of clients' blood pressures with this method will be more accurate than with automated machines."

Question 8

A nurse working on a gerontology unit notes that the majority of the clients on the unit are prescribed antihypertensive medications. When it comes to the aging process, which of the following phenomena are primarily the contributing factors to hypertension in the elderly population? Select all that apply.

Accepted Answer

A)   Stiffening of large arteries like the aorta
B)   Increased sensitivity of the renin-angiotensin-aldosterone system
C)   Decreased baroreceptor sensitivity and renal blood flow
D)   Increased peripheral vascular resistance
E)   Increase in renal perfusion

Question 9

A physician is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the physician most likelyrule out hypertension as a contributing factor?

Accepted Answer

A)   A 61-year-old man who has a heart valve infection and recurrent fever
B)   An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness
C)   A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week
D)   A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance

Question 10

During a routine physical exam for a patient diagnosed with hypertension, the nurse practitioner will be most concerned if which of the following assessments are found?

Accepted Answer

A)   Noted hemorrhages and microaneurysms during evaluation of the internal eye
B)   Unable to feel vibrations when a tuning fork is placed on the skull
C)   Inability to locate the kidneys with deep palpation to the abdomen
D)   Slight increase in the number of varicose veins noted bilaterally

Question 11

A 74-year-old man is being assessed by a nurse as part of a weekly, basic health assessment at the long-term care facility where he resides. His blood pressure at the time is 148/97 mm Hg, with a consequent pulse pressure of 51 mm Hg. The nurse would recognize that which of the following is the most significant determinant of the resident's pulse pressure?

Accepted Answer

A)   Blood volume, resistance, and flow
B)   The cardiac reserve or possible increase in cardiac output over normal resting level
C)   The amount of blood that his heart ejects from the left ventricle during each beat
D)   The relationship between total blood volume and resting heart rate

Question 12

At 4 AM, the hemodynamic monitor for a critically ill client in the intensive care unit indicates that the client's mean arterial pressure is at the low end of the normal range; at 6 AM, the client's MAP has fallen definitively below normal. The client is at risk for

Accepted Answer

A)   pulmonary hypertension.
B)   left ventricular hypertrophy.
C)   organ damage and hypovolemic shock
D)   orthostatic hypotension.

Question 13

A physical assessment of a 28-year-old female patient indicates that her blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which of the following possibilities would her care provider most likelysuspect?

Accepted Answer

A)   Pheochromocytoma
B)   Essential hypertension
C)   Coarctation of the aorta
D)   An adrenocortical disorder

Question 14

When advising a morbidly obese patient about the benefits of weight reduction, which of the following statements would be most accurate to share?

Accepted Answer

A)   "All you need to do is stop drinking sodas and sugary drinks."
B)   "A 10 lb loss of weight can produce a decrease in blood pressure."
C)   "An increased 'waist-to-hip' ratio can lead to too much pressure on the liver and intestines."
D)   "If your leptin (hormone)  level is too low, you are at increased risk for developing high BP."

Question 15

A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his physician. The patient's physician would anticipate that which of the following phenomena is most likely occurring?

Accepted Answer

A)   The patient's juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation
B)   Epinephrine from his adrenal gland is initiating the renin-angiotensin-aldosterone system.
C)   Vasopressin is exerting an effect on his chemoreceptors and baroreceptors resulting in vasoconstriction.
D)   The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.

Question 16

A number of older adults have come to attend a wellness clinic that includes both blood pressure monitoring and education about how to best control blood pressure. Which of the leader's following teaching points is most accurate?

Accepted Answer

A)   "It's important to minimize the amount of potassium and, especially, sodium in your diet."
B)   "High blood pressure is largely controllable, except for those with a significant family history or African Americans."
C)   "Too much alcohol, too little exercise, and too much body fat all contribute to high blood pressure."
D)   "Hypertension puts you at a significant risk of developing type 2 diabetes later in life."

Question 17

A 16-year-old adolescent who received a kidney transplant at the age of 10 has recently developed a trend of increasing BP readings. Of the following list of medications, which may be the primary cause for the development of hypertension?

Accepted Answer

A)   Furosemide (Lasix) 
B)   Cyclosporine (Sandimmune) 
C)   Isotretinoin (Accutane) 
D)   Hydrochlorothiazide (Hydrodiuril)

Question 18

A nurse is providing care for a number of older clients on a restorative care unit of a hospital. Many of the clients have diagnoses or histories of hypertension, and the nurse is responsible for administering a number of medications relevant to blood pressure control. Which of the following assessments would the nurse be most justified in eliminating during a busy morning on the unit?

Accepted Answer

A)   Checking the recent potassium levels of a client receiving an ACE inhibitor
B)   Measuring the heart rate of a client who takes a  β\betaβ -adrenergic blocker
C)   Measuring the pulse of a client taking an ACE inhibitor
D)   Noting the sodium and potassium levels of a client who is receiving a diuretic

Question 19

A 78-year-old male patient has undergone a total knee replacement. He just does not feel like getting out of bed and moving around. After 3 days of staying in bed, the physical therapist encourages him to get out of bed to the chair for meals. He starts to complain of dizziness and light-headedness. These symptoms are primarily caused by which of the following pathophysiological principles? Select all that apply. The patient('s)

Accepted Answer

A)   is experiencing a reduction in plasma volume.
B)   peripheral vasoconstriction mechanism has failed.
C)   is so stressed that he is releasing too many endorphins.
D)   is still bleeding from the surgical procedure.
E)   has lost all of his muscle tone.

Question 20

Which of the following hypertensive individuals is most likely to have his or her high blood pressure diagnosed as secondary rather than essential?

Accepted Answer

A)   A 51-year-old male who has been diagnosed with glomerulonephritis
B)   An African American man who leads a sedentary lifestyle
C)   A 69-year-old woman with a diagnosis of cardiometabolic syndrome
D)   A 40-year-old smoker who eats excessive amounts of salt and saturated fats

Exam 30: Respiratory Tract Infections and Neoplasms