Hypertension
A nurse is caring for a client who is diagnosed with hypertension and is prescribed spironolactone (Aldactone) 25 mg/day. Which of the following statements by the client indicates a need for further teaching?
A. “I should eat a lot of fruits and vegetables, especially bananas and potatoes.”B. “I will report any changes in heart rate or rhythm.”C. “I should use a salt substitute that is low in potassium.”D. “I will continue to take this medication even if I am feeling better.”The nurse is providing community health screening. Which of the following clients should be referred to a health care provider for further evaluation?
A. 30-year-old athlete with a heart rate of 50/min
B. 45-year-old client with a body mass index of 35 kg/m2 and fingerstick glucose of 150 mg/dL (8.3 mmol/L)
C. 55-year-old client missing all the hair on the lower legs and failing the pinprick test
D. 80-year-old client with a blood pressure of 150/90 mm Hg
What is 55-year-old client missing all the hair on the lower legs and failing the pinprick test?
Failure of pinprick testing indicates peripheral neuropathy. Loss of hair on the lower extremities indicates poor perfusion. The combination of these suggests peripheral neuropathy and peripheral arterial disease, likely from undiagnosed diabetes mellitus and atherosclerosis. Nearly a third of clients diagnosed with diabetes mellitus will already have complications from years of uncontrolled hyperglycemia. Diabetes mellitus dramatically accelerates the buildup of plaque on the arterial walls (atherosclerosis) when blood glucose levels are uncontrolled. (Option 1) Asymptomatic bradycardia in a healthy young adult is rarely pathological. Professional-level athletes will commonly develop athletic heart syndrome; increased efficiency results in resting sinus bradycardia (40-60/min). (Option 2) Fasting blood glucose of 150 mg/dL (8.3 mmol/L) would need to be evaluated for diabetes. However, in this case it would be important to verify whether the client has eaten recently. (Option 4) The Joint National Committee guidelines recommend against treating blood pressure readings <150/90 mm Hg in clients age >60. Educational objective: The impaired perfusion from severe atherosclerosis results in skin atrophy, poor wound healing, and widespread hair follicle death (hair loss).
After a prolonged surgical procedure, the client reports unilateral leg pain. Which client assessment finding is most concerning?
A. Client rates leg pain as 7
B. Negative Homan sign
C. Prominent varicose veins bilaterally
D. Right calf is 4 cm larger than left calf
What is Right calf is 4 cm larger than left calf?
Deep venous thrombosis (DVT) is a major concern in clients with unilateral leg pain after prolonged immobilization (eg, air travel, surgery) or those with obesity, pregnancy, or other hypercoagulable states (eg, cancer). Eight percent of DVTs start in the veins of the calf and move into the popliteal and femoral veins. Classic symptoms include unilateral leg edema, local warmth, erythema, and low-grade fever. Therefore, the swelling in one leg is highly concerning.
A clinic nurse is caring for a client who has hypertension and is prescribed hydrochlorothiazide, Lisinopril, and clonidine. The current blood pressure reading is 190/102 mm hg, and the client reports a headache that has lasted several days. Which question is most important for the nurse to ask next?
A. “Have you noticed any abnormal swelling in your legs?”
B. “How are you currently taking your blood pressure medications?”
C. “How has your stress level been the past few weeks?”
D. “What over-the-counter medications have you taken today?”
What is “How are you currently taking your blood pressure medications?”
A major problem in the long-term management of hypertension is poor adherence to the treatment plan, often due to unpleasant side effects (eg, fatigue, dizziness, reduced libido, erectile dysfunction) and medication cost. This problem can worsen if a client must take multiple medications. Determining whether a client is taking medications as prescribed is a priority, as sudden or abrupt discontinuation of antihypertensive medications can cause rebound hypertension and possibly hypertensive crisis (eg, blurred vision, dizziness, severe headache, shortness of breath).
A patient is prescribed atorvastatin. The nurse instructs the patient to watch for and report which side effect?
A. Nausea and vomiting
B. Cough
C. Headaches
d. Muscle cramps
What is Muscle cramps?
3-hydroxy- 3-methyglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) successfully reduces total cholesterol in most patients when used for an extended period. Some patient may experience muscle cramping and elevated liver enzyme levels.
One of the most common complaints of people taking statins is muscle pain. The patient may feel this pain as a soreness, tiredness or weakness in their muscles. The pain can be a mild discomfort, or it can be severe enough to make their daily activities difficult. Very rarely, statins can cause life-threatening muscle damage called rhabdomyolysis (rab-doe-my-OL-ih-sis). Rhabdomyolysis can cause severe muscle pain, liver damage, kidney failure and death. The risk of very serious side effects is extremely low, and calculated in a few cases per million of patients taking statins. Rhabdomyolysis can occur when a patient take statins in combination with certain drugs or a high dose of statins
A client with peripheral arterial disease has received instructions from the nurse about how to limit the progression of the disease. The nurse determines that the client needs further instructions if which statement was made by the client?
A. "I need to eat a balanced diet."
B. "A heating pad on my leg will help soothe the leg pain."
C. "I need to take special care of my feet to prevent injury."
D. "I should walk daily to increase the circulation to my legs."
What is "A heating pad on my leg will help soothe the leg pain?"
The long-term management of peripheral arterial disease consists of measures that increase peripheral circulation (exercise), promote vasodilation (warmth), relieve pain, and maintain tissue integrity (foot care and nutrition). The application of heat directly to the extremity is contradicted. The limb may have decreased sensitivity and be more at risk for burns. Additionally, the direct application of heat raises the oxygen and nutritional requirements of the tissue even further.
The nurse is inspecting the legs of a client with a suspected lower-extremity deep venous thrombosis. Which of the following clinical manifestations should the nurse expect? Select all that apply.
A. Blue, cyanotic toes
B. Calf pain
C. Dry, shiny, hairless skin
D. Lower leg warmth and redness
E. Unilateral leg edema
What is Calf pain, Lower leg warmth and redness, and Unilateral leg edema?
A deep venous thrombosis (DVT) is a blood clot (ie, thrombus) formed in large veins, generally of the lower extremities. DVTs occur commonly as a result of decreased activity or mobility (eg, prolonged travels, bed rest) or as a complication of hospitalization or surgery. Although clients with a DVT may have no symptoms, typical clinical manifestations include unilateral edema, localized pain (eg, calf pain) or tenderness to touch, warmth, erythema, and occasionally low-grade fever. Recognition of a potential DVT is critical because the thrombus can dislodge from the vessel and cause life-threatening pulmonary embolism.
What is Calf pain, Lower leg warmth and redness, and Unilateral leg edema?
A deep venous thrombosis (DVT) is a blood clot (ie, thrombus) formed in large veins, generally of the lower extremities. DVTs occur commonly as a result of decreased activity or mobility (eg, prolonged travels, bed rest) or as a complication of hospitalization or surgery. Although clients with a DVT may have no symptoms, typical clinical manifestations include unilateral edema, localized pain (eg, calf pain) or tenderness to touch, warmth, erythema, and occasionally low-grade fever. Recognition of a potential DVT is critical because the thrombus can dislodge from the vessel and cause life-threatening pulmonary embolism.
The nurse is preparing to administer 40 mg of IV furosemide. Prior to administering the medication, the nurse should assess which parameters? Select all that apply
A. Blood pressure
B. Blood urea nitrogen
C. Liver enzymes
D. Potassium
E. White blood cell count
What is blood pressure, blood urea nitrogen, and potassium?
When administering furosemide, it is important to closely monitor the client’s vital signs, serum electrolytes (potassium), and kidney function tests (blood urea nitrogen, creatinine) prior to administration to prevent side effects such as hypokalemia, hypotension, and kidney injury.
The nurse is preparing to administer 40 mg of IV furosemide. Prior to administering the medication, the nurse should assess which parameters? Select all that apply
A. Blood pressure
B. Blood urea nitrogen
C. Liver enzymes
D. Potassium
E. White blood cell count
What is blood pressure, blood urea nitrogen, and potassium?
When administering furosemide, it is important to closely monitor the client’s vital signs, serum electrolytes (potassium), and kidney function tests (blood urea nitrogen, creatinine) prior to administration to prevent side effects such as hypokalemia, hypotension, and kidney injury.
The nurse is teaching a patient about taking hydrochlorothiazide. Which foods does the nurse instruct the patient to eat in conjunction with the use of this drug?
A. bananas and oranges
B. Milk and cheese
C. Cranberries and prunes
d. Cabbage and cauliflower
What is bananas and oranges?
Thiazide inhibit sodium, chloride and water reabsorption in the distal tubules while promoting potassium, bicarbonate, and magnesium excretion.
An elderly client tells the nurse "I have experienced leg pain for several weeks when I walk to the mailbox each afternoon, but it goes away once I stop walking." What is the priority assessment the nurse should perform?
A. Assess for dry, scaly skin on the lower legs
B. Assess for presence or absence of hair growth on lower extremities
C. Check for presence and quality of posterior tibial and dorsalis pedis pulses
D. Obtain a dietary history
What is Check for presence and quality of posterior tibial and dorsalis pedis pulses?
This client is exhibiting symptoms of intermittent claudication or ischemic muscle pain that can be due to peripheral artery disease (PAD). PAD impairs circulation to the client's extremities. The nurse should first check for the adequacy of blood flow to the lower extremities by palpating for the presence of posterior tibial and dorsalis pedis pulses and their quality. Poor circulation to the extremities can place the client at increased risk for development of arterial ulcers and infection. The quality of circulation to the extremities will guide the treatment plan for this client; management will include risk factor modification for cardiovascular disease, drug therapy, and possibly surgical revascularization. (Option 1) Dry, scaly skin can be present in the client with PAD. It is a chronic condition of PAD and is not the priority assessment. (Option 2) When circulation to the extremities is impaired, the skin on the lower legs becomes thin, shiny, and taut; hair loss also occurs on the lower legs. This develops over time and would indicate that PAD has been present for a period of time and is not the priority assessment. (Option 4) The nurse should obtain a dietary history to assess for risk factors associated with cardiovascular disease. However, this is a lower level priority in this situation. Educational objective: The nurse caring for a client with intermittent claudication from PAD should assess the adequacy of circulation to the extremities by palpating and assessing the quality of posterior tibial and dorsalis pedis pulses. The quality of circulation will guide the treatment plan including risk factor modification, drug therapy, and possible surgical revascularization.
When collecting data form a client with varicose veins who is to have sclerotherapy, the nurse expects the client to report
A. Feelings of fullness in both legs
B. Intermittent claudication of the legs
C. Calf pain on dorsiflexion of the foot
D. Hematomas of the lower extremities
What is feelings of fullness in both legs?
Impaired venous return causes increased pressure, with subjective symptoms of fatigue and heaviness. More advanced disease causes venous distention (bulging), edema, a feeling of fullness in the legs, and pruritus (itching). As a result, signs and symptoms of venous insufficiency may occur, including venous stasis ulcers, brown pigmentation from extravasted red blood cells (also called skin staining), and pain. Varicose veins and reflux are diagnosed by simple or duplex ultrasonography
Which orders should the nurse question if the patient was prescribed an ACE inhibitor as a monotherapy?
A. A 45-year-old Hispanic man
B. A 48-year-old Asian woman
C. A 50-year-old Caucasian woman
D. A 55-year-old African American man
What is A 55-year-old African American man?
African Americans and older adults do not respond to ACE inhibitors with the desired reduction in blood pressure, but when taken with a diuretic, blood pressure will usually be lowered.
The nurse is consulting with the registered dietitian about diet therapy for a patient with chronic venous stasis ulcers. What are the dietary recommendations to help this patient promote would healing?
A. High-protein foods
B. Vitamin D and B supplements
C. Low-fat foods
D. High-calcium foods
What is high-protein foods?
Eating high-protein foods help with weight loss, feeling fuller after eating, and muscle building.
What is how are you currently taking your blood pressure medications?
A major problem in the long-term management of hypertension is poor adherence to the treatment plan, often due to unpleasant side effects (eg, fatigue, dizziness, reduced libido, erectile dysfunction) and medication cost. This problem can worsen if a client must take multiple medications. Determining whether a client is taking medications as prescribed is a priority, as sudden or abrupt discontinuation of antihypertensive medications can cause rebound hypertension and possibly hypertensive crisis (eg, blurred vision, dizziness, severe headache, shortness of breath) (Option 2). (Option 1) The nurse should assess for peripheral edema, which may indicate heart failure. However, this can be done after assessing medication adherence. (Options 3 and 4) Stress can elevate blood pressure. Some over-the-counter medications (eg, decongestants, NSAIDs) can also increase blood pressure. However, poor adherence to prescribed medications is the number one cause of uncontrolled hypertension. The nurse should ask about all other medications the client has taken and the client's stress level after confirming that the prescribed blood pressure medications are being taken correctly. Educational objective: A major problem in long-term management of hypertension is poor adherence to the treatment plan, often due to unpleasant side effects and medication cost. Assessing for medication adherence is important, as abrupt discontinuation of antihypertensive medications can cause rebound hypertension and hypertensive crisis.
Which patients are at risk for peripheral arterial disease (PAD)? Select all that apply
A. Patient with hypertension
B. Patient with diabetes mellitus
C. Patient who is a cigarette smoker
D. Patient with anemia
E. Patient who is very thin
F. African-American patient
What is Patient with hypertension, Patient with diabetes mellitus, Patient who is a cigarette smoker and African-American patient?
Because Atherosclerosis is the most common cause of chronic arterial obstruction, the same risk factors for Atherosclerosis apply to PAD (hypertension, diabetes mellitus, cigarette smoker, African-American, sedentary lifestyle, stress, older adult, low HDL-C, High LDL-C, increase triglycerides, genetic predisposition, ).
What is the protein-binding power of warfarin?
A. Highly protein-bound
B. Low protein-bound
C. Not protein-bound at all
D. Moderately protein-bound
What is highly protein-bound?
Because warfarin is highly protein bound, it is affected by drug interactions. Aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), other types of anti-inflammatory drugs, sulfonamides, phenytoin, cimetidine, allopurinol, and oral hypoglycemic drugs for diabetes can displace warfarin from the protein-bound site and can cause more free-circulating anticoagulant. Numerous other drugs also increase the action of warfarin, and bleeding is likely to occur.
An ARB can be combined with the thiazide diuretic hydrochlorothiazide. What is the purpose of combining these two drugs?
A. To decrease rapid blood pressure drop
B. to enhance the antihypertensive effect by promoting sodium and water loss.
C. To increase sodium and water retention for controlling blooding pressure.
D. To promote potassium retention
What is to enhance the antihypertensive effect by promoting sodium and water loss.
ARB are Angiotensin II-receptor blockers and they prevent bock angiotensin II from the angiotensin I receptors found in many tissues. ARB cause vasodilation decrease peripheral resistance. They may be used as a first-line treatment for hypertension.
providers.
The nurse has just completed discharge teaching for a client recently diagnosed with hypertension. Which of the following statements by the client indicate understanding of the Dietary Approaches to Stop Hypertension (DASH) diet? Select all that apply.
A. "I need to eat less red meat and more fresh vegetables."
B. "I'll limit drinking soda to only one at a time as an occasional treat."
C. "I'm going to replace potato chips with fruit during meals and snacking."
D. "I'm really going to miss drinking as much milk as I normally do."
E. "Taking the salt shaker off the table should be enough to reduce my sodium intake."
What is Eliminate infection, Chemically debride the ulcer, Eliminate necrotic tissue, and Prevent stasis?
What is I need to eat less red meat and more fresh vegetables, I'll limit drinking soda to only one at a time as an occasional treat, and I'm going to replace potato chips with fruit during meals and snacking?
The Dietary Approaches to Stop Hypertension (DASH) diet is often suggested to clients with hypertension due to its ability to reduce blood pressure. The diet focuses on elimination or reduction of foods and beverages high in sodium, sugar, cholesterol, and trans or saturated fats, which all contribute to increased blood pressure. The DASH diet focuses on: •Including fresh fruits and vegetables, and whole grains in the daily diet •Choosing fat-free or low-fat dairy products •Choosing meats lower in cholesterol (eg, fish, poultry) and alternate protein sources (eg, legumes) instead of red meats (Option 1) •Limiting intake of sweets, foods high in sodium (eg, potato chips, frozen meals, canned foods), and sugary beverages to the occasional treat (Options 2 and 3) (Option 4) Limiting milk intake is unnecessary; however, the nurse may need to educate the client about choosing low-fat or skim milk over whole milk. (Option 5) Taking the salt shaker off the table may be a good first step in reducing sodium intake. However, it will not be enough as salt is found in many foods. Educational objective: The Dietary Approaches to Stop Hypertension (DASH) diet is often recommended to reduce blood pressure in clients with hypertension. The client is taught to limit intake of sugar, sodium, cholesterol, and trans or saturated fats, and instead choose healthier options (eg, fresh fruit and vegetables, low-fat dairy products).
A pharmacologic nuclear stress test utilizes vasodilators (eg, adenosine, dipyridamole) to simulate exercise when clients are unable to tolerate continuous physical activity or when their target heart rate is not achieved through exercise alone. These drugs produce vasodilation of the coronary arteries in clients with suspected coronary heart disease. A radioactive dye is injected so that a special camera can produce images of the heart. Based on these images, the health care provider (HCP) can visualize if there is adequate coronary perfusion. Pre-procedure client instructions include the following: •Do not eat, drink, or smoke on the day of the test (NPO for at least 4 hours). Small sips of water may be taken with medications (Option 3). •Avoid caffeine products 24 hours before the test (Option 2). •Avoid decaffeinated products 24 hours before the test as these contain trace amounts of caffeine (Option 1). •Do not take theophylline 24-48 hours prior to the test (if tolerated). •If insulin/pills are prescribed for diabetes, consult the HCP about appropriate dosage on the day of the test. Hypoglycemia can result if the medicine is taken without food (Option 5). •Some medications can interfere with the test results by masking angina. Do not take the following cardiac medications unless the HCP directs otherwise, or unless needed to treat chest discomfort on the day of the test:◦Nitrates (nitroglycerine or isosorbide) ◦Dipyridamole ◦Beta blockers (Option 4) Educational objective: Clients scheduled for cardiac nuclear pharmacologic stress testing should not eat, drink, or smoke on the day of the test; avoid both caffeinated and decaffeinated products for 24 hours before the test; and avoid taking theophylline or antianginal medications unless otherwise instructed by the health care provider.
The nurse is instructing a patient with peripheral arterial disease (PAD) about ways to promote vasodilation. What information does the nurse include? Select all that apply
A. Maintain a warm environment at home.
B. Wear socks or insulated shoes at all times.
C. Apply direct heat the limb by using a heating pad.
D. Prevent cold exposure of the affected limb.
E. Limit fluids to prevent increased blood viscosity.
F. Completely abstain from smoking or chewing tobacco.
What is Maintain a warm environment at home, Wear socks or insulated shoes at all times, Prevent cold exposure of the affected limb, and completely abstain from smoking or chewing tobacco?
Vasodilation can be achieved by providing warmth to the affected extremity and preventing long periods of exposure to cold. Encourage the patient to maintain a warm environment at home and to wear socks or insulated shoes at all times. Caution the patient to avoid the application of direct heat to the limb with heating pads or extremely hot water. Sensitivity is decreased in the affected limb. Burns may result. Encourage patients to prevent exposure of the affected limb to the cold because cold temperatures cause vasoconstriction and therefore decrease arterial perfusion. Emotional stress, caffeine, and nicotine also can cause vasoconstriction. Emphasize that complete abstinence from smoking or chewing tobacco is essential to prevent vasoconstriction. The vasoconstrictive effects of each cigarette may last up to one hour after the cigarette is smoked.
A patient with a venous stasis ulcer is prescribed the topical agent Accuzyme. What are the purposes of this drug? Select all that apply
A. Eliminate infection
B. Promote healing
C. Chemically debride the ulcer
D. Improve circulation
E. Eliminate necrotic tissue
F. Prevent stasis
What is Eliminate infection, Chemically debride the ulcer, Eliminate necrotic tissue, and Prevent stasis?
Treatment of chronic venous insufficiency is nonsurgical unless it is complicated by a venous stasis ulcer that requires surgical debridement. The desired outcomes of managing venous stasis ulcers are to heal the ulcer, prevent infection, and prevent stasis with recurrence of ulcer formation.
A female client with liver cirrhosis and chronic anemia is hospitalized for a deep venous thrombosis. The client is receiving a heparin infusion and suddenly develops epistaxis. Which laboratory value would indicate that the heparin infusion needs to be turned off?
A. Hematocrit of 30%
B. Partial thromboplastin time of 110 seconds
C. Platelet count of 80,000
D. Prothrombin time of 11 seconds
What is Partial thromboplastin time of 110 seconds
Heparin is an anticoagulant that helps prevent further clot formation. It is titrated based on a partial thromboplastin time (PTT). The therapeutic PTT targets is 1.5-2.0 times the normal reference range of 25-35 seconds. A PTT value >100 seconds would be considered critical and could result in life-threatening side effects. Common sentinel events that result from heparin drips include epistaxis, hematuria, and gastrointestinal bleeds. Heparin infusions require close monitoring by the nurse. The partial thromboplastin
What information does the nurse include when teaching a patient with chronic venous stasis? Select all that apply
A. Elevate the legs when sitting
B. Avoid crossing the legs
C. Wear antiembolic stockings at night during sleep
D. Avoid standing still for any length of time.
E. Avoid wearing tight girdles, tight pants, and narrow-banded knee-high socks.
F. Keep legs positioned below the heart at night for better perfusion.
What is elevate the legs when sitting, avoid crossing the legs, avoid standing still for any length of time, and avoid wearing tight girdles, tight pants, and narrow-banded knee-high socks?
The arteries carry blood from the heart to the rest of the body. The veins carry blood back to the heart, and valves in the veins stop the blood from flowing backward.
When the veins have trouble sending blood from the limbs back to the heart, it’s known as venous insufficiency. In this condition, blood doesn’t flow back properly to the heart, causing blood to pool in the veins in the legs.