Nokea
The nurse is providing nutritional teaching to a patient with hypertension. Which of the following food groups should the nurse tell the patient that they should have four to five daily servings of?
- A. Whole grains
- B. Vegetables
- C. Meat, fish, and poultry
- D. Fat-free dairy food
- E. Fruit
Correct Answer: B,E
Rationale: Patients should be taught to have four to five daily servings of fruits and vegetables. Whole grains should be seven to eight servings per day. Meat, fish, and poultry are limited to less than 170 g/day. Low-fat dairy foods should be two to three servings per day.
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The nurse is reviewing the laboratory test results for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider?
- A. Serum creatinine of 230 mcmol/L
- B. Serum potassium of 3.8 mmol/L
- C. Serum hemoglobin of 147 g/L
- D. Blood glucose level of 5.3 mmol/L
Correct Answer: A
Rationale: The elevated creatinine indicates renal damage caused by the hypertension. The other laboratory results are normal.
During change-of-shift report, the nurse obtains this information about a patient who is hypertensive and received the first dose of propranolol during the previous shift. Which of the following information indicates that the patient needs immediate intervention?
- A. The patient's most recent BP reading is 156/94 mm Hg.
- B. The patient's pulse has dropped from 64 to 58 beats/minute.
- C. The patient has developed wheezes throughout the lung fields.
- D. The patient complains that the fingers and toes feel quite cold.
Correct Answer: C
Rationale: The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective β-adrenergic blockers) is occurring. The nurse should immediately obtain an oxygen saturation measurement, apply supplemental oxygen, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated; however, this is not as urgently needed as addressing the bronchospasm.
The nurse obtains a blood pressure of 180/75 mm Hg for a patient. What is the patient's mean arterial pressure (MAP)?
- A. 110
- B. 120
- C. 130
- D. 140
Correct Answer: A
Rationale: MAP = (DBP + 1/3 Pulse pressure). For a BP of 180/75 mm Hg, pulse pressure = 180 - 75 = 105 mm Hg. MAP = 75 + (1/3 * 105) = 75 + 35 = 110 mm Hg.
The nurse is caring for a patient with hypertension and has just administered the initial dose of labetalol. Which of the following actions should the nurse take?
- A. Encourage oral fluids to prevent dry mouth or dehydration.
- B. Instruct the patient to ask for help if heart palpitations occur.
- C. Ask the patient to request assistance when getting out of bed.
- D. Teach the patient that headaches may occur with this medication.
Correct Answer: C
Rationale: Labetalol decreases sympathetic nervous system activity by blocking both ?±- and β-adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension. Heart palpitations, dehydration, and headaches are possible adverse effects of other antihypertensives.
When a patient with hypertension who has a new prescription for atenolol returns to the health clinic after 2 weeks for a follow-up visit, the BP is unchanged from the previous visit. Which of the following actions should the nurse take first?
- A. Provide information about the use of multiple drugs to treat hypertension.
- B. Teach the patient about the reasons for a possible change in drug therapy.
- C. Remind the patient that lifestyle changes also are important in BP control.
- D. Ask the patient about whether the medication is actually being taken.
Correct Answer: D
Rationale: Since nonadherence with antihypertensive therapy is common, the nurse's initial action should be to determine whether the patient is taking the atenolol as prescribed. The other actions also may be implemented, but these would be done after assessing patient compliance with the prescribed therapy.