Nokea
The nurse is teaching a client about hypertension and the effects on the left ventricle. What diagnostic test will the nurse describe?
- A. echocardiography
- B. computed tomographic (CT) scan
- C. fluorescein angiography
- D. positron emission tomography (PET) scan
Correct Answer: A
Rationale: Echocardiography will reveal an enlarged left ventricle. Fluorescein angiography reveals leaking retinal blood vessels, and a PET scan is used to reveal abnormalities in blood pressure. A CT scan reveals structural abnormalities.
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The nurse is employed in a physician's office and is caring for a client present for an annual exam. A blood pressure of $124 / 84 \mathrm{~mm} \mathrm{Hg}$ is documented. Following revised guidelines for identifying hypertension, which educational pamphlet is helpful?
- A. Increasing fluids for low blood pressure
- B. Stress reduction to lower prehypertensive state
- C. Use of beta-blockers for treatment of hypertension
- D. Diagnostic testing for determining cardiac functioning
Correct Answer: B
Rationale: A blood pressure of $124 / 84 \mathrm{~mm} \mathrm{Hg}$ is now considered to be in the lower range of prehypertension. Knowledge of stress reduction may be helpful in lowering the blood pressure without medication therapy. A blood pressure of $124 / 84 \mathrm{~mm} \mathrm{Hg}$ is not considered a low blood pressure or in need of medication therapy due to hypertension. Diagnostic testing for cardiac functioning is not typical for a client with prehypertension.
The nurse is evaluating the types of medications prescribed for a client's hypertension. Which of the following medication classifications establishes an action on vasoconstrictive hormones in the blood stream?
- A. Beta-blocker
- B. ACE inhibitor
- C. Loop diuretic
- D. Calcium channel blocker
Correct Answer: B
Rationale: The angiotensin-converting enzyme (ACE) inhibitor's primary action is to prevent the conversion of angiotensin I to angiotensin II, a potent vasoconstricting hormone in the blood. A beta-blocker blocks the beta-adrenergic receptors decreasing sympathetic nervous system stimulation. Loop diuretics excrete water from the loop of Henle, reducing circulating blood volume. Calcium channel blockers dilate coronary and peripheral arteries.
A client, newly prescribed a low-sodium diet due to hypertension, is asking for help with meal choices. The client names four favorite meal choices. Which selection would be best?
- A. Toasted cheese sandwich on whole wheat toast with tomato soup
- B. Creamed chipped beef over toast with mashed potatoes
- C. Hot dog with ketchup and relish on whole wheat bun
- D. Green pepper stuffed with diced tomatoes and chicken
Correct Answer: D
Rationale: Fresh vegetables are low in sodium. A green pepper with (fresh) diced tomatoes and chicken is a good low-sodium, high vegetable and protein selection. Cheese and soup (tomato and creamed) are high in sodium. Processed meats such as a hot dogs and condiments such as ketchup are high in sodium.
Which of the following is the nurse most correct to recognize as a direct effect of client hypertension?
- A. Renal dysfunction resulting from atherosclerosis
- B. Anemia resulting from bone marrow suppression
- C. Hyperglycemia resulting from insulin receptor resistance
- D. Emphysema related to poor gas exchange
Correct Answer: A
Rationale: The nurse is most correct to realize high blood pressure damages the arterial vascular system and accelerates atherosclerosis. The effect of the atherosclerosis impairs circulation to the kidney, resulting in renal failure. Neither anemia, hyperglycemia, nor emphysema occurs as a direct effect of hypertension.
The nurse obtains a blood pressure of $136 / 86 \mathrm{~mm} \mathrm{Hg}$ on a morning assessment of a client with history of hypertension. Which pressure is of most concern when considering ventricular relaxation?
- A. Central aortic pressure
- B. Systolic pressure
- C. Diastolic pressure
- D. Central venous pressure
Correct Answer: C
Rationale: Diastolic blood pressure reflects arterial pressure during ventricular relaxation. It depends on the resistance of the arterioles and the diastolic filing times. Central aortic pressure is the blood pressure pumped from the left ventricle and measured at the root of the aorta. Systolic blood pressure is determined by the force and volume of blood that the left ventricle ejects. Central venous pressure reflects the blood pressure returning to the heart.