Question 1

The student nurse is planning a community group presentation on hypertension.Which group of individuals should the student identify as having the highest incidence of hypertension?

Accepted Answer

African Americans have a higher incidence of hypertension than any other minority group or whites.

Question 2

The nurse is teaching a pregnant patient who works as a cashier in a grocery store about varicose vein prevention.Which instruction is most important for the nurse to include in the teaching plan?

Accepted Answer

Varicose veins are enlarged and tortuous veins that are distorted in shape by accumulations of pooled blood.Treatment of varicose veins includes exercising the legs and feet periodically throughout the day,like marching in place while standing at the counter,elevating the legs whenever possible,and wearing support hose.Supportive shoes and vitamin C do not prevent venous congestion.

Question 3

The patient has been prescribed a low-sodium diet.Which food choice indicates that the patient requires additional teaching?

Accepted Answer

High-sodium foods include pickled vegetables,canned soups,and processed meats.Fresh spinach,whole-grain pasta,and grapefruit are appropriate low-sodium choices.

Question 4

The nurse is caring for a patient with a compression dressing.Which action indicates appropriate wound care?

Accepted Answer

Compression therapy options include compression stockings,elastic tubular support bandages,intermittent compression devices,a paste bandage such as Unna boot,or placement of two to four layers of compression dressings to the affected area.Venous return is accomplished as the patient moves his leg and achieves pressure on the calf muscles.Compression dressings can be placed over wound dressings.The dressings help to reduce ulcer pain,keep the wound moist,and assist debridement.The dressing is changed from every 2 to 3 days to every few weeks depending on the type of dressing applied.An alcohol-based cleanser would be drying and harsh.Compression dressings do not necessitate use of a face mask.

Question 5

An 86-year-old patient asks why her ankles have a brownish discoloration and the skin looks thick.Which response best addresses the patient's concern?

Accepted Answer

Hemosiderin leaks out of the trapped red blood cells in the dilated vessels of the feet and ankles,and stains the skin of people with venous insufficiency.In addition,fibrous tissue replaces subcutaneous tissue around the ankles and causes the skin to become thick and hardened.Iron and nicotine do not play a role in these skin changes with venous insufficiency,and these are not normal changes associated with aging.

Question 6

The nurse is caring for a 75-year-old patient with a history of diabetes and peripheral vascular disease (PVD).The nurse observes an inflamed and excoriated area on the patient's right shin.Which intervention should the nurse perform first?

Accepted Answer

The nurse should first cover the area with a clear,occlusive dressing to protect the area from scratching and infection.The nurse should then document the findings,notify the primary care provider,and review nutritional intake to confirm adequacy for wound healing.

Question 7

The nurse is caring for a patient who underwent endovenous laser treatment.Which statement indicates that the nurse's teaching about postprocedure management has been successful?

Accepted Answer

Endovenous occlusion using laser is done by placing a catheter within the vein under duplex ultrasound guidance.A laser heats the vessel,causing it to collapse and close off.Patients ambulate immediately after the procedure for 30 to 60 minutes and 1 to 2 hours per day for 1 to 2 weeks.The patient should wear compression stockings for 1 to 2 weeks.The patient should not massage the legs or notify the doctor of warm feet (a normal finding).

Question 8

Which medication is the most common and effective antiplatelet aggregation agent?

Accepted Answer

Aspirin is the most common and effective antiplatelet agent.

Question 9

Which blood pressure findings constitute a diagnosis of hypertension?

Accepted Answer

A diagnosis of hypertension is made if the systolic pressure is equal to or greater than 140 mm Hg and the diastolic pressure is equal to or greater than 90 mm Hg at least twice on two different occasions 2 weeks apart.

Question 10

The nurse is caring for a patient with peripheral arterial disease who complains of 3/10 pain in the lower extremities.The nurse observes a 0.5 cm ×1 cm ulcer on the left lower leg,and the lower legs are shiny and hairless bilaterally.The nurse identifies which priority problem statement/nursing diagnosis?

Accepted Answer

Altered skin integrity is the priority problem statement/diagnosis in this situation.Acute pain is a nursing diagnosis,but the pain is 3/10 so it is not the priority since there is an open wound.Injury and insufficient knowledge could be problems,but there is not enough information to support these diagnoses.

Question 11

Which problems are potential complications of uncontrolled hypertension?

Accepted Answer

Uncontrolled hypertension may result in stroke,kidney failure,heart attack,and congestive heart failure.A DVT is not a potential complication of hypertension.

Question 12

The home health nurse is caring for a patient with a blood pressure reading of 200/160.The patient denies any discomfort.The nurse should immediately contact the health care provider to report that the patient is experiencing which problem?

Accepted Answer

The diastolic pressure rising to readings between 140 and 170 and the patient being asymptomatic indicates hypertensive crisis.

Question 13

The nurse is caring for a patient with a deep venous thrombosis (DVT).Which finding requires the nurse's immediate attention?

Accepted Answer

The primary concern for a patient with a DVT is the potential for embolisms.Hemoptysis (coughing up rust colored sputum)is the cardinal sign of a pulmonary embolus and is a medical emergency.Hematuria (bloody urine)is a finding that requires additional assessment but is not the priority.Hematuria may occur from trauma from Foley catheter insertion,use of blood thinners to treat the DVT,or a variety of other causative factors.Decreased sensation in the affected leg is an expected abnormal finding.Urine output of 35 mL/hr is normal.

Question 14

The nurse is caring for a patient with a history of peripheral arterial disease.The patient complains of significant claudication,and findings of an ankle-brachial index are abnormal.The nurse anticipates that this patient will most likely require which type of procedure?

Accepted Answer

PTA may be done to open an artery to reduce claudication symptoms and improve extremity perfusion.

Question 15

The nurse is caring for a patient who has a new prescription for a loop diuretic.Which nutritional intervention is most important for the nurse to add to the care plan?

Accepted Answer

Loop diuretics are potent,potassium-wasting diuretics.After talking with the health care provider,the patient should recommend that the patient increase intake of potassium-rich foods like bananas and potatoes to offset potassium depletion from the diuretic.Leafy green vegetables are rich in vitamin K and may increase clotting times.Sodium-rich foods like canned soups and hot dogs should be avoided to prevent excess water retention,but this intervention does not address the risk for potassium depletion with loop diuretics.Caffeine is a stimulant that causes vasoconstriction and may increase blood pressure.While avoiding caffeine may improve blood pressure,this intervention does not address the risk of potassium depletion with a loop diuretic.

Question 16

The nurse is caring for a patient diagnosed with an abdominal aortic aneurysm who complains of sudden,intense abdominal pain and light-headedness.What action should the nurse take next?

Accepted Answer

The patient is most likely experiencing a ruptured aneurysm,which is a medical emergency requiring surgical repair.The nurse should contact the physician immediately.The vital signs may need to be measured more often than every 15 minutes.Notifying the family is not the priority intervention.Ongoing assessment of pain should continue,but after the physician is notified of the emergent status change.

Question 17

The nurse is educating an older adult patient who is taking antihypertensives with diuretics.Which information regarding safety precautions is most important for the nurse to include?

Accepted Answer

Age-related changes (reduced baroreceptor sensitivity)and risk for fluid shifts related to diuretics predispose the older adult patient to orthostatic hypotension.In order to prevent falls,the patient should change positions slowly and cautiously,like taking time to sit on the edge of the bed before standing.While purchasing a home blood pressure monitor,limiting sodium in the diet,and keeping an updated list of medications may assist with management of hypertension,fall prevention and safety are most important for the older adult patient.

Question 18

The nurse is caring for a patient with a deep venous thrombosis (DVT).Which medication would likely be used for initial inpatient treatment?

Accepted Answer

Inpatient medical treatment for DVT usually consists of intravenous (IV)heparin.Low-molecular-weight heparin (LMWH)such as enoxaparin (Lovenox)by injection may be used for inpatient management and is used more frequently for outpatient treatment.Fondaparinux (Arixtra),a Factor Xa inhibitor,may be used instead of enoxaparin.After initial IV or injection anticoagulation treatment oral anticoagulation is started with warfarin sodium (Coumadin),rivaroxaban (Xarelto),edoxaban (Lixiana),dabigatran (Pradaxa),or apixaban (Eliquis).Anticoagulation is continued for 3 to 6 months for the first episode of DVT and a year for recurrent episodes (Patel,2014).

Question 19

Which findings characterize peripheral vascular disease (PVD)?

Accepted Answer

Findings that characterize PVD include narrowed arteries,obstructed veins,deficient valvular function,and thrombophlebitis.PVD usually involves only the lower extremities.

Question 20

The nurse is teaching a patient who takes warfarin (Coumadin)about a coagulation monitoring device.Which blood clotting time should the device monitors?

Accepted Answer

A coagulation monitoring device measures the INR level for clotting time for a person on therapeutic doses of warfarin.

Quiz 18: Care of Patients with Hypertension and Peripheral Vascular Disease