MSN 277 EXAM 3- MSN 277 EXAM 3 ACTUAL
EXAM WITH QUESTION AND ANSWERS WITH
DETAILED RATIONALES ALREADY GRADED
EXAM 2024
Which action will be included in the plan of care when the nurse is
caring for a patient who is receiving sodium nitroprusside
(Nipride) to treat a hypertensive emergency?
a. Organize nursing activities so that the patient has undisturbed
sleep for 6 to 8 hours at night.
b. Assist the patient up in the chair for meals to avoid
complications associated with immobility.
c. Use an automated noninvasive blood pressure machine to
obtain frequent BP measurements.
d. Place the patient on NPO status to prevent aspiration caused
by nausea and the associated vomiting. Correct Answer ANS: C
Frequent monitoring of BP is needed when the patient is receiving
rapid-acting IV antihypertensive medications. This can be most
easily accomplished with an automated BP machine or arterial
line. The patient will require frequent assessments, so allowing 6
to 8 hours of undisturbed sleep is not appropriate. When patients
are receiving IV vasodilators, bed rest is maintained to prevent
decreased cerebral perfusion and fainting. There is no indication
that this patient is nauseated or at risk for aspiration, so an NPO
status is unnecessary.
The nurse has just finished teaching a hypertensive patient about
the newly prescribed quinapril (Accupril). Which patient statement
indicates that more teaching is needed?
a. The medication may not work as well if I take any aspirin.
b. The doctor may order a blood potassium level occasionally.
,c. I will call the doctor if I notice that I have a frequent cough.
d. I wont worry if I have a little swelling around my lips and face.
Correct Answer ANS: D
Angioedema occurring with angiotensin-converting enzyme (ACE)
inhibitor therapy is an indication that the ACE inhibitor should be
discontinued. The patient should be taught that if any swelling of
the face or oral mucosa occurs, the health care provider should
be immediately notified because this could be life threatening.
The other patient statements indicate that the patient has an
accurate understanding of ACE inhibitor therapy.
During change-of-shift report, the nurse obtains this information
about a hypertensive patient who received the first dose of
propranolol (Inderal) during the previous shift. Which information
indicates that the patient needs immediate intervention?
a. The patients most recent BP reading is 156/94 mm Hg.
b. The patients 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 ANS: C
The most urgent concern for this patient is the wheezes, which
indicate that bronchospasm (a common adverse effect of the
noncardioselective b-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
are associated with b-receptor blockade but 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.
A patient has been diagnosed with possible white coat
hypertension. Which action will the nurse plan to take next?
,a. Schedule the patient for frequent BP checks in the clinic.
b. Instruct the patient about the need to decrease stress levels.
c. Tell the patient how to self-monitor and record BPs at home.
d. Teach the patient about ambulatory blood pressure monitoring.
Correct Answer ANS: C
Having the patient self-monitor BPs at home will provide a reliable
indication about whether the patient has hypertension. Frequent
BP checks in the clinic are likely to be high in a patient with white
coat hypertension. Ambulatory blood pressure monitoring may be
used if the data from self-monitoring is unclear. Although elevated
stress levels may contribute to hypertension, instructing the
patient about this is unlikely to reduce BP.
Which BP finding by the nurse indicates that no changes in
therapy are needed for a patient with stage 1 hypertension who
has a history of heart failure?
a. 108/64 mm Hg
b. 128/76 mm Hg
c. 140/90 mm Hg
d. 136/ 82 mm Hg Correct Answer ANS: B
The goal for antihypertensive therapy for a patient with
hypertension and heart failure is a BP of <130/80 mm Hg. The BP
of 108/64 may indicate overtreatment of the hypertension and an
increased risk for adverse drug effects. The other two blood
pressures indicate a need for modifications in the patients
treatment.
Which information should the nurse include when teaching a
patient with newly diagnosed hypertension?
a. Dietary sodium restriction will control BP for most patients.
b. Most patients are able to control BP through lifestyle changes.
c. Hypertension is usually asymptomatic until significant organ
damage occurs.
, d. Annual BP checks are needed to monitor treatment
effectiveness. Correct Answer ANS: C
Hypertension is usually asymptomatic until target organ damage
has occurred. Lifestyle changes and sodium restriction are used
to help manage blood pressure, but drugs are needed for most
patients. BP should be checked by the health care provider every
3 to 6 months.
The nurse in the emergency department received change-of-shift
report on four patients with hypertension. Which patient should
the nurse assess first?
a. 52-year-old with a BP of 212/90 who has intermittent
claudication
b. 43-year-old with a BP of 190/102 who is complaining of chest
pain
c. 50-year-old with a BP of 210/110 who has a creatinine of 1.5
mg/dL
d. 48-year-old with a BP of 200/98 whose urine shows
microalbuminuria Correct Answer ANS: B
The patient with chest pain may be experiencing acute myocardial
infarction and rapid assessment and intervention is needed. The
symptoms of the other patients also show target organ damage,
but are not indicative of acute processes.
The nurse is reviewing the laboratory tests 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 2.6 mg/dL
b. Serum potassium of 3.8 mEq/L
c. Serum hemoglobin of 14.7 g/dL
d. Blood glucose level of 98 mg/dL Correct Answer ANS: A
The elevated creatinine indicates renal damage caused by the
hypertension. The other laboratory results are normal.
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