Contemporary Medical Surgical Nursing 2nd Edition by Daniels, Rick -Test Bank

Contemporary Medical Surgical Nursing 2nd Edition by Daniels, Rick -Test Bank

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WITH ANSWERS

Contemporary Medical Surgical Nursing 2nd Edition by Daniels, Rick -Test Bank

Chapter 2Clinical Decision Making and Evidence-Based Practice

 

MULTIPLE CHOICE

 

1. The nurse is implementing evidence-based practice. Which of the following is not a component of this process?

1.	Patient preference
2.	Clinical expertise
3.	Research evidence
4.	Leader practice

 

 

ANS:  4

Evidence-based practice is the combination of applying research findings, creating clinical guidelines, and the individualization of the plan of care to meet the patients needs and desired. Leader practice is not a component of the evidence-based process.

 

PTS:   1                    DIF:    Analyze         REF:   The Process of EBP

 

2. The nurse is planning the care for a client using an unstructured approach. Which of the following approaches did the nurse most likely use?

1.	Research
2.	Trial and error
3.	Nursing theory
4.	Validated order

 

 

ANS:  2

Examples of unstructured approaches to plan client care include trial and error, tradition, and authority. The approaches of research, nursing theory, and validated order all represent a structured approach to planning client care.

 

PTS:   1                    DIF:    Analyze         REF:   Knowledge Bases for Clinical Decisions

 

3. The nurse is participating in an activity that is the first step of the ACE Star Model of Knowledge Transformation. Which of the following is the nurse doing?

1.	Creating evidence summaries
2.	Evaluating outcomes
3.	Integrating findings into practice
4.	Participating in research

 

 

ANS:  4

The ACE Star Model of Knowledge Transformation depicts the transfer of knowledge according to five sequential steps. The first step is primary research. Subsequent steps are: 2) evidence summary, 3) translation, 4) integration, and 5) evaluation.

 

PTS:   1                    DIF:    Analyze         REF:   EBP in Nursing

 

4. A committee has been developed to implement knowledge transformation when providing client care. The members realize that the purpose of knowledge transformation is to:

1.	reduce length of stay.
2.	convert research findings to impact health outcomes.
3.	reduce the cost of care.
4.	increase the number of patients with health insurance.

 

 

ANS:  2

The core concept of the ACE Star Model is knowledge transformation. Knowledge transformation is the conversion of research findings to have an impact on health outcomes by way of evidence-based care. Knowledge transformation is not a method to reduce length of stay, reduce the cost of care, or increase the number of patients with health insurance.

 

PTS:   1                    DIF:    Analyze         REF:   Definition of Knowledge Transformation

 

5. An advance practice nurse is being consulted to participate during the translation phase of the ACE Star Model of Knowledge Transformation. During this phase, which of the following will the nurse create?

1.	Standardized care plans
2.	Critical pathways
3.	Clinical practice guidelines
4.	Checklists to streamline documentation

 

 

ANS:  3

In the third step of the ACE Star Model of Knowledge Transformation, experts are consulted to consider the evidence summaries, fill in gaps, and merge research knowledge with expertise to produce clinical practice guidelines. The nurse is not creating standardized care plans, critical pathways, or checklists to streamline documentation since these items are not a part of the ACE Star Model of Knowledge Transformation.

 

PTS:   1                    DIF:    Apply            REF:   Star Point 3: Translation

 

6. The nurse leaders of a health care organization are creating plans to change clinical and organizational practices to support evidence-based practice. Which phase of the ACE Star Model of Knowledge Transformation are the leaders implementing?

1.	Integration
2.	Evaluation
3.	Translation
4.	Evidence summaries

 

 

ANS:  1

During the Integration phase of the ACE Star Model of Knowledge Transformation, implementation plans are put into action to change the individual clinician practices, organizational practices, and environmental policies. Implementation plans are not a part of the evidence summaries, translation, or evaluation of the ACE Star Model of Knowledge Transformation.

 

PTS:   1                    DIF:    Apply            REF:   Star Point 4: Integration

 

7. The advance practice nurse is writing clinical practice guidelines. Prior to writing these guidelines which of the following will the nurse need?

1.	Current client census
2.	Evidence summaries
3.	Nursing department budget
4.	Staffing ratios

 

 

ANS:  2

The ideal base for writing clinical guidelines are evidence summaries because they increase the power and validity of the cause-and-effect relationship between interventions and outcomes. Current client census, nursing department budgets, and staffing ratios are not used to write clinical practice guidelines.

 

PTS:   1                    DIF:    Apply            REF:   Evidence Summaries

 

8. The nurse is writing a systematic review. After the nurse formulates questions and locates relevant studies, the nurse thing the nurse will do is:

1.	update the reviews.
2.	interpret the findings.
3.	summarize and synthesize results.
4.	select and appraise the studies.

 

 

ANS:  4

The next step in the systematic review writing process is selecting and appraising the studies. Afterwards, the nurse will complete, in order, summarize and synthesize results, interpret the findings, and regularly update the reviews.

 

PTS:   1                    DIF:    Apply            REF:   Method for Producing Systematic Reviews

 

9. The nurse is using the scale for rating the strength of research evidence for one research article for potential inclusion in a clinical practice guideline. Which of the following is considered the strongest evidence?

1.	Individual cohort study
2.	Meta-analysis of randomized clinical trials
3.	Expert opinion
4.	Case studies

 

 

ANS:  2

When utilizing the Scale for Rating the Strength of Research Evidence, the level with the strongest evidence is level I, meta-analysis of randomized clinical trials. Level III is individual cohort studies. Expert opinion is Level VII or the weakest evidence. Case studies are Level VI.

 

PTS:   1                    DIF:    Analyze

REF:   Table 2-1 Scale for Rating the Strength of Research Evidence

 

10. The nurse is considering a research study for inclusion in a clinical practice guideline that has been identified as being sufficient to determine effects on health outcomes. This research study would be considered as being:

1.	fair.
2.	passable.
3.	poor.
4.	good.

 

 

ANS:  1

Research studies are rated according to the Scale for Rating the Quality of Research Evidence. According to this scale, a research study that is sufficient to determine the effects on health outcomes is considered fair. A good study has consistent results for well-designed, well-conducted studies that directly assess effects on health outcomes. A poor study has insufficient results to assess the affects on health outcomes. Passable is not a category of this rating scale.

 

PTS:   1                    DIF:    Analyze

REF:   Table 2-2 Scale for Rating the Quality of Research Evidence

 

11. The nurse is reviewing evidence-based clinical practice guidelines to use when planning care for a client. One guideline has been graded by the U.S. Preventive Services Task Force as being an A. According to this grade, the nurse should do which of the following?

1.	Do not use this guideline because the harm outweighs the benefits.
2.	Do not use this guideline because the benefits and harms cannot be determined.
3.	Use this guideline because the benefit is substantial.
4.	Use this guideline but understand that the net benefit to the client is small.

 

 

ANS:  3

The U.S. Preventive Services Task Force grades clinical practice guidelines from A to D plus I. A grade A guideline is recommended for care since there is high certainty that the benefit to the client is substantial. A grade C guideline has a small net benefit to the client. A grade D guideline has harms that outweigh the benefits. A grade I guideline has benefits and harms that cannot be determined.

 

PTS:   1                    DIF:    Apply

REF:   Box 2-6 Strength of Recommendations from the U.S. Preventive Services Task Force

 

12. The nurse identifies errors and hazards in a care environment and implements basic safety to reduce the likelihood of an adverse event. Which of the following core competencies is this nurse implementing?

1.	Provide patient-centered care
2.	Apply quality improvement
3.	Employ evidence-based practice
4.	Utilize informatics

 

 

ANS:  2

Of the five Core Competencies for Health Professions, the competency that focuses on the identification of errors and hazards with implementation of basic safety is apply quality improvement. Provide patient-centered care focuses on direct care activities. Employ evidence-based practice focuses on the integration of research with clinical expertise. Utilize informatics to focus on communication and the use of information technology to support decision making.

 

PTS:   1                    DIF:    Apply            REF:   Box 2-1 Core Competencies for Health Professions

 

13. The nurse is participating on a committee to select evidence-based practice guidelines.Which of the following statements by the nurse indicate a clear understanding of the purpose of these guidelines?

1.	They provide the best evidence to make decisions about the care of individual clients.
2.	They promote changes in client care according to a research study.
3.	They ensure cost-effective care to the client.
4.	They identify safe staffing ratios for client care.

 

 

ANS:  1

Evidence-based practice guidelines provide the best evidence to make decisions about the care of individual clients. The use of a single research study to make changes in client care is a concept within research utilization and not evidence-based practice. Evidence-based practice does impact the costs of client care but their intent is not to ensure cost-effective care but rather to improve the overall quality of care. Evidence-based guidelines do not provide staffing ratios for client care.

 

PTS:   1                    DIF:    Analyze         REF:   The Process of EBP

 

MULTIPLE RESPONSE

 

1. The nurse is determining the best way to ensure adherence to the core competencies for health professions. Which of the following competencies will the nurse implement when providing client care? (Select all that apply.)

1.	Work in interdisciplinary teams
2.	Utilize informatics
3.	Implement basic safety principles
4.	Employ evidence-based practice
5.	Apply quality improvement
6.	Provide patient-centered care

 

 

ANS:  1, 2, 4, 5, 6

Core competencies for health professions include providing patient-centered care, working in interdisciplinary teams, employing evidence-based practice, applying quality improvement, and utilizing informatics. Implementing basic safety principles is only one part of a quality improvement program.

 

PTS:   1                    DIF:    Apply

REF:   Box 2-1 Core Competencies for Health Professions.

 

2. There are impediments that make the practice of evidence-based practice difficult. Which of the following are impediments to evidence-based practice? (Select all that apply.)

1.	Complexity of science and technology
2.	Difficulty of nowledge transformation
3.	Variety of knowledge forms
4.	Number of patient diagnoses
5.	Evidence summary
6.	Application of quality improvement

 

 

ANS:  1, 3

Hurdles to evidence-based practice are the increasing complexity of science and technology and the variety of knowledge forms, many of which are not suitable for direct practice. Knowledge transformation, number of patient diagnoses, evidence summary, application of quality improvement are not considered impediments to the implementation of evidence-based practice.

 

PTS:   1                    DIF:    Apply            REF:   Applying Evidence-Based Concept

 

3. The nurse identifyies evidence summaries for evidence-based practice. Which of the following are references to types of evidence summaries? (Select all that apply.)

1.	Review of literature
2.	Evidence synthesis
3.	Authentication review
4.	Systematic reviews
5.	Integrative reviews
6.	Substantiation evidence

 

 

ANS:  1, 2, 4, 5

Evidence summaries are also referred to as being review of literature, evidence synthesis, systematic reviews, and integrative reviews. These summaries are not referred to as being authentication review or substantiation evidence.

 

PTS:   1                    DIF:    Apply            REF:   Star Point 2: Evidence Summary

 

4. A health care organization is determining which clinical practice guidelines to adopt when providing client care. The organization is using the AGREE Instrument for Assessing Guidelines because this checklist helps the organization determine which of the following? (Select all that apply.)

1.	Scope and purpose
2.	Stakeholder involvement
3.	Rigor of development
4.	Clarity and presentation
5.	Author credentials
6.	Application

 

 

ANS:  1, 2, 3, 4, 6

The AGREE Instrument for Assessing Guidelines outlines the primary facets of the clinical practice guideline being appraised for adoption. It includes the following criteria: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, application, and editorial independence. Author credentials is not a criteria of this checklist.

 

PTS:   1                    DIF:    Analyze         REF:   Clinical Practice Guidelines

 

5. The nurse is participating in a committee to address the Institute of Medicines priority areas for quality improvement. Which of the following are considered priority areas? (Select all that apply.)

1.	Diabetes
2.	End-of-life organ failures
3.	Motor vehicle accidents
4.	Scoliosis
5.	Tobacco dependence
6.	Major depression

 

 

ANS:  1, 2, 5, 6

The Institute of Medicine has identified 20 priority areas for quality improvement which include diabetes, end-of-life organ failures, tobacco dependence, and major depression. Motor vehicle accidents and scoliosis are not priority areas identified by the Institute of Medicine.

 

PTS:   1                    DIF:    Analyze         REF:   Box 2-7 IOM-Priority Areas for National Action

Chapter 14Complementary and Alternative Therapies

 

MULTIPLE CHOICE

 

1. A client from the Asian culture tells the nurse that he has blockages in his life force that are causing him to have a disease. The nurse realizes that within this culture, the life force is considered:

1.	Ayurveda.
2.	Chi.
3.	Prana.
4.	Qi.

 

 

ANS:  2

In Chinese culture, the life force is known as chi. Ayurveda is Indian medicine. In Indian culture the life force is known as prana. In the Japanese culture the life force is know as qi.

 

PTS:   1                    DIF:    Analyze

REF:   History of Complementary and Alternative Therapies

 

2. The nurse is planning to learn Reiki to become a master practitioner. Which level of learning will the nurse need to achieve in order to become a Reiki master?

1.	Level I
2.	Level II
3.	Level III
4.	Level IV

 

 

ANS:  3

Level I Reiki practitioners are prepared to provide healing work at the physiological/physical level, and they work with the patient physically present. Level II Reiki practitioners are prepared to provide healing on the emotional and spiritual levels and in absentia. The masters or Reiki teachers are Level III practitioners. There is no Level IV Reiki practitioner.

 

PTS:   1                    DIF:    Analyze         REF:   Reiki

 

3. A client tells the nurse that she utilizes biofeedback to combat chronic back pain. The nurse identifies this type of complementary alternative medicine as being:

1.	biological therapy.
2.	mind-body therapy.
3.	body-based therapy.
4.	energy therapy.

 

 

ANS:  2

Mind-body therapies are a variety of techniques to facilitate the minds capacity to affect the body and various symptoms. Biofeedback is one type of mind-body therapy. Biological therapies use naturally occurring substances such as herbal medicine. Body-based therapies are based on manipulation or movement of one or more body parts. Energy therapy use energy fields to increase the flow of energy throughout the body.

 

PTS:   1                    DIF:    Analyze

REF:   NCCAM Categories of Complementary and Alternative Therapies

 

4. A client tells the nurse that his health has improved since he starting practicing tai chi. The nurse realizes this alternative medicine approach:

1.	is a modern form of yoga.
2.	uses breathing, movement, and posture.
3.	enhances the flow of prana.
4.	improves the flow of chi through the meridians of the body.

 

 

ANS:  4

Tai chi improves the flow of chi through the meridians of the body to enhance health and promote healing. Tai chi is an ancient ritual movement that involves concentration, strength, flexibility, breathing, and the use of symbolic movements. Tai chi originated in China. Yoga originated in the Hindu culture. Yoga uses breathing, movement, and postures to enhance the flow of prana.

 

PTS:   1                    DIF:    Analyze         REF:   Tai Chi

 

5. After an assessment, the nurse believes a client would benefit form the care of a chiropractor. Which of the following health problems could be addressed with this form of alternative therapy?

1.	Headache
2.	Sinusitis
3.	Anemia
4.	Kidney stones

 

 

ANS:  1

Chiropractic therapy is useful to treat back pain, neck pain, joint pain of the arms or legs, headaches, and other neuromuscular complaints. Chiropractic therapy is not indicated for sinusitis, anemia, or kidney stones.

 

PTS:   1                    DIF:    Analyze         REF:   Chiropractic Therapy

 

6. When asked about an armband that a pregnant client is wearing, the client tells the nurse that it helps reduce morning sickness. The nurse realizes this client is utilizing which form of alternative medicine?

1.	Acupressure
2.	Acupuncture
3.	Reiki
4.	Guided imager

 

 

ANS:  1

Acupressure is the stimulation of pressure points on the body to affect a body response. Antiemetic armbands are one example of an acupressure device. Acupuncture uses needles to stimulate identified points to affect a body response. Reiki is the manipulation of energy fields. Guided imagery is the use of relaxation and mental visualization to improve mood or physical well-being.

 

PTS:   1                    DIF:    Analyze         REF:   Acupressure

 

7. A client tells the nurse that she is having a series of massages to break up scar tissue created from back surgery which have caused uneven hip and shoulder height. The nurse realizes the type of massages the client is receiving would be:

1.	shiatsu.
2.	rolfing.
3.	therapeutic.
4.	relaxation.

 

 

ANS:  2

Rolfing is a form of deep tissue massage and manipulation to correct body posture. Usually 10 sessions are required to completely restore the bodys alignment. Shiatsu is a combination of acupressure, massage, stretching, and joint manipulation to unblock the flow of chi. Therapeutic massage will not break up scar tissue. Relaxation is not a type of massage.

 

PTS:   1                    DIF:    Analyze         REF:   Rolfing

 

8. A client tells the nurse that he believes watching old comedy movies has helped him achieve a quick recovery from orthopedic surgery. The nurse realizes this client has been using which of the following forms of complementary alternative medicine?

1.	Meditation
2.	Prayer
3.	Humor
4.	Music

 

 

ANS:  3

Humor is a frequently used complementary alternative medicine therapy and one of the therapies most often used to promote wellness. Humor increases the ability to cope with pain, enhance immune function, enhance respiratory function, and reduce preprocedural anxiety.

 

PTS:   1                    DIF:    Analyze         REF:   Humor

 

9. A client tells the nurse that she is not concerned about recovering from an acute illness since she has several people from her church praying for her health. The nurse realizes this client is utilizing which form of complementary alternative medicine?

1.	Denial
2.	Wishful thinking
3.	Intercessory prayer
4.	Positive thinking

 

 

ANS:  3

Intercessory prayer is defined as a group that holds their focused thought for healing on behalf of someone else. Denial, wishful thinking, and positive thinking are not forms of complementary alternative medicine.

 

PTS:   1                    DIF:    Analyze         REF:   Intercessory Prayer

 

10. A client tells the nurse that he ingests only herbal preparations and not medications prescribed from a physician. Which of the following should the nurse respond to this client?

1.	How long have you been using herbal preparations?
2.	Are you aware of the side effects of using herbal preparations?
3.	They must be working.
4.	They are probably less expensive than other medications.

 

 

ANS:  2

The nurse must assess the client for herbal use and participate in knowledgeable client education on the potential effects of herbal preparations. The length of time the client has been using herbal preparations may or may not be significant. The nurse should not comment on the effectiveness of the preparations or the cost.

 

PTS:   1                    DIF:    Apply            REF:   Herbal Therapies

 

11. The nurse is providing a client with a massage in order to create which of the following benefits?

1.	Reduce blood glucose level
2.	Increase heart rate
3.	Reduce blood pressure
4.	Enhance appetite

 

 

ANS:  3

Massage reduces heart rate, reduces blood pressure, increases energy, and increases immune system activity. Massage does not reduce blood glucose level, increase heart rate, or enhance appetite.

 

PTS:   1                    DIF:    Apply            REF:   Massage Therapy

 

12. A client tells the nurse that she is interested in learning yoga to help with chronic back and leg pain. Which of the following should the nurse respond to this client?

1.	Local organizations have yoga classes and training programs that you could attend.
2.	Yoga is not as good acupuncture.
3.	Tai chi is probably better for you.
4.	Have you considered weight training?

 

 

ANS:  1

Nurses can encourage clients to participate in yoga by finding a local organization that has yoga teachers and training programs. This is what the nurse should respond to the client. Yoga has other benefits that acupuncture may not have. The nurse should not encourage the client to utilize one type of mind-body therapy over another. The client did not express an interest in weight training so the nurse should not make that suggestion.

 

PTS:   1                    DIF:    Apply            REF:   Yoga

 

13. The client tells the nurse that his practitioner recommended whirlpool baths to relieve chronic back spasms. The nurse realizes the client is participating in which type of complementary alternative medicine approach?

1.	Naturopathy
2.	Homeopathy
3.	Osteopathy
4.	Heroic

 

 

ANS:  1

Naturopathy is a medical system that focuses on supporting health rather than fighting diseases. An example of a naturopathic treatment is hydrotherapy. Homeopathy is a medical system that is used for wellness and prevention and utilizes natural substances such as herbs to treat health concerns. Heroic medicine is the use of aggressive medical practices or methods of treatment. Osteopathy uses a full spectrum of medical treatments to include medication, surgery, and manipulation.

 

PTS:   1                    DIF:    Analyze         REF:   Naturopathy

 

MULTIPLE RESPONSE

 

1. A client tells the nurse that she uses alternative forms of health care to help with her chronic health problems. The nurse realizes that which of the following would be considered alternative forms of health care? (Select all that apply.)

1.	Acupuncture
2.	Chiropractic
3.	Weight lifting
4.	Cycling
5.	Massage
6.	Yoga

 

 

ANS:  1, 2, 5, 6

Complementary alternative medicine therapies are numerous and include acupuncture, chiropractic, massage, and yoga. Weight lifting and cycling are not complementary alternative medicine therapies.

 

PTS:   1                    DIF:    Analyze

REF:   Table 14-1 CAM Therapies Used in the United States

 

2. A client tells the nurse that he rarely sees a physician and relies upon complementary alternative medicine therapies to address ailments. Which of the following should the nurse be aware of regarding these different types of therapies? (Select all that apply.)

1.	Potential benefits of complementary alternative medicine therapies
2.	Cost of complementary alternative medicine therapies
3.	Frequency of use
4.	Drug interactions
5.	Location of providers
6.	Length of time used

 

 

ANS:  1, 2, 4

Nurses need to be knowledgeable about the different potential benefits of complementary alternative medicine therapies including costs, client knowledge, and drug interactions. Frequency of use, location of providers, and length of time used are not necessarily important for the nurse to be aware.

 

PTS:   1                    DIF:    Analyze

REF:   Box 14-1 Healthy People 2010 and Complementary and Alternative Therapies

 

3. A client tells the nurse that her primary care physician is an osteopath. The nurse realizes that this physician will utilize which of the following approaches when providing care to the client? (Select all that apply.)

1.	Hypnosis
2.	Manipulation
3.	Tai chi
4.	Surgery
5.	Yoga
6.	Medications

 

 

ANS:  2, 4, 6

Osteopathy originally used manipulative techniques for correcting physical abnormalities thought to cause disease. Osteopathy now uses the full spectrum of medicine, including the use of surgery and medications in addition to manipulation to treat illnesses.

 

PTS:   1                    DIF:    Analyze

REF:   History of Complementary and Alternative Therapies in the United States

 

4. The nurse is using guided imagery to help reduce a clients pain level. When using this alternative medicine approach, which of the following client senses can be used? (Select all that apply.)

1.	Visual
2.	Auditory
3.	Kinesthetic
4.	Cognitive
5.	Gustatory
6.	Olfactory

 

 

ANS:  1, 2, 3, 5, 6

When using guided imagery, all five senses can be used to include visual, auditory, kinesthetic, gustatory, and olfactory. Cognitive is not one of the five senses.

 

PTS:   1                    DIF:    Apply

REF:   Table 14-2 Incorporating All Five Senses into Guided Imagery

 

5. The nurse has identified the diagnosis of Disturbed Energy Field as appropriate for a client. Which of the following are identified causes for the slowing or blocking of this clients energy field? (Select all that apply.)

1.	Pathological
2.	Socioeconomic
3.	Situational
4.	Treatment-related
5.	Environmental
6.	Maturational

 

 

ANS:  1, 3, 4, 6

The nursing diagnosis of Disturbed Energy Field is defined as a disruption of the flow of energy which can be due to pathological, situational, treatment-related, or maturational factors. Socioeconomic and environmental factors do not disrupt the flow of energy.

 

PTS:   1                    DIF:    Analyze         REF:   Energy Therapies

Chapter 28Hypertension: Nursing Management

 

MULTIPLE CHOICE

 

1. Which of the following should the nurse instruct a client who is newly diagnosed with hypertension?

1.	It is a lifelong process.
2.	It can be managed easily.
3.	It is a short-term problem.
4.	It happens only in the very poor and treatment is expensive.

 

 

ANS:  1

Treatment of hypertension is a lifelong process. It requires lifestyle modification and occurs in all racial and economical groups. Hypertension can either be easy or difficult to manage.

 

PTS:   1                    DIF:    Apply            REF:   Introduction

 

2. A client is diagnosed with isolated systolic hypertension. The nurse realizes that this diagnosis means the client is experiencing a systolic pressure:

1.	greater than 140 mmHg and a diastolic pressure greater than 90 mmHg.
2.	greater than 90 mmHg and a diastolic pressure greater than 60 mmHg.
3.	greater than 140 mmHg and a diastolic pressure lower than 90 mmHg.
4.	lower than 140 mmHg and a diastolic pressure greater than 90 mmHg.

 

 

ANS:  3

The likelihood of developing isolated systolic hypertension is greater with age and is confirmed with a systolic pressure greater than 140 mmHg while the diastolic pressure remains less than 90 mmHg.

 

PTS:   1                    DIF:    Analyze         REF:   Hypertension: Nonmodifiable Risk Factors

 

3. The nurse is instructing a client on the impact of cigarette smoking and the development of hypertension. Which of the following would not be appropriate for the nurse to include in these instructions?

1.	Tobacco damages the lining of the artery walls.
2.	Tobacco temporarily constricts blood vessels, increasing pulse and blood pressure.
3.	Tobacco thins the blood and makes the person at risk for bleeding.
4.	Carbon monoxide in tobacco smoke replaces the oxygen in the blood, forcing the heart to work harder to supply oxygen.

 

 

ANS:  3

Tobacco and smoking have been shown to increase heart rate and blood pressure because of vasoconstriction and the accumulation of plaque on the artery walls. Because of the replacement of oxygen with carbon monoxide from tobacco smoke, the heart has to work harder to supply oxygen to the organs. There is no evidence that smoking thins the blood and causes bleeding.

 

PTS:   1                    DIF:    Apply            REF:   Hypertension: Modifiable Risk Factors

 

4. The nurse is assessing a clients pulse pressure. His blood pressure reading is 130/82 mmHg. Which of the following is the correct pulse pressure?

1.	40
2.	48
3.	130
4.	82

 

 

ANS:  2

The pulse pressure is the difference between the systolic and diastolic pressure: 130 82 = 48. The other choices represent miscalculations or not understanding the correct way to calculate pulse pressure.

 

PTS:   1                    DIF:    Apply            REF:   Hypertension: Pathophysiology

 

5. A client is surprised to learn that she has high blood pressure. Which of the following should the nurse assess in this client? The presence or occurrence of:

1.	nausea.
2.	pain.
3.	headache.
4.	fear.

 

 

ANS:  3

With very elevated blood pressure, headache is the most commonly reported symptom. Although pain and nausea may be reported, they are not the most common. Fear is not commonly associated with hypertension though it may occur with an onset of pain or nausea.

 

PTS:   1                    DIF:    Apply

REF:   Hypertension: Assessment with Clinical Manifestations

 

6. A clients blood pressure has been measured at 130/86 mmHg on two separate occasions. The nurse realizes this clients blood pressure reading would be categorized as being:

1.	normal.
2.	prehypertension.
3.	stage 1 hypertension.
4.	stage 2 hypertension.

 

 

ANS:  2

Prehypertension is a new designation used to identify individuals at high risk for the development of hypertension. Systolic blood pressure of 120 to 139 and diastolic blood pressure of 80 to 90 are values for prehypertension. A normal blood pressure is less than or equal to 120 mmHg systolic and less than or equal to 80 mmHg diastolic. Stage 1 hypertension is a systolic blood pressure between 140 to 159 and a diastolic pressure between 90 to 99. Stage 2 hypertension is a systolic reading greater than or equal to 160 and a diastolic pressure of greater than or equal to 100 mmHg.

 

PTS:   1                    DIF:    Analyze

REF:   Table 28-6 JNC VII Classification of Blood Pressure in Adults

 

7. The nurse uses a blood pressure cuff that is too small for the circumference of the clients arm. How will this size of blood pressure cuff affect the clients blood pressure measurement?

1.	Falsely low
2.	Falsely high
3.	Not clearly heard
4.	More time consuming

 

 

ANS:  2

The blood pressure cuff must be the appropriate size to get an accurate reading. A cuff that is too small could result in a falsely high reading. A blood pressure cuff that is too large could result in a falsely low reading. The cuff size may not affect the nurses ability to hear the blood pressure sounds. An incorrect blood pressure cuff size will not be more time consuming to use.

 

PTS:   1                    DIF:    Analyze

REF:   Table 28-2 Factors Causing False Blood Pressure Readings

 

8. A client diagnosed with hypertension should be instructed by the nurse to avoid which of the following foods?

1.	Cold cuts
2.	Bananas
3.	Milk
4.	Oatmeal

 

 

ANS:  1

Cold cuts are processed meats that are usually high in sodium and may cause water retention and an increase in blood pressure. The rest of the foods really have no effect on blood pressure.

 

PTS:   1                    DIF:    Apply

REF:   Hypertension: Planning and Implementation: Evidence-Based Care

 

9. A client is instructed to reduce his intake of daily sodium intake so that the total amount is what his body needs. The nurse should instruct the client to reduce sodium intake to:

1.	500 mg a day.
2.	1000 mg a day.
3.	2500 mg a day.
4.	4500 mg a day.

 

 

ANS:  1

A human body needs about 500 mg of sodium each day. The average intake of sodium for individuals in the United States is between 4000 to 6000 mg a day.

 

PTS:   1                    DIF:    Apply

REF:   Hypertension: Planning and Implementation: Evidence-Based Care

 

10. A client asks the nurse why she should be concerned about the amount of sodium in ice cream. Which of the following should the nurse respond to this client?

1.	Sodium is used to enhance the flavor.
2.	Sodium is used to emulsify the ice cream.
3.	Sodium is used to prevent mold.
4.	Sodium is used as a preservative.

 

 

ANS:  2

Sodium is used in ice cream as an emulsifier. Sodium in canned or processed foods is used to enhance flavor. Sodium is used to prevent mold in cheese, breads, and cakes. Sodium is used as a preservative in cured meats and sausages.

 

PTS:   1                    DIF:    Apply            REF:   Table 28-6 Sodium-Based Food Additives

 

11. Which of the following should the nurse instruct a client who desires to reduce his blood pressure through increasing physical activity?

1.	Regular exercise can lower the blood pressure by 5 to 10 mmHg.
2.	Regular exercise must be done 7 days a week.
3.	Regular exercise has to be done for at least 2 hours each day.
4.	Regular exercise is the participation in aerobic activities.

 

 

ANS:  1

Regular exercise can lower blood pressure by 5 to 10 mmHg. Regular exercise should be done 5 days a week for 60 minutes or 20 minutes of vigorous exercise at least 3 times a week to be effective. Regular exercise includes aerobic activity, flexibility, and strengthening exercises.

 

PTS:   1                    DIF:    Apply

REF:   Hypertension: Planning and Implementation: Evidence-Based Care

 

12. A client is prescribed Spironolactone (Aldactone) for blood pressure control. Which of the following should the nurse assess in this client as a potential side effect?

1.	Hypokalemia
2.	Hyperkalemia
3.	Hyponatremia
4.	Hypernatremia

 

 

ANS:  2

Spironolactone (Aldactone) is a potassium-sparing diuretic. Side effects include hyperkalemia. Hypokalemia and hyponatremia are side effects of the thiazide diuretics. Hypernatremia is not a known side effect of any antihypertensive medication.

 

PTS:   1                    DIF:    Apply

REF:   Table 28-9 Pharmacologic Management of Hypertension

 

13. A client is prescribed an ACE inhibitor for management of hypertension. Which of the following side effects should the nurse instruct the client as being expected with this medication?

1.	Tachycardia
2.	Constipation
3.	Bizarre dreams
4.	Persistent dry cough

 

 

ANS:  4

One side effect of ACE inhibitors that is expected with this medication is a persistent dry cough. Tachycardia, constipation, and bizarre dreams are not side effects associated with ACE inhibitors.

 

PTS:   1                    DIF:    Apply

REF:   Table 28-9 Pharmacologic Management of Hypertension

 

MULTIPLE RESPONSE

 

1. The nurse is considering the risk factors for a clients development of primary hypertension. Which of the following would be considered nonmodifiable risk factors for the client? (Select all that apply.)

1.	Age
2.	Stress
3.	Gender
4.	Ethnicity
5.	Regular exercise
6.	Limits fat and salt in diet

 

 

ANS:  1, 3, 4

Nonmodifiable risk factors are those thing we cannot change or control, such as age, gender, and ethnicity. Stress, exercise, and diet are considered modifiable risk factors or those the client can control.

 

PTS:   1                    DIF:    Analyze         REF:   Hypertension: Risk Factors

 

2. Which of the following should the nurse tell a client when instructing on ways to reduce the risk factors for hypertension? (Select all that apply.)

1.	Smoking
2.	Diet
3.	Exercise
4.	Family history
5.	Race
6.	Stress

 

 

ANS:  1, 2, 3, 6

Modifiable risk factors can be changed or modified to help control hypertension. Smoking, diet, stress, and exercise can be changed to affect blood pressure. Persons with more risk factors have a greater chance of having hypertension during their lives. Family history and race cannot be modified.

 

PTS:   1                    DIF:    Apply            REF:   Hypertension: Risk Factors

 

3. Which of the following assessment questions would be appropriate for the nurse to use when assessing a client for hypertension? (Select all that apply.)

1.	Do you consume alcohol products? How much? How long?
2.	Do you use nicotine products? How much? How long?
3.	Do you experience nosebleeds?
4.	Do you get hungry at night?
5.	Do you experience cold sweats?
6.	Do you experience headaches?

 

 

ANS:  1, 2, 3, 6

The nurse will often ask the client

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