MSN Exam for Hypertension

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1) This hypertension drug is the first choice for diabetic and renal failure pts.

1. K sparing diuretics
2. ACE inhibitors
3. Loop diuretics
4. Calcium channel blockers

2) While a client with hypertension is being assessed, he says to the nurse, “I really don’t know why I am here. I feel fine and haven’t had any symptoms.” The nurse would explain to the client that symptoms of hypertension:

1. Are often not present
2. Signify a high risk of stroke
3. Occur only with malignant hypertension
4. Appear after irreversible kidney damage has occurred

3) A client is admitted to the hospital. Twelve hours later the nurse observes hand tremors, hyperexicitability, tachycardia, diaphoresis and hypertension. The nurse suspects alcohol withdrawal. The nurse should ask the client:

1. at what time was your last drink taken?
2. Why didn’t you tell us you’re a drinker?
3. Do you drink beer or hard liquor?
4. How long have you been drinking?

4) How does metoprolol work?

1. Selectively blocks beta 1 receptors
2. Inhibits the conversion of angiotensin I to angiotensin II
3. Blocks angiotensin II receptors
4. Stimulate alpha 2 receptors

5) Sodium intake is good to prevent high blood pressure?

1. True
2. False

6) A female client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, nurse Lyka expects to administer:

1. phentolamine (Regitine).
2. methyldopa (Aldomet).
3. mannitol (Osmitrol).
4. felodipine (Plendil).

7) Norvasc is a:

1. Loop diuretic
2. Beta Blocker
3. ACE inhibitor
4. Calcium Channel Blocker

8) Alpha blockers work by keeping the hormone _________ from simulating the muscle walls of the small arteries/veins.

1. ephinephrine
2. angiotensin 1
3. norepinephrine
4. PTH

9) Which drug inhibits calcium ion influx into vascular smooth muscle?

1. Atenolol
2. Verapamil
3. Hydralazine
4. Hydrochlorothiazide

10) The nurse teaches the patient which of the following guidelines regarding lifestyle modifications for hypertension?

1. Maintain adequate dietary intake of potassium
2. Reduce smoking to no more than four cigarettes per day
3. Limit aerobic physical activity to 15 minutes, three times per week
4. Stop alcohol intake

11) Methyldopa is the drug of choice in pregnancy patients?

1. True
2. False

12) According to the JNC Guidelines, what drugs are considered first-line agents for hypertension?

1. Thiazide-type diuretics
2. ACE Inhibitors
3. Beta Blockers
4. All of the above

13) The client is admitted to the hospital with hypertensive crises. Diazoxide (Hyperstat) is ordered. During administration, the nurse should:

1. Utilize an infusion pump
2. Check the blood glucose level
3. Place the client in Trendelenburg position
4. Cover the solution with foil

14) Glenn comes into the ED with olguria. Upon his assessment he says that he is on an antihypertensive. Glenn was outside in the hot sun working in his garden when he became dizzy. His wife found him soaked in sweat. What could have caused Glenn’s problem?

1. ACE inhibitor
2. Calcium Channel Blocker
3. K sparing diruretic
4. Loop Diuretic

15) Nurse Rose is aware that the statement that best explains why furosemide (Lasix) is administered to treat hypertension is:

1. It dilates peripheral blood vessels.
2. It decreases sympathetic cardioacceleration.
3. It inhibits the angiotensin-coverting enzymes
4. It inhibits reabsorption of sodium and water in the loop of Henle.

16) The nurse is teaching a client with a history of obesity and hypertension regarding dietary requirements during pregnancy. Which statement indicates that the client needs further teaching?

1. “I need to reduce my daily intake to 1,200 calories a day.”
2. “I need to drink at least a quart of milk a day.”
3. “I shouldn’t add salt when I am cooking.”
4. “I need to eat more protein and fiber each day.”

17) How do you prevent from getting high blood pressure

1. Finding a healthy wieght and not smoke
2. eating fruit
3. going outside and eating chicken

18) A client with hypertension has begun an aerobic exercise program. The nurse should tell the client that the recommended exercise regimen should begin slowly and build up to:

1. 20–30 minutes three times a week
2. 45 minutes two times a week
3. 1 hour four times a week
4. 1 hour two times a week

19) The client admitted for alcohol detoxification develops increased tremors, irritability, hypertension and fever. The nurse should be alert for impending:

1. delirium tremens
2. Korsakoff’s syndrome
3. esophageal varices
4. Wernicke’s syndrome

20) Carapres works by:

1. increasing parasympathetic response
2. keeps the hormone norepinephrine from stimulating the muscle walls of the small arteries/veins.
3. decreases sympathetic response
4. Directly inhibits renin.

21) Which of the following terms is given to hypertension in which the blood pressure, which is controlled with therapy, becomes uncontrolled (abnormally high) with the discontinuation of therapy?

1. Rebound
2. Essential
3. Primary
4. Secondary

22) The nurse has been teaching the role of diet in regulating blood pressure to a client with hypertension. Which meal selection indicates that the client understands his new diet?

1. Cornflakes, whole milk, banana, and coffee
2. Scrambled eggs, bacon, toast, and coffee
3. Oatmeal, apple juice, dry toast, and coffee
4. Pancakes, ham, tomato juice, and coffee

23) A patient with a blood pressure of 180/120 and end organ damage is an hypertensive EMERGENCY

1. True
2. False

24) Which class of drugs can cause lupus-like syndrome?

1. Direct Vasodilators
2. Beta Blockers
3. Calcium Channel Blockers
4. Alpha-2 Agonists

25) A client has been diagnosed with hypertension. The nurse priority nursing diagnosis would be:

1. Ineffective health maintenance
2. Impaired skin integrity
3. Deficient fluid volume
4. Pain

26) Steven is taking a anti hypertensive. He takes ibuprofen for knee pain as well. Which ant hypertensive medication should Steven have further education on?

1. Losartan
2. Zestril
3. Atenolol
4. Norvasc

27) Peggy is switching from lisinopril to norvasc. She understands her new medication when she states:

1. I may have headaches
2. It causes vadodilation and decreases SVR and lowers B/P
3. It may cause edema peripherally
4. all the above

28) An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, nurse Lily teaches the client to treat hypoglycemia by ingesting:

1. 2 to 5 g of a simple carbohydrate.
2. 10 to 15 g of a simple carbohydrate.
3. 18 to 20 g of a simple carbohydrate.
4. 25 to 30 g of a simple carbohydrate.

29) How does Catapress work?

1. Selectively blocks beta 1 receptors
2. Inhibits the conversion of angiotensin I to angiotensin II
3. Blocks angiotensin II receptors
4. Stimulates alpha 2 receptors

30) What side effects are associated with ACE Inhibitors?

1. Cough
2. Hypotension
3. Angioedema
4. All of the above

31) Which individual is at greatest risk for developing hypertension?

1. 45 year-old African American attorney
2. 60 year-old Asian American shop owner
3. 40 year-old Caucasian nurse
4. 55 year-old Hispanic teacher

32) Nicole has been taking a central alpha2-agonist. She was doing very well on it and has now ended up in the ED. She reports that she was doing so well that she stopped taking her medication because she felt fine and couldn’t afford her medication since being laid off. What could be the reason for Nicole’s reaction?

1. Over abundance of K in her system
2. Orthostatic BP problems
3. Drug Induced lupus syndrome
4. Withdrawl phenomenon

33) Cindy is taking a hypertensive. She has been complaining of feeling light headed and dizzy when she stands up. She has not been tasting food correctly and her UA came back with proteinuria. Further testing showed she has angioedema. What could be causing Cindy’s problem?

1. Lasix
2. Aldactone
3. Prinivil
4. Lostran

34) What medications should be avoided in pregnant women, especially in the 2nd-3rd trimester. (check all that apply)

1. ARBs
2. ACE Inhibitors
3. Beta Blockers
4. Tekturna

35) Officially, hypertension is diagnosed when the patient demonstrates a systolic blood pressure greater than ______ mm Hg and a diastolic blood pressure greater than _____ mm Hg over a sustained period.

1. 140, 90
2. 130, 80
3. 110, 60
4. 120, 70

36) Primary focus should be reaching systolic blood pressure goal.

1. True
2. False

37) Norma has started a new drug for hypertension. Thirty minutes after she takes the drug, she develops chest tightness and becomes short of breath and tachypneic. She has a decreased level of consciousness. These signs indicate which of the following conditions?

1. Asthma attack
2. Pulmonary embolism
3. Respiratory failure
4. Rheumatoid arthritis

38) The nurse is assessing a multigravida, 36 weeks gestation for symptoms of pregnancy-induced hypertension and preeclampsia. The nurse should give priority to assessing the client for:

1. Facial swelling
2. Pulse deficits
3. Ankle edema
4. Diminished reflexes

39) Kids,Between the ages of 1 and 10 are the only ones prone to hypertension

1. True
2. False

40) Aldactone can cause which of the following side effects?

1. Hypokalemia
2. Hypercalcemia
3. Hyperkalemia
4. Hyperphosphemia

41) When taking Atenolol, the nurse knows to hold the medication if:

1. HR <50
2. Dry Coughing
3. pt becomes hypotensive
4. if K levels increase

42) Direct vasodilators work by peripheral vasodilation. However, the nurse needs to educate their pt by including which of these side effects in their pt education?

1. Increases HR
2. Na retention
3. Drug induced lupus syndrome
4. all the above
5. none of the above

43) A client with hypertension ask the nurse which factors can cause blood pressure to drop to normal levels?

1. Kidneys’ excretion to sodium only.
2. Kidneys’ retention of sodium and water
3. Kidneys’ excretion of sodium and water
4. Kidneys’ retention of sodium and excretion of water

44) Hydralazine works on hypertension by:

1. decreases sympathetic response
2. peripheral vasodilation
3. directly inhibits renin
4. blocks Ca from stimulating muscle walls

45) Younger patients are at a higher risk for orthostatic hypotension than Elderly patients

1. True
2. False

46) 134/85 is considered to be:

1. Pre-hypertension
2. Stage 1 Hypertension
3. Stage 2 Hypertension
4. None of the above

47) K sparing diuretic has been prescribed to Lisa. She has been feeling week, tired, and has numbness. Lisa has been eating extra bananas to increase he K because she knows that K sparing diuretics shed K in urine. The nurse responds by saying:

1. Lisa will need to go on a K supplement.
2. Lisa has become hyperkalemic and needs reeducation on her medication.
3. Lisa is only showing 3 of the 5 indicators for hyperkalemia, so she needs to continue her medication.
4. Lisa needs to be put on a different hypertensive because she is complaining too much.

48) Perry is going on lisinopril. When he asks how it works, the nurse would answer:

1. It releases Ca and HCO3 while holding onto K.
2. It blocks the angiotensin I from turning into angiotensin II, leaving the vessels dilated for better blood flow.
3. It blocks the reabsorbtion of Na.
4. Blocks stimulation of beta .

49) Which drug is used to treat hypertensive emergencies?

1. Zyprexa
2. Lasix
3. Sodium Chloride
4. Nitroprusside

50) The immediate objective of nursing care for an overweight, mildly hypertensive male client with ureteral colic and hematuria is to decrease:

1. Pain
2. Weight
3. Hematuria
4. Hypertension

51) A client with chronic schizophrenia who takes neuroleptic medication is admitted to the psychiatric unit. Nursing assessment reveals rigidity, fever, hypertension, and diaphoresis. These findings suggest which life-threatening reaction:

1. tardive dyskinesia.
2. dystonia.
3. neuroleptic malignant syndrome.
4. akathisia.

52) 119/80 is considered to be:

1. Pre-hypertension
2. Stage 1 Hypertension
3. Stage 2 Hypertension
4. None of the above

53) What medication directly dilates the peripheral vesicles?

1. Tekturna
2. Furosemide
3. Hydralazine
4. Valsartan

54) How can you prevent high blood pressure?

1. drink water,eat a lot of salt,stay at home
2. drink water,eat healthy,eat a lot of sugar,drink wine
3. Drink a lot of water,exercise,consume less sodium and have a life style change
4. eat healthy,go for a walk once a week,drink 1 bottle of water per day

55) The physician orders lisinopril (Zestril) and furosemide (Lasix) to be administered concomitantly to the client with hypertension. The nurse should:

1. Question the order
2. Administer the medications
3. Administer separately
4. Contact the pharmacy

56) Check all of the complications that can result from chronic hypertension

1. Retinopathy
2. Kidney disease
3. Depression
4. Alzheimers

57) African Americans have an increased need for combination therapy to attain and maintain blood pressure goals

1. True
2. False

58) 163/112 is considered to be:

1. Pre-hypertension
2. Stage 1 Hypertension
3. Stage 2 Hypertension
4. None of the above

59) A patient with pregnancy-induced hypertension probably exhibits which of the following symptoms?

1. Proteinuria, headaches, vaginal bleeding
2. Headaches, double vision, vaginal bleeding
3. Proteinuria, headaches, double vision
4. Proteinuria, double vision, uterine contractions

60) This hypertension drug is the first choice for diabetic patients?

1. Beta Blockers
2. ACE Inhibitors
3. Calcium Channel Blockers
4. Direct Vasodilators

Answers and Rationales

1. C. Loop diuretics 
2. A. Are often not present 
3. A. at what time was your last drink taken?. This question will give the nurse idea WHEN will the withdrawal occur. Withdrawal occurs 5 to 10 hours after the last intake of alcohol. This is a crucial and mortality is very high during this period.
4. A. Selectively blocks beta 1 receptors 
5. B. False 
6. A. phentolamine (Regitine). Pheochromocytoma causes excessive production of epinephrine and norepinephrine, natural catecholamines that raise the blood pressure. Phentolamine, an alpha-adrenergic blocking agent given by I.V. bolus or drip, antagonizes the body’s response to circulating epinephrine and norepinephrine, reducing blood pressure quickly and effectively. Although methyldopa is an antihypertensive agent available in parenteral form, it isn’t effective in treating hypertensive emergencies. Mannitol, a diuretic, isn’t used to treat hypertensive emergencies. Felodipine, an antihypertensive agent, is available only in extended-release tablets and therefore doesn’t reduce blood pressure quickly enough to correct hypertensive crisis.
7. D. Calcium Channel Blocker
8. C. norepinephrine
9. B. Verapamil
10. A. Maintain adequate dietary intake of potassium . In general, one serving of a potassium-rich food such as banana, kale, broccoli, or orange juice will meet the daily need for potassium.
11. A. True 
12. D. All of the above
13. B. Check the blood glucose level . Hyperstat is given IV push for hypertensive crises, but it often causes hyperglycemia. The glucose level will drop rapidly when stopped. Answer A is incorrect because the hyperstat is given by IV push. The client should be placed in dorsal recumbent position, not a Trendelenburg position, as stated in answer C. Answer D is incorrect because the medication does not have to be covered with foil.
14. D. Loop Diuretic
15. D. It inhibits reabsorption of sodium and water in the loop of Henle. Furosemide is a loop diuretic that inhibits sodium and water reabsorption in the loop Henle, thereby causing a decrease in blood pressure. Vasodilators cause dilation of peripheral blood vessels, directly relaxing vascular smooth muscle and decreasing blood pressure. Adrenergic blockers decrease sympathetic cardioacceleration and decrease blood pressure. Angiotensin-converting enzyme inhibitors decrease blood pressure due to their action on angiotensin.
16. A. “I need to reduce my daily intake to 1,200 calories a day.” The client does not need to drastically reduce her caloric intake during pregnancy. Doing so would not provide adequate nourishment for proper development of the fetus.
17. A. Finding a healthy wieght and not smoke
18. A. 20–30 minutes three times a week. The client’s aerobic workout should be 20–30 minutes long three times a week.
19. A. delirium tremens. Delirium Tremens is the most extreme central nervous system irritability due to withdrawal from alcohol B. This refers to an amnestic syndrome associated with chronic alcoholism due to a deficiency in Vit. B C. This is a complication of liver cirrhosis which may be secondary to alcoholism . D. This is a complication of alcoholism characterized by irregularities of eye movements and lack of coordination.
20. C. decreases sympathetic response 
21. A. Rebound . Rebound hypertension may precipitate a hypertensive crisis. Essential or primary hypertension denotes high blood pressure from an unidentified source. Essential or primary hypertension denotes high blood pressure from an unidentified source. Secondary hypertension denotes high blood pressure from an identified cause, such as renal disease.
22. C. Oatmeal, apple juice, dry toast, and coffee. Oatmeal is low in sodium and high in fiber. Limiting sodium intake and increasing fiber helps to lower cholesterol levels, which reduce blood pressure. Answer A is incorrect because cornflakes and whole milk are higher in sodium and are poor sources of fiber. Answers B and D are incorrect because they contain animal proteins that are high in both cholesterol and sodium.
23. A. True 
24. A. Direct Vasodilators
25. A. Ineffective health maintenance. Managing hypertension is the priority for the client with hypertension. Clients with hypertension frequently do not experience pain, deficient volume, or impaired skin integrity. It is the asymptomatic nature of hypertension that makes it so difficult to treat.
26. B. Zestril
27. D. all the above
28. B. 10 to 15 g of a simple carbohydrate. To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. If necessary, this treatment can be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.
29. D. Stimulates alpha 2 receptors
30. D. All of the above
31. A. 45 year-old African American attorney. 45 year-old African American attorney The incidence of hypertension is greater among African Americans than other groups in the US. The incidence among the Hispanic population is rising.
32. D. Withdrawl phenomenon
33. C. Prinivil
34. A. ARBs,  B. ACE Inhibitors, D. Tekturna 
35. A. 140, 90 . According to the categories of blood pressure levels established by the JNC VI, stage 1 hypertension is demonstrated by a systolic pressure of 140–159 or a diastolic pressure of 90–99.
36. A. True 
37. C. Respiratory failure . The client was reacting to the drug with respiratory signs of impending anaphylaxis, which could lead to eventually respiratory failure. Although the signs are also related to an asthma attack or a pulmonary embolism, consider the new drug first. Rheumatoid arthritis doesn’t manifest these signs.
38. A. Facial swelling. The nurse should pay close attention to swelling in the client with preeclampsia. Facial swelling indicates that the client’s condition is worsening and blood pressure will be increased. Answer B is not related to the question; therefore, it is incorrect. Answer C is incorrect because ankle edema is expected in pregnancy. Diminished reflexes are associated with the use of magnesium sulfate, which is the treatment of preeclampsia; therefore, answer D is incorrect.
39. B. False 
40. C. Hyperkalemia 
41. A. HR <50
42. D. all the above
43. C. Kidneys’ excretion of sodium and water . The kidneys respond to rise in blood pressure by excreting sodium and excess water. This response ultimately affects sysmolic blood pressure by regulating blood volume. Sodium or water retention would only further increase blood pressure. Sodium and water travel together across the membrane in the kidneys; one can’t travel without the other.
44. B. peripheral vasodilation
45. B. False
46. A. Pre-hypertension 
47. B. Lisa has become hyperkalemic and needs reeducation on her medication. 
48. B. It blocks the angiotensin I from turning into angiotensin II, leaving the vessels dilated for better blood flow.
49. D. Nitroprusside
50. A. Pain . Sharp, severe pain (renal colic) radiating toward the genitalia and thigh is caused by uretheral distention and smooth muscle spasm; relief form pain is the priority.
51. C. neuroleptic malignant syndrome. The client’s signs and symptoms suggest neuroleptic malignant syndrome, a life-threatening reaction to neuroleptic medication that requires immediate treatment. Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Akathisia causes restlessness, anxiety, and jitteriness.
52. D. None of the above
53. C. Hydralazine
54. C. Drink a lot of water,exercise,consume less sodium and have a life style change
55. B. Administer the medications. Zestril is an ACE inhibitor and is frequently given with a diuretic such as Lasix for hypertension. Answers A, C, and D are incorrect because the order is accurate. There is no need to question the order, administer the medication separately, or contact the pharmacy.
56. A. Retinopathy ,  B. Kidney disease
57. A. True
58. C. Stage 2 Hypertension 
59. C. Proteinuria, headaches, double vision . A patient with pregnancy-induced hypertension complains of headache, double vision, and sudden weight gain. A urine specimen reveals proteinuria. Vaginal bleeding and uterine contractions are not associated with pregnancy-induces hypertension.
60. B. ACE Inhibitors