ATI LPN
Timby's Introductory Medical-Surgical Nursing Thirteenth, North American Edition
Chapter 27 : Caring for Clients With Hypertension Questions
Question 1 of 5
The nurse and a dietitian are instructing the client on a low-sodium diet needed to lower the blood pressure. Which question is most important for the nurse to ask?
Correct Answer: B
Rationale: Asking the client how food is prepared gives the nurse and dietitian the ability to judge the sodium content. Typically, canned or prepared food and food from a restaurant will have elevated sodium levels. Sodium content in food prepared from fresh ingredients is usually minimal. Asking about whom the client eats with or the client's eating patterns are not as helpful in determining sodium content.
Question 2 of 5
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?
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.
Question 3 of 5
The nurse would screen a client from which ethnic background for hypertension at an early age?
Correct Answer: D
Rationale: The population of African descent is at the highest risk for development of hypertension. The other ethnic backgrounds have a lower risk.
Question 4 of 5
The nurse is caring for a client with essential hypertension. The nurse reviews lab work and assesses kidney function. Which action of the kidney would the nurse evaluate as the body's attempt to regulate high blood pressure?
Correct Answer: B
Rationale: Hypernatremia (elevated serum sodium level) increases blood volume, which raises blood pressure. The kidney's response to the elevation in blood pressure is to excrete sodium and excess water. Any retention of sodium and water would increase blood volume and, thus, blood pressure. Sodium and water move together.
Question 5 of 5
Which of the following nursing diagnoses is the nurse most correct to choose when caring for a client with long-standing hypertension?
Correct Answer: C
Rationale: The nurse is most correct in choosing Altered Tissue Perfusion for the client with long-standing hypertension. In hypertension, the extra work increases the size of the heart muscle. Eventually, the heart cannot meet the body's metabolic needs limiting the perfusion to the tissues. Impaired Gas Exchange, Activity Intolerance, and a Risk for Decreased Cardiac Output may occur due to the ineffective perfusion.