Sherpath CH 29- BP; WK 3
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Questions and Answers

Which information is accurate about blood pressure?

  • Blood pressure is measured by subtracting the diastolic from the systolic pressure
  • The numerator is the diastolic pressure.
  • Blood pressure is the force against the venous walls.
  • The heart exerts maximum pressure during contractions. (correct)
  • Match the blood vessel or mechanism of blood pressure regulation to its function.

    Controls delivery of blood to organs, tissues, and cells = Arterioles Manages mechanisms used for short-term blood pressure regulation = Autonomic Nervous System Allows a continuous flow of blood into capillaries = Arteries Releases in response to low blood pressure to retain water = Antidiuretic hormone

    Which factors increase blood pressure?Select all that apply

  • Shock
  • Head injury, Acute pain (correct)
  • Weight gain (correct)
  • Vasodilation
  • Which area is the most common site for a blood pressure measurement?

    <p>Upper arm</p> Signup and view all the answers

    Which questions would the nurse ask the patient before measuring blood pressure? Select all that apply.

    <p>Are you in pain? Do you feel stressed?</p> Signup and view all the answers

    Which blood pressure measurement is an unexpected finding?

    <p>Adult: 128/84</p> Signup and view all the answers

    Match the blood pressure measurement to its classification.

    <h1>Hypertension stage 1 = 130–139 systolic Elevated = &lt;80 diastolic with systolic 120–129 Hypertension stage 2 = ≥90 diastolic</h1> Signup and view all the answers

    Which cue would alert the nurse that a patient may be experiencing orthostatic hypotension?

    <p>Patient feels faint upon position change.</p> Signup and view all the answers

    Which action would the nurse take to obtain patient observation cues to determine blood pressure alterations?

    <p>Question the patient.</p> Signup and view all the answers

    Match the hypothesis to its pathophysiologic cause.

    <h1>Hypovolemia and decreased cardiac output = Hypotension Peripheral vasodilation with no compensation = Postural hypotension Thickened arteries that reduce compliance = Thickened arteries that reduce compliance</h1> Signup and view all the answers

    Which patient situation would the nurse assess first?

    <p>Absence of breathing</p> Signup and view all the answers

    Which outcome would the nurse develop for a patient with hypotension?

    <p>Patient’s blood pressure will return to expected ranges 2 hours after treatment.</p> Signup and view all the answers

    Which finding alerts the nurse that a patient with hypertension is improving?

    <p>Nose bleeds decrease.</p> Signup and view all the answers

    Which action would the nurse take for a patient with hypotension?

    <p>Apply oxygen.</p> Signup and view all the answers

    Which patient care strategy would the nurse take for a patient with worsening orthostatic hypotension?

    <p>Perform a head-to-toe assessment.</p> Signup and view all the answers

    Which description would the nurse use when discussing stroke volume?

    <p>The amount of blood injected into the arterial system with each heartbeat</p> Signup and view all the answers

    Which cues would the nurse observe in a patient with a blood pressure of 60/40 and shock?

    <p>Clammy skin</p> Signup and view all the answers

    Which statement indicates the nurse understands possible errors in blood pressure assessment?

    <p>“A noisy environment can cause a false low reading.”</p> Signup and view all the answers

    Which factor would the nurse suspect is causing the blood pressure to fall when a patient who experienced a myocardial infarction (heart attack) is becoming cool and clammy?

    <p>Decreased cardiac output</p> Signup and view all the answers

    Match the type of hypertension to its description.

    <p>No known cause = Primary Caused by a specific disease = Secondary hypertension Systolic blood pressure over 140 = Hypertension stage 2 Diastolic blood pressure 80–89 = Hypertension stage 1</p> Signup and view all the answers

    Which action by the nurse when caring for a patient with a left mastectomy would cause the charge nurse to intervene?

    <p>Takes the blood pressure in the left arm</p> Signup and view all the answers

    Which interventions would the nurse implement to help an obese adult patient who smokes cigarettes successfully manage hypertension?

    <p>Arranging for nutritional support</p> Signup and view all the answers

    Which site would the nurse use to measure blood pressure when the patient’s upper body is severely burned?

    <p>Popliteal</p> Signup and view all the answers

    Which adult patient’s blood pressure reading would the nurse realize is unexpected?

    <p>96/64 to 118/74</p> Signup and view all the answers

    What is the patient’s pulse pressure (mm Hg) when the blood pressure is 130/70? Record your answer as a whole number. __ mm Hg

    <p>60</p> Signup and view all the answers

    Which actions would the nurse take when manually measuring the patient’s brachial blood pressure? Select all that apply

    <p>Deflate cuff at a rate of 2 mm Hg/second.</p> Signup and view all the answers

    For which patients would the nurse measure blood pressure with an electronic device?

    <p>Has a regular heartbeat</p> Signup and view all the answers

    Which patient cue would the nurse identify as relevant for blood pressure?

    <p>Reports blurred vision</p> Signup and view all the answers

    Which information would the nurse share with a team member about the pathophysiology of hypertension?

    <p>Overstimulation of angiotensin and aldosterone causes the blood pressure to increase.</p> Signup and view all the answers

    Place the adult patients in the order in which the nurse would prioritize their care from highest priority to lowest priority

    <p>Patient with an occluded airway = 1 Patient who has a blood pressure of 76/40 = 2 Patient with blood pressure of 110/64 = 4 Patient with chronic hypertension = 3</p> Signup and view all the answers

    Which hypothesis would the nurse select for a patient with a blood pressure of 130/70 who when sitting up becomes dizzy and the blood pressure is 108/60?

    <p>Postural hypotension</p> Signup and view all the answers

    Which actions would the nurse take for a patient with low blood pressure from decreased peripheral vascular resistance?

    <p>Administer prescribed intravenous (IV) fluids.</p> Signup and view all the answers

    Which factor would the nurse consider is likely causing hypertension in an older adult female who is 5’4”, weighs 100 lbs (45.4 kg), drinks an occasional glass of red wine before bed, and limits salt in her diet?

    <p>Age</p> Signup and view all the answers

    Which finding would alert the nurse that a patient with a blood pressure of 80/40 is improving?

    <p>Skin becomes warm and dry.</p> Signup and view all the answers

    Which actions would the nurse take for a patient with the following blood pressures: 119/74, 125/78, 130/83, and 135/88? Select all that apply

    <p>Measure oxygen saturation level.</p> Signup and view all the answers

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