NCLEX Secrets - Neurology Board Review
Situation: Warren was admitted to the hospital with a diagnosis of hypertension.
1. The nurse should carefully evaluate the pulse prior to administering which medication?
a) clonidine (catapres)
b) propanolol (inderal)
c) atorvastitin calcium (lipitor)
d) lovastatin (mevinolin)
2. At the time of Warren's physical examination, which finding was indicative of hypertension?
a) pupil changes an opthalmoscopic exam
b) presence of the second heart sound
c) sinus rhythm on auscultation
d) cardiac electrocardiogram
3. When teaching Warren on precautions to take while on antihypertensive medication, the nurse should advice him to:
a) avoid changing position suddenly
b) observe for black and blue marks
c) learn to take his blood pressure TID
d) take the drugs always on empty stomach
4. Warren has renal damage related to his hypertensive condition. When teaching him about his diet the nurse should advice him to:
a) replace whole milk with milk products
b) use salt substitute such as potassium chloride
c) eliminate protein from his diet
d) limit processed foods to fruits and juices
5. Which test should you order for Warren before treatment is indicated?
a) creatinine clearance
b) serum uric acid
c) serum creatinine
d) resting electrocardiogram
NCLEX Secrets - Neurology Board Review:
ANSWERS AND RATIONALE
1) B
- Propanolol is a drug that is used for angina pectoris, MI, arrythmias, hypertension, migraine, essential tremor, pheochromocytoma. Its main effect is to block catecholamine effect in heart and blood pressure, thereby, lowering BP and heart rate. The main potential adverse effect of the drug is bradycardia, heart failure, and hypotension. Thus it is very important to always check the patient's apical pulse and blood pressure before administering the drug. If the patient has bradycardia (below 60), withhold giving the drug and notify physician.
- always give with food to increase absorption
- advise not to discontinue abruptly as it can exacerbate angina and precipitate MI
- advise to continue taking the drug even he is already feeling well
- this drug should not be given to patients with asthma
- do not discontinue before surgery for pheochromocytoma
- clonidene may cause a weakly positive Coomb's test and decreases excretion of vanilymandelic acid
- avoid giving with propanolol and betablockers as it results in rebound hypertension
- avoid giving with Verapamil as it may cause AV block and severe hypotension
- avoid giving with herbal supplement capsicum as it may reduce antihypertensive effect of catapres
- avoid orthostatic hypotension by rising slowly and changing position slowly
- side effect drowsiness will diminish after 4 to 6 weeks
- the last dose should be taken immediately before going to bed
- advise not to discontinue drug abruptly as it may cause rebound hypertension
2) A
- letters b,c,d are examinations and findings that are more often carried out and associated with disease conditions of the heart.
Hypertension is a persistent systolic blood pressure greater than 140 mmHg and a diastolic pressure greater than 90 mmHg. It is characterized by elevated peripheral vascular resistance from constriction of arterioles, which may be caused by sympathetic responses and stimulation of the renin angiotensin mechanism.
It is classified as primary or essential hypertension in which there is no known etiology, and secondary, which develops as a result of some other condition.
On Physical Examination:
- opthalmoscopic exam: the eyes will usually reveal narrowed arterioles, hemorrhage, exudates and papilledema or swelling of the optic nerve
- apical and peripheral pulses
- vital signs and BP
- edema of extremities
- headache at the back of the head and neck
- nocturia
- confusion
- nausea and vomiting
- visual disturbances
- the most common side effect of antihypertensive drugs is orthostatic hypotension. To prevent it, instruct the patient to avoid changing position suddenly and standing for prolonged periods of time. Advise patient to sit down if he feels dizzy.
4) D
- hypertensive patients without renal damage are often placed on a fat/cholesterol, low sodium and low calorie diet.
Processed, preserved and fast foods are often high in sodium and must be avoided in a low sodium diet
Proteins are not eliminated in the diet but its intake is limited to the recommended daily allowance to prevent overloading the kidney, adding calories and weight gain.
Using salt substitutes that contain potassium may interact with the antihypertensive drugs being taken by the patient, especially when patient is taking ACE inhibitors as it may result in hyperkalemia.
5) C
- the purpose of the diagnostic tests is to identify possible causes of hypertension and to identify the organs already affected by the disorder in order to institute the most effective treatment regimen for the patient. The routine laboratory tests conducted before initiating treatment include CBC, urinalysis and blood chemistry including glucose, electrolytes, cholesterol, serum creatinine and blood urea nitrogen.
Serum creatinine and blood urea nitrogen reflect renal function. Hypertension can significantly decrease blood supply to the kidney which can damage the renal system and impair kidney function resulting in fluid retention and inability of the kidney to regulate electrolytes balance and excrete metabolic waste products such as urea. Hematocrit and hemoglobin are monitored as they reflect changes in fluid volume.
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