Which is(are) potential result(s) of end-organ damage from chronic hypertension? (Select all that apply.)

Cardiac disease

Renal insufficiency

Stroke

Familial hypercholesterolemia

Atrial fibrillation

Isolated systolic hypertension

Answer and Explanation

Correct Answer : A,B,C,E

A. Chronic hypertension is a significant risk factor for the development of various cardiac diseases, including coronary artery disease, left ventricular hypertrophy, heart failure, and arrhythmias. The increased workload on the heart caused by hypertension can lead to myocardial remodeling, impaired cardiac function, and ultimately heart disease.

B. Chronic hypertension can cause damage to the kidneys over time, leading to renal insufficiency or chronic kidney disease. The elevated blood pressure damages the delicate blood vessels in the kidneys, impairing their ability to filter waste products and regulate fluid and electrolyte balance. Persistent hypertension can ultimately lead to kidney dysfunction and renal failure.

C. Hypertension is a major risk factor for the development of stroke, particularly ischemic stroke (caused by a blockage in a blood vessel supplying the brain) and hemorrhagic stroke (caused by bleeding into the brain). Chronic hypertension can damage blood vessels in the brain, leading to the formation of blood clots or weakening of vessel walls, increasing the risk of stroke.

E. Chronic hypertension is a significant risk factor for the development of atrial fibrillation, a type of irregular heart rhythm characterized by rapid and chaotic electrical activity in the upper chambers of the heart (atria). The structural changes in the heart caused by hypertension, such as left atrial enlargement and fibrosis, can predispose individuals to atrial fibrillation.

D. Familial hypercholesterolemia is a genetic disorder characterized by high levels of LDL cholesterol in the blood. While chronic hypertension itself does not directly cause familial hypercholesterolemia, hypertension and hypercholesterolemia are often comorbid conditions that contribute to cardiovascular risk. Both conditions can lead to atherosclerosis, increasing the risk of heart disease and stroke.

F. Isolated systolic hypertension refers to elevated systolic blood pressure with normal diastolic blood pressure. While isolated systolic hypertension itself is a manifestation of hypertension, it is not a direct result of end-organ damage. However, if left untreated, isolated systolic hypertension can lead to complications such as stroke, heart failure, and kidney disease, which are consequences of end-organ damage from chronic hypertension.

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Correct Answer is C

Explanation

C. Amiodarone is a Class III antiarrhythmic medication commonly used for the acute management of atrial fibrillation with a rapid ventricular rate. It works by blocking multiple ion channels, prolonging the action potential duration, and slowing conduction in the atria and ventricles. Amiodarone is often used when other interventions such as vagal maneuvers or beta blockers are ineffective or contraindicated. In this scenario, where the patient is hypotensive and symptomatic, intravenous amiodarone may be administered to control the ventricular rate and stabilize hemodynamics

A. Bearing down, or the Valsalva maneuver, is a vagal maneuver that can sometimes help slow the heart rate in certain arrhythmias by increasing parasympathetic tone. However, it may not be effective or safe in all situations, especially if the patient is hypotensive or confused. In this scenario, immediate pharmacological intervention is likely needed to control the heart rate and stabilize hemodynamics.

B. Lidocaine is not typically used to treat atrial fibrillation with a rapid ventricular rate. Lidocaine is a Class IB antiarrhythmic medication primarily used for the treatment of ventricular arrhythmias, such as ventricular tachycardia and ventricular fibrillation. It is not considered a first-line agent for atrial fibrillation and may not effectively control the ventricular rate in this situation.

D. While beta blockers are commonly used for rate control in atrial fibrillation, they may not be the best choice in this scenario where the patient is hypotensive and symptomatic. Beta blockers can further decrease blood pressure and exacerbate hypotension, especially in patients with compromised hemodynamics. In such cases, other rate-controlling agents like calcium channel blockers or amiodarone may be preferred.

A. Give PRN lorazepam (Ativan) and cancel the transfer. B. Obtain an order for restraints as needed and transfer the patient. C. Notify the health care provider and postpone the transfer. D. Inform the receiving nurse and then transfer the patient.

Correct Answer is C

Explanation

C. This allows for the patient's condition to be re-evaluated, ensuring that they receive the necessary care and attention before being transferred.

A. Benzodiazepines can cause sedation, cognitive impairment, and delirium, which may worsen the patient's condition. Canceling the transfer without addressing the underlying cause of confusion may delay appropriate management.

B. Restraints can increase agitation, anxiety, and risk of injury, and they do not address the underlying cause of confusion. Restraints should only be considered as a last resort if all other measures to ensure patient safety have been exhausted.

D. This option is not appropriate because transferring the patient without addressing the new-onset confusion could compromise patient safety. It's essential to identify and manage the underlying cause of confusion before transferring the patient to another unit.

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Which is(are) potential result(s) of end-organ damage from chronic hypertension? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who was admitted for atrial fibrillation rapid ventricular rate of 130 beat/min with confusion. The client's blood pressure is 87/50. What order should the nurse expect to receive from the provider?

Correct Answer is C

Explanation

An 81-yr-old patient who has been in the intensive care unit (ICU) for a week is now stable and transfer to the progressive care unit is planned. On rounds, the nurse notices that the patient has new onset confusion. What should the nurse plan to do?

Correct Answer is C

Explanation

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