A 56-year-old male client at a screening event has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, the client states, "My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it?" What is the nurse's best response?

"Yes. Hypertension is prevalent among men; it is fortunate we caught this during your routine examination."

"We will need to reevaluate your blood pressure because age places you at high risk for hypertension."

"A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made.

"You have no need to worry. Your pressure is probably elevated because you are being tested."

Answer and Explanation

The Correct Answer is C

A. "Yes. Hypertension is prevalent among men; it is fortunate we caught this during your routine examination.": This response is premature as it assumes a diagnosis of hypertension based on a single elevated blood pressure reading without further assessment or confirmation.

B. "We will need to reevaluate your blood pressure because age places you at high risk for hypertension.": While age is a risk factor for hypertension, it is important not to jump to conclusions based on one blood pressure reading. Reevaluation and monitoring are necessary before making any definitive diagnoses or treatment decisions.

C. "A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made.": This response is appropriate because it acknowledges the need for further assessment and monitoring before determining if the client has hypertension. It also educates the client about the importance of multiple readings for an accurate diagnosis.

D. "You have no need to worry. Your pressure is probably elevated because you are being tested.": This response dismisses the client's concerns and does not provide accurate information about blood pressure assessment and hypertension diagnosis.

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Correct Answer is D

Explanation

A. "I will have canned chicken noodle soup with crackers and an apple for lunch": Canned soups are often high in sodium, and crackers can also contribute to sodium intake. This meal choice would not align with a low-sodium diet.

B. "I will have a ham and cheese sandwich for lunch": Processed meats like ham and cheese can be high in sodium, especially if they are not low-sodium options. This choice may not be suitable for a low-sodium diet unless specific low-sodium products are used.

C. "I will have a BLT and a side salad with cheese and croutons for lunch": Bacon, cheese, and croutons are all sources of sodium, so this meal would likely not be appropriate for a low-sodium diet unless modifications are made, such as using low-sodium bacon and limiting cheese and crouton amounts.

D. "I will have a baked potato with broiled chicken for dinner": This statement indicates an understanding of choosing low-sodium options. Baked potatoes and broiled chicken are generally low in sodium, especially if prepared without added salt or high-sodium seasonings. This choice aligns well with a low-sodium diet for someone with heart failure.

A. Whether the client and involved family members understand dietary changes and the role of nutrition B. Whether the client and involved family members understand the role of genetics in the etiology of the disease C. Whether the client and involved family members are able to recognize symptoms of an acute cardiac problem and respond appropriately D. Whether the client and involved family members understand the importance of social support and community agencies

Correct Answer is C

Explanation

A. Whether the client and involved family members understand dietary changes and the role of nutrition:

This assessment is important as diet plays a crucial role in managing coronary artery disease (CAD) and preventing further complications. Understanding dietary changes, such as reducing saturated fats, sodium intake, and incorporating heart-healthy foods like fruits, vegetables, and whole grains, is essential. Nutrition education can help clients and their families make informed choices that promote heart health and improve overall well-being. However, while understanding dietary changes is significant, it may not be the most critical determination during the initial intake assessment, especially when compared to immediate concerns like recognizing acute cardiac symptoms.

B. Whether the client and involved family members understand the role of genetics in the etiology of the disease:

Understanding the genetic factors contributing to coronary artery disease can provide valuable insights into the client's risk factors and potential hereditary predispositions. This knowledge can help guide screening, prevention, and management strategies tailored to the client's specific genetic profile. While genetic factors are important considerations in CAD, they typically require a more detailed evaluation and may not be the primary focus during the initial intake assessment, especially compared to immediate concerns related to symptom recognition and response.

C. Whether the client and involved family members are able to recognize symptoms of an acute cardiac problem and respond appropriately:

This is a crucial assessment because recognizing symptoms such as chest pain, shortness of breath, nausea, sweating, and arm or jaw pain is essential in identifying a potential heart attack or unstable angina. Knowing when to seek emergency medical assistance and how to respond appropriately can significantly impact outcomes and reduce the risk of complications. Immediate response to acute cardiac symptoms is a critical aspect of CAD management, making it a top priority during the intake assessment.

D. Whether the client and involved family members understand the importance of social support and community agencies:

Social support and community resources play a valuable role in CAD management, providing emotional support, access to education programs, rehabilitation services, and other supportive resources. Understanding the importance of social support and knowing how to access community agencies can enhance the client's overall well-being and facilitate long-term management.

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A 56-year-old male client at a screening event has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, the client states, "My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it?" What is the nurse's best response?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with heart failure is placed on a low-sodium diet. Which statement by the client indicates that the nurse's nutritional teaching plan has been effective?

Correct Answer is D

Explanation

The nurse is performing an intake assessment on a client with a new diagnosis of coronary artery disease. What would be the most important determination to make during this intake assessment?

Correct Answer is C

Explanation

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