A 62-year-old woman sees the APRN for evaluation of hypertension. According to JNC 8 guidelines for hypertension, what is the threshold for treating hypertension?
120/80 mmHg
130/80 mmHg
140/90 mmHg
150/90 mmHg
The Correct Answer is D
Choice A reason: 120/80 mmHg is considered normal blood pressure. It is not a treatment threshold under JNC 8 guidelines and does not warrant pharmacologic intervention unless other risk factors are present.
Choice B reason: 130/80 mmHg is the threshold used in more recent guidelines such as ACC/AHA 2017, but JNC 8 recommends a higher threshold for older adults. For individuals over 60 years old, the treatment threshold is 150/90 mmHg.
Choice C reason: 140/90 mmHg is the treatment threshold for adults younger than 60 years or those with diabetes or chronic kidney disease. For patients over 60 without these conditions, JNC 8 recommends initiating treatment at 150/90 mmHg.
Choice D reason: According to JNC 8, for adults aged 60 years or older without diabetes or chronic kidney disease, pharmacologic treatment should be initiated when systolic blood pressure is ≥150 mmHg or diastolic is ≥90 mmHg. This recommendation is based on evidence showing reduced stroke and cardiovascular events at this threshold.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: While education and discussion about the risks of discontinuing medication are important, trying to convince the patient without respecting autonomy may undermine trust. This approach is paternalistic and does not honor the patient’s legal rights.
Choice B reason: Predicting hospitalization may be perceived as coercive and fear-inducing. It is not appropriate unless there is clear evidence of imminent risk. The patient is currently stable and competent, so this approach is not justified.
Choice C reason: Competent adults have the legal right to refuse medical treatment, including psychiatric medications. The PMHNP should assess the patient’s decision-making capacity and, if intact, respect his autonomy. The provider can offer education and support but must honor the patient’s informed choice.
Choice D reason: This response is inappropriate and stigmatizing. It assumes incompetence without assessment and threatens involuntary hospitalization without cause. Such actions violate ethical and legal standards in psychiatric care.
Correct Answer is B
Explanation
Choice A reason: Buffalo hump, easy bruising, and abdominal striae are hallmark features of Cushing's syndrome, which results from excess cortisol. These findings are not associated with hypothyroidism, which is characterized by a slowing of metabolic processes rather than hypercortisolism.
Choice B reason: Periorbital puffiness, bradycardia, and changes in blood pressure (decreased systolic and increased diastolic) are consistent with hypothyroidism. These symptoms reflect fluid retention, reduced cardiac output, and systemic vascular resistance changes due to low thyroid hormone levels. Bradycardia is a classic cardiovascular manifestation of hypothyroidism due to decreased sympathetic tone.
Choice C reason: Increased systolic blood pressure, decreased diastolic pressure, tachycardia, and moon facies are more indicative of hyperthyroidism or Cushing's syndrome. Tachycardia and widened pulse pressure are not typical in hypothyroidism, which tends to cause bradycardia and narrowed pulse pressure.
Choice D reason: An enlarged thyroid gland and protruding eyeballs (exophthalmos) are features of Graves' disease, a form of hyperthyroidism. Hypothyroidism does not typically present with these findings unless it follows treatment for Graves' disease, in which case ophthalmopathy may persist.
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