A group of student nurses are practicing taking blood pressures. A 56-year-old male student has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, he exclaims, “My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it?” Which of the following responses by the nursing instructor would be best?
“A single elevated blood pressure does not confirm hypertension. A diagnosis of hypertension requires two or more elevated readings taken by your physician before a diagnosis can be made.”
“We will need to reevaluate your blood pressure because your age places you at high risk for hypertension.”
“Hypertension is prevalent among men: it is fortunate we caught this during your routine examination.”
“You have no need to worry. Your pressure is probably elevated because you are being tested.”
The Correct Answer is A
A. "A single elevated blood pressure does not confirm hypertension. A diagnosis of hypertension requires two or more elevated readings taken by your physician before a diagnosis can be made."
This response emphasizes the need for multiple elevated readings for a diagnosis of hypertension. It educates the individual about the diagnostic criteria and encourages them to seek further evaluation from their physician.
B. "We will need to reevaluate your blood pressure because your age places you at high risk for hypertension."
This response might be seen as implying that age alone is a significant factor in determining hypertension, which may not be accurate. While age is a risk factor, the emphasis should be on the need for multiple readings and a physician's evaluation rather than attributing it solely to age.
C. "Hypertension is prevalent among men: it is fortunate we caught this during your routine examination."
This response suggests that the elevated blood pressure is automatically assumed to be hypertension based on gender. It is important to avoid making assumptions and instead focus on the need for proper evaluation and multiple readings for a hypertension diagnosis.
D. "You have no need to worry. Your pressure is probably elevated because you are being tested."
This response dismisses the individual's concerns and attributes the elevated blood pressure solely to the testing situation. While stress or anxiety can influence blood pressure readings, it's essential to address the need for further evaluation and not completely disregard the possibility of hypertension.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Factor VIII: Factor VIII is a component of the clotting cascade, but it is not the antidote for warfarin. Factor VIII is used in the treatment of hemophilia A.
B. Vitamin K: This is the correct answer. Vitamin K is the antidote for warfarin overdose. It helps in the synthesis of clotting factors.
C. IVIG (Intravenous Immunoglobulin): IVIG is not an antidote for warfarin. It is used for various immune-related conditions.
D. Factor X: Factor X is also a clotting factor, but it is not the antidote for warfarin. Factor Xa inhibitors are used as anticoagulants.
Correct Answer is C
Explanation
A. The patient pain reflects the target heart rate has been set too high and needs to be lowered to finish the test.
This option suggests that the chest pain is related to the target heart rate being set too high. However, chest pain during an exercise stress test is more commonly associated with myocardial ischemia rather than an inappropriate target heart rate. Lowering the target heart rate may not address the underlying issue of ischemia.
B. The patient’s pain reflects pericarditis and the test should be stopped.
Chest pain during an exercise stress test is more commonly associated with myocardial ischemia rather than pericarditis. Pericarditis is inflammation of the pericardium, and its symptoms may include chest pain that is often sharp and pleuritic. However, during an exercise stress test, the focus is on detecting cardiovascular abnormalities, and chest pain is more concerning for ischemia.
C. The patient’s pain reflects ischemia to the myocardium and the test should be stopped.
This is the most appropriate interpretation. Chest pain during an exercise stress test may indicate insufficient oxygen supply to the myocardium (ischemia). Stopping the test allows for further evaluation and appropriate intervention.
D. The patient’s pain reflects that supplemental oxygen is needed to finish the test.
Chest pain during an exercise stress test is not typically addressed by providing supplemental oxygen. Stopping the test and evaluating the cause of the chest pain is a more appropriate action.
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