A nurse caring for a client”who has hypertension and asks the nurse about a prescription for propranolol. The nurse should inform the client that this medication is contraindicated in clients who have a history of which of the following conditions?

Here's how to find the volume the nurse should administer:

Medication dose to be administered: 250 mg

Available medication concentration: 1000 mg/8 mL

We need to find the volume (in mL) that contains the desired dose (250 mg) of hydrocortisone sodium succinate.

Set up a proportion:

Desired dose (mg) : Volume to administer (mL) = Concentration (mg/mL) : Available volume (mL)

In this case:

Desired dose (mg) = 250 mg

Concentration (mg/mL) = 1000 mg/8 mL (available concentration)

Volume to administer (mL) = Unknown (what we need to find)

Available volume (mL) = 8 mL (volume of solution containing the concentrated medication)

Solve for the volume to administer (mL):

Volume to administer (mL) = (Desired dose (mg) x Available volume (mL)) / Concentration (mg/mL)

Volume to administer (mL) = (250 mg x 8 mL) / 1000 mg/mL

Calculate the volume:

Volume to administer (mL) = 2000 mg / 1000 mg/mL

Volume to administer (mL) = 2 mL (round to nearest whole number as requested)

Therefore, the nurse should administer approximately 2 mL of the hydrocortisone sodium succinate solution.

A) Lifestyle modification, including exercise, diet, and decreased smoking and alcohol intake:
This statement is accurate. Lifestyle modifications are essential components of hypertension management and are recommended as the first step in treatment. These modifications include regular physical activity, adopting a heart-healthy diet such as the DASH (Dietary Approaches to Stop Hypertension) diet, reducing sodium intake, limiting alcohol consumption, and quitting smoking. These changes can help lower blood pressure and reduce the risk of cardiovascular events.

B) Use of diuretic, beta-blocker, or ACE inhibitor to supplement lifestyle changes:
This statement is also accurate. If lifestyle modifications alone are insufficient to achieve blood pressure control, pharmacotherapy may be initiated. The choice of antihypertensive medications depends on various factors, including the individual's comorbidities, medication tolerance, and response to treatment. Diuretics, beta-blockers, and ACE inhibitors are commonly used as first-line agents in the management of hypertension, either as monotherapy or in combination with other drugs.

C) All of the above:
This statement is correct. The stepped-care approach to hypertension management involves a combination of lifestyle modifications and pharmacotherapy. Lifestyle changes are typically recommended as the initial step, followed by the addition of antihypertensive medications if necessary to achieve target blood pressure goals. Therefore, both lifestyle modifications and pharmacological interventions are integral components of the stepped-care approach.

D) A combination of antihypertensive drug classes to achieve desired control:
While this statement is true, it does not encompass all aspects of the stepped-care approach. The use of combination therapy with multiple antihypertensive drug classes may be necessary in some cases to achieve optimal blood pressure control. However, it is only one component of the broader treatment strategy, which also includes lifestyle modifications as the foundation of therapy. Therefore, while combination therapy is important, it does not fully represent the stepped-care approach on its own.