A nurse is administering nicardipine to a client who has a BP of 180/120 mm Hg. Which of the following actions should the nurse take first?
Check for orthostatic hypertension.
Assist the client to make lifestyle changes.
Instruct the client to restrict sodium intake.
Monitor the client's BP every 5 minutes.
The Correct Answer is D
A. Check for orthostatic hypotension. While important, checking for orthostatic hypotension is not the priority action in a hypertensive emergency, where rapid blood pressure reduction is necessary.
B. Assist the client to make lifestyle changes. Assisting the client with lifestyle changes is part of long-term blood pressure management but is not a priority action when administering nicardipine for acute hypertension.
C. Instruct the client to restrict sodium intake. Sodium restriction is a key component of managing hypertension but is not the priority action during an acute hypertensive crisis.
D. Monitor the client's BP every 5 minutes. In a hypertensive crisis, frequent monitoring of the client’s blood pressure is essential to ensure the medication is lowering blood pressure safely and effectively.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. 42 units: The nurse needs to prepare 14 units of regular insulin and 28 units of NPH insulin, for a total of 42 units. Both insulins can be combined in the same syringe.
B. 32 units: This option underestimates the total units. The correct total is 42 units, not 32.
C. 14 units: This only accounts for the regular insulin dose. The client also requires 28 units of NPH insulin.
D. 28 units: This only accounts for the NPH insulin dose. The client also requires 14 units of regular insulin.
Correct Answer is A
Explanation
A. Bradycardia: Atenolol can slow the heart rate as it reduces the workload of the heart. Bradycardia (a heart rate below 60 beats per minute) is a potential adverse effect and should be monitored.
B. Dry Cough: A dry cough is a common side effect of ACE inhibitors, not beta-blockers like atenolol. This statement is incorrect.
C. Migraine Headache: Atenolol is sometimes used to prevent migraines, not cause them. Therefore, migraines are not an expected adverse effect of atenolol. This statement is incorrect.
D. Insomnia or Hyperactivity: Atenolol can cause fatigue or lethargy, but insomnia or hyperactivity is not a typical side effect. This statement is incorrect.
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