A nurse is caring for a patient who is returning for a repeat blood pressure to determine if white coat syndrome occurred during the first clinical visit. Which diagnostic test will be used to confirm a diagnosis of hypertension?

A. Changes in peristalsis: Changes in peristalsis, which refers to the rhythmic contraction and relaxation of the gastrointestinal tract muscles, are not typically associated with target organ damage in hypertension. While hypertension can indirectly affect gastrointestinal function through its impact on other organ systems, such as the kidneys and cardiovascular system, alterations in peristalsis are more commonly attributed to gastrointestinal disorders or neurological conditions rather than hypertension-induced target organ damage.

B. Decreased urine output: In a patient diagnosed with hypertension, decreased urine output may indicate the development of target organ damage, particularly renal damage. Hypertension can lead to chronic kidney disease (CKD) over time, which is characterized by a gradual decline in kidney function. Decreased urine output may be a sign of impaired renal function, reduced glomerular filtration rate (GFR), or the presence of proteinuria. These changes indicate that the kidneys are no longer effectively filtering waste products and regulating fluid balance, suggesting the onset of renal damage as a consequence of long-standing hypertension.

C. Decreased insulin resistance: Hypertension is not directly linked to changes in insulin resistance. However, hypertension and insulin resistance are often comorbid conditions that share common risk factors, such as obesity, sedentary lifestyle, and unhealthy diet. While poorly controlled hypertension and insulin resistance can contribute to the development of cardiovascular disease and other complications, a decrease in insulin resistance would not typically be considered an indicator of target organ damage in hypertension.

D. Hypercholesterolemia: Hypercholesterolemia, or high levels of cholesterol in the blood, is a risk factor for cardiovascular disease, including atherosclerosis and coronary artery disease. While hypertension and hypercholesterolemia frequently coexist and contribute to the progression of vascular damage, the presence of hypercholesterolemia alone does not necessarily indicate target organ damage specific to hypertension. However, elevated cholesterol levels can exacerbate vascular changes and increase the risk of cardiovascular events in individuals with hypertension.

A. "Your veins are not functioning properly. Lack of venous blood volume causes these ulcers": While venous insufficiency contributes to the development of venous ulcers, the primary issue is not necessarily a lack of venous blood volume but rather impaired venous return due to valve dysfunction.

B. "Your veins are weaker and blood is not moving up as it should. The congestion in your veins causes the ulcers to form.": This explanation accurately describes the pathophysiology of venous ulcers. Venous insufficiency leads to venous congestion, which causes increased pressure in the veins of the lower extremities. This pressure can result in the breakdown of skin and the formation of ulcers, typically around the ankles.

C. "Because the veins are not working properly, there is not enough oxygen going to the skin of your legs.": While venous insufficiency can affect tissue oxygenation to some extent, the primary mechanism leading to venous ulcers is venous congestion and increased pressure in the lower extremities, rather than insufficient oxygen delivery.

D. "Your veins clogged so the body causes the arteries to swell and the excess oxygen in the blood causes the ulcers.": This explanation does not accurately describe the pathophysiology of venous ulcers. Venous ulcers result from impaired venous return and venous congestion, not arterial swelling or excess oxygen in the blood.