A nurse is going to teach a patient about hypertension. Which action should the nurse implement first?

Set mutual goals for knowledge of hypertension.

Teach what the patient wants to know about hypertension.

Assess what the patient already knows about hypertension.

Evaluate the outcomes of patient education for hypertension.

Answer and Explanation

The Correct Answer is C

Choice A reason: Setting mutual goals is important but premature without assessing the patient’s knowledge. Goals depend on understanding gaps, which are identified through assessment. Without this, goals may be irrelevant, reducing teaching effectiveness, per patient education and learning theory principles.

Choice B reason: Teaching what the patient wants to know assumes prior assessment of their needs and knowledge of their baseline. Without assessing existing knowledge, the nurse risks delivering redundant or irrelevant information, decreasing engagement and retention, per adult learning and education strategies.

Choice C reason: Assessing the patient’s current knowledge of hypertension is the first, as it establishes a baseline understanding, identifying gaps and misconceptions. This guides tailored education, ensuring relevance and effectiveness, enhancing patient engagement, and adherence to management, per patient-centered education and health literacy principles.

Choice D reason: Evaluating outcomes follows education, not precedes it. Assessment of knowledge is needed first to inform teaching. Evaluation without teaching is illogical, as there are no interventions to assess, making this step irrelevant at the start, per educational process and nursing teaching frameworks.

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Correct Answer is A

Explanation

Choice A reason: The carotid pulse is used for unresponsive, non-breathing patients, as it is the most reliable central pulse, reflecting cardiac output during cardiac arrest. Its accessibility and strength make it ideal for rapid assessment, guiding CPR initiation, per ACLS and emergency assessment protocols.

Choice B reason: The apical pulse, assessed via auscultation, is impractical for an unresponsive, non-breathing patient, requiring time and equipment. In emergencies, the carotid pulse is faster and more reliable to confirm pulselessness, ensuring timely CPR, per cardiac arrest management guidelines.

Choice C reason: The radial pulse is peripheral and less reliable in cardiac arrest, as it may be absent due to poor perfusion. The carotid pulse better reflects central circulation, critical for assessing unresponsiveness and apnea, guiding immediate resuscitation efforts, per emergency care standards.

Choice D reason: The brachial pulse is used in infants or for blood pressure but is less accessible than the carotid in adults during arrest. The carotid provides a quick, reliable pulse check, ensuring rapid initiation of life-saving measures, per ACLS and pulse assessment protocols.

A. Sodium (Na+) 125 mEq/L B. Potassium (K+) 4.2 mEq/L C. Calcium (Ca+) 4.8 mg/dL D. Magnesium (Mg+) 2.0 mEq/L

Correct Answer is A

Explanation

Choice A reason: Sodium 125 mEq/L (normal 135-145 mEq/L) indicates hyponatremia, likely from excessive sweating during running, causing water retention or sodium loss. Low sodium disrupts cellular osmosis, leading to cerebral edema, explaining lethargy and pallor. This critical imbalance affects nerve conduction and muscle function, requiring urgent correction to prevent seizures or coma.

Choice B reason: Potassium 4.2 mEq/L (normal 3.5-5.0 mEq/L) is within normal range. Potassium regulates muscle and nerve function, including cardiac rhythm. Normal levels do not explain lethargy or pallor, as they ensure proper membrane potential and muscle contraction. In this scenario, potassium is not a concern compared to severe hyponatremia affecting neurological status.

Choice C reason: Calcium 4.8 mg/dL (normal 8.5-10.2 mg/dL) indicates hypocalcemia, which can cause muscle cramps or tetany. However, lethargy and pallor are more directly linked to hyponatremia’s neurological effects. Calcium affects muscle contraction and nerve signaling, but its impact is less acute than sodium’s role in osmotic balance and cerebral function here.

Choice D reason: Magnesium 2.0 mEq/L (normal 1.7-2.2 mEq/L) is normal. Magnesium supports muscle and nerve function, including ATP production. Normal levels do not contribute to lethargy or pallor, which are more likely due to sodium imbalance affecting brain hydration. Magnesium is not a priority concern in this acute presentation.

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A nurse is going to teach a patient about hypertension. Which action should the nurse implement first?

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