A nurse is providing teaching to a client who has a family history of hypertension. The nurse should inform the client that his blood pressure of 124/79 mm Hg places him in which of the following categories?

Elevated

Stage 1 hypertension

Stage 2 hypertension

Normal

Answer and Explanation

The Correct Answer is A

Choice A reason: A blood pressure reading of 124/79 mm Hg is considered elevated. The normal range for blood pressure is less than 120/80 mm Hg. Elevated blood pressure is when readings consistently range from 120129 systolic and less than 80 mm Hg diastolic.

Choice B reason: Stage 1 hypertension is defined by a systolic blood pressure ranging from 130 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. The client's blood pressure does not fall into this category.

Choice C reason: Stage 2 hypertension is characterized by a systolic blood pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher. The client's blood pressure is below these levels.

Choice D reason: A normal blood pressure reading is typically below 120/80 mm Hg. Although the client's diastolic pressure is within the normal range, the systolic pressure is above normal, thus it does not qualify as a normal blood pressure reading.

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Correct Answer is B

Explanation

Choice A reason: The visibility of chest tube eyelets is not typically a concern unless there is evidence that the tube is dislodged. In normal circumstances, the eyelets may not be visible, and this does not necessarily indicate a need for intervention.

Choice B reason: The development of subcutaneous emphysema, which is the presence of air in the subcutaneous tissue, can be a sign of a serious complication such as a pneumothorax. It requires immediate assessment and possible intervention to prevent further complications.

Choice C reason: Tidal fluctuation in the water seal chamber is a normal finding when a chest tube is in place. It indicates that the system is patent and functioning correctly as it reflects the pressure changes in the pleural space during respiration.

Choice D reason: Continuous bubbling in the suction control chamber may indicate an air leak in the system, which could be normal if the system is set to continuous suction. However, if the bubbling is vigorous and the system is not set to continuous suction, it may indicate a new air leak and require intervention.

A. Hypernatremia B. Hyperkalemia C. Hypophosphatemia D. Hypercalcemia

Correct Answer is B

Explanation

Choice A reason: Hypernatremia is not typically associated with prerenal AKI. Prerenal AKI is characterized by conditions that reduce blood flow to the kidneys, not directly causing high sodium levels.

Choice B reason: This choice is correct. Hyperkalemia, which is a high level of potassium in the blood, is a common electrolyte imbalance seen in prerenal AKI due to decreased kidney function and the inability to excrete potassium.

Choice C reason: Hypophosphatemia, or low levels of phosphate in the blood, is not a typical finding in prerenal AKI.

Choice D reason: Hypercalcemia, or high levels of calcium in the blood, is not commonly associated with prerenal AKI. It is more often related to other conditions such as hyperparathyroidism or malignancy.

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A nurse is providing teaching to a client who has a family history of hypertension. The nurse should inform the client that his blood pressure of 124/79 mm Hg places him in which of the following categories?

Nursing Test Bank

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