A nurse is reviewing blood pressure classifications with a client who has been newly diagnosed with hypertension.
Which of the following should the nurse include as an example of stage 1 hypertension?
108/60 mm Hg.
154/96 mm Hg.
164/104 mm Hg.
128/88 mm Hg.
The Correct Answer is B
The correct answer is choice B.
Choice A rationale:
A blood pressure of 108/60 mm Hg is considered normal, as it is less than 120/80 mm Hg.
Choice B rationale:
A blood pressure of 154/96 mm Hg falls into the category of stage 1 hypertension. Stage 1 hypertension is classified as a systolic blood pressure reading that falls between 130 and 139 mm Hg or a diastolic reading that is between 80 and 89 mm Hg.
Choice C rationale:
A blood pressure of 164/104 mm Hg is considered stage 2 hypertension, as the systolic blood pressure is 140 mm Hg or higher, or the diastolic pressure is 90 mm Hg or higher.
Choice D rationale:
A blood pressure of 128/88 mm Hg is considered elevated, as the systolic blood pressure ranges from 120 to 129 mm Hg and the diastolic blood pressure is below 80 mm Hg.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
The medication should be dropped into the conjunctival sac, which is the space between the lower eyelid and the eyeball. This is the correct method for administering ophthalmic drops.
Choice B rationale:
The eyedropper should not touch any part of the eye, including the sclera, to avoid contamination and potential infection.
Choice C rationale:
It is not necessary to don sterile gloves when administering ophthalmic drops. Clean gloves or hand hygiene is sufficient.
Choice D rationale:
Rubbing the eye after instilling medication can cause irritation and may disperse the medication, reducing its effectiveness.
Correct Answer is B
Explanation
Choice A rationale:
Metabolic alkalosis is incorrect because it would present with a high pH and high HCO3. This client’s pH is low, indicating acidosis, not alkalosis.
Choice B rationale:
Respiratory acidosis is correct. It is characterized by a low pH and high PaCO2, as seen in this client’s results. This condition occurs when the lungs can’t remove enough CO2, causing it to build up in the blood and lower the pH.
Choice C rationale:
Metabolic acidosis is incorrect because it would present with a low pH and low HCO3. This client’s HCO3 is normal.
Choice D rationale:
Respiratory alkalosis is incorrect because it would present with a high pH and low PaCO2. This client’s pH is low and PaCO2 is high.
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