A nurse is reviewing the medical history of a client who has angina. Which of the following findings in the client's medical record should the nurse identify as a risk factor for angina?

A. Weak peripheral pulses are not a defining manifestation of hypertensive crisis. In severe hypertension, vascular resistance is increased, but peripheral pulses are not typically described as weak; instead, the key issue is dangerously elevated blood pressure and end-organ damage symptoms.

B. Pitting edema is not an acute manifestation of hypertensive crisis. Edema is more commonly associated with chronic conditions such as heart failure, renal disease, or fluid overload rather than the immediate presentation of a hypertensive emergency or urgency.

C. Headache is correct. A hypertensive crisis (severely elevated blood pressure, often ≥180/120 mm Hg) can cause symptoms of end-organ involvement, including severe headache due to increased intracranial pressure and cerebral vascular changes. Other expected manifestations may include visual changes, chest pain, or neurologic deficits.

D. Skin cool to touch is not a typical manifestation of hypertensive crisis. Cool, clammy skin is more commonly associated with shock states or decreased perfusion rather than severe hypertension, where perfusion pressure is elevated rather than reduced.

Rationale:

A. Pregnant clients should avoid cleaning cat litter boxes due to the risk of Toxoplasma gondii, a parasite that can cause serious congenital infection. If no one else can perform the task, gloves and strict hand hygiene are required, but ideally exposure should be avoided.

B. Proper hand hygiene requires washing hands for at least 20 seconds using soap and clean running water. Additionally, “hot water” is not required—lukewarm or cool water is appropriate. Gardening can expose clients to soil-borne organisms, so thorough handwashing is important, but the duration and technique stated are inaccurate.

C. Varicella-zoster virus (chickenpox) is contagious until all lesions have crusted over. Once lesions are fully crusted, the infected individual is no longer considered contagious, and exposure risk is significantly reduced. Therefore, visiting after crusting indicates understanding of infection control precautions.

D. Antibiotics are ineffective against viral infections. Taking antibiotics for viral illnesses contributes to antibiotic resistance and unnecessary medication exposure. Viral infections should be managed with supportive care unless a secondary bacterial infection is diagnosed.