A nurse sustained a needlestick injury from a patient whose human immunodeficiency virus (HIV) status was unknow. The nursing supervisor is notified, an incident report is generated, and a post-HIV exposure prophylaxis checklist is started for this nurse. Which implementation will be the first to perform?

Answer: D

Rationale:

A) A renal ultrasound: A renal ultrasound is not typically used to confirm a diagnosis of hypertension. While renal artery stenosis can contribute to hypertension in some cases, it is not the primary diagnostic test for hypertension.

B) A cardiac stress test: A cardiac stress test is not used to confirm a diagnosis of hypertension. It is primarily used to assess cardiovascular function and detect coronary artery disease or cardiac arrhythmias.

C) A manual blood pressure cuff: While manual blood pressure measurements can provide accurate readings, they are subject to potential inaccuracies due to factors such as observer bias and white coat syndrome. Therefore, they may not be the most reliable method for confirming a diagnosis of hypertension.

D) Ambulatory blood pressure measurement: Ambulatory blood pressure measurement involves obtaining multiple blood pressure readings over a 24-hour period using a portable monitor. It is considered the gold standard for diagnosing hypertension, as it provides a more comprehensive assessment of blood pressure variability and reduces the impact of white coat syndrome. Therefore, it is the preferred diagnostic test in this scenario to confirm whether the patient has hypertension outside of the clinical setting.

A. "I will take this medication at the same time each day": This statement demonstrates an understanding of the importance of consistency in medication administration, which is essential for maintaining therapeutic levels of warfarin in the bloodstream. Therefore, this statement does not indicate a need for further teaching.
B. "I will add a green leafy salad to my dinner today": This statement is concerning because warfarin interacts with vitamin K, which is abundant in green leafy vegetables. Increasing intake of vitamin K-rich foods, such as green leafy salads, can interfere with the anticoagulant effects of warfarin, potentially leading to ineffective treatment. The patient should be educated to maintain a consistent intake of vitamin K-containing foods to avoid fluctuations in warfarin effectiveness.
C. "I will avoid alcohol when I am taking warfarin": This statement demonstrates an understanding of the potential interactions between alcohol and warfarin. Alcohol can increase the risk of bleeding in individuals taking warfarin, so it is advisable to limit or avoid alcohol consumption while on this medication. Therefore, this statement does not indicate a need for further teaching.
D. "I will use an electronic shaver and a soft toothbrush": This statement reflects the patient's understanding of the precautions to minimize the risk of bleeding while taking warfarin. Using an electronic shaver and a soft toothbrush helps reduce the risk of cuts or injuries that could lead to bleeding, especially in individuals whose blood clotting ability may be compromised by warfarin therapy. Therefore, this statement does not indicate a need for further teaching.