A patient’s blood pressure is 118/82 mm Hg. He asks the nurse, “What do the numbers mean?” What is the nurse’s best reply?

Choice A reason: Herniated brainstem causes bilateral pupil changes and severe neurological signs, not unilateral dilation. Unilateral pupil dilation suggests increased intracranial pressure, so this is incorrect for these findings.

Choice B reason: Unilateral pupil dilation and nonreactivity, as seen in the right pupil, indicate increased intracranial pressure, often from mass effect compressing the oculomotor nerve. This is critical, making it the correct finding.

Choice C reason: Subdural hemorrhage may cause pressure but isn’t specific to these pupil changes. Unilateral dilation points to increased intracranial pressure as the immediate concern, so this is less precise.

Choice D reason: Cerebral edema contributes to pressure but is a broader term. Unilateral pupil dilation specifically suggests increased intracranial pressure, a more immediate and precise diagnosis, so this is incorrect.

Choice A reason: Telling the patient not to worry dismisses their concern and provides no educational value. Inguinal hernias, while common in older men, require explanation and monitoring, as they can lead to complications like incarceration, making this an inappropriate response.

Choice B reason: An inguinal hernia is a protrusion of bowel or tissue through a weak spot in the abdominal wall, typically in the inguinal canal. This accurate explanation addresses the patient’s question, describing the condition’s pathophysiology clearly, making it the correct response.

Choice C reason: Inguinal hernias are typically acquired due to abdominal wall weakness or increased intra-abdominal pressure, not prenatal growth abnormalities. Congenital hernias (e.g., indirect inguinal) are less common in adults, making this an inaccurate explanation for the patient’s condition.

Choice D reason: Referring the patient back to the physician avoids the nurse’s responsibility to educate. Nurses are equipped to explain diagnoses like hernias in simple terms, and deferring entirely does not address the patient’s immediate need for understanding, making this less optimal.