During a health screening, a patient's blood pressure is confirmed by two clinic nurses to be 220/120 mm Hg. Which of the following actions should the nurse recommend to the patient?

“Take off work for the rest of the day to rest at home."

"Return to work and have your blood pressure rechecked in 2 days."

"Take two doses of blood pressure medication right now."

"Sit quietly while we call 911 to request an ambulance."

Answer and Explanation

The Correct Answer is D

A. “Take off work for the rest of the day to rest at home.": This advice is not adequate for such a high blood pressure reading, which indicates a hypertensive crisis that requires immediate medical intervention.
B. "Return to work and have your blood pressure rechecked in 2 days.": This is inappropriate as it delays necessary urgent medical evaluation and treatment.
C. "Take two doses of blood pressure medication right now.": Without medical supervision, this could be dangerous and is not appropriate in an emergency situation where the blood pressure is critically high.
D. "Sit quietly while we call 911 to request an ambulance.": A blood pressure of 220/120 mm Hg suggests a hypertensive emergency, which can lead to life-threatening complications like stroke or heart attack. The patient needs immediate medical attention, and calling 911 is the appropriate response.

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Correct Answer is A

Explanation

A. Uric acid: Elevated uric acid levels are the hallmark of gout and are used to monitor and diagnose the condition. Managing uric acid levels is crucial to prevent gout attacks.
B. Blood urea nitrogen: This is more related to kidney function and not directly relevant to gout.
C. Creatinine: Also related to kidney function. While kidney function is important in gout patients, uric acid levels are more directly related to gout management.
D. Cholesterol: High cholesterol is a cardiovascular risk but is not directly related to gout. Monitoring cholesterol is important but not the primary focus for gout management.

A. Has the patient been taking his medications as prescribed? B. Does the patient hurt anywhere else? C. When does the patient take his furosemide? D. Has the patient fallen before?

Correct Answer is D

Explanation

Has the patient been taking his medications as prescribed? This is the most important information to collect. Understanding the patient's medication adherence is crucial because if the patient is not taking his medications as prescribed, it could explain why his blood pressure is elevated. Noncompliance with medication regimens is a common cause of hypertensive urgency and can lead to severe complications. Therefore, knowing whether he has been taking his medications regularly and correctly would directly influence the management plan and help identify the cause of the current crisis.

Does the patient hurt anywhere else? While it’s important to assess for pain and discomfort to address immediate symptoms, this information does not directly address the potential cause of the elevated blood pressure. The patient already reported pain in the head, chest, and left leg, so the primary concern is managing his hypertensive urgency and understanding its underlying causes rather than identifying additional pain locations at this moment.

When does the patient take his furosemide? Knowing the timing of furosemide intake could provide insights into his diuretic therapy management and its potential impact on his blood pressure. However, it is less immediately relevant than understanding whether he has been taking all his medications as prescribed. This question might be more pertinent once medication adherence is confirmed to understand diuretic effects throughout the day.

Has the patient fallen before? This is relevant for assessing the risk of recurrent falls and potential underlying issues such as orthostatic hypotension or balance problems, which are crucial for long-term management and safety. However, it is not as immediately critical in the context of the current hypertensive urgency and the elevated blood pressure despite medication.

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During a health screening, a patient's blood pressure is confirmed by two clinic nurses to be 220/120 mm Hg. Which of the following actions should the nurse recommend to the patient?

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