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."
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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Related Questions
Correct Answer is C
Explanation
A. Provide names of support groups: While support groups can offer emotional and educational support, they do not address the immediate financial barrier to obtaining necessary medications.
B. Schedule an annual physical examination: Regular check-ups are important, but they do not directly address the issue of medication affordability and access to care.
C. Refer the patient to a free clinic: Free clinics often provide low-cost or no-cost medications and healthcare services, which can help the patient access the necessary treatments and follow-up care.
D. Refer the patient for financial assistance: Financial assistance programs can be helpful, but they might take time to apply and be approved. Immediate referral to a free clinic can provide more immediate support.
Correct Answer is D
Explanation
A. Place three pillows between the legs, one distal and three proximal: This is incorrect and excessive. Using three pillows in this manner can lead to improper leg positioning and discomfort.
B. Side-lying position is permitted with a pillow between the legs: While side-lying is allowed, the pillow is to prevent adduction of the legs, not just any pillow placement. It must specifically keep the hips aligned.
C. Sitting in a bedside chair is permitted if the legs are elevated: While sitting is often encouraged, elevating the legs too high can risk hip dislocation or improper alignment. The patient should sit in a way that maintains proper hip angles and alignment.
D. A triangular pillow is used between the legs to avoid adduction: A triangular or abduction pillow helps keep the legs in an appropriate position, preventing the legs from crossing and reducing the risk of hip dislocation post-surgery.
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