Hypertension Management

A nurse in a provider’s office is caring for a 55-year-old male client who is being evaluated for response to prescribed antihypertensive and lipid-lowering medications.

Complete the following sentence by using the list of options.
The nurse is evaluating the client’s response to the prescribed medications. The client’s

and
indicate an improvement in the client’s condition.

Answer and Explanation

The Correct Answer is {"dropdown-group-1":"E","dropdown-group-2":"E"}

The nurse is evaluating the client’s response to the prescribed medications. The client’s HDL level and blood pressure indicate an improvement in the client’s condition.

Rationale for correct answers:

HDL level (High-Density Lipoprotein):
HDL is the "good" cholesterol that helps remove excess cholesterol from blood vessels. Normal target HDL is >45 mg/dL in men. The client’s HDL increased from 25 mg/dL to 60 mg/dL, reflecting significant improvement in lipid profile, indicating effective response to lipid-lowering therapy.

Blood pressure:
The client’s blood pressure decreased from 180/88 mm Hg (stage 2 hypertension) to 138/70 mm Hg, which is much closer to the recommended target of <140/90 mm Hg for general hypertension control. This reflects a positive response to antihypertensive treatment.

Rationale for incorrect options:

A. Potassium level:
Today's potassium is 5.3 mEq/L, slightly above the normal range (3.5–5.0 mEq/L). Although not yet critical, this mild hyperkalemia may warrant monitoring, especially if the patient is on potassium-sparing agents like ACE inhibitors or ARBs.

B. Weight:
The client’s weight increased from 86 kg to 90 kg, which is not desirable. Weight gain can negatively impact both blood pressure and lipid control. Ideally, weight should decrease or remain stable.

C. Heart rate:
The heart rate dropped from 96/min to 58/min. While not necessarily dangerous, a low heart rate (bradycardia) could be a side effect of certain antihypertensives (e.g., beta-blockers). It's not a direct indicator of improved cardiovascular health.

D. Pulse oximetry:
Oxygen saturation changed slightly from 97% to 95%, both within normal limits (normal is >94%). No respiratory complaints are present, so this change is not clinically significant.

F. Pedal findings:
No peripheral edema is noted, but this is a neutral finding rather than an improvement. The absence of edema is expected in a stable patient and does not directly reflect medication effectiveness.

Take-home points:

Improved HDL and blood pressure are key indicators of effective antihypertensive and lipid-lowering therapy.
Slightly elevated potassium may suggest medication side effects and requires monitoring.
Weight gain may counteract benefits of therapy and should be addressed in lifestyle counseling.
Bradycardia and mild hyperkalemia should prompt review of medication types and dosages.

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Correct Answer is B

Explanation

Choice A rationale

Alteplase (tPA) is a thrombolytic agent, meaning it dissolves existing blood clots by activating plasminogen to form plasmin, which then breaks down fibrin. It is used to treat acute thrombotic events like pulmonary embolism or ischemic stroke, but it is not typically used for prophylactic prevention of DVT due to its significant bleeding risk.

Choice B rationale

Enoxaparin is a low molecular weight heparin (LMWH). It exerts its anticoagulant effect primarily by potentiating the action of antithrombin on Factor Xa, thereby inhibiting the coagulation cascade. LMWHs are highly effective and commonly used for the prophylactic prevention of deep vein thrombosis following orthopedic surgeries, including total knee replacement, due to their predictable pharmacokinetics.

Choice C rationale

Warfarin is an oral anticoagulant that works by inhibiting vitamin K epoxide reductase, an enzyme necessary for the synthesis of vitamin K-dependent clotting factors (II, VII, IX, X). While effective for long-term anticoagulation, its delayed onset of action and need for frequent INR monitoring make it less suitable for immediate postoperative DVT prophylaxis compared to LMWHs.

Choice D rationale

Clopidogrel is an antiplatelet agent that works by selectively inhibiting the binding of adenosine diphosphate (ADP) to its receptor on platelet surfaces, thereby preventing platelet activation and aggregation. It is used to prevent arterial thrombotic events like myocardial infarction and stroke, but it is not the primary medication for preventing venous thromboembolism such as DVT.

A. White blood cell count B. Upper respiratory infection C. Breath sounds D. Hemoglobin E. Oxygen saturation F. Retractions G. Respiratory rate H. Skin assessment

Correct Answer is ["A","B","E","F","G","H"]

Explanation

A. White blood cell count – The WBC is elevated at 15,000/mm³, which is above the normal range for children (5,000–10,000/mm³). In a child with leukemia, this could indicate infection or relapse.
B. Upper respiratory infection – A 2-month unresolved URI in an immunocompromised child (history of leukemia) is concerning and requires further evaluation.
E. Oxygen saturation – The child’s SpO₂ dropped to 92%, indicating possible respiratory compromise, especially in the context of retractions and increasing respiratory rate.
F. Retractions – Subcostal retractions are a sign of increased work of breathing and may indicate respiratory distress.
G. Respiratory rate – The child’s respiratory rate increased from 22 to 30/min, which is tachypnea for a 10-year-old, and in combination with other signs, indicates worsening status.
H. Skin assessment – The child has bruising and petechiae, which are abnormal findings and could suggest thrombocytopenia or leukemia relapse.

❌ Rationale for Incorrect Answers:

C. Breath sounds – The child has clear breath sounds, so this is a normal finding and does not need to be reported urgently.
D. Hemoglobin – The level is 10 g/dL, which is low-normal for a child and not critical on its own, though it should be monitored.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a postoperative client following a total knee replacement. Which of the following medications should the nurse anticipate the provider to prescribe to prevent the formation of a deep vein thrombosis (DVT)?

Correct Answer is B

Explanation

Correct Answer is ["A","B","E","F","G","H"]

Explanation

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