JH is a 67-year-old male who presents to the clinic with complaints of dizziness and lightheadedness upon standing. His blood pressure is 140/80 mmHg while sitting but drops to 115/70 mmHg upon standing His past medical history includes type 2 diabetes, hypertension, myocardial infarction (heart attack) at age 63, arthritis, two falls in the past year, and hyperlipidemia. His current medications include: Lantus 50 units at bedtime, amlodipine 5 mg daily, metoprolol succinate 50 mg daily, atorvastatin 40 mg nightly, and aspirin 81 mg daily. He reports starting vitamin D3 5,000 unit capsules two weeks ago based on his wife's recommendation. His symptoms are consistent with
Arthritis pain
Low vitamin D levels
Previous falls in the past year
Orthostatic hypotension
The Correct Answer is D
A. Arthritis pain: Arthritis typically causes joint stiffness, pain, and reduced mobility rather than acute changes in blood pressure with position changes. It does not produce dizziness or lightheadedness specifically associated with standing. These symptoms point toward a cardiovascular or autonomic cause rather than musculoskeletal pain.
B. Low vitamin D levels: Vitamin D deficiency is associated with bone pain, muscle weakness, and increased fracture risk. It does not cause acute postural blood pressure drops or positional dizziness. Recent vitamin D supplementation is unlikely to explain the described hemodynamic changes.
C. Previous falls in the past year: A history of falls is a risk factor and possible consequence of balance or blood pressure abnormalities, but it is not a diagnosis. Falls do not explain the current positional symptoms or documented drop in blood pressure upon standing.
D. Orthostatic hypotension: Orthostatic hypotension is defined by a significant drop in blood pressure when moving from sitting to standing, leading to dizziness or lightheadedness. The client’s blood pressure change meets diagnostic criteria and is likely exacerbated by antihypertensive medications and age-related autonomic dysfunction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Bulging vein disorder: This is not a recognized medical diagnosis and does not describe a specific pathophysiologic condition. Visible neck veins require interpretation within established cardiovascular assessment frameworks.
B. Jugular vein distension: Jugular vein distension occurs when elevated right atrial pressure causes venous blood to back up into the jugular veins. In heart failure exacerbations, increased central venous pressure leads to visible neck vein enlargement, especially when the client is supine. A measurement greater than 4 cm supports this finding.
C. Increased neck pressure: This is a nonspecific descriptive phrase rather than a clinical diagnosis. It does not identify the underlying cardiovascular mechanism responsible for venous engorgement.
D. Jugular vein stenosis: Jugular vein stenosis refers to narrowing of the vein, which would reduce venous flow rather than cause visible distension. It is not associated with heart failure–related volume overload.
Correct Answer is D
Explanation
A. Normalize fears: Acknowledging and validating adolescents’ concerns about medications, side effects, or procedures helps build trust and reduces anxiety. This approach encourages openness and promotes adherence.
B. Use age-appropriate language: Communicating in a manner that matches the adolescent’s cognitive and emotional development ensures understanding. Avoiding overly technical jargon or overly simplistic explanations improves engagement and retention of information.
C. Offer other forms of medications when possible: Providing alternatives such as liquids, chewables, or smaller doses can accommodate swallowing difficulties, taste preferences, or lifestyle considerations, enhancing adherence and comfort.
D. All of the above: Combining normalization of fears, age-appropriate language, and flexible medication options creates a comprehensive communication strategy. This approach strengthens rapport, encourages questions, and supports safe and effective medication use in adolescents.
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