The client diagnosed with primary hypertension states, "I don't know why the doctor is worried about my blood pressure. I am feeling just fine." Which statement by the nurse would be the most appropriate response?

Your blood pressure reflects how strong your heart muscle contracts."

"If you feel good your medication is working properly"

"Even if you are feeling good, damage can occur to your heart and kidneys."

"Have you told your doctor that you are feeling good?"

Answer and Explanation

The Correct Answer is C

A. Your blood pressure reflects how strong your heart muscle contracts: This statement oversimplifies the complexities of blood pressure and doesn't directly address the client's misunderstanding about the implications of hypertension.

B. "If you feel good your medication is working properly": While this may be true, it fails to convey the importance of monitoring blood pressure, regardless of symptoms. It might lead the client to believe that feeling well means there are no health concerns.

C. "Even if you are feeling good, damage can occur to your heart and kidneys": This response is the most appropriate as it emphasizes that hypertension can cause silent damage over time, even in the absence of symptoms. It educates the client about the potential long-term consequences of uncontrolled hypertension.

D. "Have you told your doctor that you are feeling good?": While it encourages communication, it does not provide useful information or address the client’s misconceptions about hypertension and its risks.

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Correct Answer is D

Explanation

A. Encourage oral fluids: While hydration is important, it is not the most immediate concern following the administration of prazosin.

B. Record the client's weight: Weight monitoring is not specifically indicated after the initial dose of prazosin and is not a priority action in this context.

C. Take a pulse oximetry reading: While monitoring oxygen saturation is important in many situations, it is not directly related to the administration of prazosin, which primarily affects blood pressure.

D. Place the call bell in reach of the client: This is the most appropriate action. Prazosin can cause orthostatic hypotension, particularly after the first dose, leading to dizziness or fainting. Ensuring that the call bell is within reach allows the client to request help if they feel lightheaded or need assistance.

A. Withhold the dose and reassess the blood pressure in 30 minutes B. Administer the medication and notify the healthcare provider of the blood pressure C. Administer the dose and continue to monitor the vital signs D. Call the healthcare provider to obtain an order for oral furosemide

Correct Answer is A

Explanation

A) Withhold the dose and reassess the blood pressure in 30 minutes: Given that the client's blood pressure is 90/60, which indicates hypotension, withholding the furosemide is the safest initial action. Administering a diuretic in the context of low blood pressure could exacerbate the hypotensive state, potentially leading to further complications. It is prudent to reassess the blood pressure before proceeding with the medication.

B) Administer the medication and notify the healthcare provider of the blood pressure: Administering furosemide despite the hypotensive reading may pose significant risks to the client. While notifying the healthcare provider is important, the immediate priority should be to ensure the client's safety by withholding the medication until the blood pressure can be reassessed.

C) Administer the dose and continue to monitor the vital signs: This approach is not advisable due to the low blood pressure. Administering the medication without addressing the hypotension could lead to a further drop in blood pressure and increase the risk of adverse effects such as dizziness or syncope.

D) Call the healthcare provider to obtain an order for oral furosemide: While oral furosemide may be a reasonable alternative, the priority is to manage the client's current hypotensive state. The immediate action should focus on reassessing the blood pressure and ensuring the client is stable before considering alternative routes of medication administration.

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The client diagnosed with primary hypertension states, "I don't know why the doctor is worried about my blood pressure. I am feeling just fine." Which statement by the nurse would be the most appropriate response?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse administers the first dose of prazosin 1 mg PO to a client. Which nursing action is most appropriate following the administration of this medication?

Correct Answer is D

Explanation

The nurse obtains a prescription for furosemide 40 mg IV for a client who has pulmonary congestion as the result of fluid volume overload. The nurse assesses the vital signs to be T-98.6, P-110, RR-24 and BP-90/60. What is the most appropriate action at this time?

Correct Answer is A

Explanation

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