The nurse is assessing a patient with chronic hypertension whose blood pressure has been 160/90 for the last three clinic visits. What new symptom indicates that the patient may be experiencing target organ damage?

Muscle cramps

Bounding pulses

Vision changes

Increased energy

Answer and Explanation

The Correct Answer is C

A. Muscle cramps: While muscle cramps can occur with hypertension, they are not specific indicators of target organ damage. Muscle cramps are more commonly associated with electrolyte imbalances or peripheral vascular disease.

B. Bounding pulses: Bounding pulses can indicate increased stroke volume and cardiac output, which may occur in response to chronic hypertension. However, they are not direct indicators of target organ damage.

C. Vision changes: Vision changes, such as blurred vision or vision loss, can be indicative of hypertensive retinopathy, a complication of chronic hypertension affecting the blood vessels in the retina. These changes may manifest as decreased visual acuity, floaters, or even sudden vision loss and are considered signs of target organ damage.

D. Increased energy: Increased energy is not typically associated with target organ damage in the context of chronic hypertension. It may be a result of various factors unrelated to hypertension, such as improved sleep quality or changes in lifestyle habits.

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Correct Answer is D

Explanation

A. Urinary retention: While urinary retention can occur in conditions such as benign prostatic hyperplasia or neurogenic bladder, it is not a typical manifestation of hypertensive emergency. Hypertensive emergencies primarily involve acute and severe elevations in blood pressure, which can lead to target organ damage, but urinary retention is not a direct consequence.

B. Headache: Headache is a common symptom associated with hypertension, especially during hypertensive emergencies. However, it is not specific to hypertensive emergencies and can occur in less severe cases of hypertension as well.

C. Jaundice: Jaundice is not a typical manifestation of hypertensive emergency. It is more commonly associated with liver dysfunction or hemolytic disorders rather than acute elevations in blood pressure.

D. Tachycardia: Tachycardia, or an elevated heart rate, is a hallmark sign of hypertensive emergency. When blood pressure rises significantly, the heart may respond by increasing its rate to maintain cardiac output. Tachycardia is indicative of the body's compensatory mechanisms in response to the acute hypertension and can be a sign of impending cardiovascular complications.

A. The partial thromboplastin time is 30 seconds B. The International normalized ratio is 6.0 C. Creatinine is 12 D. The patient's hematocrit level is 43%

Correct Answer is B

Explanation

A. The partial thromboplastin time is 30 seconds:

The partial thromboplastin time (PTT) measures the clotting time of blood and is typically used to monitor patients on heparin therapy, not warfarin. A PTT of 30 seconds is within the normal range and does not directly relate to warfarin therapy. Therefore, it does not require immediate follow-up in the context of warfarin administration.

B. The International normalized ratio is 6.0:

The International Normalized Ratio (INR) is a standard measure used to monitor the effectiveness of warfarin therapy. For most indications, the therapeutic range for INR is typically between 2.0 and 3.0. A value of 6.0 indicates that the patient's blood is taking six times longer to clot than normal, suggesting a significantly increased risk of bleeding. Therefore, this result requires immediate follow-up by the nurse to assess the patient's condition and potentially adjust warfarin dosage to reduce the risk of bleeding.

C. Creatinine is 12:

Creatinine is a waste product generated by muscle metabolism and is filtered out of the blood by the kidneys. Elevated levels of creatinine may indicate impaired kidney function, but this result does not directly relate to warfarin therapy. While an elevated creatinine level may require follow-up for other reasons, it does not necessitate immediate action related to warfarin therapy.

D. The patient's hematocrit level is 43%:

Hematocrit is a measure of the proportion of red blood cells in the blood. A hematocrit level of 43% is within the normal range for both men and women and does not directly relate to warfarin therapy. While changes in hematocrit may occur in some patients taking warfarin, this result alone does not require immediate follow-up in the context of warfarin administration.

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The nurse is assessing a patient with chronic hypertension whose blood pressure has been 160/90 for the last three clinic visits. What new symptom indicates that the patient may be experiencing target organ damage?

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