The nurse is assessing four clients at the neighborhood clinic.
Which of these clients should the nurse identify to be at risk for the development of pernicious anemia?

Choice A rationale

Restricting sodium intake is essential as high sodium levels can increase fluid retention, leading to elevated blood pressure. A low-sodium diet reduces the workload on blood vessels and decreases the risk of cardiovascular complications associated with hypertension. The recommended sodium intake for adults should be less than 2,300 mg per day, and ideally closer to 1,500 mg daily for optimal blood pressure control.

Choice B rationale

Hypertension can lead to damage to the small blood vessels in the retina, resulting in hypertensive retinopathy. Stressing ophthalmic care ensures early detection and management of vision changes that may be indicative of ongoing vascular damage. Regular ophthalmologic evaluation aids in preventing irreversible vision loss and allows better management of systemic hypertension's effects on ocular health.

Choice C rationale

Increasing the intake of fruits and vegetables provides essential nutrients such as potassium, magnesium, and dietary fiber. Potassium helps counteract the effects of sodium and relaxes blood vessel walls, lowering blood pressure. The DASH diet, rich in fruits and vegetables, is widely recommended for individuals with hypertension to promote cardiovascular health and regulate blood pressure.

Choice D rationale

Taking prescribed medications as ordered ensures consistent management of blood pressure and prevention of complications such as stroke, heart attack, and kidney damage. Antihypertensive medications, including ACE inhibitors, beta-blockers, or diuretics, work through various mechanisms to lower blood pressure. Adherence prevents fluctuations and maintains target levels of less than 140/90 mmHg.

Choice E rationale

Not taking medication when blood pressure is less than 140/90 mmHg is incorrect because hypertension management requires consistent medication to maintain target levels and prevent rebound hypertension. Abrupt discontinuation can lead to complications such as severe hypertensive episodes and organ damage. Regular monitoring is crucial to guide therapy adjustments safely.

Choice A rationale

Waiting one month before reevaluating blood pressure may overlook potential adherence issues or medication effects. Hypertension requires timely intervention because consistently high values can lead to complications such as stroke or heart attack. The readings of 145/92 mm Hg and 150/89 mm Hg are above the normal range (<120/80 mm Hg), necessitating immediate review of possible contributing factors rather than postponing evaluation.

Choice B rationale

Adherence to lifestyle modifications and prescribed therapies directly affects blood pressure control. Factors such as diet, exercise, and medication compliance significantly influence systolic and diastolic values. Poor adherence can lead to inadequate control of hypertension, which is evident in the readings of 145/92 mm Hg and 150/89 mm Hg. Exploring adherence helps identify reasons for high readings and can guide targeted interventions.

Choice C rationale

Increasing medication dosage without first reviewing adherence overlooks potential causes of suboptimal control such as missed doses, incorrect timing, or lifestyle factors. Adjusting doses may lead to overtreatment, causing complications like hypotension. Addressing adherence first ensures interventions are appropriate and prevents unnecessary medication changes.

Choice D rationale

Adding a calcium-channel blocker involves modifying therapy without investigating adherence to current medications and lifestyle changes. Such an approach risks complicating the treatment plan unnecessarily. It is scientifically prudent to first evaluate the effectiveness of existing treatments through adherence assessments, ensuring interventions are tailored to the individual's needs.