The nurse is assisting a client diagnosed with hypertension with menu selection. Which items should the nurse suggest?

Choice A reason: This is not the best nursing action. Documenting the pulse rate and administering the medications as prescribed may be harmful to the client. Atenolol and diltiazem are both medications that lower the blood pressure and the heart rate. Atenolol is a beta blocker that blocks the effects of adrenaline on the heart and blood vessels. Diltiazem is a calcium channel blocker that relaxes the muscles of the heart and blood vessels. Giving both medications to a client who already has a low and irregular heart rate may cause further bradycardia, which is a heart rate below 60 beats/minute, or arrhythmia, which is an abnormal heart rhythm. The nurse should check the parameters and the contraindications for the medications before administering them.

Choice B reason: This is not the best nursing action. Assessing for chest pain and administering atenolol if pain free may not be appropriate for the client. Chest pain can be a sign of angina or myocardial infarction, which are conditions where the blood flow to the heart is reduced or blocked. Atenolol can help relieve chest pain by reducing the oxygen demand of the heart, but it can also lower the heart rate and the blood pressure. The client already has a low and irregular heart rate, which may indicate a problem with the electrical conduction of the heart. The nurse should not give atenolol without checking the pulse rate and the blood pressure, and consulting the health care provider.

Choice C reason: This is the best nursing action. Holding the atenolol and administering the diltiazem is the most appropriate for the client. Atenolol can lower the heart rate and the blood pressure, which may worsen the client's condition. The nurse should hold the atenolol and notify the health care provider of the client's pulse rate and rhythm. Diltiazem can also lower the heart rate and the blood pressure, but it can also help regulate the heart rhythm by slowing down the electrical impulses in the heart. The nurse should administer the diltiazem as prescribed, and monitor the client's vital signs and cardiac status.

Choice D reason: This is not the best nursing action. Withholding the medications and reassessing the heart rate in 30 minutes may delay the treatment and the care of the client. The client has a low and irregular heart rate, which may indicate a serious cardiac problem that needs immediate attention. The nurse should not wait for 30 minutes to reassess the heart rate, but rather act promptly and notify the health care provider. The nurse should also administer the diltiazem as prescribed, unless there is a specific reason to withhold it.

Choice A reason: This is the correct answer. Stool for occult blood is a diagnostic test that detects the presence of hidden blood in the feces. This can indicate bleeding in the gastrointestinal tract, which is the most common cause of chronic iron deficiency anemia. Iron deficiency anemia is a condition where the body does not have enough iron to produce hemoglobin, the protein that carries oxygen in the red blood cells.

Choice B reason: Vitamin B12 level is not the diagnostic test that is used to detect the most common cause of chronic iron deficiency anemia. Vitamin B12 level is a blood test that measures the amount of vitamin B12 in the body. Vitamin B12 is a nutrient that is essential for the production of red blood cells and the maintenance of the nervous system. Vitamin B12 deficiency can cause pernicious anemia, a type of megaloblastic anemia where the red blood cells are large and immature.

Choice C reason: Schilling's test is not the diagnostic test that is used to detect the most common cause of chronic iron deficiency anemia. Schilling's test is a urine test that evaluates the absorption of vitamin B12 in the body. It involves giving the client an oral dose of radioactive vitamin B12 and an intramuscular injection of non-radioactive vitamin B12. The urine is then collected and measured for the amount of radioactive vitamin B12. Schilling's test can help diagnose pernicious anemia and other causes of vitamin B12 malabsorption.

Choice D reason: Bone marrow aspiration study is not the diagnostic test that is used to detect the most common cause of chronic iron deficiency anemia. Bone marrow aspiration study is a procedure that involves taking a sample of bone marrow from the hip or sternum and examining it under a microscope. Bone marrow is the soft tissue inside the bones that produces blood cells. Bone marrow aspiration study can help diagnose various blood disorders, such as leukemia, lymphoma, and aplastic anemia.