The nurse is evaluating the blood pressure for a client with hypertension who is taking a prescribed diuretic, an angiotensin-converting enzyme (ACE) inhibitor, and an angiotensin II receptor blocker (ARB). The client's first blood pressure is 145/92 mm Hg and the second measurement obtained is 150/89 mm Hg. Which of the following actions should the nurse take first?

Explain that the client should return in one month to be reevaluated.

Assess the client's adherence to lifestyle modifications and medication therapy.

Explain to the client that the health care provider will increase the dose of one of the medications already prescribed.

Discuss adding a prescribed calcium-channel blocker to the client's medication regimen.

Answer and Explanation

The Correct Answer is B

Choice A rationale

Delaying follow-up without immediate intervention may result in the client's blood pressure remaining uncontrolled, increasing the risk of complications like cardiovascular events. Reevaluation in one month without assessing adherence neglects the urgent need for optimizing management.

Choice B rationale

Assessing adherence to both lifestyle modifications and medication therapy is crucial as noncompliance may explain the suboptimal blood pressure control. Ensuring adherence and addressing any barriers are necessary steps in evaluating the effectiveness of treatment.

Choice C rationale

Increasing medication dosage without first assessing the client's adherence to current prescriptions or lifestyle modifications may be premature. Nonadherence to therapy could render dosage adjustments ineffective, leading to unnecessary changes to the regimen.

Choice D rationale

Adding a calcium-channel blocker without assessing adherence disregards the importance of compliance. Treatment should be optimized based on existing therapy before considering additional pharmacological interventions. .

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Correct Answer is D

Explanation

Choice A rationale

Chronic renal failure results in decreased erythropoietin production, leading to anemia due to poor red blood cell production, not the vitamin B12 deficiency seen in pernicious anemia. Pernicious anemia specifically results from the lack of intrinsic factor causing B12 deficiency.

Choice B rationale

Pregnancy may cause iron-deficiency anemia due to increased iron demands, not pernicious anemia. Pernicious anemia stems from intrinsic factor deficiency, unrelated to pregnancy physiology. Iron supplementation is required in pregnancy-induced anemia, not B12.

Choice C rationale

A high-fat, high-protein diet does not inherently affect vitamin B12 absorption. Pernicious anemia results from the deficiency of intrinsic factor or issues with B12 absorption, not dietary composition. This individual is not at increased risk based on diet alone.

Choice D rationale

Gastric bypass surgery can disrupt intrinsic factor secretion due to altered gastric mucosa. Intrinsic factor is essential for vitamin B12 absorption in the ileum, and its deficiency directly contributes to the development of pernicious anemia in post-gastric bypass patients. .

A. Edema of the lower extremities. B. Pulmonary crackles auscultated. C. Ascites. D. Jugular vein distention.

Correct Answer is B

Explanation

Choice A rationale

Lower extremity edema is often associated with right-sided heart failure rather than left ventricular failure. Right-sided failure leads to systemic venous congestion, causing fluid accumulation in peripheral tissues like the legs. Left ventricular failure predominantly affects pulmonary circulation, making edema of the lower extremities a less expected finding.

Choice B rationale

Pulmonary crackles are a hallmark finding in left ventricular failure due to fluid accumulation in the alveoli. This occurs because reduced cardiac output causes blood to back up into pulmonary veins and capillaries, increasing hydrostatic pressure and leading to pulmonary congestion. Crackles indicate the presence of interstitial or alveolar fluid, a direct result of left-sided dysfunction.

Choice C rationale

Ascites results from portal hypertension and systemic venous congestion, typically seen in right-sided heart failure or advanced liver disease. Left ventricular failure impacts the pulmonary system rather than the abdominal cavity, making ascites an unlikely finding during assessment for this condition.

Choice D rationale

Jugular vein distention is indicative of systemic venous congestion caused by right-sided heart failure. In left ventricular failure, pulmonary congestion dominates, and jugular vein distention is not a primary finding. Assessments should focus on symptoms directly linked to pulmonary effects such as crackles or dyspnea.

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Naxlex Comprehensive Predictor Exams

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?

Correct Answer is D

Explanation

The nurse is assessing a newly admitted client diagnosed with left ventricular failure.Which of the following findings should the nurse expect during the assessment?

Correct Answer is B

Explanation

The nurse is caring for a client with thrombocytopenia whose platelet level is 18,000/mm³. Which of the following assessment findings should the nurse expect?

The nurse is explaining to a client diagnosed with heart failure that the client's heart muscle has thickened on the right side and is not able to fill properly. The nurse is explaining which of the following types of heart failure?

The nurse is caring for a client who has thrombocytopenia.Which of the following will the nurse administer for this disorder?

The nurse has taught a client with urinary incontinence about managing the problem.Which of the following statements by the client would indicate the need for more teaching?

The nurse is evaluating the outcomes for a client who is being treated for iron deficiency anemia.Which of the following findings would indicate that the treatment is effective?

The nurse is caring for a client diagnosed with secondary immune thrombocytopenic purpura (ITP). The nurse should expect the client to be tested for which of the following possible causes?

The nurse is planning care for a female client with a lower urinary tract infection (UTI). Which of the following interventions should be the priority for the nurse to include in the client's plan of care?