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

Serum electrolyte analysis provides insights into fluid and electrolyte balance but does not specifically diagnose heart failure. Electrolyte changes may occur secondary to heart failure but are not definitive markers for the condition.

Choice B rationale

Complete blood count evaluates for anemia or infection, which may contribute to symptomatology but is not diagnostic for heart failure. Heart failure diagnosis focuses on cardiac-specific markers rather than hematologic parameters.

Choice C rationale

Blood urea nitrogen assesses renal function and reflects perfusion status but lacks specificity for heart failure. Although renal dysfunction may occur in advanced heart failure, BNP measurement is more definitive for cardiac assessment.

Choice D rationale

Brain natriuretic peptide (BNP) is a key diagnostic marker for heart failure. Elevated BNP levels occur due to ventricular stretch and strain associated with fluid overload, a hallmark of heart failure. Normal BNP levels are typically <100 pg/mL, with elevated levels strongly suggesting cardiac dysfunction. .

A. Low sodium, high calorie diet. B. Increase fluid intake of 3 to 4 L/day. C. Tamsulosin (Flomax) 0.4 mg p.o. daily. D. Morphine sulfate (Morphine) 2 mg IV every 4 hours PRN.

Correct Answer is D

Explanation

Choice A rationale

A low-sodium, high-calorie diet is not the priority for immediate management of renal colic. Nutritional changes are addressed as part of long-term care but do not alleviate acute pain and discomfort caused by obstruction or irritation in the urinary tract.

Choice B rationale

Increasing fluid intake of 3 to 4 L/day is beneficial for preventing stone formation and enhancing urinary output, but fluid intake changes alone do not address acute renal colic. The urgency lies in alleviating the pain and promoting ureteral relaxation.

Choice C rationale

Tamsulosin (Flomax) 0.4 mg p.o. daily relaxes smooth muscles in the ureter, aiding stone passage, but does not provide immediate pain relief. It is a supportive measure rather than a first-line intervention during acute renal colic.

Choice D rationale

Morphine sulfate (Morphine) 2 mg IV every 4 hours PRN is the correct choice, as it addresses severe pain due to renal colic by acting directly on opioid receptors to block pain transmission. Pain relief improves the client’s comfort and allows further management strategies.

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Naxlex Comprehensive Predictor Exams

The nurse is monitoring the results of laboratory tests for a client suspected of having heart failure.Which of the following tests would provide key diagnostic information for the nurse?

Correct Answer is D

Explanation

The nurse is reviewing the prescriptions for a client with severe pain from renal colic.Which of the following prescriptions should the nurse implement first?

Correct Answer is D

Explanation

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