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

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.

A. The client is obese and has been exercising for 20 minutes per day twice each week. B. The client has reduced sodium intake from 5 grams per day to 3.5 grams per day. C. The client drinks 1 to 2 glasses of wine with dinner a few nights per week. D. The client has reduced smoking cigarettes from 2 packs per day to 1.5 packs per day.

Correct Answer is A

Explanation

Choice A rationale

Obesity and minimal exercise contribute significantly to hypertension due to increased vascular resistance and poor cardiac health. Recommendations for hypertension management include regular physical activity at least 30 minutes daily, five times per week. Current exercise efforts are insufficient, indicating a need for intervention to optimize blood pressure reduction.

Choice B rationale

Sodium intake reduction to 3.5 grams daily is an improvement but still exceeds the recommended limit of 2.3 grams. Excess sodium contributes to hypertension by increasing fluid retention and vascular resistance, though this change alone does not prioritize follow-up over sedentary behavior, which has a larger impact.

Choice C rationale

Alcohol consumption can elevate blood pressure by affecting vascular tone and increasing sympathetic nervous system activity. While 1-2 glasses per day may be within moderation, prioritizing increased physical activity would have a greater benefit on hypertension management than reducing alcohol intake alone.

Choice D rationale

Reducing cigarette smoking from 2 packs to 1.5 packs per day lowers nicotine exposure but still significantly contributes to hypertension through vasoconstriction and arterial damage. Exercise intervention is more impactful for cardiovascular health and blood pressure management in this context.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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

The nurse is evaluating a client at a one-month check-up who is being treated for hypertension through lifestyle modifications.Which of the following findings would be a priority for the nurse to follow up?

Correct Answer is A

Explanation

The nurse has taught nutrition management for a client diagnosed with oxalate kidney stones.Which of the following food choices by the client would indicate that the client requires more teaching?

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?

The nurse is caring for a client after receiving extracorporeal shock wave lithotripsy (ESWL). Which of the following actions should the nurse take?

The nurse is performing a health screening for a client at a local clinic and the client states, "I have noticed changes in my vision recently and I have also had some bad headaches.”. Which of the following actions should be a priority for the nurse to take?

The nurse is assessing a client suspected of having peripheral artery disease (PAD) in the legs.Which of the following findings should the nurse expect during the assessment?

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?

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 taking prescribed oxybutynin chloride.Which of the following statements by the client would indicate a correct understanding of the teaching?