The nurse is obtaining a health history from a client with a blood pressure of 146/88 mm Hg. The client states that lifestyle changes have not been effective in lowering blood pressure. Which medication classification does the nurse anticipate first?

A. Thiazide diuretic: Thiazide diuretics are often the first-line pharmacologic treatment for stage 1 hypertension when lifestyle changes alone are ineffective. They reduce blood volume and peripheral resistance, effectively lowering blood pressure.
B. ACE inhibitors: ACE inhibitors are commonly used, especially in clients with diabetes or heart failure, but they are generally considered after thiazide diuretics unless there is a compelling comorbidity.
C. Calcium channel blocker: These are also used to manage hypertension, particularly in older adults or those with certain cardiovascular risks, but not typically as the first step without other indications.
D. Beta-blocker: Beta-blockers are not usually first-line for uncomplicated hypertension. They are more appropriate when there are concurrent conditions like heart failure, arrhythmias, or post-MI care.

A. "I will receive chemotherapy until most of the cancer is gone, and then I will get my own stem cells back.": This correctly describes the autologous transplant process, where the client receives high-dose chemotherapy followed by reinfusion of their own previously harvested stem cells. This approach avoids donor-related complications.
B. "I hope they find a bone marrow donor who matches.": This indicates a misunderstanding, an autologous transplant uses the client’s own stem cells, not donor cells. Mentioning a donor implies confusion with an allogeneic transplant and signals the need for further teaching.
C. "I will need to be in protective isolation for up to 3 months after treatment.": This is accurate because high-dose chemotherapy destroys immune cells, leaving the client highly susceptible to infection. Protective isolation helps reduce the risk of life-threatening opportunistic infections during recovery.
D. "The doctor will remove cells from my bone marrow before beginning chemotherapy.": This statement aligns with the autologous transplant protocol. Stem cells are collected before chemotherapy begins to preserve them for later reinfusion, once the high-dose treatment is complete.