The nurse working at a community health fair is assessing risk factors for hypertension. Which client does the nurse recognize as having the greatest risk factor?
A 73-year-old adult client with asthma and glaucoma
An 80-year-old client with a family history of hypertension
A 36-year-old client who was just diagnosed with obstructive sleep apnea
A 45-year-old client with obesity and uncontrolled type 2 diabetes mellitus.
The Correct Answer is D
A. A 73-year-old adult client with asthma and glaucoma: Age is a non-modifiable risk factor for hypertension, but asthma and glaucoma are not primary drivers of systemic high blood pressure. While chronic steroid use for asthma could impact pressure, this client lacks the metabolic profile that confers the highest risk. This profile is less concerning than metabolic syndrome.
B. An 80-year-old client with a family history of hypertension: Advanced age and genetics are significant risk factors for the development of essential hypertension. However, these factors are often managed over decades and may be less volatile than acute metabolic disease. This client has risk but lacks the compounded metabolic stressors found in other candidates.
C. A 36-year-old client who was just diagnosed with obstructive sleep apnea: Sleep apnea is a known secondary cause of hypertension due to repeated nocturnal sympathetic surges. While significant, the risk in a 36-year-old without other comorbidities is generally lower than in those with multiple chronic metabolic conditions. This represents a single, albeit important, risk factor.
D. A 45-year-old client with obesity and uncontrolled type 2 diabetes mellitus: The combination of obesity and uncontrolled diabetes significantly accelerates vascular damage and activates the renin-angiotensin-aldosterone system. These comorbidities contribute to metabolic syndrome, which is the strongest predictor of severe cardiovascular disease and hypertension. The inflammatory state of diabetes causes profound endothelial dysfunction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. "This medication should be taken before going to bed.": HMG-CoA reductase inhibitors like simvastatin are most effective when administered in the evening. Most endogenous cholesterol synthesis occurs during the night while the patient is fasting. Timing the dose at bedtime ensures peak drug levels coincide with the body's highest rate of production.
B. "You should take these medications first thing in the morning on an empty stomach.": Administering statins in the morning reduces their efficacy because the peak plasma concentration occurs when cholesterol synthesis is at its lowest. Unlike some medications, simvastatin does not require an empty stomach for absorption. Morning dosing is generally avoided for statins with shorter half-lives.
C. "You should take this medication in the morning with your breakfast to prevent upset stomach.": While taking medication with food can reduce gastric irritation, the morning timing is pharmacologically suboptimal for simvastatin. Standard nursing practice emphasizes evening administration to maximize the inhibition of the cholesterol-producing enzyme. This instruction would decrease the overall therapeutic benefit.
D. "You should take this medication with your mid-day meal with food.": Mid-day dosing does not align with the circadian rhythm of hepatic cholesterol synthesis. For maximal lipid-lowering effects, the medication must be present during the nocturnal hours. Afternoon administration is not the standard of care for short-acting statin therapy.
Correct Answer is C
Explanation
A. "If I miss a dose of hy medication I can just double up the next day.": Doubling the dose of an anticoagulant like warfarin significantly increases the risk of life-threatening hemorrhage. Because warfarin has a narrow therapeutic index and a long half-life, sudden changes in dosing lead to unpredictable fluctuations in the INR. Patients should be instructed to take the missed dose as soon as remembered or skip it entirely as directed.
B. "I will eat broccoli and collard greens three times a week and I can have extra helpings to improve my iron intake.": Broccoli and collard greens are extremely rich in Vitamin K, which functions as the direct physiological antagonist to warfarin. Increasing the intake of these vegetables will lower the INR and render the anticoagulant therapy ineffective, increasing the risk of stroke. Patients must maintain a consistent, stable intake of Vitamin K rather than increasing it.
C. "I will need to get frequent blood work to check the INR level, that shows if this medication is at the right dose.": The International Normalized Ratio (INR) is the standardized laboratory measurement used to monitor the effectiveness of warfarin therapy. Regular testing is essential to ensure the patient remains within the target therapeutic range, usually between 2 and 3 for atrial fibrillation. This statement confirms the patient understands the necessity of ongoing clinical monitoring for safety.
D. "I should eat 1-2 bananas a day because this medication can cause me to loose potassium through my urine.": Warfarin does not affect renal tubular function or cause the excretion of electrolytes like potassium. This instruction is relevant for patients taking loop or thiazide diuretics, but it has no pharmacological basis for those on anticoagulant therapy. This statement indicates a confusion between the side effects of diuretics and those of vitamin K antagonists.
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