To test for cranial nerve I, we would instruct our client to:

Choice A reason: Normal blood pressure is <120/<80 mmHg, far below 148/92 mmHg, which is stage 2 hypertension per AHA guidelines. Assuming normal misclassifies the reading, risking untreated hypertension, leading to complications like stroke or heart failure. Accurate classification ensures proper management with lifestyle changes or medications.

Choice B reason: Stage 1 hypertension is 130-139/80-89 mmHg, lower than 148/92 mmHg, which is stage 2. Misclassifying as stage 1 underestimates severity, potentially delaying aggressive treatment like dual antihypertensives. Correct staging ensures timely intervention, critical for preventing cardiovascular damage in patients with elevated blood pressure readings.

Choice C reason: Stage 2 hypertension, per AHA, is ≥140/≥90 mmHg, matching 148/92 mmHg. This requires immediate lifestyle changes and likely medications to prevent cardiovascular events. Accurate classification guides treatment, ensuring blood pressure control, reducing risks of stroke, heart attack, or kidney damage in patients with significant hypertension.

Choice D reason: Elevated blood pressure is 120-129/<80 mmHg, below 148/92 mmHg, which is stage 2 hypertension. Assuming elevated underestimates the condition, risking inadequate intervention and progression to organ damage. Correct classification ensures appropriate management, critical for controlling hypertension and preventing long-term complications in affected patients.

Choice A reason: Not obtaining a translator is a communication barrier, not a type involving empathy or active listening. Therapeutic communication includes these qualities. Assuming this is the type risks perpetuating ineffective communication, hindering patient trust and understanding, critical for building therapeutic relationships and ensuring accurate information exchange in healthcare.

Choice B reason: Nonverbal communication involves gestures or expressions, which may convey empathy but lacks active listening or verbal acceptance, unlike therapeutic communication. Assuming nonverbal is sufficient risks incomplete interaction, missing verbal empathy and respect, essential for fostering patient trust and effective dialogue in therapeutic nursing relationships.

Choice C reason: Verbal communication involves spoken words but doesn’t inherently include empathy, respect, or active listening, unlike therapeutic communication. Assuming verbal alone suffices risks superficial interactions, neglecting emotional connection and acceptance, critical for building trust and supporting patient-centered care in therapeutic nursing practice.

Choice D reason: Therapeutic communication involves active listening, empathy, respect, and acceptance, fostering trust and understanding in patient interactions. It combines verbal and nonverbal skills to support emotional and informational needs, critical for effective nursing care, enhancing patient outcomes, and building therapeutic relationships in diverse clinical settings.