A nurse is providing teaching to a client who has a family history of hypertension. The nurse should inform the client that his blood pressure of 130/82 mm Hg places him in which of the following categories?
Within the expected reference range
Elevated
Stage 2 hypertension
Stage 1 hypertension
The Correct Answer is B
A. Within the expected reference range: While a blood pressure of 130/82 mm Hg is close to normal, it is not considered fully within the expected reference range. The normal range is typically defined as less than 120/80 mm Hg.
B. Elevated: The reading of 130/82 mm Hg falls into the "elevated" category, which is defined as systolic blood pressure between 120-129 mm Hg and diastolic pressure less than 80 mm Hg. This indicates that while the client is not hypertensive, they are at increased risk for developing hypertension in the future.
C. Stage 2 hypertension: This category is defined by a systolic reading of 140 mm Hg or higher, or a diastolic reading of 90 mm Hg or higher. The client’s reading does not meet these criteria, so this option is not applicable.
D. Stage 1 hypertension: Stage 1 hypertension is characterized by systolic readings between 130-139 mm Hg and diastolic readings between 80-89 mm Hg. Although the systolic reading is in the Stage 1 range, the diastolic reading of 82 mm Hg places the overall reading in the "elevated" category, rather than Stage 1 hypertension.
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Correct Answer is D
Explanation
A) Tachycardia: Propranolol is often used to manage tachycardia by reducing heart rate and controlling excessive adrenergic activity. Therefore, this diagnosis would not warrant clarification of the order; it is an appropriate use of the medication.
B) End-stage kidney failure: While caution is necessary when administering medications in clients with renal impairment, propranolol is primarily metabolized by the liver, and its use is not contraindicated in end-stage kidney failure. However, renal function can affect dosing, so monitoring would be important, but this diagnosis alone wouldn't require clarification.
C) Hypertension: Propranolol is commonly prescribed to manage hypertension, making this diagnosis a valid reason for the medication order. The use of propranolol in this context would not need clarification.
D) Asthma: Propranolol is a non-selective beta-blocker, which can cause bronchoconstriction and exacerbate asthma symptoms. This diagnosis would require the nurse to clarify the order, as beta-blockers are generally contraindicated in clients with asthma due to the risk of respiratory complications. If the client has reactive airway disease, an alternative medication should be considered.
Correct Answer is ["A","C","D"]
Explanation
A) Furosemide: This is a loop diuretic that can lead to dehydration and electrolyte imbalances, both of which can contribute to orthostatic hypotension. The medication's diuretic effect can cause a significant drop in blood volume, increasing the risk of low blood pressure upon standing.
B) Simvastatin: This medication is used to lower cholesterol levels and is not associated with orthostatic hypotension. It does not have a direct impact on blood pressure or volume.
C) Losartan: As an angiotensin II receptor blocker (ARB), losartan is used to treat hypertension. It can cause vasodilation and may lead to orthostatic hypotension, particularly in elderly clients or those who are volume-depleted.
D) Nifedipine: This calcium channel blocker is used to treat hypertension and can cause vasodilation. It may lead to orthostatic hypotension as well, especially during dose adjustments or if the client is dehydrated.
E) Clopidogrel: This antiplatelet medication is used to prevent blood clots and does not directly cause orthostatic hypotension. Its primary action is to inhibit platelet aggregation, not to affect blood pressure.