A nurse is teaching a client just diagnosed with mild hypertension. Which of the following information should the nurse include in the teaching?
"Diuretics are the first line therapy to control hypertension."
"Reaching your goal blood pressure will occur within 2 months."
"Plan to add saturated fats to 10 percent of your daily calorie intake."
"Limit your alcohol consumption to three drinks a day."
The Correct Answer is A
A. "Diuretics are the first line therapy to control hypertension.": This statement is accurate. Thiazide diuretics are commonly recommended as first-line treatment for mild hypertension, as they help reduce blood volume and lower blood pressure effectively.
B. "Reaching your goal blood pressure will occur within 2 months.": While treatment can lead to improvements in blood pressure, the timeline for reaching target levels can vary significantly among individuals based on adherence to lifestyle changes and medication. It's important to communicate that achieving the goal may take longer than two months.
C. "Plan to add saturated fats to 10 percent of your daily calorie intake.": This recommendation is misleading. Guidelines generally suggest limiting saturated fats to less than 10 percent of total daily calories to promote heart health, not adding them.
D. "Limit your alcohol consumption to three drinks a day.": This statement is also inaccurate. For most adults, the recommendation is to limit alcohol to no more than two drinks per day for men and one drink per day for women to help manage blood pressure effectively.
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View Related questions
Correct Answer is ["B","E"]
Explanation
A) Provide discharge instructions for a client who has a new skin graft: This task should not be delegated to an assistive personnel (AP) as it requires clinical judgment and knowledge about the specific care needs associated with a new skin graft. Discharge instructions must be provided by a qualified nurse.
B) Weigh a client who is on fluid restriction: This task can be delegated to an AP. Weighing a client is a straightforward procedure that does not require nursing judgment and is within the scope of practice for an AP.
C) Check a blood product with another nurse prior to administration: This task must be performed by a licensed nurse to ensure patient safety and compliance with protocols. Checking blood products requires knowledge of the client's specific needs and potential reactions.
D) Perform an admission assessment on a client: Admission assessments require nursing expertise and critical thinking. This task cannot be delegated to an AP, as it involves evaluating the client's condition and creating a care plan based on the assessment findings.
E) Ambulate an older adult client who has hypertension: This task can be delegated to an AP, provided the client is stable and there are no other complications. Assisting with ambulation is within the scope of practice for an AP, and it can help promote mobility and independence for the client.
Correct Answer is C
Explanation
A) Ventricular tachycardia: Ventricular tachycardia is characterized by a rapid heart rate exceeding 100 bpm, typically arising from abnormal ventricular activity. In this case, the heart rate is 59 bpm, which does not support this interpretation. Additionally, ventricular tachycardia usually presents with wide QRS complexes and no discernible P waves, neither of which is true in this scenario.
B) Sinus tachycardia: Sinus tachycardia is defined by a heart rate exceeding 100 bpm originating from the sinoatrial (SA) node, with a regular rhythm and normal P waves. The heart rate of 59 bpm in this client is too low for a diagnosis of sinus tachycardia, making this option incorrect.
C) Sinus bradycardia: Sinus bradycardia occurs when the heart rate is less than 60 bpm, with a regular rhythm and a normal PR interval and QRS duration. The provided data shows a heart rate of 59 bpm, a regular rhythm, one P wave for every QRS complex, a PR interval of 0.20 seconds, and a QRS duration of 0.10 seconds, which aligns perfectly with the criteria for sinus bradycardia.
D) Normal sinus rhythm: Normal sinus rhythm typically presents with a heart rate of 60-100 bpm, a regular rhythm, and appropriate P waves for each QRS complex. Given the heart rate of 59 bpm, this does not meet the criteria for normal sinus rhythm, as it falls below the acceptable range.