A nurse is assessing a client who is experiencing a hypertensive crisis. Which of the following manifestations should the nurse expect?

Skin cool to touch

Jugular vein distention

Headache

Weak peripheral pulses

Answer and Explanation

The Correct Answer is C

Rationale:

A. Skin cool to touch: Cool skin is more commonly associated with shock states or severe peripheral vasoconstriction, not with a hypertensive crisis. In hypertensive crisis, the client is more likely to have warm skin due to increased circulation from elevated blood pressure.

B. Jugular vein distention: While jugular vein distention can occur in right-sided heart failure or severe fluid overload, it is not a hallmark manifestation of hypertensive crisis. The acute issue in hypertensive crisis is extreme elevation in blood pressure with end-organ effects.

C. Headache: Severe headache is a common and classic symptom of hypertensive crisis due to sudden, extreme elevations in blood pressure causing increased ICP and cerebral vessel stress. It often signals an urgent need for BP control to prevent complications such as stroke.

D. Weak peripheral pulses: Weak pulses are more often associated with low cardiac output or severe arterial obstruction. In hypertensive crisis, peripheral pulses are typically bounding and strong because of the elevated systemic vascular resistance.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. "A living will is a document that includes my wishes about health care decisions.": A living will is an advance directive that specifies a client’s preferences for medical treatment in situations where they are unable to communicate.

B. "My partner needs to be present as a witness when I sign a living will.": Witness requirements vary by state, and typically a neutral adult, not necessarily a partner, must witness the signing.

C. "My provider will make my health care decisions if I complete advance directives.": Advance directives are intended to communicate the client’s own wishes, not delegate decision-making solely to the provider. The provider’s role is to follow the client’s documented preferences.

D. "Advance directives outline who inherits my material possessions in the event of my death.": Inheritance is addressed in a will, not advance directives. Advance directives focus exclusively on medical and end-of-life care decisions.

A. Food exchange lists for meal planning from the American Diabetes Association B. Food label recommendations from the Institute of Medicine C. Diabetes medication information from the Physicians' Desk Reference D. Personal blogs about managing the adverse effects of diabetes medications

Correct Answer is A

Explanation

Rationale:

A. Food exchange lists for meal planning from the American Diabetes Association: The ADA provides evidence-based, reliable resources for meal planning that help clients manage blood glucose levels and make informed dietary choices. These lists are tailored for diabetes management.

B. Food label recommendations from the Institute of Medicine: While the IOM provides general nutrition guidelines, they are not specifically designed for diabetes management and may not address individualized meal planning needs for blood glucose control.

C. Diabetes medication information from the Physicians' Desk Reference: The PDR contains medication details but is intended for healthcare professionals, not clients. It may be too technical for patient education purposes.

D. Personal blogs about managing the adverse effects of diabetes medications: Blogs may provide anecdotal information that is not evidence-based and could be inaccurate or misleading, making them an unreliable resource for client education.

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A nurse is assessing a client who is experiencing a hypertensive crisis. Which of the following manifestations should the nurse expect?

Nursing Test Bank

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