A nurse is assessing a client with a history of high blood pressure. The client's blood pressure is 210/106 mm Hg during the assessment. What follow-up question should the nurse ask?

"Have you recently taken any antihistamines?"

"Have there been recent stressful events in your life?"

"Did you take any acetaminophen today?"

"Have you consistently taken your medications?"

Answer and Explanation

The Correct Answer is D

Choice D: This question is crucial as it addresses the client's adherence to their prescribed medication regimen for managing high blood pressure. Consistent medication use is essential for controlling blood pressure and reducing the risk of complications associated with hypertension. The elevated blood pressure reading suggests that the current medication regimen may not be effectively controlling the client's blood pressure. By assessing medication adherence, the nurse can determine if non-adherence is contributing to the high blood pressure reading or if adjustments to the medication regimen are required.

"Have you recently taken any antihistamines?": Asking about recent antihistamine use is not directly relevant to the client's high blood pressure reading of 210/106 mm Hg. Antihistamines are medications primarily used to relieve allergy symptoms and do not typically have a signiﬁcant impact on blood pressure levels.

"Have there been recent stressful events in your life?": While stress can contribute to temporary increases in blood pressure, asking about recent stressful events is not the most critical follow-up question in this situation. The client's blood pressure reading of 210/106 mm Hg indicates a severe elevation that requires immediate attention and management beyond stress reduction alone.

"Did you take any acetaminophen today?": Acetaminophen, also known as paracetamol, is a pain reliever and fever reducer. It does not typically have a signiﬁcant effect on blood pressure. Therefore, asking about acetaminophen use is not the most relevant follow-up question for the client's high blood pressure reading.

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Correct Answer is C

Explanation

The inability to move the left arm and leg suggests a neurological deficit, which is a significant finding that requires immediate attention. It could indicate a potential stroke or another neurological emergency that requires prompt evaluation and intervention. The health care provider needs to be notified immediately so that appropriate diagnostic tests and interventions can be initiated.

Tremors in the fingers when extending the arms can be a sign of tremor disorders or medication side effects but may not warrant immediate intervention.

Atrial fibrillation is a cardiac arrhythmia that requires monitoring and management but may not be directly related to the acute neurological issue.

The headache reported by the patient, although significant, is subjective and may be related to the hypertensive emergency or other factors but does not require immediate intervention compared to the potential neurological deficit.

A. The procedure stimulates the growth of new pathways between the atria B. The procedure uses cold therapy to stop the formation of the ﬂutter waves C. The procedure prevents or minimizes the patient's risk for sudden cardiac death D. The procedure uses electrical energy to destroy areas of the conduction system

Correct Answer is D

Explanation

The procedure uses electrical energy to destroy areas of the conduction system: Catheter ablation is a minimally invasive procedure performed to treat abnormal heart rhythms, such as atrial ﬂutter. During the procedure, a catheter is inserted into the heartand used to deliver electrical energy to speciﬁc areas of the heart tissue. This energy is used to destroy or ablate the abnormal conduction pathways that are causing the atrial ﬂutter.

Let's go through the other options and explain why they are not accurate:

The procedure stimulates the growth of new pathways between the atria: Catheter ablation does not stimulate the growth of new pathways. Instead, it aims to eliminate or modify existing abnormal pathways in the heart to restore normal electrical conduction.

The procedure uses cold therapy to stop the formation of the ﬂutter waves: Catheter ablation does not use cold therapy. It primarily utilizes radiofrequency energy or other sources of heat to ablate the targeted areas of the heart tissue.

The procedure prevents or minimizes the patient's risk for sudden cardiac death: While catheter ablation can be an effective treatment for certain arrhythmias, including atrial ﬂutter, it is not primarily performed to prevent or minimize the risk of sudden cardiac death. Its main purpose is to restore normal heart rhythm and alleviate symptoms associated with the arrhythmia.

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A nurse is assessing a client with a history of high blood pressure. The client's blood pressure is 210/106 mm Hg during the assessment. What follow-up question should the nurse ask?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is assessing a client who has been admitted to the intensive care unit (ICU) with a hypertensive emergency. Which finding is most important to report to the health care provider?

Correct Answer is C

Explanation

The nurse is teaching a client with atrial ﬂutter who is scheduled for a catheter ablation? What should the nurse include in the teaching plan?

Correct Answer is D

Explanation

The nurse is assessing a client with a heart rate of 124 bpm. What clinical ﬁnding(s) should the nurse assess as causes of tachycardia? Select all that apply.

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The nurse is providing discharge education to a client with hypertension. Which essential information should the nurse include in the teaching plan?

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