A nurse is caring for a client with a history of hypertension who presents with a severe headache and blurred vision. What is the most likely cause of these symptoms?
Hypertensive crisis.
Migraine.
Sinus infection.
Gastroenteritis.
The Correct Answer is A
Choice A rationale
A hypertensive crisis is characterized by severely elevated blood pressure, which can cause severe headache and blurred vision due to increased intracranial pressure.
Choice B rationale
Migraines can cause severe headaches and visual disturbances, but in a patient with a history of hypertension, a hypertensive crisis is more likely.
Choice C rationale
Sinus infections can cause headaches and facial pain, but not typically blurred vision.
Choice D rationale
Gastroenteritis causes gastrointestinal symptoms like diarrhea and vomiting, not headaches and blurred vision.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Deep vein thrombosis (DVT) can lead to pulmonary embolism but does not directly cause chest pain and shortness of breath.
Choice B rationale
Pulmonary embolus (PE) is characterized by chest pain, shortness of breath, and hemoptysis (coughing up blood), especially in patients on bed rest.
Choice C rationale
Anemia can cause fatigue and shortness of breath but not typically chest pain and hemoptysis.
Choice D rationale
Right heart failure can cause shortness of breath and edema but not typically chest pain and hemoptysis.
Correct Answer is A
Explanation
Choice A rationale
Administering antipyretic medication as prescribed is a priority intervention for a client with a body temperature of 38°C (100.4°F). Antipyretics help reduce fever and provide comfort to the patient. They work by inhibiting the production of prostaglandins, which are involved in the fever response.
Choice B rationale
Encouraging fluid intake to prevent dehydration is also important, but it is not the priority intervention. Adequate hydration helps maintain fluid balance and supports the body’s ability to regulate temperature.
Choice C rationale
Monitoring vital signs every 4 hours is essential for assessing the patient’s condition, but it is not an intervention that directly addresses the fever. It helps track the patient’s response to treatment and detect any changes in their condition.
Choice D rationale
Applying a cooling blanket to reduce fever can be effective, but it is typically used when antipyretic medications are not sufficient or contraindicated. Cooling measures help lower body temperature through conduction and evaporation.
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