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 124/79 mm Hg places him in which of the following categories?
Elevated
Stage 1 hypertension
Stage 2 hypertension
Normal
The Correct Answer is A
Choice A reason: A blood pressure reading of 124/79 mm Hg is considered elevated. The normal range for blood pressure is less than 120/80 mm Hg. Elevated blood pressure is when readings consistently range from 120129 systolic and less than 80 mm Hg diastolic.
Choice B reason: Stage 1 hypertension is defined by a systolic blood pressure ranging from 130 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. The client's blood pressure does not fall into this category.
Choice C reason: Stage 2 hypertension is characterized by a systolic blood pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher. The client's blood pressure is below these levels.
Choice D reason: A normal blood pressure reading is typically below 120/80 mm Hg. Although the client's diastolic pressure is within the normal range, the systolic pressure is above normal, thus it does not qualify as a normal blood pressure reading.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Keeping the client NPO (nothing by mouth) is not directly related to preventing a thyroid crisis. While it may be necessary in some situations, such as preoperative care, it does not address the hyperthyroid state.
Choice B reason: Observing the client for signs of hypocalcemia is important, especially after thyroid surgery, as hypocalcemia can occur due to accidental removal or damage to the parathyroid glands. However, it is not a preventive measure for a thyroid crisis.
Choice C reason: Providing a quiet, low stimulus environment can help reduce stress and agitation, which are potential triggers for a thyroid crisis. Stress can exacerbate hyperthyroid symptoms and precipitate a crisis.
Choice D reason: Aspirin is contraindicated in clients with hyperthyroidism as it can increase thyroid hormone levels by displacing them from their binding proteins. This can potentially worsen the condition and lead to a crisis.
Correct Answer is C
Explanation
Choice A reason: The blood should not be infusing for 5 hours as transfusions of packed RBCs should be completed within 2 to 4 hours to minimize the risk of bacterial growth and transfusion reactions.
Choice B reason: Medications should not be administered through the same IV line as blood products due to the risk of reactions and interactions.
Choice C reason: The packed RBCs are indeed connected by Tubing to normal saline, which is used to keep the line open and prevent clotting.
Choice D reason: The drip chamber should not be filled completely with blood as it is necessary to monitor the drip rate and to ensure that air does not enter the line.
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