A nurse is reinforcing teaching with a client who has a family history of hypertension. The nurse should inform the client that his blood pressure reading of 124/74 mm Hg places him in which of the following categories or stages?

Hypertension stage 2

Elevated or Prehypertension

Hypertension stage 1

Within the expected reference range

Answer and Explanation

The Correct Answer is B

A. Hypertension stage 2: Hypertension stage 2 is defined as a systolic blood pressure ≥140 mm Hg or diastolic ≥90 mm Hg. The client’s reading of 124/74 mm Hg does not fall into this category.

B. Elevated or Prehypertension: A systolic blood pressure between 120-129 mm Hg and a diastolic <80 mm Hg is classified as elevated or prehypertension. The client’s systolic BP of 124 mm Hg places him in this category.

C. Hypertension stage 1: Hypertension stage 1 is defined as a systolic BP between 130-139 mm Hg or diastolic BP between 80-89 mm Hg. The client’s BP of 124/74 mm Hg does not meet this criterion.

D. Within the expected reference range: The normal range for blood pressure is less than 120/80 mm Hg. The client’s BP of 124/74 mm Hg is slightly elevated and does not fall within the expected reference range.

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Correct Answer is C

Explanation

A. "I can drink wine in moderation." Moderate wine consumption (particularly red wine) is often considered acceptable as part of the Mediterranean diet. This statement does not indicate a need for further teaching.

B. "I will limit my intake of eggs." Eggs can be consumed in moderation on the Mediterranean diet, typically no more than a few times a week. This statement reflects an understanding of the diet and does not indicate a need for further teaching.

C. "I will limit my intake of red meat to two times per week." The Mediterranean diet recommends limiting red meat consumption, but typically to less than two times per week. This statement indicates a need for further teaching as it suggests a higher frequency than recommended.

D. "I should cook with olive oil." Olive oil is a key component of the Mediterranean diet, replacing butter and other fats. This statement reflects correct understanding and does not indicate a need for further teaching.

A. Check the client's blood pressure. B. Check the client's IV catheter insertion site. C. Check the level of the client's pain. D. Check the client's bowel sounds.

Correct Answer is C

Explanation

A. Check the client's blood pressure. While it is important to monitor vital signs after surgery, checking blood pressure is not the first action unless the client is showing signs of instability.

B. Check the client's IV catheter insertion site. Assessing the IV site is important for identifying complications such as infiltration or phlebitis, but this is not the priority.

C. Check the level of the client's pain. Pain assessment is the priority because unmanaged pain can affect recovery and indicate complications such as bleeding or infection. Managing pain is crucial in the postoperative period.

D. Check the client's bowel sounds. Assessing bowel sounds is important following abdominal surgery, but it is not the first priority compared to pain assessment.

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A nurse is reinforcing teaching with a client who has a family history of hypertension. The nurse should inform the client that his blood pressure reading of 124/74 mm Hg places him in which of the following categories or stages?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

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