A patient with a history of hypertension arrives in the emergency department with a blood pressure (BP) reading of 213/126 mm Hg. The patient has a history of drug abuse.
Which of the following initial questions posed by the nurse is MOST appropriate?.
"Did you take any Tylenol today?".
"Have there been recent stressful events in your life?".
"Have you recently taken any cocaine or crack?".
"Have you eaten any salty foods lately?". .
The Correct Answer is C
Choice A rationale:
Tylenol, or acetaminophen, is a common over-the-counter medication used to reduce fevers and manage mild aches and pains. It does not directly affect blood pressure.
Choice B rationale:
While stress can cause temporary spikes in blood pressure, it’s not clear whether stress can cause long-term increases in blood pressure34.
Choice C rationale:
Cocaine or crack use can cause a significant and dangerous increase in blood pressure. Given the patient’s history of drug abuse and the current high blood pressure reading, this is a critical question to ask.
Choice D rationale:
Eating salty foods can contribute to high blood pressure over time, but it’s unlikely to cause an immediate severe increase in blood pressure.
So, the correct answer is Choice C, after analyzing all choices. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
A brief episode of ventricular tachycardia, or a rapid heart rate, can occur in patients receiving thrombolytic therapy. However, it is not typically a reason to stop the drug infusion.
Choice B rationale:
Bleeding from the gums can be a sign of excessive bleeding, which is a major risk of thrombolytic therapy. This would be a reason to stop the drug infusion.
Choice C rationale:
A decreased level of consciousness can have many causes and is not specifically associated with thrombolytic therapy.
Choice D rationale:
An increase in blood pressure is not typically a reason to stop thrombolytic therapy.
So, the correct answer is B, after analyzing all choices.
Correct Answer is D
Explanation
Choice A rationale:
While aspirin is often given to patients with suspected myocardial infarction, asking if the patient took aspirin does not help determine the timing of the onset of symptoms.
Choice B rationale:
Knowing the patient’s allergies is important for medication safety, but it does not help determine eligibility for thrombolytic therapy.
Choice C rationale:
Rating the pain on a scale helps assess the severity of the pain, but it does not provide information about the timing of the onset of symptoms.
Choice D rationale:
The time of pain onset is crucial in determining eligibility for thrombolytic therapy. Thrombolytic therapy is most effective when given within a certain time frame from the onset of symptoms.
So, the correct answer is D, after analyzing all choices.
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