The nurse is caring for a client diagnosed with secondary immune thrombocytopenic purpura (ITP). The nurse should expect the client to be tested for which of the following possible causes?

Choice A rationale

Waiting one month before reevaluating blood pressure may overlook potential adherence issues or medication effects. Hypertension requires timely intervention because consistently high values can lead to complications such as stroke or heart attack. The readings of 145/92 mm Hg and 150/89 mm Hg are above the normal range (<120/80 mm Hg), necessitating immediate review of possible contributing factors rather than postponing evaluation.

Choice B rationale

Adherence to lifestyle modifications and prescribed therapies directly affects blood pressure control. Factors such as diet, exercise, and medication compliance significantly influence systolic and diastolic values. Poor adherence can lead to inadequate control of hypertension, which is evident in the readings of 145/92 mm Hg and 150/89 mm Hg. Exploring adherence helps identify reasons for high readings and can guide targeted interventions.

Choice C rationale

Increasing medication dosage without first reviewing adherence overlooks potential causes of suboptimal control such as missed doses, incorrect timing, or lifestyle factors. Adjusting doses may lead to overtreatment, causing complications like hypotension. Addressing adherence first ensures interventions are appropriate and prevents unnecessary medication changes.

Choice D rationale

Adding a calcium-channel blocker involves modifying therapy without investigating adherence to current medications and lifestyle changes. Such an approach risks complicating the treatment plan unnecessarily. It is scientifically prudent to first evaluate the effectiveness of existing treatments through adherence assessments, ensuring interventions are tailored to the individual's needs.

Choice A rationale

Medications, such as phosphodiesterase type-5 inhibitors (e.g., sildenafil), are typically the next line of treatment for erectile dysfunction (ED) after lifestyle modifications fail. These agents enhance blood flow to the penile tissues during sexual stimulation by inhibiting the breakdown of cyclic guanosine monophosphate, facilitating erectile function.

Choice B rationale

Negative-pressure devices, also known as vacuum erection devices, are considered third-line treatments and are typically used in clients for whom oral medications are contraindicated or have failed. These devices work by mechanically increasing blood flow to the penis but are less effective than pharmacological interventions.

Choice C rationale

Penile injections, such as alprostadil, are invasive and used as a later option when oral medications and devices are unsuccessful or contraindicated. These injections directly relax the smooth muscle to increase penile blood flow, but they are generally not first-line treatments.

Choice D rationale

Penis transplants are experimental and not recognized as a standard treatment for erectile dysfunction. This option is far from practical or feasible and is considered unsuitable for most clients, especially given the complexity of the condition.