The nurse is reviewing the prescriptions for a client with severe pain from renal colic.
Which of the following prescriptions should the nurse implement first?

Choice A rationale

Lower extremity edema is often associated with right-sided heart failure rather than left ventricular failure. Right-sided failure leads to systemic venous congestion, causing fluid accumulation in peripheral tissues like the legs. Left ventricular failure predominantly affects pulmonary circulation, making edema of the lower extremities a less expected finding.

Choice B rationale

Pulmonary crackles are a hallmark finding in left ventricular failure due to fluid accumulation in the alveoli. This occurs because reduced cardiac output causes blood to back up into pulmonary veins and capillaries, increasing hydrostatic pressure and leading to pulmonary congestion. Crackles indicate the presence of interstitial or alveolar fluid, a direct result of left-sided dysfunction.

Choice C rationale

Ascites results from portal hypertension and systemic venous congestion, typically seen in right-sided heart failure or advanced liver disease. Left ventricular failure impacts the pulmonary system rather than the abdominal cavity, making ascites an unlikely finding during assessment for this condition.

Choice D rationale

Jugular vein distention is indicative of systemic venous congestion caused by right-sided heart failure. In left ventricular failure, pulmonary congestion dominates, and jugular vein distention is not a primary finding. Assessments should focus on symptoms directly linked to pulmonary effects such as crackles or dyspnea.

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.