The nurse is teaching an older adult with a new prescription for hydrochlorothiazide as a second anti-hypertensive drug. What safety precaution will the nurse include in the teaching?

A. A 29-year-old female who reports drinking a glass of wine with dinner: While excessive alcohol consumption can contribute to hypertension, moderate alcohol intake, such as drinking a glass of wine with dinner, is not typically a significant risk factor for hypertension in the absence of other contributing factors. Therefore, this individual may not be considered at high risk for hypertension solely based on this information.

B. A 35-year-old male who works 50 hours a week: While chronic stress from long work hours can potentially contribute to hypertension, working 50 hours a week alone may not be sufficient to significantly increase the risk of hypertension, especially in the absence of other significant risk factors. Therefore, this individual may not be considered at high risk for hypertension solely based on this information.

C. A 50-year-old male who reports smoking 2 packs of cigarettes a day: Smoking is a significant risk factor for hypertension. Nicotine in cigarettes can cause blood vessels to narrow, leading to increased blood pressure. Smoking also damages blood vessel walls, making them more susceptible to plaque buildup and narrowing, further increasing the risk of hypertension. Therefore, this individual is at high risk for hypertension due to their smoking habit.

D. A 30-year-old female with a family history of diabetes mellitus: While a family history of diabetes mellitus may increase the risk of developing hypertension due to shared risk factors such as obesity and unhealthy lifestyle habits, it is not as directly associated with hypertension as smoking. Additionally, the individual's age and family history alone may not be sufficient to determine a significant risk for hypertension without additional information about lifestyle and other risk factors.

Answer: D

Rationale:

A) A renal ultrasound: A renal ultrasound is not typically used to confirm a diagnosis of hypertension. While renal artery stenosis can contribute to hypertension in some cases, it is not the primary diagnostic test for hypertension.

B) A cardiac stress test: A cardiac stress test is not used to confirm a diagnosis of hypertension. It is primarily used to assess cardiovascular function and detect coronary artery disease or cardiac arrhythmias.

C) A manual blood pressure cuff: While manual blood pressure measurements can provide accurate readings, they are subject to potential inaccuracies due to factors such as observer bias and white coat syndrome. Therefore, they may not be the most reliable method for confirming a diagnosis of hypertension.

D) Ambulatory blood pressure measurement: Ambulatory blood pressure measurement involves obtaining multiple blood pressure readings over a 24-hour period using a portable monitor. It is considered the gold standard for diagnosing hypertension, as it provides a more comprehensive assessment of blood pressure variability and reduces the impact of white coat syndrome. Therefore, it is the preferred diagnostic test in this scenario to confirm whether the patient has hypertension outside of the clinical setting.