A 62-year-old woman has been followed by you for 3 years and has had recent onset of hypertension. She is still not at goal despite three antihypertensive medicines, and you strongly doubt nonadherence. Her father died of a heart attack at age 58. Today her pressure is 168/94 and pressure on the other arm is similar. What would you do next?

Correct Answer: D

Rationale: At this point, it is important to consider secondary causes for this woman's hypertension because of its severity, rapidity of progression, and lack of response to therapy. While you will most likely add a fourth medicine, it is important to carefully examine the abdomen for the presence of renal artery bruits. These are usually heard best in the upper quadrants. It may be necessary to have the patient hold her breath, to have a very quiet room, and to listen with the diaphragm for a very soft, high-pitched sound with systole. It may also help to simultaneously feel the patient's pulse (a bruit with both a systolic and diastolic component is very specific for a significant blockage, while a lone systolic bruit may not be abnormal). Obtaining a CT scan is not likely to be useful, and you may save the delay, expense, and inconvenience of a nephrology referral if you can hear a bruit.

Correct Answer: D

Rationale: In the nursing process, assessment is the step that involves the systematic collection of data through health history, physical examination, and interviews. This step is crucial as it forms the foundation for all further nursing interventions and decisions. Through assessment, nurses gather essential information about the patient's current health status, which then guides the subsequent steps of the nursing process. Option A, Planning, is incorrect because planning comes after assessment. Once data has been collected through assessment, the nurse then moves on to planning interventions and setting goals based on the assessment findings. Option B, Diagnosis, is incorrect because diagnosis follows the assessment phase. In the nursing process, diagnosis involves analyzing the data collected during assessment to identify the patient's health problems and needs. Option C, Evaluation, is incorrect because evaluation occurs after interventions have been implemented. Evaluation involves assessing the patient's response to the interventions and determining the effectiveness of the care provided. Understanding the sequential nature of the nursing process is essential for nurses to provide comprehensive and effective care to their patients. By correctly identifying assessment as the step involving data collection, nurses can ensure they have a solid foundation on which to base their subsequent nursing actions.

Correct Answer: D

Rationale: In the technique of auscultating heart sounds, the correct answer is D) Listen to each area of the precordium in a systematic manner. This is the most appropriate technique because it ensures a comprehensive assessment of all cardiac areas, allowing for the detection of any abnormal heart sounds that may indicate underlying cardiac conditions. Option A is incorrect because placing the stethoscope diaphragm lightly on the patient's chest may lead to inadequate sound transmission and result in missed heart sounds. Option B is incorrect because the bell of the stethoscope is actually used for low-pitched sounds, not high-pitched sounds like heart murmurs. Option C is incorrect because listening over clothing can dampen the sounds and interfere with accurate auscultation. Educationally, it is essential for healthcare providers to master the correct technique for auscultating heart sounds to accurately assess cardiac function and detect abnormalities early. By systematically listening to each area of the precordium, healthcare providers can ensure a thorough examination and provide optimal patient care. This technique is crucial in diagnosing various cardiac conditions and monitoring changes in a patient's heart health over time.

Correct Answer: C

Rationale: In the first 24 hours after thrombolytic therapy for ischemic stroke, the primary goal is to control the client's blood pressure (Option C). This is because thrombolytic therapy carries the risk of bleeding, including intracerebral hemorrhage. Elevated blood pressure can exacerbate this risk by increasing the chances of bleeding. Therefore, controlling blood pressure is crucial to reduce the risk of hemorrhagic transformation post-thrombolytic therapy. Option A, Pulse, is not the primary focus because while monitoring pulse is important, it is not the immediate concern post-thrombolytic therapy for stroke. Respirations (Option B) and Temperature (Option D) are also not the primary goals in this context. Educationally, understanding the rationale behind monitoring and controlling blood pressure in the acute phase after thrombolytic therapy for ischemic stroke is vital for nursing and healthcare students. It emphasizes the critical role of maintaining hemodynamic stability to prevent complications and optimize patient outcomes in stroke care. This knowledge guides clinical decision-making and promotes safe and effective patient care.

Correct Answer: D

Rationale: The correct answer is option D) Distance walked. In the context of assessing endurance using the Six-Minute Walk Test, measuring the distance walked is the most appropriate variable for determining the patient's endurance level. Distance walked is a direct and objective measure of how far the patient can walk in six minutes, reflecting their physical endurance capacity. It provides a clear and quantifiable result that can be easily tracked and compared over time to monitor progress in rehabilitation. Perceived exertion (option A) can be subjective and influenced by factors such as pain tolerance or emotional state, making it less reliable for quantifying endurance objectively. Heart rate response (option B) may vary based on individual fitness levels or medications, and may not always directly correlate with endurance capacity. Elapsed time (option C) is a measure of the duration of the test but does not provide specific information about the patient's endurance level in terms of physical capacity. In an educational context, understanding the rationale behind selecting the appropriate variable for a specific assessment helps healthcare professionals make informed decisions in patient care. By choosing the most relevant measure, therapists can accurately evaluate a patient's progress, tailor interventions effectively, and set appropriate goals for rehabilitation.