A male client, age 78, complains of dizziness, especially when he stands up after sleeping or sitting. The client also informs the nurse that he periodically experiences nosebleeds and blurred vision. Which of the following conditions should the nurse assess for the client?

Correct Answer: A

Rationale: The correct answer is A) Postural hypotension. Postural hypotension, also known as orthostatic hypotension, is characterized by a drop in blood pressure when a person stands up from sitting or lying down. In this case, the client's symptoms of dizziness upon standing, along with nosebleeds and blurred vision, are indicative of decreased blood flow to the brain upon changing positions. These symptoms align with the classic presentation of postural hypotension in older adults. Option B) White-coat hypertension is incorrect in this scenario as the client's symptoms are not consistent with the phenomenon of elevated blood pressure readings in a clinical setting due to anxiety. Option C) Postural hypertension is not a recognized medical condition. The term typically used is postural hypotension for a drop in blood pressure upon standing. Option D) White-coat hypotension is also an inaccurate choice as it does not match the symptoms described by the client. White-coat hypotension refers to elevated blood pressure readings in a clinical setting due to stress or anxiety. Educationally, understanding the manifestations of postural hypotension is crucial for nurses in assessing and managing older adults who may be at higher risk for this condition. Proper assessment, monitoring, and interventions are essential to prevent falls and other complications related to postural changes in blood pressure.

Correct Answer: D

Rationale: The correct answer is D) Aortic aneurysm, as it is a condition that can persist in an asymptomatic patient. Aortic aneurysms can often be asymptomatic until they reach a critical size or rupture, making them potentially dangerous if left undetected. Option A) Angina is incorrect because angina typically presents with chest pain or discomfort due to reduced blood flow to the heart muscle, which is a symptomatic condition. Option B) Cardiogenic shock is incorrect as it is a life-threatening condition characterized by a sudden drop in blood pressure and inadequate blood flow to the body's organs, leading to symptoms such as rapid breathing, confusion, and cold extremities. Option C) Ventricular tachycardia is incorrect because it is an abnormal heart rhythm that can cause symptoms such as palpitations, dizziness, chest discomfort, and fainting, making it a symptomatic condition. Educationally, understanding the distinction between asymptomatic and symptomatic cardiovascular conditions is crucial for healthcare providers in assessing and managing patients effectively. Recognizing that some conditions can be silent but still pose serious risks underscores the importance of regular screenings and diagnostic tests to identify potential issues before they become symptomatic and potentially life-threatening.

Correct Answer: A

Rationale: The correct answer is A) assess the patient's perception of the event with open-ended questions. This is the most effective action because it allows the nurse to understand the patient's perspective, concerns, and beliefs regarding their diagnosis. By using open-ended questions, the nurse can engage in a meaningful dialogue with the patient, which can help build rapport and trust. Option B) presenting research to support the need for risk-factor reduction may not be as effective in this scenario because the patient's resistance seems to stem from their perception and feelings rather than a lack of information. Providing research may come off as dismissive of the patient's emotions. Option C) reinforcing patient education could be premature without first addressing the patient's emotional response and understanding their perspective. It is essential to address the patient's concerns before providing further education. Option D) reviewing the laboratory values with the patient may not address the underlying emotional and psychological aspects of the patient's response to their diagnosis. Understanding the patient's emotional state is crucial before delving into medical details. In an educational context, this scenario highlights the importance of patient-centered care and the need for healthcare providers to acknowledge and address patients' emotions and beliefs when providing care. Effective communication and empathy are key components of building a therapeutic relationship with patients, especially in challenging situations like a myocardial infarction diagnosis.

Correct Answer: B

Rationale: The correct answer is B) Holter monitoring. Holter monitoring is used to evaluate ECG responses to normal activity over an extended period, usually 1 or 2 days. This method allows for continuous monitoring of the heart's electrical activity during daily activities, providing a more comprehensive assessment compared to a single ECG. Option A) Serial ECGs involve taking multiple ECG readings at different time points but do not provide continuous monitoring over an extended period like Holter monitoring. Option C) The 6-minute walk test is a measure of exercise capacity and functional status, not a method for continuous ECG monitoring. Option D) Event monitors or loop recorders are used for intermittent monitoring to capture specific cardiac events or symptoms, not for continuous monitoring over 1 or 2 days like Holter monitoring. In an educational context, understanding the different methods of cardiac monitoring is crucial for healthcare professionals, especially those working in cardiology or primary care settings. Knowing when to use each method based on the patient's symptoms and clinical presentation is essential for accurate diagnosis and appropriate management of cardiovascular conditions. Holter monitoring plays a specific role in assessing cardiac rhythm disturbances that may occur during daily activities, providing valuable information for diagnosis and treatment planning.

Correct Answer: D

Rationale: In the treatment of hypertensive crises, the most commonly used drugs are fenoldopam (Corlopam) and sodium nitroprusside (Nipride) as indicated by option D. Fenoldopam is a selective dopamine receptor agonist that promotes vasodilation, helping to reduce blood pressure quickly. Sodium nitroprusside is a potent vasodilator that acts on both arteries and veins, rapidly lowering blood pressure in emergency situations. Option A, Esmolol and captopril, are not typically used in hypertensive crises. Esmolol is a beta-blocker that acts more for long-term blood pressure control, while captopril is an ACE inhibitor that may take longer to show its full effect. Option B, Enalaprilat and minoxidil, are also not the first-line agents for hypertensive crises. Enalaprilat is an ACE inhibitor, similar to captopril, and minoxidil is a potent vasodilator that is more commonly used for chronic hypertension. Option C, Labetalol and bumetanide, are used in hypertensive emergencies, but they are not the most commonly used drugs for this purpose. Labetalol is a combined alpha and beta-blocker, and bumetanide is a loop diuretic, which are not the primary choices for immediate blood pressure reduction. It is crucial for healthcare professionals to be well-versed in the appropriate medications for hypertensive crises to ensure prompt and effective management of potentially life-threatening situations. Understanding the mechanisms of action and indications of each drug is essential for providing optimal patient care in emergency situations.