ATI NCLEX-PN Practice Questions Practice Question
The client is complaining of nonspecific body aches, congestion, and coughing. The client's blood pressure is elevated. Which intervention should the nurse implement first?
Correct Answer: C
Rationale: Determining if the client takes any over-the-counter medication is essential because these medications can contribute to elevated blood pressure and may interact with other treatments. Understanding the client's current medication use can guide further interventions.
Instructing the client to decrease salt intake (A) is a long-term dietary change and does not address the immediate concerns. Notifying the healthcare provider for antihypertensive medication (B) may be necessary later, but assessing the client's current medications takes priority. Discussing long-term effects of atherosclerosis and hypertension (D) is educational but not an immediate intervention for the client's acute symptoms.
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