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question 20 of 20 a client is admitted to the emergency room with a blo…

Question

question 20 of 20
a client is admitted to the emergency room with a blood pressure reading of 200/130 mm hg.
what are this clients therapeutic goals? select all that apply.
achievement of a goal pressure of about 160/100 within 2 to 6 hours.
reduction to a target goal pressure over a period of days.
an immediate lowering of the blood pressure to a normotensive level within the first 30 minutes.
reduction of the mean blood pressure by 25% within the first hour.

Explanation:

Brief Explanations
  1. For "Achievement of a goal pressure of about 160/100 within 2 to 6 hours": In hypertensive emergencies (like this client's very high BP of 200/130), the initial goal is to reduce BP by about 25% in the first hour or achieve a pressure around 160/100 within 2 - 6 hours to prevent end - organ damage. This is a correct therapeutic goal.
  2. For "Reduction to a target goal pressure over a period of days": After the initial acute management (first few hours to days), the BP can be further adjusted to the long - term target over days to weeks. But in the acute phase (emergency room admission), the initial goals are more immediate (like 2 - 6 hours for 160/100 or 25% reduction in first hour). However, this option can be part of the overall therapeutic plan (after the acute phase), but in the context of emergency room admission, the more acute goals are prioritized. But let's check the other options.
  3. For "An immediate lowering of the blood pressure to a normotensive level within the first 30 minutes": Rapidly lowering BP to normotensive levels (e.g., 120/80) in the first 30 minutes can cause cerebral hypoperfusion and other end - organ damage. So this is not a therapeutic goal.
  4. For "Reduction of the mean blood pressure by 25% within the first hour": In hypertensive emergencies, reducing the mean arterial pressure (MAP) by 25% within the first hour is a recommended initial therapeutic goal to prevent end - organ damage without causing hypoperfusion. This is a correct therapeutic goal.

So the correct options are the first, second (depending on the phase, but in the context of overall therapeutic goals including acute and subsequent), and fourth? Wait, no. Let's re - evaluate. The client has a hypertensive emergency (BP 200/130). The acute therapeutic goals for hypertensive emergency:

  • First hour: Reduce MAP by no more than 25% (so "Reduction of the mean blood pressure by 25% within the first hour" is correct).
  • Then, over the next 2 - 6 hours, aim for a BP of around 160/100 (so "Achievement of a goal pressure of about 160/100 within 2 to 6 hours" is correct).
  • Then, over the next 24 - 48 hours, can further reduce to normal levels (so "Reduction to a target goal pressure over a period of days" can be part of the plan, but in the emergency room setting, the first two (and the fourth) are more immediate. Wait, the "Reduction to a target goal pressure over a period of days" is a bit ambiguous. But the "An immediate lowering...30 minutes" is incorrect. So the correct options are:
  • Achievement of a goal pressure of about 160/100 within 2 to 6 hours.
  • Reduction of the mean blood pressure by 25% within the first hour.
  • Reduction to a target goal pressure over a period of days (but this is more of the long - term, post - acute phase). However, in the context of the question (client admitted to emergency room, what are the therapeutic goals), the first, second (if we consider the overall plan including post - acute), and fourth? Wait, no, let's check standard guidelines.

Standard hypertensive emergency management:

  • Initial (1 hour): Reduce MAP by 20 - 25% or to a BP of 160/100 - 110 (but not lower than that in the first hour). So "Reduction of the mean blood pressure by 25% within the first hour" and "Achievement of a goal pressure of about 160/100 within 2 to 6 hours" are correct. "Reduction to a target goal pressure over a period of days" is part of the subsequent management (after the first 2 - 6 hours, over the next days to weeks). "An immediate lowering...30 minutes" is incorrect.

So the correct options are:

  • Ac…

Answer:

  • Achievement of a goal pressure of about 160/100 within 2 to 6 hours.
  • Reduction of the mean blood pressure by 25% within the first hour.
  • Reduction to a target goal pressure over a period of days. (Note: The "An immediate lowering of the blood pressure to a normotensive level within the first 30 minutes" is incorrect and should not be selected.)