The nurse receives report on 4 clients. Which client should the nurse see first?

Question

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Hypertensive encephalopathy (HE) is a medical emergency caused by a sudden elevation in blood pressure (eg, hypertensive crisis) creating cerebral edema and increased intracranial pressure (ICP). Triggers of HE include an acute exacerbation of pre-existing hypertension, drug use, MAOI-tyramine interaction, head injury, and pheochromocytoma. The client may report severe headache, visual impairment, anxiety, confusion, and observed epistaxis, seizures, or coma. HE may precipitate life-threatening complications such as myocardial infarction, hemorrhagic stroke, and acute kidney injury. The client with a history of chronic hypertension and active signs of increased ICP (eg, anxiety, epistaxis) requires immediate assessment and treatment (Option A). (Option B) The client with a unilateral, pulsating headache has symptoms consistent with migraine. Supportive care for this client includes pain and environmental management but is not a priority over a client with HE. (Option C) The client with abdominal cramping and vomiting may likely have food poisoning and require nonemergency supportive care, along with additional assessment. (Option D) The client with multiple sclerosis (MS) may have recurrent exacerbations, including symptoms of blurred vision (due to optic neuritis), focal weakness, and/or sensory abnormalities (eg, numbness, tingling). MS exacerbations are treated with corticosteroids but are not immediately life-threatening. Educational objective: Clients with a history of chronic hypertension should immediately be assessed for hypertensive encephalopathy (ie, emergency syndrome caused by hypertensive crisis) if signs of increased intracranial pressure (eg, epistaxis, visual impairment, confusion) are present.

The Nurse Receives Report on 4 Clients