# Situation: The public health nurse at a Barangay Health Station (BHS) follows up adults with asthma, chronic obstructive pulmonary disease (COPD), and hypertension who are listed in the barangay registry for noncommunicable diseases (NCDs). The nurse reviews the registry. For 40 hypertensive clients who missed two or more follow-up visits, the recorded reasons are: Side effects of medicine: 12 Cost of transport: 11 Stopped after home readings became normal: 9 Felt well, with no symptoms: 8 Which intervention addresses the LARGEST shared cause of defaulting?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627119  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The public health nurse at a Barangay Health Station (BHS) follows up adults with asthma, chronic obstructive pulmonary disease (COPD), and hypertension who are listed in the barangay registry for noncommunicable diseases (NCDs).

The nurse reviews the registry. For 40 hypertensive clients who missed two or more follow-up visits, the recorded reasons are:
Side effects of medicine: 12
Cost of transport: 11
Stopped after home readings became normal: 9
Felt well, with no symptoms: 8
Which intervention addresses the LARGEST shared cause of defaulting?

## 보기

1. Reviewing each client's medicines with the physician for side effects
2. Having barangay health workers (BHWs) deliver medicines at home
3. Teaching that treatment continues when readings and symptoms are normal **✔ 정답**
4. Asking the barangay council to fund transport to the station

**정답: 3**

## 해설

The two reasons 'stopped after readings became normal' (9) and 'felt well' (8) reflect the same misconception: that controlled or symptom-free hypertension no longer needs treatment. Together they account for 17 of the 40 defaulters, more than side effects (12) or transport (11). Hypertension is usually silent, and normal readings on treatment mean the medicine is working, so teaching continued daily treatment addresses the largest shared cause.

## 심화 해설

Looking for the largest shared cause
The question does not ask for the largest single category but for the largest shared cause. Two of the recorded reasons, stopped after home readings became normal (9) and felt well, with no symptoms (8), express the same belief: that hypertension no longer needs treatment once it is silent or controlled. Together they account for 17 of the 40 defaulters, more than side effects (12) or transport cost (11). Teaching that treatment continues even when readings and symptoms are normal addresses the largest shared cause.

Why the belief is wrong and dangerous
Hypertension is usually silent: most people with high blood pressure feel well until a complication such as stroke, heart attack, or kidney damage occurs. Normal readings while on treatment mean the medicine is working, not that the disease is cured. When the medicine is stopped, blood pressure rises again, often without symptoms, and the risk of complications returns. Correcting this misconception is therefore one of the most important teaching points in hypertension follow-up.

| Reason for defaulting | Number | Underlying cause |
| --- | --- | --- |
| Stopped after readings became normal | 9 | Belief that silent or controlled hypertension needs no treatment (17) |
| Felt well, with no symptoms | 8 | Same belief |
| Side effects of medicine | 12 | Medicine tolerability |
| Cost of transport | 11 | Access |

Why the other interventions address less
Reviewing medicines for side effects responds to the largest single category, 12 of 40, and is still worth doing, but it reaches fewer defaulters than the shared belief. Home delivery of medicines by barangay health workers improves access, yet a client who believes he no longer needs treatment will not take medicine delivered to his door. Funding transport addresses 11 of 40. Watch out! The highest single number is a deliberate lure; when categories share a root cause, add them before choosing.

Exam takeaway
Group the reasons by underlying cause before deciding on an intervention. For these clients, the nurse plans health teaching that explains that hypertension is lifelong and silent, that normal readings on treatment show the medicine is working, and that daily treatment must continue. The other causes still deserve attention in the plan, but the first priority is the intervention that reaches the most defaulters at once. Follow-up of defaulters through the registry and BHW home visits supports the teaching.

## 임상 시나리오

Analyzing Reasons for DefaultingGrouping causes before choosing an intervention
"Stopped after readings became normal" (9) and "felt well" (8) share one belief: that silent or controlled hypertension needs no more treatment. Together: 17 of 40.

Side effects (12) and transport cost (11) are separate causes and smaller.

Teach that hypertension is lifelong and usually silent, and that normal readings on treatment mean the medicine is working.

CautionDo not pick the largest single category without first combining categories that share a root cause.

## 핵심 개념

- **Defaulter** — A client who misses scheduled follow-up visits or stops treatment without advice.
- **Adherence** — The extent to which a client takes medicines and follows treatment as agreed with the provider.
- **Silent disease** — A condition, such as hypertension, that usually causes no symptoms until complications occur.
- **Root cause** — The underlying reason that explains several surface problems at once.

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