Antihypertensive Drugs
A nurse is providing teaching for a client who has hypertension and a prescription change from metoprolol to metoprolol/hydrochlorothiazide. Which of the following statements by the client indicates an understanding of the teaching? -"Now I will not have to diet to lose weight." -With the new medication, I should experience fewer side effects." -"I will not have to do anything different because it is the same medication." -"The extra letters after the name of medication means it is a stronger dose."
-"Now I will not have to diet to lose weight." (Hydrochlorothiazide (HCTZ) is a diuretic, and the loss of fluid will result in weight loss. The client should be instructed to weigh daily and watch for weight loss, but it is a change in fluid rather than loss of fat that is the cause of the weight loss. Continuing the recommended diet for control of BP can be an additional part of the client's care plan. This client needs further reinforcement of teaching to understand the action of the thiazide diuretic.) -With the new medication, I should experience fewer side effects." (The client has stated an understanding of the purpose of the addition of the HCTZ to the metoprolol dosage. When used in combination with thiazide diuretics, a lower dose of the beta-blocker can be used. The benefit is there are fewer side effects when beta-blockers (and other antihypertensives) are used in lower dosages.) !!! -"I will not have to do anything different because it is the same medication." (This. medication includes a diuretic that requires an increase in potassium in the diet. This statement indicates a need for further teaching on the addition of the diuretic in the combination drug.) -"The extra letters after the name of medication means it is a stronger dose." (The nurse should clarify that the additional letters indicate a new medication has been combined with the old medication rather than a stronger dose being given.)
A nurse is assessing a client after administering a dose of losartan. The client has a hoarse voice, and a swollen lips and tongue. In which order should the nurse take the following actions? Move the nursing actions into the box on the right, placing them in the selected order of performance. All steps must be used.
-Assess the client's airway. -Call the emergency response team. -Apply high-flow oxygen. -Initiate IV site. -Administer IV antihistamines. -Administer IV antihistamines.
A nurse is caring for a client who has hypertension and asks the nurse about a prescription for propranolol. The nurse should inform the client that this medication is contraindicated in clients who have a history of which of the following conditions? -Asthma -Glaucoma -Depression -Migraines
-Asthma (Propranolol, a beta-blocker, is contraindicated in clients who have asthma because it can cause bronchospasms. Propranolol blocks the sympathetic stimulation, which prevents smooth muscle relaxation.) !!! -Glaucoma (Beta-blockers are contraindicated in clients who have cardiogenic shock, but are not contraindicated in a client who has glaucoma.) -Depression (Beta-blockers are contraindicated in clients who have AV heart block, but are not contraindicated in clients who have depression.) -Migraines (Beta-blockers are used for prophylactic treatment of migraine headaches.)
A nurse is teaching a client who has hypertension and a new prescription for atenolol. Which of the following findings should the nurse include as adverse effects of this medication? -Bradycardia -Tremor -Cough -Constipation
-Bradycardia (Atenolol is a beta blocker, which slows the heart rate. The nurse should instruct the client to monitor his pulse rate and report bradycardia). !!! -Tremor (Lethargy and drowsiness are adverse effects of atenolol.) -Cough (Bronchospasms and wheezing are adverse effects of atenolol. Coughing is an adverse effect of ACE inhibitors.) -Constipation (Nausea, vomiting, and diarrhea are adverse effects of atenolol.)
A nurse is reviewing the medical record of a client who has hypertension and a new prescription for metoprolol. Which of the following findings should the nurse investigate further? -Diet-controlled Type 2 DM -A history of left-sided failure -A concurrent prescription for tadalafil -Recently treated bilateral pneumonia
-Diet-controlled Type 2 DM (Metoprolol does not suppress beta2 mediated glycogenolysis, so it can be used more safely than other beta blockers in clients who have DM, especially for a client who is diet-controlled and not taking diabetic medications. The nurse should instruct the client that manifestations of hypoglycemia can be masked with this medication.) -A history of left-sided heart failure (Although metoprolol can be used to treat heart failure, it can also cause heart failure, so this medication should be used with great caution with a client who has a history of heart failure. The nurse should teach the client to watch for signs of increasing left-sided heart failure, such as shortness of breath and weight gain indicating fluid retention, and report these findings to the provider.) !!! -A concurrent prescription for tadalafil (Beta blockers are not contraindicated for concurrent use of an erectile dysfunction medication; however, erectile dysfunction medication used concurrently with nitrates can cause a catastrophic drop in BP that does not respond to treatment.) -Recently treated bilateral pneumonia (Pneumonia, and its course of treatment, is not contraindication for the use of beta blockers. Beta blockers are generally not used with clients who have bronchospastic diseases.)
A nurse is providing teaching to a client who has hypertension and a new prescription for captopril. Which of the following instruction should the nurse provide? -Do not use salt substitutes while taking this medication. -Take this medication with food. -Count your pulse rate before taking the medication. -Expect to gain weight while taking this medication.
-Do not use salt substitutes while taking this medication. (Captopril, an ACE inhibitor, can cause hyperkalemia due to potassium retention by the kidney. The client should avoid salt substitutes, as most of them are high in potassium.) !!! -Take this medication with food. (The client should take captopril on an empty stomach, 1 hr before or 2 hr after a meal, in order to not reduce the medication absorption.) -Count your pulse rate before taking the medication. (It is not necessary to count a pulse before taking captopril.) -Expect to gain weight while taking this medication. (Weight gain is not an adverse effect of captopril.)
A nurse is assessing a client who is taking lisinopril to treat hypertension. Which of the following findings is a priority to report? -Dry cough -Swelling of the tongue -Nausea -Nasal congestion
-Dry cough (Dry cough is non-urgent because it is a mild adverse effect of lisinopril; therefore, there is another finding that is the priority.) -Swelling of the tongue (When using the urgent vs non-urgent approach to client care, the nurse determines that the priority finding is swelling of the tongue, which is a manifestation of angioedema. The nurse should withhold the medication and notify the provider immediately if the client reports swelling of the tongue or throat. Other manifestations include giant wheals and edema of the tongue, glottis, and pharynx. Severe reactions are treated with subcutaneous epinephrine. If angioedema develops, ACE inhibitors are discontinued.) !!! -Nausea (Nausea is non-urgent because it is a mild adverse effect of lisinopril; therefore, there is another finding that is the priority.) -Nasal congestion (Nasal congestion is non-urgent because it is a mild adverse effect of lisinopril; therefore, there is another finding that is the priority.)
A nurse is teaching a client who has a new prescription for captopril. Which of the following instructions should the nurse include in the teaching? -Monitor for a cough. -Hold medication for heart rate less than 60/min. -Take this medication with food. -Avoid grapefruit juice.
-Monitor for a cough. (Captopril is an ACE inhibitor used to treat hypertension. The client should monitor and report a cough and dyspnea.) !!! -Hold medication for heart rate less than 60/min. (Captopril can cause tachycardia.) -Take this medication with food.(The client should take captopril on an empty stomach to increase absorption.) -Avoid grapefruit juice. (Grapefruit juice can reduce the metabolism of atorvastatin.)
