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A patient who is now in heart failure after a recent myocardial infarction will be receiving a new prescription for eplerenone. The nurse is reviewing the patient's laboratory results and will report which of these as a potential contraindication?
- A. Serum sodium level 136 mEq/L
- B. Serum potassium 5.6 mEq/L
- C. Elevated white blood cell count
- D. Elevated cardiac troponin levels
Correct Answer: B
Rationale: Eplerenone is contraindicated in patients with elevated serum potassium levels (higher than 5.5 mEq/L). The other answers are incorrect.
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An older adult patient will be taking a vasodilator for hypertension. Which adverse effect is of most concern for the older adult patient taking this class of drug?
- A. Dry mouth
- B. Restlessness
- C. Constipation
- D. Hypotension
Correct Answer: D
Rationale: The older adult patient is more sensitive to the blood pressure-lowering effects of vasodilators, and consequently experiences more problems with hypotension, dizziness, and syncope. The other options are incorrect.
A patient with type 2 diabetes mellitus has been found to have trace proteinuria. The prescriber writes an order for an angiotensin-converting enzyme (ACE) inhibitor. What is the main reason for prescribing this class of drug for this patient?
- A. Cardioprotective effects
- B. Renal protective effects
- C. Reduces blood pressure
- D. Promotes fluid output
Correct Answer: B
Rationale: ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This is one reason that they are among the cardiovascular drugs of choice for diabetic patients. The other drugs do not have this effect.
When teaching a patient about antihypertensive drug therapy, which statements by the nurse are correct?
- A. You need to have your blood pressure checked once a week and keep track of the readings.
- B. If you notice that the symptoms have gone away, you should be able to stop taking the drug.
- C. An exercise program may be helpful in treating hypertension, but let's check with your doctor first.
- D. If you experience severe side effects, stop the medicine and let us know at your next office visit.
- E. Most over-the-counter decongestants are compatible with antihypertensive drugs.
- F. Please continue taking the medication, even if you are feeling better.
Correct Answer: A,C,F
Rationale: Keeping a record of weekly blood pressure checks helps to monitor the effectiveness of the therapy. An exercise program may be beneficial but should be confirmed with the prescriber. Therapy is often lifelong, and patients should continue taking the medication even if feeling better to prevent rebound hypertension. Abruptly stopping medication or assuming over-the-counter decongestants are safe can lead to serious complications.
A patient with severe liver disease is receiving the angiotensin-converting enzyme (ACE) inhibitor, captopril. The nurse is aware that the advantage of this drug for this patient is which characteristic?
- A. Captopril rarely causes first-dose hypotensive effects.
- B. Captopril has little effect on electrolyte levels.
- C. Captopril is a prodrug and is metabolized by the liver before becoming active.
- D. Captopril does not need to be metabolized by the liver before becoming active because it is not a prodrug.
Correct Answer: D
Rationale: A prodrug relies on a functioning liver to be converted to its active form. Captopril is not a prodrug, and therefore it would be safer for the patient with liver dysfunction.
A patient's blood pressure elevates to 270/150 mm Hg, and a hypertensive emergency is obvious. He is transferred to the intensive care unit and started on a sodium nitroprusside drip to be titrated per his response. With this medication, the nurse knows that the maximum dose of this drug should be infused for how long?
- A. 10 minutes
- B. 30 minutes
- C. 1 hour
- D. 24 hours
Correct Answer: A
Rationale: Sodium nitroprusside is a potent vasodilator and may lead to extreme decreases in the patient's blood pressure. For this reason, it is never infused at the maximum dose for more than 10 minutes. If this drug does not control a patient's blood pressure after 10 minutes, it will most likely be ordered to be discontinued. The other times listed are incorrect.