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The nurse is reviewing the orders for a patient and notes a new order for an angiotensin-converting enzyme (ACE) inhibitor. The nurse checks the current medication orders, knowing that this drug class may have a serious interaction with what other drug class?
- A. Calcium channel blockers
- B. Diuretics
- C. Nonsteroidal anti-inflammatory drugs
- D. Nitrates
Correct Answer: C
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can reduce the antihypertensive effect of ACE inhibitors. In addition, the use of NSAIDs and ACE inhibitors may also predispose patients to the development of acute renal failure.
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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.
A patient who has been taking antihypertensive drugs for a few months states that a new, persistent dry cough is very bothersome. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs?
- A. Beta blockers
- B. Angiotensin-converting enzyme (ACE) inhibitors
- C. Angiotensin II receptor blockers (ARBs)
- D. Calcium channel blockers
Correct Answer: B
Rationale: ACE inhibitors cause a characteristic dry, nonproductive cough that reverses when therapy is stopped. The other drug classes do not cause this cough.
During a follow-up visit, the health care provider examines the fundus of the patient's eye. Afterward, the patient asks the nurse, -Why is he looking at my eyes when I have high blood pressure? It does not make sense to me! What is the best response by the nurse?
- A. We need to monitor for drug toxicity.
- B. We must watch for increased intraocular pressure.
- C. The provider is assessing for visual changes that may occur with drug therapy.
- D. The provider is making sure the treatment is effective over the long term.
Correct Answer: D
Rationale: The physician would examine the fundus of a patient's eyes during antihypertensive therapy because it is a more reliable indicator than blood pressure readings of the long-term effectiveness of treatment.
A patient has a new order for the adrenergic drug doxazosin. When providing education about this drug, the nurse will include which instructions?
- A. Weigh yourself daily, and report any weight loss to your prescriber.
- B. Increase your potassium intake by eating more bananas and apricots.
- C. The impaired taste associated with this medication usually goes away in 2 to 3 weeks.
- D. Be sure to lie down after taking the first dose, because first-dose hypotension may make you dizzy.
Correct Answer: D
Rationale: A patient who is starting doxazosin should take the first dose while lying down because there is a first-dose hypotensive effect with this medication. The other options are incorrect.
The nurse is creating a plan of care for a patient with a new diagnosis of hypertension. Which is a potential human needs statement for the patient taking antihypertensive medications?
- A. Altered GI elimination (diarrhea)
- B. Altered sexual function
- C. Altered urinary elimination (urge incontinence)
- D. Need for effective perception
Correct Answer: B
Rationale: Altered sexual function is a potential human needs statement related to possible adverse effects of antihypertensive drug therapy. The other human needs statements are not appropriate.