A client presents to the healthcare setting and ordered verapamil to treat his hypertension. Which assessment finding by the nurse would determine if the medication should be held?
Pulse oximetry of 92%
Pulse of 78
Respiratory rate of 12
History of a myocardial infarction a week ago
The Correct Answer is D
A) Pulse oximetry of 92%: While a pulse oximetry reading of 92% is slightly below normal, it is not a definitive reason to hold verapamil. This reading indicates mild hypoxemia, but it does not directly contraindicate the use of verapamil. Other factors should be considered before making a decision based solely on this value.
B) Pulse of 78: A pulse rate of 78 beats per minute is within the normal range for adults and does not warrant holding verapamil. This finding alone does not indicate any immediate concerns related to the administration of the medication.
C) Respiratory rate of 12: A respiratory rate of 12 breaths per minute is within the normal range for adults. This finding does not provide any indication that verapamil should be withheld. It is important to consider other clinical factors when assessing the appropriateness of medication administration.
D) History of myocardial infarction a week ago: Verapamil, a calcium channel blocker, can have significant effects on cardiac function. Administering it to a client who recently experienced a myocardial infarction (heart attack) could exacerbate cardiac issues and lead to complications. Therefore, it is crucial to hold the medication and consult with the healthcare provider before proceeding.
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View Related questions
Correct Answer is A
Explanation
A) Losartan (Cozaar): This medication is an angiotensin II receptor blocker (ARB) and is often used as an alternative for patients who experience a cough due to ACE inhibitors. Unlike ACE inhibitors, ARBs do not typically cause a cough because they do not affect bradykinin levels, making losartan an appropriate choice for managing hypertension without the adverse effect of a persistent cough.
B) Hydralazine HCL (Apresoline): While hydralazine is an antihypertensive, it works through a different mechanism (direct vasodilation) and is not a first-line alternative for patients with a history of ACE inhibitor-induced cough. It's generally used in specific situations, such as severe hypertension or heart failure.
C) Furosemide (Lasix): This is a loop diuretic primarily used for conditions like heart failure or edema, rather than for the management of hypertension alone. It does not address the underlying hypertension in the same manner as ACE inhibitors or ARBs.
D) Metoprolol (Lopressor): This is a beta-blocker that can be used for hypertension, but it does not directly address the issue of cough related to ACE inhibitors. Switching to a beta-blocker may not be the best option if the client is specifically seeking to avoid the cough associated with ACE inhibitors.
Correct Answer is A
Explanation
A) Dry, non-productive cough: One of the most common side effects associated with ACE inhibitors is a dry, non-productive cough. This occurs due to the accumulation of bradykinin, a peptide that can increase in the body when ACE is inhibited. Nurses should assess for this symptom, as it may require changing the medication if it becomes bothersome to the client.
B) Nausea and vomiting: While nausea and vomiting can occur with various medications, they are not specific or common side effects of ACE inhibitors. If these symptoms do arise, they may be due to other factors and should be investigated further.
C) Hypokalemia and vomiting: ACE inhibitors are more commonly associated with hyperkalemia (elevated potassium levels) rather than hypokalemia. Monitoring potassium levels is important, but vomiting is not a typical side effect of ACE inhibitors.
D) Epistaxis and headache: Although headaches can occur with many medications, epistaxis (nosebleeds) is not a common side effect associated with ACE inhibitors. While headache assessment is appropriate, the dry cough is the more characteristic and important symptom to monitor in clients on these medications.