A nurse is caring for a client due for their dose of carvedilol (Coreg). The nurse completes vital signs prior to administration of the medication. Which vital sign would be an indication to hold the dose scheduled and notify the healthcare provider?
Blood pressure 102/76
Temperature of 100.3 F
Respiratory rate 10
Heart rate of 49
The Correct Answer is D
A) Blood pressure 102/76: While this blood pressure reading is on the lower side, it does not typically warrant withholding carvedilol unless the client exhibits symptoms of hypotension, such as dizziness or fainting. Carvedilol is an antihypertensive, but the reading itself is not critically low enough to necessitate holding the medication.
B) Temperature of 100.3 F: A mild fever at this temperature does not directly relate to carvedilol administration. It may indicate an underlying infection or inflammation, but it is not a contraindication for administering the medication. Monitoring the client’s temperature is important, but it does not require notifying the healthcare provider in this context.
C) Respiratory rate 10: A respiratory rate of 10 breaths per minute indicates bradypnea, which can be concerning. However, it is not the primary reason to withhold carvedilol unless the client shows significant respiratory distress. Monitoring is essential, but the decision to withhold the medication would depend on the overall clinical picture.
D) Heart rate of 49: A heart rate of 49 bpm is considered bradycardia and is a significant concern when administering carvedilol, a beta-blocker that can further decrease heart rate. It is essential to hold the medication and notify the healthcare provider, as this bradycardia could lead to potential adverse effects or complications. Monitoring the client's heart rate is crucial in managing their medication safely.
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Correct Answer is C
Explanation
A) Increase of high-density lipoproteins: While higher levels of high-density lipoproteins (HDL) are generally associated with a lower risk of cardiovascular disease, enalapril is not primarily used to target lipid levels. Its main purpose is to manage blood pressure and reduce the risk of heart failure and renal complications, rather than specifically affecting HDL levels.
B) Decreased pain from intermittent claudication: Intermittent claudication is typically related to peripheral artery disease, which may not be directly improved by enalapril. While managing blood pressure can indirectly benefit circulation, enalapril is not indicated specifically for alleviating pain associated with claudication.
C) Decreased blood pressure: Enalapril is an ACE inhibitor used primarily to treat hypertension. A significant decrease in blood pressure is a direct therapeutic effect of the medication, indicating that it is effectively managing the client’s condition. Monitoring blood pressure helps assess the medication's efficacy in achieving the desired therapeutic outcome.
D) Decrease in low-density lipoproteins: Although reducing low-density lipoprotein (LDL) levels can benefit cardiovascular health, enalapril is not primarily prescribed for this purpose. Its effects on lipid levels are minimal compared to its role in lowering blood pressure and protecting renal function, making a decrease in LDL levels an irrelevant indicator of its therapeutic effect.
Correct Answer is ["A","C","D"]
Explanation
A) Furosemide: This is a loop diuretic that can lead to dehydration and electrolyte imbalances, both of which can contribute to orthostatic hypotension. The medication's diuretic effect can cause a significant drop in blood volume, increasing the risk of low blood pressure upon standing.
B) Simvastatin: This medication is used to lower cholesterol levels and is not associated with orthostatic hypotension. It does not have a direct impact on blood pressure or volume.
C) Losartan: As an angiotensin II receptor blocker (ARB), losartan is used to treat hypertension. It can cause vasodilation and may lead to orthostatic hypotension, particularly in elderly clients or those who are volume-depleted.
D) Nifedipine: This calcium channel blocker is used to treat hypertension and can cause vasodilation. It may lead to orthostatic hypotension as well, especially during dose adjustments or if the client is dehydrated.
E) Clopidogrel: This antiplatelet medication is used to prevent blood clots and does not directly cause orthostatic hypotension. Its primary action is to inhibit platelet aggregation, not to affect blood pressure.