An older adult client with hypertension has recently been prescribed a beta-adrenergic blocker and a thiazide diuretic. When educating the client about preventing and managing adverse effects, the nurse will provide which instruction?
"Change positions slowly to prevent lightheadedness or dizziness."
"Reduce your fluid intake initially, to prevent excessive urination."
"Identify and eliminate any high-potassium foods from your diet."
"Expect your blood pressure to increase for several days before it begins to decrease."
The Correct Answer is A
A. Changing positions slowly is critical for older adults taking beta-adrenergic blockers and diuretics to prevent orthostatic hypotension, which can lead to lightheadedness or dizziness.
B. Reducing fluid intake is not advisable, as thiazide diuretics can lead to dehydration, and maintaining adequate fluid intake is essential for overall health and to avoid excessive urinary output.
C. Identifying and eliminating high-potassium foods is unnecessary unless there is a specific indication of hyperkalemia, particularly since thiazide diuretics do not typically cause potassium retention, and beta-blockers are not potassium-specific.
D. Expecting blood pressure to increase before it decreases is misleading; clients should see a gradual reduction in blood pressure with proper medication adherence, and any sudden increases should be reported.
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Correct Answer is B
Explanation
A. Decreased appetite may occur but is not the most critical concern in this context.
B. The combination of metoclopramide, which can influence serotonin pathways, with certain antidepressants, especially SSRIs, increases the risk of serotonin syndrome, a potentially life-threatening condition.
C. While some antidepressants can influence blood pressure, monitoring for elevated blood pressure is not the primary concern with metoclopramide.
D. There is no evidence to suggest that metoclopramide enhances the effects of antidepressants; the focus should be on potential adverse interactions instead.
Correct Answer is ["A","B","C","D"]
Explanation
A. Spontaneous bleeding after taking an anticoagulant is a secondary action that occurs due to the anticoagulant's effect on blood clotting, which is an undesired effect when it leads to excessive bleeding.
B. Dizziness after starting an antihypertensive is a common secondary action related to the lowering of blood pressure, which can lead to hypotension and resultant dizziness.
C. Drowsiness after taking an antihistamine is a well-known secondary action, especially with first-generation antihistamines, which can cause sedation as a side effect.
D. Diarrhea after taking an antibiotic is a secondary action that can occur due to disruption of the normal gut flora, leading to gastrointestinal upset. All these examples illustrate secondary effects of medications.