The nurse is caring for a client newly diagnosed with hypertension and requires medication therapy. Which of the following medications below is considered a first line treatment for hypertension?
carvedilol
lisinopril
clonidine
doxazosin
The Correct Answer is B
A) Carvedilol: While carvedilol is a beta-blocker that can be used to treat hypertension, it is not considered a first-line treatment. Beta-blockers are typically used when other first-line agents are not effective or in specific situations such as heart failure or ischemic heart disease.
B) Lisinopril: Lisinopril is an ACE inhibitor and is considered a first-line treatment for hypertension. It effectively reduces blood pressure by inhibiting the angiotensin-converting enzyme, leading to vasodilation and decreased blood volume. Its well-documented efficacy and favorable side effect profile make it a common choice for initial therapy.
C) Clonidine: Clonidine is an alpha-2 adrenergic agonist that can lower blood pressure but is generally not used as a first-line treatment due to its side effects and potential for rebound hypertension if discontinued abruptly.
D) Doxazosin: Doxazosin is an alpha-1 blocker that can be used to treat hypertension but is not typically a first-line choice. It may be used in specific cases, such as in patients with benign prostatic hyperplasia, but other classes of medications are usually preferred for initial hypertension treatment.
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Correct Answer is D
Explanation
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.
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.