The nurse is caring for a client with a history of hypertension who has experienced uncontrollable non-productive cough related to an ACE inhibitor. Which alternative medication would the nurse anticipate administering?
losartan (Cozaar)
hydralazine HCL (Apresoline)
furosemide (Lasix)
metoprolol (Lopressor)
The Correct Answer is A
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.
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Correct Answer is D
Explanation
A. "Depending on the level of your PT/INR, the clot will begin to dissolve.": This response is misleading, as heparin's effect is not primarily monitored by PT/INR; rather, heparin is monitored by activated partial thromboplastin time (aPTT). Moreover, heparin does not directly dissolve clots; it prevents further clot formation.
B. "After the first dose, the clot will begin to dissolve.": This statement inaccurately suggests that heparin has an immediate effect on dissolving existing clots. While heparin acts quickly to inhibit further clotting, it does not lead to the dissolution of clots after the first dose.
C. "It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level.": This is not accurate for heparin, which has an immediate effect on coagulation. While the therapeutic effects can be optimized over several days, heparin begins to work right away to prevent further clotting.
D. "Heparin does not dissolve clots. It stops new clots from forming.": This response accurately describes the mechanism of action of heparin. Heparin prevents the extension of existing clots and the formation of new clots, but it does not actively dissolve clots. This clarification is essential for the client’s understanding of their treatment and expectations regarding DVT management.
Correct Answer is D
Explanation
A) Atenolol: This is a beta-blocker that can be used for various cardiac conditions, including hypertension and certain arrhythmias, but it is not typically the first-line treatment for acute life-threatening ventricular dysrhythmias in the emergency setting.
B) Lisinopril: This medication is an ACE inhibitor primarily used to manage hypertension and heart failure. It does not address acute ventricular dysrhythmias and would not be appropriate for immediate use in this scenario.
C) Adenosine: While adenosine is effective for certain types of supraventricular tachycardia, it is not indicated for life-threatening ventricular dysrhythmias. It has a very short duration of action and is not the drug of choice in this context.
D) Procainamide: This antiarrhythmic medication is specifically used to treat life-threatening ventricular dysrhythmias. It works by stabilizing the cardiac membrane and is indicated in emergency situations to manage these types of arrhythmias. Therefore, preparing procainamide is the most appropriate action for the nurse in this scenario.