The nurse is educating a client on the possible side effects associated with quinapril. Which of the following side effects are associated with this medication classification?(Select All that Apply)
angioedema
dry non-productive cough
hyperkalemia
first dose phenomenon
hypotension
Hypertension
Correct Answer : A,B,C,D,E
A) Angioedema: Quinapril, an ACE inhibitor, can cause angioedema, which is a serious allergic reaction characterized by swelling of the deeper layers of the skin. This side effect is critical to monitor, as it can lead to airway obstruction.
B) Dry non-productive cough: A persistent dry cough is a well-known side effect of ACE inhibitors like quinapril. This occurs due to the accumulation of bradykinin and can be bothersome enough to require discontinuation of the medication.
C) Hyperkalemia: Quinapril can lead to increased potassium levels in the blood, a condition known as hyperkalemia. This is due to the drug's mechanism of action, which reduces aldosterone secretion, leading to decreased potassium excretion.
D) First dose phenomenon: This refers to a significant drop in blood pressure following the first dose of an ACE inhibitor, which can lead to dizziness or fainting. Patients are often advised to take the first dose at bedtime to minimize this risk.
E) Hypotension: Quinapril can cause hypotension, particularly after the initial dosing or in patients who are dehydrated or on diuretics. It’s important for patients to be aware of this potential side effect.
F) Hypertension: Quinapril is used to treat hypertension, so it is not a side effect associated with this medication. Instead, the goal of treatment is to lower blood pressure, making this option incorrect.
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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) "This medication decreases chest pain by dissolving blood clots that are occluding the arteries.": This statement is incorrect because nitroglycerin does not dissolve blood clots. Instead, it works by relaxing and dilating blood vessels, which helps improve blood flow to the heart muscle and relieve angina.
B) "Place one tablet under your tongue every 15 minutes and repeat up to 5 times for relief of chest pain.": This is not accurate; while nitroglycerin can be taken sublingually, the typical recommendation is to take one tablet every 5 minutes as needed for chest pain, not every 15 minutes, and not to exceed 3 tablets within 15 minutes.
C) "This medication is the first-line treatment for hypertension.": Although nitroglycerin can lower blood pressure, it is not typically considered a first-line treatment for hypertension. It is primarily used for angina relief rather than as a primary antihypertensive agent.
D) "This medication dilates cardiac blood vessels to deliver more oxygen to the heart.": This statement accurately describes the action of nitroglycerin. By dilating the coronary arteries, nitroglycerin increases blood flow and oxygen delivery to the heart muscle, which helps alleviate angina symptoms. This is a key point to emphasize during patient education.