Which patient should be advised by the nurse to avoid over-the-counter cold and allergy preparations that contain phenylephrine?
A 47-year-old female with hypertension
A 52-year-old male with adult-onset diabetes
A 17-year-old female with symptoms of an upper respiratory infection
A 62-year-old male with gout
The Correct Answer is A
A. Phenylephrine is a decongestant that can raise blood pressure, making it contraindicated for individuals with hypertension. Advising a patient with hypertension to avoid phenylephrine is essential to prevent potential cardiovascular complications.
B. While patients with diabetes should be cautious about certain medications, phenylephrine is not specifically contraindicated in this condition.
C. A 17-year-old female with an upper respiratory infection typically does not have contraindications for phenylephrine unless there are underlying conditions not mentioned.
D. Gout does not have a direct contraindication for phenylephrine use, so the patient may not need to avoid it unless other health issues are present.
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Correct Answer is B
Explanation
A. Rebound hypertension can occur if antihypertensive medications are abruptly stopped, but it is not a direct reason for switching from an ACE inhibitor to an angiotensin II receptor blocker.
B. A persistent cough is a well-known side effect of ACE inhibitors due to the accumulation of bradykinin. If the client experienced this side effect, it would likely prompt the healthcare provider to switch to an angiotensin II receptor blocker, which does not typically cause this issue.
C. A transient ischemic attack (TIA) would require urgent intervention but is not a reason for changing from an ACE inhibitor to an angiotensin II receptor blocker.
D. Non-adherence to ACE inhibitor treatment may lead to ineffective blood pressure control but would not directly justify a switch to a different class of medication.
Correct Answer is D
Explanation
A. By directly relaxing vascular smooth muscle is not how lisinopril primarily works; it does not act directly on smooth muscle but rather affects hormonal pathways.
B. By blocking aldosterone from binding to mineralocorticoid receptors is a secondary effect of the angiotensin-converting enzyme (ACE) inhibitors but not the primary action of lisinopril itself.
C. By blocking the movement of calcium ions into arterial smooth muscles describes the action of calcium channel blockers, not ACE inhibitors like lisinopril.
D. By inhibiting the transformation of angiotensin I to angiotensin II is the correct answer because lisinopril inhibits the ACE enzyme, reducing the production of angiotensin II, which lowers blood pressure and decreases strain on the heart.