A 46-year-old man started antihypertensive drug therapy 3 months earlier and is in the office for a follow-up visit. While the nurse is taking his blood pressure, he informs the nurse that he has had some problems with sexual intercourse. Which is the most appropriate response by the nurse?
“Not to worry. Eventually, tolerance will develop.”
“The physician can work with you on changing the dose and/or drugs.”
“Sexual dysfunction happens with this therapy, and you will learn to accept it.”
“This is an unusual occurrence, but it is important to stay on your medications.”
The Correct Answer is B
Many antihypertensive drugs, such as beta blockers and certain diuretics, can cause sexual dysfunction, including decreased libido, erectile dysfunction, or difficulty with ejaculation. These effects can significantly impact adherence to therapy. The most appropriate nursing action is to acknowledge the concern and inform the patient that the physician can adjust the dose or change the medication to minimize side effects while maintaining blood pressure control.
Rationale for correct answer:
B. “The physician can work with you on changing the dose and/or drugs.”
This response shows therapeutic communication and supports collaboration in care. The nurse recognizes that sexual dysfunction is a common adverse effect of some antihypertensives and encourages the patient to discuss it with the provider. Adjusting the dose, changing to a different class (e.g., ACE inhibitor, ARB, or calcium channel blocker), or timing the medication differently can often resolve the issue.
Rationales for incorrect answers:
A. “Not to worry. Eventually, tolerance will develop.”
This statement is inaccurate and dismissive. Tolerance to sexual side effects does not typically occur with antihypertensive therapy, and reassurance without intervention may discourage further communication about the issue.
C. “Sexual dysfunction happens with this therapy, and you will learn to accept it.”
This response is non-therapeutic and lacks empathy. It dismisses the patient’s concern and may lead to nonadherence, as sexual health is an important aspect of quality of life.
D. “This is an unusual occurrence, but it is important to stay on your medications.”
This response provides false reassurance, as sexual dysfunction is actually a common side effect of many antihypertensive drugs. It also ignores the opportunity to address the patient’s concern through collaborative problem-solving.
Take-home points:
• Sexual dysfunction is a common side effect of beta blockers and diuretics used for hypertension.
• The nurse should encourage open communication and refer the patient for possible medication adjustment.
• Empathetic, therapeutic responses improve adherence and patient satisfaction with treatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Hydrochlorothiazide (HCTZ) is the most frequently combined diuretic with various antihypertensive agents such as ACE inhibitors, ARBs, beta blockers, and calcium channel blockers. This is because it has a proven ability to enhance blood pressure control, works synergistically with other antihypertensives, and has a long record of safety and efficacy. By reducing plasma volume and peripheral resistance, hydrochlorothiazide helps improve blood pressure outcomes while allowing for lower doses of other drugs, minimizing side effects.
Rationale for correct answer:
B. Hydrochlorothiazide
Hydrochlorothiazide is a thiazide diuretic that acts on the distal convoluted tubule to inhibit sodium and water reabsorption, promoting mild diuresis and reducing blood pressure. It is commonly combined with antihypertensive agents like ACE inhibitors or ARBs (e.g., lisinopril/HCTZ or losartan/HCTZ) to enhance efficacy, especially in populations such as African-American clients, where thiazides show superior response.
Rationales for incorrect answers:
A. Chlorthalidone
Although chlorthalidone is also a thiazide-like diuretic and may be more potent than HCTZ, it is less frequently used in fixed-dose combination products. It has a longer half-life, but HCTZ remains the most common diuretic found in combination formulations due to extensive clinical use and established safety data.
C. Bendroflumethiazide
This diuretic is used in some regions (especially the UK), but it is not as widely available or commonly combined with antihypertensive agents as hydrochlorothiazide in standard practice, particularly in the United States.
D. Potassium-sparing diuretic
Agents such as spironolactone or amiloride are sometimes combined with thiazides to reduce potassium loss, but they are not the most frequent diuretic combined with antihypertensives. These are typically used in resistant hypertension or in patients with specific conditions like heart failure.
Take-home points:
• Hydrochlorothiazide is the most commonly combined diuretic with antihypertensive drugs due to its proven efficacy and safety.
• Thiazide diuretics lower blood pressure by reducing plasma volume and peripheral vascular resistance.
• Combining hydrochlorothiazide with ACE inhibitors or ARBs enhances blood pressure control and reduces adverse effects like hypokalemia.
Correct Answer is C
Explanation
Hypertension in African-American patients tends to respond differently to various antihypertensive drug classes due to genetic and physiological variations in the renin-angiotensin system and salt sensitivity. Studies show that Beta blockers and ACE inhibitors are less effective as monotherapy in African-American patients because they have a low-renin profile. These clients respond better to calcium channel blockers and thiazide diuretics, which act independently of renin levels to control blood pressure effectively.
Rationale for correct answer:
C. Beta blockers and ACE inhibitors
African-American patients often exhibit low plasma renin activity, meaning they produce less renin and therefore less angiotensin II. Since ACE inhibitors work by blocking the conversion of angiotensin I to angiotensin II, and beta blockers reduce renin release from the kidneys, these drugs have diminished antihypertensive effects in this population when used alone. However, when combined with diuretics, their effectiveness improves.
Rationales for incorrect answers:
A. Diuretics
Thiazide diuretics are highly effective in African-American patients. They promote sodium and water excretion, which directly reduces blood pressure without depending on renin levels. They are often part of the first-line therapy for hypertension in this population.
B. Calcium channel blockers and vasodilators
Calcium channel blockers are particularly effective in African-American patients because they cause vasodilation through inhibition of calcium influx into vascular smooth muscle, leading to improved blood pressure control. Vasodilators can also be effective in resistant hypertension.
D. Alpha blockers
Alpha blockers, such as prazosin, lower blood pressure by relaxing vascular smooth muscles and have no evidence of reduced efficacy in African-American patients. However, they are usually not first-line agents due to risks of orthostatic hypotension and reflex tachycardia.
Take-home points:
• Beta blockers and ACE inhibitors are less effective as monotherapy in African-American patients due to low renin levels.
• Thiazide diuretics and calcium channel blockers are preferred for initial hypertension management in this population.
• Combination therapy with a diuretic can improve the effectiveness of ACE inhibitors and beta blockers.
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