A 70-year-old client comes to the hospital for after suffering a syncopal episode. Patient states that she felt dizzy when she stood up, then passed out. The client's blood pressure on admission is 88/48 mmHg. A list of medications is obtained as part of the medication reconciliation process. Which three medications are most likely to have contributed to this client's signs and symptoms? (Select all that apply.)
Diltiazem
Carbidopa/levodopa
Hydrochlorothiazide
Metoprolol
Aspirin
Correct Answer : A,C,D
A. Diltiazem: This calcium channel blocker reduces blood pressure and slows the heart rate, both of which can contribute to orthostatic hypotension. In a 70-year-old patient, the baroreceptor reflex is less efficient, making them more susceptible to syncopal episodes during position changes. Lowering systemic vascular resistance too much can result in an acute drop in cerebral perfusion.
B. Carbidopa/levodopa: This medication is primarily used to treat Parkinson's disease and, while it can cause some hypotension, it is not a primary cardiovascular agent. Its impact on blood pressure is generally less profound than that of diuretics or dedicated antihypertensives. It is less likely than the other choices to be the primary driver of a blood pressure of 88/48.
C. Hydrochlorothiazide: Diuretics reduce the total intravascular volume by promoting the excretion of sodium and water. A decrease in blood volume directly lowers the blood pressure and can lead to dehydration-related syncope. This medication is a very common cause of orthostatic dizziness and falls in the geriatric population.
D. Metoprolol: As a beta-blocker, metoprolol reduces cardiac output and inhibits the compensatory tachycardia usually seen when standing. This prevents the body from quickly adjusting the blood pressure during postural changes, leading to the reported dizziness. The combination of reduced heart rate and reduced force of contraction contributes to the hypotensive state.
E. aspirin: Aspirin is an antiplatelet agent used for the prevention of cardiovascular events and does not have a direct effect on blood pressure. It does not cause vasodilation, volume depletion, or changes in heart rate that would lead to syncope. Its primary side effects are related to gastrointestinal irritation and bleeding risks rather than hemodynamics.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. "If I miss a dose of hy medication I can just double up the next day.": Doubling the dose of an anticoagulant like warfarin significantly increases the risk of life-threatening hemorrhage. Because warfarin has a narrow therapeutic index and a long half-life, sudden changes in dosing lead to unpredictable fluctuations in the INR. Patients should be instructed to take the missed dose as soon as remembered or skip it entirely as directed.
B. "I will eat broccoli and collard greens three times a week and I can have extra helpings to improve my iron intake.": Broccoli and collard greens are extremely rich in Vitamin K, which functions as the direct physiological antagonist to warfarin. Increasing the intake of these vegetables will lower the INR and render the anticoagulant therapy ineffective, increasing the risk of stroke. Patients must maintain a consistent, stable intake of Vitamin K rather than increasing it.
C. "I will need to get frequent blood work to check the INR level, that shows if this medication is at the right dose.": The International Normalized Ratio (INR) is the standardized laboratory measurement used to monitor the effectiveness of warfarin therapy. Regular testing is essential to ensure the patient remains within the target therapeutic range, usually between 2 and 3 for atrial fibrillation. This statement confirms the patient understands the necessity of ongoing clinical monitoring for safety.
D. "I should eat 1-2 bananas a day because this medication can cause me to loose potassium through my urine.": Warfarin does not affect renal tubular function or cause the excretion of electrolytes like potassium. This instruction is relevant for patients taking loop or thiazide diuretics, but it has no pharmacological basis for those on anticoagulant therapy. This statement indicates a confusion between the side effects of diuretics and those of vitamin K antagonists.
Correct Answer is ["B","D"]
Explanation
A. Assess the patient's appetite and thirst: While loop diuretics can cause dehydration, appetite monitoring is not the primary nursing priority for managing loop diuretic therapy. Thirst may occur, but it is a subjective symptom rather than a critical objective indicator of electrolyte imbalance. Clinical focus remains on metabolic and hemodynamic stability.
B. Monitor magnesium levels, as ordered: Loop diuretics inhibit the reabsorption of cations in the thick ascending limb of the loop of Henle. This mechanism leads to increased urinary excretion of magnesium alongside water and sodium. Hypomagnesemia can predispose the client to cardiac arrhythmias and muscle tetany.
C. Assess the client for gastric distress including nausea, vomiting and diarrhea: These gastrointestinal symptoms are not the most common or significant adverse effects of furosemide administration. While they can occur with many medications, they do not reflect the primary pharmacological risks associated with diuretic-induced fluid shifts. Monitoring should prioritize renal function and electrolyte concentrations.
D. Monitor the client's potassium levels as ordered: Furosemide promotes significant potassium wasting by increasing delivery of solutes to the distal tubule. Hypokalemia is a frequent and dangerous complication that can lead to life-threatening cardiac conduction disturbances. Frequent serum monitoring is essential to ensure the safety of the heart failure patient.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
