A client is prescribed lisinopril 20 mg PO daily for the treatment of hypertension. Which finding would alert the nurse that a side effect of the medication has occurred?
Blood pressure of 120/80 mmHg.
Serum potassium of 5.5 mEq/L.
Heart rate of 80 beats per minute.
Respiration rate of 16 breaths per minute.
The Correct Answer is B
Choice A Reason
A blood pressure of 120/80 mmHg is considered within the normal range and is an ideal target for most individuals being treated for hypertension. This finding would not typically alert the nurse to a side effect of lisinopril.
Choice B Reason
Serum potassium of 5.5 mEq/L is higher than the normal range, which is typically between 3.5 and 5.0 mEq/L. Lisinopril can cause hyperkalemia, which is an elevated level of potassium in the blood. This is a known side effect of lisinopril, especially in clients with renal impairment, as it inhibits the renin-angiotensin-aldosterone system and reduces potassium excretion.
Choice C Reason
A heart rate of 80 beats per minute is within the normal range for adults, which is typically 60-100 beats per minute at rest. This finding would not alert the nurse to a side effect of lisinopril.
Choice D Reason
A respiration rate of 16 breaths per minute is within the normal range for adults, which is typically 12-20 breaths per minute at rest. This finding would not alert the nurse to a side effect of lisinopril.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A Reason:
St. John's Wort is a well-known herbal remedy that has been used for centuries to treat various ailments, including depression. It is believed to work by increasing the levels of neurotransmitters in the brain, such as serotonin, which can help improve mood and alleviate depressive symptoms. Clinical studies have shown that St. John's Wort can be effective for mild to moderate depression.
Choice B Reason:
Black Cohosh is primarily used to relieve symptoms associated with menopause, such as hot flashes and night sweats. While it may have some mood-stabilizing effects, there is insufficient evidence to support its use as a primary treatment for depression.
Choice C Reason:
Peppermint is commonly used for its soothing properties to aid digestion and reduce headaches. However, it is not typically used as a treatment for depression, and there is no substantial evidence to suggest it would be effective for this purpose.
Choice D Reason:
Echinacea is best known for its potential to boost the immune system and reduce symptoms of colds and other infections. It is not recognized as a treatment for depression, and there is no significant research to support its use in this context.
Correct Answer is B
Explanation
Choice A Reason
Taking alprazolam with food may help with some gastrointestinal side effects but does not address the client's concerns about dizziness and light-headedness. While it is a practical suggestion, it is not the priority response when the client is experiencing symptoms that could affect their safety¹.
Choice B Reason
The priority for the nurse is to ensure the client's safety. Dizziness and light-headedness can increase the risk of falls or accidents, especially when performing tasks that require alertness, such as driving or operating machinery. Therefore, advising the client to avoid dangerous activities is the most immediate and appropriate response¹.
Choice C Reason
While it is true that alprazolam is often prescribed for short-term use and some side effects may diminish over time, this does not provide the client with a solution to their current symptoms. The nurse should address the client's immediate concerns and ensure their safety before discussing the duration of medication use¹.
Choice D Reason
Using sugarless gum or candy can help with dry mouth, which is a common side effect of alprazolam. However, this advice does not address the more serious side effects of dizziness and light-headedness that the client is experiencing. Therefore, it is not the priority response but can be included as additional advice¹.
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