A client is teaching a client who has a new prescription for hydrochlorothiazide for management of hypertension. Which of the following Instructions should the nurse include?

"Reduce intake of potassium-rich foods."

"Take this medication before bedtime."

"Avoid grape juice.'

"Monitor for leg cramps."

Answer and Explanation

The Correct Answer is D

A) "Reduce intake of potassium-rich foods":
Hydrochlorothiazide is a diuretic medication that can cause potassium loss through increased urinary excretion. Therefore, instructing the client to reduce intake of potassium-rich foods could further decrease potassium levels, leading to hypokalemia. Instead, clients taking hydrochlorothiazide should be encouraged to consume potassium-rich foods to help maintain normal potassium levels, unless otherwise instructed by their healthcare provider.

B) "Take this medication before bedtime":
While hydrochlorothiazide can be taken once daily, it is typically recommended to take it in the morning rather than before bedtime. Taking the medication earlier in the day can help minimize the need to wake up during the night to urinate, as it is a diuretic that increases urine production. Therefore, instructing the client to take hydrochlorothiazide before bedtime is not the optimal recommendation.

C) "Avoid grape juice":
There is no significant interaction between hydrochlorothiazide and grape juice. In general, grapefruit juice is known to interact with certain medications by inhibiting cytochrome P450 enzymes in the liver, affecting drug metabolism. However, grape juice is not known to interact with hydrochlorothiazide, so advising the client to avoid grape juice is not necessary.

D) "Monitor for leg cramps":
This is the correct instruction. Leg cramps can be a potential side effect of hydrochlorothiazide therapy due to electrolyte imbalances, particularly hypokalemia. By monitoring for leg cramps, the client can promptly report any symptoms to their healthcare provider for further evaluation and management. This instruction promotes client safety and awareness of potential adverse effects associated with the medication."

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Correct Answer is B

Explanation

A) Weight and caloric intake:
While weight and caloric intake are important aspects of overall health assessment, they are not directly related to the administration of beta-adrenergic blocking agents. These medications primarily affect cardiovascular function, so assessing pulse and blood pressure is more pertinent.

B) Pulse and blood pressure:
This is the correct answer. Before administering beta-adrenergic blocking agents, it is essential to assess the client's pulse rate and blood pressure. Beta blockers work by blocking the effects of adrenaline, leading to a decrease in heart rate and blood pressure. Monitoring these vital signs helps determine the appropriateness of administering the medication and allows for adjustments based on the client's current cardiovascular status.

C) Serum sodium level:
Assessing serum sodium level is not typically necessary before administering beta-adrenergic blocking agents. While electrolyte imbalances can occur as a result of certain medications or health conditions, beta blockers do not directly affect serum sodium levels.

D) Serum albumin level:
Assessing serum albumin level is not specifically indicated before administering beta-adrenergic blocking agents. Serum albumin levels may be assessed in clients with certain conditions such as liver or kidney disease, but it is not a routine assessment before administering beta blockers.

A. lifestyle modification, including exercise, diet and decreased smoking and alcohol intake. B. use of diuretic, beta-blocker, or ACE inhibitor to supplement lifestyle changes. C. all of the above. D. a combination of antihypertensive drug classes to achieve desired control.

Correct Answer is C

Explanation

A) Lifestyle modification, including exercise, diet, and decreased smoking and alcohol intake:
This statement is accurate. Lifestyle modifications are essential components of hypertension management and are recommended as the first step in treatment. These modifications include regular physical activity, adopting a heart-healthy diet such as the DASH (Dietary Approaches to Stop Hypertension) diet, reducing sodium intake, limiting alcohol consumption, and quitting smoking. These changes can help lower blood pressure and reduce the risk of cardiovascular events.

B) Use of diuretic, beta-blocker, or ACE inhibitor to supplement lifestyle changes:
This statement is also accurate. If lifestyle modifications alone are insufficient to achieve blood pressure control, pharmacotherapy may be initiated. The choice of antihypertensive medications depends on various factors, including the individual's comorbidities, medication tolerance, and response to treatment. Diuretics, beta-blockers, and ACE inhibitors are commonly used as first-line agents in the management of hypertension, either as monotherapy or in combination with other drugs.

C) All of the above:
This statement is correct. The stepped-care approach to hypertension management involves a combination of lifestyle modifications and pharmacotherapy. Lifestyle changes are typically recommended as the initial step, followed by the addition of antihypertensive medications if necessary to achieve target blood pressure goals. Therefore, both lifestyle modifications and pharmacological interventions are integral components of the stepped-care approach.

D) A combination of antihypertensive drug classes to achieve desired control:
While this statement is true, it does not encompass all aspects of the stepped-care approach. The use of combination therapy with multiple antihypertensive drug classes may be necessary in some cases to achieve optimal blood pressure control. However, it is only one component of the broader treatment strategy, which also includes lifestyle modifications as the foundation of therapy. Therefore, while combination therapy is important, it does not fully represent the stepped-care approach on its own.

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A client is teaching a client who has a new prescription for hydrochlorothiazide for management of hypertension. Which of the following Instructions should the nurse include?

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