A client with a history of heart failure and hypertension is in the clinic for a follow-up visit.
The client is on lisinopril and warfarin.
The client reports a new-onset cough.
What action by the nurse is most appropriate?
Assess the client's lung sounds and oxygenation.
Instruct the client on another antihypertensive.
Obtain a set of vital signs and document them.
Remind the client that a cough is a side effect of lisinopril.
The Correct Answer is A
Choice A rationale
While a cough is a known side effect of lisinopril due to bradykinin accumulation, a new-onset cough in a client with heart failure and hypertension could also signal worsening heart failure, particularly pulmonary edema. Assessing lung sounds for crackles and monitoring oxygenation is paramount to differentiate between these two distinct etiologies and guide appropriate intervention.
Choice B rationale
Changing antihypertensives is a medical decision made by the provider. The nurse's role is to assess the client's symptoms and provide objective data to the provider. Switching medications without a thorough assessment could be premature and might delay the diagnosis of a more serious condition like decompensated heart failure.
Choice C rationale
Obtaining vital signs is a fundamental nursing action, but it is not the most appropriate initial action in this specific clinical scenario. The report of a new cough in a client with heart failure necessitates a targeted assessment of the respiratory system, including auscultating lung sounds and evaluating for signs of hypoxemia, to rule out a life-threatening complication.
Choice D rationale
While a cough is a known side effect of lisinopril, dismissing the symptom could be dangerous. The cough may not be benign; it could be an early sign of pulmonary congestion from heart failure. The nurse must perform a comprehensive assessment to ensure the client's safety and to avoid misattributing a serious finding to a common medication side effect.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
There is no conclusive scientific evidence to support the claim that specific foods like chocolate, peanuts, and cola directly cause or worsen acne. Acne is a multifactorial condition primarily driven by hormonal changes, sebum production, follicular hyperkeratinization, and the bacteria Propionibacterium acnes. While a high glycemic diet may be linked to acne, there is no direct causal link with these specific foods.
Choice B rationale
Over-washing the face with harsh cleansing products can strip the skin of its natural oils (sebum), leading to a rebound effect where the sebaceous glands produce even more oil. This can exacerbate acne by creating a more favorable environment for bacterial proliferation and follicular clogging. Gentle cleansing twice a day is recommended, not frequent washing, to maintain skin barrier integrity.
Choice C rationale
Moderate sun exposure can be beneficial for some individuals with acne. Ultraviolet (UV) light has anti-inflammatory and antibacterial properties that can reduce the population of Propionibacterium acnes. Avoiding sun exposure completely is not a standard recommendation for acne prevention, although excessive sun exposure can lead to other skin problems and should be avoided.
Choice D rationale
Stress and lack of rest can increase cortisol levels, which can stimulate sebum production and inflammation, contributing to acne formation. A balanced diet provides essential vitamins and minerals for skin health, and sufficient rest helps regulate hormonal balance. Promoting overall well-being through diet and rest indirectly supports skin health and can help in the prevention of acne.
Correct Answer is A
Explanation
St. John's wort (Hypericum perforatum) is a potent inducer of the cytochrome P450 enzyme system, specifically CYP3A4, in the liver. Warfarin is metabolized by the same enzyme system, primarily by CYP2C9. However, St. John's wort also induces other CYP enzymes that may indirectly affect warfarin metabolism. This enzyme induction accelerates the metabolism of warfarin, leading to subtherapeutic plasma concentrations. This reduces the anticoagulant effect of warfarin, increasing the risk of thrombus formation and thromboembolic events in the client.
Choice B rationale
This statement is factually incorrect. There is extensive scientific literature and numerous studies documenting the significant and clinically relevant drug interaction between St. John's wort and warfarin. The interaction is well-established, with multiple case reports and randomized controlled trials demonstrating that St. John's wort reduces the international normalized ratio (INR) in clients on warfarin therapy.
Choice C rationale
This response is non-therapeutic and dismissive of the client's question. It fails to provide the necessary health and safety information regarding a potentially dangerous drug interaction. A therapeutic communication approach requires the nurse to provide accurate, evidence-based information to empower the client to make informed health decisions.
Choice D rationale
This statement is factually incorrect and potentially life-threatening. St. John's wort can cause a dangerous drug-drug interaction with warfarin by reducing its therapeutic effect. Recommending this supplement to a client on warfarin could lead to a stroke, pulmonary embolism, or other life-threatening thromboembolic events due to the loss of adequate anticoagulation.
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