A client with alcoholism is admitted to a medical-surgical unit with a serum magnesium level of 0.9 mEq/L. Which clinical manifestations would the nurse expect to find in this client?

Choice A reason: The client had an allergic reaction to losartan, a drug that belongs to the class of angiotensin II receptor blockers (ARBs). ¹ Anaphylaxis is a severe and potentially life-threatening allergic reaction that can cause swelling of the lips, tongue, throat, and face, as well as difficulty breathing, low blood pressure, and shock. ² The client needs immediate medical attention and treatment with oxygen, fluids, and epinephrine. ³

Choice B reason: The client did not have an expected side effect of the medication. Losartan is used to treat high blood pressure and heart failure by blocking the action of angiotensin II, a hormone that causes blood vessels to constrict and retain salt and water. ¹ Some common side effects of losartan include dizziness, headache, fatigue, cough, and nausea. ⁴ Anaphylaxis is not a common or expected side effect of losartan, but a rare and serious adverse reaction.

Choice C reason: The client should not have a prescription change to enalapril. Enalapril is another drug that lowers blood pressure and heart failure, but it belongs to the class of angiotensin-converting enzyme (ACE) inhibitors. ⁵ ACE inhibitors and ARBs have similar mechanisms of action and effects, but they differ in how they block the angiotensin system. However, both classes of drugs can cause allergic reactions and anaphylaxis in some people, especially those who have a history of allergy to either drug. The client should avoid both ACE inhibitors and ARBs and use another type of blood pressure medication.

Choice D reason: The client should not avoid taking the medication with food. Food does not affect the absorption or effectiveness of losartan. ⁴ The client can take the medication with or without food, as directed by the provider. However, the client should avoid grapefruit and grapefruit juice, as they can interact with losartan and increase the risk of side effects.

Choice A reason: Performing meditation every day will not be the most important information that the nurse should stress first. Meditation is a practice that involves focusing the mind on a particular object, thought, or activity, and can help reduce stress, anxiety, and blood pressure. However, meditation alone is not enough to prevent or treat coronary artery disease, which is a condition where the arteries that supply blood to the heart become narrowed or blocked by plaque. The nurse should advise the client to practice meditation as a complementary therapy, but not as the primary intervention.

Choice B reason: It is important to look into a smoking cessation program is the most important information that the nurse should stress first. Smoking is a major risk factor for coronary artery disease, as it damages the lining of the arteries, increases the buildup of plaque, reduces the oxygen in the blood, and raises the blood pressure and heart rate. Smoking can also worsen the symptoms and complications of coronary artery disease, such as chest pain, shortness of breath, or heart attack. The nurse should urge the client to quit smoking as soon as possible, and provide them with resources and support to help them achieve this goal.

Choice C reason: It is important to take a fish oil capsule daily is not the most important information that the nurse should stress first. Fish oil is a source of omega-3 fatty acids, which are beneficial for the heart and blood vessels, as they can lower the triglycerides, reduce inflammation, and prevent blood clots. However, fish oil alone is not enough to prevent or treat coronary artery disease, which is a condition where the arteries that supply blood to the heart become narrowed or blocked by plaque. The nurse should recommend the client to take fish oil as a supplement, but not as the main treatment.

Choice D reason: You will not be able to eat meat or have other fats in your diet is not the most important information that the nurse should stress first. A healthy diet is essential for preventing and managing coronary artery disease, as it can help lower the cholesterol, blood pressure, and weight, and improve the blood flow and oxygen to the heart. However, a healthy diet does not mean that the client has to avoid all meat or fats, as some of them can be beneficial for the heart, such as lean meat, poultry, fish, nuts, seeds, or olive oil. The nurse should educate the client to limit the intake of saturated and trans fats, which are found in red meat, butter, cheese, pastries, or fried foods, and to choose more fruits, vegetables, whole grains, and low-fat dairy products.