A client with heart failure is taking an angiotensin-converting enzyme inhibitor (ACE-I) and reports a nagging cough. Which replacement medication will the nurse expect to be prescribed for this client?
Calcium channel blocker
Beta blocker
Potassium-sparing diuretic
Angiotensin receptor blocker (ARB)
The Correct Answer is D
Choice A reason: Calcium channel blockers reduce blood pressure by relaxing vascular smooth muscle but are not primary replacements for ACE inhibitors in heart failure. They do not address the renin-angiotensin system or the cough side effect mechanism, making them less suitable for this scenario.
Choice B reason: Beta blockers reduce heart rate and myocardial oxygen demand in heart failure but do not directly replace ACE inhibitor effects on the renin-angiotensin system. They are often used adjunctively, not as replacements, and do not address the cough side effect.
Choice C reason: Potassium-sparing diuretics manage fluid retention in heart failure but do not inhibit the renin-angiotensin system like ACE inhibitors. They are not a direct replacement and do not address the cough, which is specific to ACE inhibitor intolerance.
Choice D reason: ARBs block angiotensin II receptors, providing similar benefits to ACE inhibitors in heart failure by reducing vascular resistance and cardiac workload. They are less likely to cause cough, as they do not increase bradykinin levels, making them the expected replacement medication.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Recommending both treatments due to insurance coverage is not therapeutic, as it does not address the clinical rationale. Antidepressants and therapy target different aspects of depression (neurochemical and behavioral), and this response fails to explain their complementary roles effectively.
Choice B reason: Antidepressants correct neurotransmitter imbalances (e.g., serotonin) to alleviate depressive symptoms, while therapy (e.g., CBT) addresses maladaptive thought patterns and behaviors, promoting long-term coping skills. This combination enhances recovery, making this the most therapeutic explanation for the client’s treatment plan.
Choice C reason: Suggesting medications are temporary implies the client will stop treatment, which may not be true for chronic depression. This undermines the importance of ongoing management and therapy’s role in behavioral change, making it less therapeutic and potentially discouraging.
Choice D reason: Asking about reservations may encourage dialogue but does not directly explain the need for therapy alongside medication. It sidesteps the clinical rationale for combined treatment, which is critical for understanding the comprehensive approach to depression management.
Correct Answer is D
Explanation
Choice A reason: Daily weight monitoring and reporting a 3-pound gain in one day indicates fluid retention, a sign of worsening heart failure. This is correct and shows understanding of self-monitoring to prevent complications, requiring no further teaching.
Choice B reason: Notifying the provider about increasing shortness of breath at rest is appropriate, as it signals worsening heart failure due to reduced cardiac output or pulmonary edema. This reflects proper understanding of symptom monitoring, requiring no additional teaching.
Choice C reason: A low-sodium diet reduces fluid retention in heart failure by decreasing sodium-induced water retention, preventing worsening of edema or congestion. This statement is correct and demonstrates understanding of dietary management, requiring no further teaching.
Choice D reason: Sleeping in a reclining chair may occur in severe heart failure due to orthopnea, but it is not a standard recommendation. It suggests poor symptom control, requiring further teaching on optimizing medical management, such as medication adherence and fluid monitoring, to prevent this need.
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