A nurse is preparing a teaching plan for a client who has chronic constipation secondary to irregular bowel habits. Which of the following should the nurse plan to include in the teaching?

Answer: A. “Syncope episodes may occur when taking this medication.”

Rationale:

A) “Syncope episodes may occur when taking this medication.”
Syncope (fainting) is a possible side effect of donepezil, a cholinesterase inhibitor used to treat Alzheimer’s disease. Donepezil can cause bradycardia, which may lead to a decrease in blood pressure and reduced blood flow to the brain, resulting in syncope. It's important for family members to monitor for episodes of dizziness, fainting, or lightheadedness, particularly when the client changes positions (orthostatic hypotension).

B) “You will need to monitor for constipation.”
Constipation is not commonly associated with donepezil use. In fact, donepezil may cause diarrhea or gastrointestinal upset due to its cholinergic effects. Family members should be more concerned about potential gastrointestinal disturbances such as nausea, vomiting, or diarrhea rather than constipation.

C) “This medication may cause tachycardia.”
Donepezil is more likely to cause bradycardia (a slower-than-normal heart rate) rather than tachycardia (a fast heart rate). Bradycardia is a known side effect because the medication increases acetylcholine, which enhances parasympathetic activity, leading to a slower heart rate.

D) “You should administer the medication each morning.”
Donepezil is typically administered in the evening before bed. This schedule helps reduce the risk of daytime gastrointestinal side effects, like nausea and vomiting, which can interfere with daily activities. Administering the medication at night can also reduce the impact of potential dizziness or syncope during the day.

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.