A nurse is providing teaching to a client who has hypertension and a new prescription for captopril. Which of the following instructions should the nurse provide?
Expect to gain weight while taking this medication.
Do not use salt substitutes while taking this medication.
Count your pulse rate before taking the medication.
Take the medication with food.
The Correct Answer is B
Choice A reason: Expecting to gain weight while taking this medication is not a correct instruction, as it may discourage the client from adhering to the treatment and may worsen the hypertension. Captopril is an angiotensin-converting enzyme (ACE) inhibitor that lowers the blood pressure by preventing the formation of angiotensin II, a potent vasoconstrictor. Captopril does not cause significant weight gain, but it may cause fluid retention or edema in some cases. The nurse should advise the client to monitor the weight daily and report any sudden or excessive increase to the provider.
Choice B reason: Not using salt substitutes while taking this medication is a correct instruction, as it may prevent the risk of hyperkalemia, a potentially life-threatening condition. Captopril may increase the potassium level in the blood by reducing the secretion of aldosterone, a hormone that regulates the sodium and potassium balance. Salt substitutes may contain potassium chloride, which may further elevate the potassium level. The nurse should advise the client to avoid salt substitutes and high-potassium foods, such as bananas, oranges, or tomatoes, and to have regular blood tests to check the electrolyte levels.
Choice C reason: Counting the pulse rate before taking the medication is not a necessary instruction, as it may not reflect the effect of the medication on the blood pressure. Captopril does not affect the heart rate significantly, but it may lower the blood pressure too much, especially in the first few weeks of treatment or after a dose increase. This may cause hypotension, dizziness, or fainting. The nurse should advise the client to monitor the blood pressure regularly and report any symptoms of hypotension to the provider.
Choice D reason: Taking the medication with food is not a correct instruction, as it may reduce the absorption and effectiveness of the medication. Captopril should be taken on an empty stomach, at least one hour before or two hours after a meal, to ensure optimal bioavailability. The nurse should advise the client to take the medication at the same time every day and to avoid skipping or doubling the doses.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Infection is the correct condition that the client is at increased risk for. Agranulocytosis is a severe decrease in the number of granulocytes, which are a type of white blood cell that fight infection. Propylthiouracil is an antithyroid drug that can cause agranulocytosis as a rare but serious side effect. The client with agranulocytosis is more susceptible to bacterial and fungal infections, and may present with fever, sore throat, mouth ulcers, and skin lesions.
Choice B reason: Excessive bleeding is not the correct condition that the client is at increased risk for. Agranulocytosis does not affect the platelets, which are the blood cells that help with clotting. Propylthiouracil does not cause bleeding disorders, although it may interact with anticoagulants and increase their effect.
Choice C reason: Hyperglycemia is not the correct condition that the client is at increased risk for. Agranulocytosis does not affect the insulin, which is the hormone that regulates blood glucose levels. Propylthiouracil does not cause hyperglycemia, although it may interfere with the metabolism of oral hypoglycemic agents and decrease their effect.
Choice D reason: Ecchymosis is not the correct condition that the client is at increased risk for. Ecchymosis is a bruise caused by bleeding under the skin. Agranulocytosis does not cause ecchymosis, as it does not affect the blood vessels or the platelets. Propylthiouracil does not cause ecchymosis, although it may increase the risk of skin rash and pruritus.
Correct Answer is D
Explanation
Choice A reason: The extra letters after the name of the medication do not mean it is a stronger dose, but that it is a combination of two different medications. Metoprolol is a beta-blocker that lowers blood pressure and heart rate, while hydrochlorothiazide is a diuretic that reduces fluid retention and blood volume. The combination of these two medications may have a synergistic effect and lower blood pressure more effectively than either one alone.
Choice B reason: The client will have to do some things differently because it is not the same medication, but a combination of two medications. The client will have to monitor their blood pressure, weight, fluid intake, and electrolyte levels more closely, as the addition of hydrochlorothiazide may increase the risk of dehydration, hypotension, and hypokalemia. The client will also have to avoid alcohol, salt, and potassium supplements, as they may interact with the medication and affect its efficacy or safety.
Choice C reason: The client will still have to diet to lose weight, as the medication does not cause weight loss, but may cause weight gain due to fluid retention. The client will have to follow a healthy diet that is low in sodium, fat, and cholesterol, as these may worsen hypertension and increase the risk of cardiovascular complications. The client will also have to exercise regularly, as this may help lower blood pressure and improve overall health.
Choice D reason: The client may experience fewer side effects with the new medication, as the combination of metoprolol and hydrochlorothiazide may lower the dose and frequency of each medication, and reduce the adverse effects of each one. For example, metoprolol may cause fatigue, dizziness, or bradycardia, while hydrochlorothiazide may cause dry mouth, headache, or gout. The combination of these two medications may balance out these effects and improve the client's tolerance and compliance.
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