A patient is prescribed diltiazem for hypertension, what should the nurse monitor the patient for?

A. Instruct the patient to go to an emergency department because this is a hypersensitivity reaction.: A persistent cough from captopril is not an immediate hypersensitivity reaction; it is a common, non-life-threatening side effect. Emergency care is not required unless there are signs of angioedema or respiratory distress.

B. Schedule an appointment with the provider to discuss changing to an angiotensin II receptor blocker (ARB).: ACE inhibitors like captopril can cause a persistent dry cough due to increased bradykinin levels. Switching to an ARB avoids this side effect while maintaining antihypertensive efficacy. Discussing alternatives with the provider is the appropriate action.

C. Tell the patient to stop taking the drug immediately since this is a serious side effect of this drug.: Abrupt discontinuation without provider guidance may lead to uncontrolled hypertension. While the cough is bothersome, it is not immediately dangerous, and medication changes should be managed through the prescriber.

D. Reassure the patient that this side effect is nothing to worry about and will diminish over time.: The cough caused by captopril often persists as long as the drug is taken. Reassuring the patient without considering alternative therapy may prolong discomfort and reduce adherence to treatment.

A. Request an order for a blood glucose level: TMP-SMX does not typically cause acute changes in blood glucose, so testing glucose would not clarify the cause of petechiae. Petechial rashes suggest a possible blood dyscrasia such as thrombocytopenia rather than a metabolic disturbance.

B. Hold the dose and notify the provider.: A petechial rash can signal a serious hypersensitivity reaction or drug-induced thrombocytopenia. Giving another dose could worsen the reaction and increase the risk of bleeding or systemic complications. Holding the medication and seeking immediate evaluation is the safest intervention.

C. Request an order for a BUN and creatinine level.: Although TMP-SMX can affect renal function, petechiae primarily indicate a hematologic problem rather than isolated kidney dysfunction. Checking kidney values does not address the risk for severe allergic or platelet-related complications.

D. Request an order for diphenhydramine (Benadryl): Antihistamines can help mild allergic reactions but may mask symptoms of a more serious underlying condition such as thrombocytopenia. Giving it without stopping the medication could delay correct diagnosis and treatment.