A patient on an ACE inhibitor reports a dry cough.
What is the most appropriate nursing response?
Reassure the patient that this is a common side effect and will resolve on its own.
Suggest increasing fluid intake to alleviate the cough.
Notify the healthcare provider about the cough.
Discontinue the medication immediately.
The Correct Answer is C
Choice A rationale
While a dry cough is a common side effect of ACE inhibitors, it should not be simply dismissed. The cough is caused by the accumulation of bradykinin, a substance that is normally degraded by the enzyme that ACE inhibitors block. This cough can be very bothersome to patients, and in some cases, can progress and may warrant a change in medication.
Choice B rationale
Increasing fluid intake is a supportive measure for many types of coughs, but it does not address the underlying pharmacological cause of an ACE inhibitor-induced cough. The cough is a direct result of bradykinin accumulation in the lungs, and simply drinking more water will not reduce this level or resolve the cough. The appropriate action involves addressing the root cause.
Choice C rationale
The cough associated with ACE inhibitors is a known side effect that occurs due to the accumulation of bradykinin. This side effect is often a significant reason for discontinuation. The most appropriate nursing action is to report the finding to the healthcare provider so they can evaluate the patient and consider alternative therapies, such as an angiotensin II receptor blocker (ARB), which does not affect bradykinin levels.
Choice D rationale
Discontinuing the medication immediately is not the appropriate action. While a cough can be bothersome, it is not a life-threatening emergency. Abruptly stopping the medication, especially in a patient with a history of hypertension or heart failure, could lead to a sudden and dangerous increase in blood pressure or a worsening of their underlying condition. The decision to discontinue or change medication must be made by the healthcare provider.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Lithium is a mood stabilizer primarily used in the treatment of bipolar disorder. Its therapeutic and toxic effects are not directly related to blood sugar regulation. While some antipsychotics can impact glucose metabolism, lithium's mechanism of action does not involve insulin or glucagon pathways. Therefore, blood sugar assessment is not the most critical lab value prior to administration.
Choice B rationale
Lithium is a monovalent cation that competes with sodium for renal reabsorption. When sodium levels are low, the kidneys reabsorb more lithium to compensate, increasing the risk of lithium toxicity. Conversely, high sodium can increase lithium excretion. Therefore, assessing a patient's serum sodium level (normal range: 135-145 mEq/L) is crucial to prevent lithium accumulation and subsequent toxicity.
Choice C rationale
While urine osmolality can be affected by lithium's long-term effects on the kidneys, such as nephrogenic diabetes insipidus, it is not the most crucial parameter to assess before starting therapy. The primary and immediate risk is related to the competition between lithium and sodium for reabsorption, which directly influences serum lithium levels and the risk of toxicity, making sodium assessment paramount.
Choice D rationale
Hematocrit measures the proportion of red blood cells in the blood and is not directly influenced by lithium. While long-term lithium use can affect other blood cell lines, such as leukocytes, hematocrit is not a primary safety concern or a pre-administration requirement. The most critical lab value for lithium safety is its close relationship with sodium and renal function.
Correct Answer is B
Explanation
Choice A rationale
Nonselective beta blockers can mask the symptoms of hypoglycemia, such as tachycardia and tremors, in patients with type 1 diabetes. This poses a significant risk as it can delay recognition and treatment of a dangerously low blood sugar level, which can lead to seizures, coma, and death.
Choice B rationale
Nonselective beta blockers block both beta-1 and beta-2 adrenergic receptors. Blocking beta-2 receptors in the lungs leads to bronchoconstriction, which can trigger a severe, life-threatening asthma attack (status asthmaticus) by narrowing the airways and making breathing extremely difficult.
Choice C rationale
Nonselective beta blockers can decrease lower esophageal sphincter tone and may worsen acid reflux symptoms. While uncomfortable, this effect is not typically considered an immediately life-threatening adverse event and can be managed by diet, lifestyle changes, and other medications.
Choice D rationale
While nonselective beta blockers are used to treat hypertension, they can cause adverse effects like bradycardia or hypotension. However, these effects are usually manageable and not as immediately life-threatening as the bronchoconstriction that can be induced in a patient with asthma.
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