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
Digoxin is a cardiac glycoside that increases myocardial contractility and stroke volume, leading to improved cardiac output. It primarily affects the heart's pumping ability and heart rate, but it is not the main drug used to reduce both preload and afterload. Its role is more to manage symptoms of heart failure and improve cardiac output.
Choice B rationale
ACE inhibitors (e.g., lisinopril) work by blocking the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This leads to vasodilation, which decreases both systemic vascular resistance (afterload) and venous pressure (preload), making them a cornerstone for treating heart failure and reducing the workload on the heart.
Choice C rationale
Beta-blockers (e.g., carvedilol) block the effects of epinephrine and norepinephrine on beta receptors, leading to a decrease in heart rate and contractility. This reduces myocardial oxygen demand and can improve ventricular remodeling over time in heart failure, but they do not primarily reduce both preload and afterload in the same way as ACE inhibitors.
Choice D rationale
Diuretics (e.g., furosemide) work by increasing the excretion of sodium and water from the body, which reduces blood volume. This primarily reduces preload (volume returned to the heart) and is used to manage symptoms like edema and congestion, but it is not as effective at reducing afterload as ACE inhibitors.
Correct Answer is B
Explanation
Choice A rationale
While taking a nitroglycerin tablet is a common treatment for angina, it should not be the first action. The immediate priority is to stop the activity causing the increased myocardial oxygen demand. Continuing to exert oneself can worsen myocardial ischemia and potentially lead to a more severe cardiac event, such as a myocardial infarction.
Choice B rationale
The primary action should be to stop the activity immediately and rest. Mowing the lawn is a strenuous activity that increases the heart's workload and oxygen demand. By stopping and resting, the patient decreases myocardial oxygen consumption, which can help alleviate the chest pain and prevent further myocardial ischemia.
Choice C rationale
While moving inside to cool off and get water may seem helpful, it is not the most critical first step. The immediate need is to reduce the cardiac workload, which is best achieved by ceasing the physical exertion. A patient should first sit or lie down to rest, as this action directly addresses the increased oxygen demand.
Choice D rationale
Calling 911 is crucial if the chest pain does not subside with rest or if it worsens. However, it is not the very first action to take. The initial step is always to stop the activity and rest, as this may be sufficient to resolve the symptoms. If the pain persists after resting, then it is appropriate to seek immediate emergency medical help.
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