A patient taking losartan experiences dizziness upon standing.
What should the nurse advise?
Increase the dose of medication.
Change position slowly to prevent orthostatic hypotension.
Take the medication with food.
Discontinue the medication immediately.
The Correct Answer is B
Choice A rationale
Increasing the dose of losartan would exacerbate the patient's dizziness and hypotension. Losartan, an angiotensin II receptor blocker (ARB), works by blocking the vasoconstrictive effects of angiotensin II, leading to vasodilation and a decrease in blood pressure. An increased dose would lead to more profound vasodilation, resulting in an even greater drop in blood pressure and worsening orthostatic hypotension. This could increase the risk of falls and injury.
Choice B rationale
Losartan is a vasodilator, and its action can lead to a drop in blood pressure, especially when a person moves from a sitting or lying position to a standing position, a condition known as orthostatic hypotension. The dizziness is a symptom of this sudden drop in blood pressure. Changing positions slowly allows the body's baroreceptor reflex to compensate and regulate blood pressure, thus mitigating the orthostatic effect and preventing falls.
Choice C rationale
Taking losartan with food does not significantly alter its absorption or a patient's risk of orthostatic hypotension. Losartan can be taken with or without food. However, this action does not address the underlying physiological mechanism of orthostatic hypotension, which is a common side effect of this class of antihypertensive medications. The dizziness is directly related to the vasodilation effect, not food intake.
Choice D rationale
Discontinuing losartan abruptly without consulting a healthcare provider can be dangerous. It could lead to a rebound increase in blood pressure, or a hypertensive crisis, which can increase the risk of stroke or myocardial infarction. The patient should be advised to manage the side effect by changing position slowly, and if symptoms persist, they should consult their healthcare provider to discuss alternative medication options or dose adjustments.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
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.
Correct Answer is C
Explanation
Choice A rationale
While the chest is a common site for patch application, it is not mandatory to apply the patch directly over the heart. The patch can be applied to any hairless area of the body to allow for optimal absorption of the medication through the skin.
Choice B rationale
Transdermal nitroglycerin patches are designed to provide a continuous, sustained release of the medication. Applying two patches at a time can lead to an overdose, resulting in severe hypotension, headache, and dizziness. Patients should be instructed to apply a new patch each day and remove the old one.
Choice C rationale
Hair on the skin can interfere with the adherence of the patch and the absorption of the medication. Applying the patch to a hairless area ensures that the medication is in direct contact with the skin, allowing for proper transdermal delivery and therapeutic effect.
Choice D rationale
Applying petroleum jelly to the skin before applying a transdermal patch can create a barrier that prevents the medication from being absorbed. This would render the patch ineffective. The skin should be clean, dry, and free of any lotions or creams before patch application.
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