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 C
Explanation
Choice A rationale
The HbA1c test measures the average blood glucose concentration over the past two to three months by assessing the amount of glycated hemoglobin in red blood cells. It does not differentiate between type 1 or type 2 diabetes mellitus, as both conditions can result in elevated blood glucose levels and thus an elevated HbA1c reading. A diagnosis of type 1 versus type 2 diabetes requires a different diagnostic approach.
Choice B rationale
The HbA1c test measures the percentage of hemoglobin with glucose molecules attached. This is an indicator of long-term average blood glucose control and is not a marker for infection. Infections can cause an acute increase in blood glucose levels but do not directly or immediately affect the HbA1c, which reflects a longer-term trend. The normal HbA1c is below 5.7%.
Choice C rationale
Glycated hemoglobin forms when hemoglobin in red blood cells binds to glucose in the bloodstream. Since red blood cells have a lifespan of approximately 120 days, the HbA1c level reflects the average blood glucose concentration over the preceding two to three months. This provides a valuable metric for assessing patient adherence to diet, exercise, and medication regimens over an extended period.
Choice D rationale
The HbA1c value represents the average blood glucose level over a two to three month period, not the patient’s current or fasting blood glucose level. A fasting blood glucose test measures the glucose concentration in the blood at a single point in time, specifically after at least eight hours of not eating. These two tests provide different snapshots of glycemic control.
Correct Answer is ["C","D"]
Explanation
Choice A rationale
Beta-blockers, such as propranolol, are not known to cause vasodilation of the coronary arteries. These medications block the effects of epinephrine, which results in a reduction in heart rate and blood pressure, but they do not directly dilate the coronary arteries. The main effect is on cardiac workload and oxygen demand.
Choice B rationale
Beta-blockers primarily function by antagonizing the effects of catecholamines on beta-adrenergic receptors, leading to a decrease in the force of cardiac contraction (negative inotropic effect). This reduction in contractility lowers the heart's workload and oxygen demand, which is beneficial in post-MI patients, not by increasing it.
Choice C rationale
Beta-blockers produce a negative chronotropic effect by blocking beta-1 receptors in the sinoatrial (SA) node. This action slows the heart rate, allowing for increased diastolic filling time and improved coronary artery perfusion. This decreased heart rate also reduces myocardial oxygen consumption, which is crucial after a myocardial infarction.
Choice D rationale
By reducing heart rate, contractility, and blood pressure, beta-blockers significantly decrease the oxygen demand of the heart muscle. This is their primary therapeutic benefit following an MI. A lower myocardial oxygen demand helps to prevent further ischemia and limits the extent of myocardial damage.
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