Patient Data

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Amlodipine → Calcium channel blocker → Relaxes vascular smooth muscle, causing vasodilation and decreased blood pressure
Aspirin → Antiplatelet → Inhibits cyclooxygenase (COX-1), preventing thromboxane A₂ formation and reducing platelet aggregation
Lisinopril → Angiotensin-converting enzyme (ACE) inhibitor → Blocks conversion of angiotensin I to angiotensin II, leading to vasodilation and decreased aldosterone secretion
Nitroglycerin → Nitrate → Causes vasodilation (primarily venous), reducing preload and myocardial oxygen demand

Rationale:

Amlodipine is a calcium channel blocker that inhibits calcium ion influx into vascular smooth muscle and myocardial cells. This leads to arterial vasodilation, decreasing systemic vascular resistance and lowering blood pressure. By reducing afterload, amlodipine decreases cardiac workload, which is particularly helpful in patients with hypertension and chest pain from myocardial ischemia.

Aspirin is an antiplatelet medication that irreversibly inhibits cyclooxygenase-1 (COX-1), preventing the formation of thromboxane A₂, a substance that promotes platelet aggregation. This reduces the risk of thrombus formation, which is critical in acute coronary syndrome (ACS) and in patients presenting with chest pain suggestive of myocardial infarction.

Lisinopril is an ACE inhibitor that blocks the conversion of angiotensin I to angiotensin II. This leads to vasodilation and decreased secretion of aldosterone, which reduces blood pressure and decreases fluid retention. By lowering afterload and preload, lisinopril reduces myocardial oxygen demand, protecting the heart during episodes of ischemia.

Nitroglycerin is a nitrate that primarily causes venous vasodilation, decreasing preload and myocardial oxygen demand. This improves coronary blood flow and relieves ischemic chest pain. Nitroglycerin is commonly used in the management of angina and acute chest pain associated with myocardial ischemia.

A. Palpating the popliteal pulse can provide information about circulation, but it does not give an accurate blood pressure reading. Using this method alone is not sufficient for documentation of the client’s blood pressure.

B. Estimating blood pressure based on radial pulse volume is unreliable and can lead to inaccurate assessment and unsafe clinical decisions. Blood pressure must be measured using validated methods.

C. Documenting the last recorded blood pressure without attempting an accurate measurement is inappropriate because it does not reflect the client’s current condition and could lead to unsafe care.

D. Documenting why the blood pressure cannot be accurately measured is the correct action. This communicates the limitation to the healthcare team, ensures patient safety, and provides justification for alternative monitoring strategies until an accurate measurement can be obtained, such as using a thigh cuff or waiting until the client can be positioned appropriately.