The nurse administers losartan 50 mg PO to a client. One hour after administration, the client calls the nurse and complains of tingling of the lips. The nurse notes that the client's lips are edematous and recognizes that the client is experiencing anaphylaxis and notifies the healthcare provider. The client requires supplemental oxygen and a fluid bolus. Which statement is true regarding this situation?

The client had an allergic reaction to losartan.

The client had an expected side effect of the medication.

The client should have a prescription change to enalapril.

The client should avoid taking the medication with food.

Answer and Explanation

The Correct Answer is A

Choice A reason: The client had an allergic reaction to losartan, a drug that belongs to the class of angiotensin II receptor blockers (ARBs). ¹ Anaphylaxis is a severe and potentially life-threatening allergic reaction that can cause swelling of the lips, tongue, throat, and face, as well as difficulty breathing, low blood pressure, and shock. ² The client needs immediate medical attention and treatment with oxygen, fluids, and epinephrine. ³

Choice B reason: The client did not have an expected side effect of the medication. Losartan is used to treat high blood pressure and heart failure by blocking the action of angiotensin II, a hormone that causes blood vessels to constrict and retain salt and water. ¹ Some common side effects of losartan include dizziness, headache, fatigue, cough, and nausea. ⁴ Anaphylaxis is not a common or expected side effect of losartan, but a rare and serious adverse reaction.

Choice C reason: The client should not have a prescription change to enalapril. Enalapril is another drug that lowers blood pressure and heart failure, but it belongs to the class of angiotensin-converting enzyme (ACE) inhibitors. ⁵ ACE inhibitors and ARBs have similar mechanisms of action and effects, but they differ in how they block the angiotensin system. However, both classes of drugs can cause allergic reactions and anaphylaxis in some people, especially those who have a history of allergy to either drug. The client should avoid both ACE inhibitors and ARBs and use another type of blood pressure medication.

Choice D reason: The client should not avoid taking the medication with food. Food does not affect the absorption or effectiveness of losartan. ⁴ The client can take the medication with or without food, as directed by the provider. However, the client should avoid grapefruit and grapefruit juice, as they can interact with losartan and increase the risk of side effects.

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Correct Answer is C

Explanation

Choice A reason: Stopping the medication if the client develops a change in vision is not the information that the nurse should provide in the teaching about rosuvastatin. Rosuvastatin is a drug that lowers the cholesterol and prevents the complications of cardiovascular disease. It belongs to a class of drugs called statins, which work by inhibiting an enzyme that produces cholesterol in the liver. Change in vision is not a common or serious side effect of rosuvastatin, and it may be caused by other factors, such as eye strain, infection, or disease. The nurse should not advise the client to stop the medication without consulting the healthcare provider, as this may increase the risk of adverse outcomes, such as heart attack or stroke.

Choice B reason: Monitoring body weight weekly is not the information that the nurse should provide in the teaching about rosuvastatin. Rosuvastatin is a drug that lowers the cholesterol and prevents the complications of cardiovascular disease. It belongs to a class of drugs called statins, which work by inhibiting an enzyme that produces cholesterol in the liver. Body weight is not a direct indicator of the effectiveness or safety of rosuvastatin, and it may fluctuate due to various factors, such as diet, exercise, or fluid retention. The nurse should encourage the client to maintain a healthy weight and lifestyle, but not to focus on the weekly changes in body weight.

Choice C reason: Reporting muscle weakness or pain is the information that the nurse should provide in the teaching about rosuvastatin. Rosuvastatin is a drug that lowers the cholesterol and prevents the complications of cardiovascular disease. It belongs to a class of drugs called statins, which work by inhibiting an enzyme that produces cholesterol in the liver. However, statins can also cause muscle damage, which can manifest as weakness, pain, tenderness, or cramps. This can be a sign of a serious condition called rhabdomyolysis, which is the breakdown of muscle tissue that can lead to kidney failure or death. The nurse should instruct the client to report any muscle symptoms to the healthcare provider as soon as possible, and to avoid taking any other drugs or supplements that may interact with rosuvastatin and increase the risk of muscle damage.

Choice D reason: Having biannual renal function studies is not the information that the nurse should provide in the teaching about rosuvastatin. Rosuvastatin is a drug that lowers the cholesterol and prevents the complications of cardiovascular disease. It belongs to a class of drugs called statins, which work by inhibiting an enzyme that produces cholesterol in the liver. Renal function studies are tests that measure the health and function of the kidneys, which are responsible for filtering the blood and removing waste and excess fluid. Rosuvastatin is not known to cause significant kidney damage, and it is excreted mainly by the liver. The nurse should not recommend the client to have biannual renal function studies, as this may be unnecessary and costly. The nurse should advise the client to follow the healthcare provider's orders regarding the frequency and type of laboratory tests that are needed to monitor the effects of rosuvastatin.

A. Place the patch on the anterior chest. B. Remove the patch if a headache develops. C. Rotate the application sites and inspect the skin. D. Monitor weight on a daily basis.

Correct Answer is C

Explanation

Choice A reason: Placing the patch on the anterior chest is not the best discharge instruction for this client. Clonidine is a drug that lowers blood pressure by stimulating alpha-2 receptors in the brain. ¹ The patch delivers the drug through the skin and into the bloodstream. ² The patch should be applied to a hairless area on the upper arm or torso, not the chest, to ensure proper absorption and avoid irritation. ³

Choice B reason: Removing the patch if a headache develops is not a good discharge instruction for this client. Headache is a common side effect of clonidine, especially when starting or changing the dose. ² Removing the patch abruptly may cause a rebound increase in blood pressure, which can be dangerous. ³ The client should keep the patch on for 7 days, unless instructed otherwise by the provider, and report any severe or persistent headaches.

Choice C reason: Rotating the application sites and inspecting the skin is the best discharge instruction for this client. Rotating the sites helps prevent skin irritation and allergic reactions from the patch. ³ Inspecting the skin helps detect any signs of infection, inflammation, or rash that may require medical attention. The client should also wash the old site with soap and water after removing the patch. ²

Choice D reason: Monitoring weight on a daily basis is not a necessary discharge instruction for this client. Weight is not a sensitive indicator of the effectiveness or safety of clonidine therapy. Weight may be monitored periodically to assess the client's fluid status and possible signs of heart failure, which clonidine can help prevent. ¹ However, this is not a priority action for the client using the patch.

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Naxlex Comprehensive Predictor Exams

The client is prescribed rosuvastatin 10 mg PO daily. What information will the nurse provide in the teaching about this medication?

Correct Answer is C

Explanation

A client who has had long standing hypertension has been prescribed a clonidine patch. Which discharge instruction should the nurse provide?

Correct Answer is C

Explanation

The nurse should monitor the client for clinical manifestations of digoxin toxicity if the laboratory report reflects a serum:

The nurse is reviewing the laboratory test results of a client with long-standing hypertension. Which result would be of most concern to the nurse?

The nurse is providing medication teaching to a client prescribed lisinopril 10 mg PO daily. Which side effect of the medication will the nurse explain to the client is most common?

Which statement, made by a client receiving pharmacologic therapy for hypertension, indicates a need for further clarification by the nurse?

The nurse is caring for a client diagnosed with iron deficiency anemia as the result of a gastrointestinal (GI) bleed. What discharge instruction should the nurse provide if this client is also prescribed aspirin 81 mg daily?

The nurse is aware that the goal of using diltiazem 30 mg PO bid in the collaborative plan of care for a client diagnosed with variant (Prinzmetal's) angina is to:

The client, who is scheduled for a nuclear stress test, tells the nurse that the breakfast tray was not delivered and complains of hunger. The nurse's best response is:

The client who is newly diagnosed with coronary artery disease asks the nurse, "What should I do to help to avoid further complications from my disease?" What information should the nurse stress first?