The nurse is about to administer the combination medication chlorthalidone and atenolol to a client diagnosed with chronic hypertension. Which interventions should the nurse include in the plan of care? (Select all that apply)

Administer if the blood pressure is 90/60 and monitor for side effects

Hold if the heart rate is less than 60 beats per minute

Teach to dangle feet before standing

Encourage to limit the intake of potassium-rich foods

Monitor fluid intake and output

Answer and Explanation

Correct Answer : B,C,E

Choice A reason: Chlorthalidone and atenolol are used to treat hypertension⁴⁵. However, administering the medication when the blood pressure is 90/60 might not be advisable. This is because atenolol, a beta-blocker, can further lower the heart rate and blood pressure¹¹⁷. Therefore, it's important to monitor the patient's blood pressure before administration¹.

Choice B reason: Atenolol can slow the heart rate¹¹⁷. If the heart rate is already less than 60 beats per minute, which is the lower limit of the normal range¹, the medication should be held and the healthcare provider should be notified⁵.

Choice C reason: One of the side effects of atenolol and chlorthalidone is dizziness or lightheadedness¹¹⁷. Teaching the patient to dangle their feet before standing can help prevent orthostatic hypotension, a form of low blood pressure that happens when you stand up from sitting or lying down¹¹.

Choice D reason: Chlorthalidone is a diuretic that can cause the body to lose potassium¹¹⁷. However, atenolol does not have this effect⁵. Therefore, it's not necessary to limit the intake of potassium-rich foods unless advised by a healthcare provider.

Choice E reason: Monitoring fluid intake and output is important when administering diuretics like chlorthalidone⁵. This can help ensure the patient is not becoming dehydrated and help monitor the medication's effectiveness¹¹.

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Correct Answer is D

Explanation

Choice A reason: This is a high-fat, high-sodium, and high-calorie meal that is not suitable for a client with hypertension. Fried foods, processed meats, and baked beans are sources of saturated fat and sodium that can raise blood pressure and cholesterol levels. Cake is a source of added sugar that can contribute to obesity and diabetes.

Choice B reason: This is a moderate-fat, moderate-sodium, and moderate-calorie meal that is not ideal for a client with hypertension. Fried flounder and tomato soup are sources of fat and sodium that can increase blood pressure. White rice is a refined carbohydrate that can spike blood sugar levels and increase the risk of diabetes.

Choice C reason: This is a high-fat, high-sodium, and high-calorie meal that is not appropriate for a client with hypertension. Barbecue pulled pork sandwich, mashed potatoes, and ice cream are sources of saturated fat and sodium that can elevate blood pressure and cholesterol levels. Fresh green beans are the only healthy component of this meal.

Choice D reason: This is a low-fat, low-sodium, and low-calorie meal that is suitable for a client with hypertension. Baked tuna, fresh broccoli, brown rice, and fresh cantaloupe are sources of lean protein, fiber, complex carbohydrates, vitamins, minerals, and antioxidants that can lower blood pressure and cholesterol levels, prevent obesity and diabetes, and promote cardiovascular health.

A. Elevated troponins B. Decreased homocysteine levels C. Elevated CK-MB D. Decreased alkaline phosphatase (ALP) E. Increased platelet count

Correct Answer is ["A","C"]

Explanation

Choice A: Elevated troponins. This is a correct answer. Troponins are proteins that regulate the myocardial contractile process². They are released into the bloodstream when the myocardial cells are damaged by ischemia or infarction². Troponins are highly specific and sensitive indicators of myocardial injury². The normal range for troponin I is less than 0.03 ng/mL and for troponin T is less than 0.01 ng/mL².

Choice B: Decreased homocysteine levels. This is not a correct answer. Homocysteine is an amino acid that is involved in the metabolism of methionine². Elevated homocysteine levels are associated with an increased risk of cardiovascular disease, but they are not a direct marker of myocardial injury². The normal range for homocysteine is 5 to 15 micromol/L².

Choice C: Elevated CK-MB. This is a correct answer. CK-MB is one of the isoenzymes of creatine kinase, an enzyme that catalyzes the conversion of creatine to phosphocreatine, which is used for energy storage in the muscles². CK-MB is found mainly in the myocardium and is released into the blood when the myocardial cells are injured². CK-MB is a specific and sensitive marker of myocardial injury, but it is less specific than troponins². The normal range for CK-MB is 0 to 3 ng/mL².

Choice D: Decreased alkaline phosphatase (ALP).This is not a correct answer. ALP is an enzyme that is found in various tissues, such as the liver, bone, intestine, and placenta². ALP is not a marker of myocardial injury, and its levels are not affected by ischemia or infarction². The normal range for ALP is 30 to 120 U/L².

Choice E: Increased platelet count.This is not a correct answer. Platelets are blood cells that are involved in hemostasis and clot formation². Increased platelet count, or thrombocytosis, can be a sign of inflammation, infection, malignancy, or other conditions². Platelet count is not a marker of myocardial injury, and it does not reflect the extent of ischemia or infarction². The normal range for platelet count is 150,000 to 450,000 per microliter of blood².

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The nurse is about to administer the combination medication chlorthalidone and atenolol to a client diagnosed with chronic hypertension. Which interventions should the nurse include in the plan of care? (Select all that apply)

Nursing Test Bank

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