The nurse is preparing a client for an echocardiogram. The client asks what the test can show Which of the following is a correct statement?

A. GERD:
Gastroesophageal reflux disease (GERD) typically presents with symptoms such as heartburn, regurgitation, and chest pain. It is not related to head trauma or the symptoms described, such as severe headache, vomiting, seizure, and unresponsiveness. GERD is not associated with a fall or neurological events, making it an unlikely diagnosis in this scenario.

B. Hemorrhagic stroke:
A hemorrhagic stroke is a strong suspicion in this case, given the client’s recent fall, the report of a severe headache, vomiting, followed by a seizure and loss of consciousness. These are classic symptoms of increased intracranial pressure, which may result from bleeding in the brain, such as from a hemorrhagic stroke. The client’s hypertension (248/120 mmHg) further increases the risk of a hemorrhagic stroke, particularly in someone on long-term Warfarin, which increases the risk of bleeding. The seizure and unresponsiveness are concerning signs of significant brain injury, and a CT scan or MRI would be essential for confirming this diagnosis.
C. Septic shock:
Septic shock presents with hypotension, fever, tachycardia, and signs of infection. While the client’s elevated temperature (99.2 F) and pulse (102/min) are abnormal, they are not out of proportion to what would be expected with a head injury and potential hemorrhage. Septic shock is unlikely without signs of infection or systemic inflammatory response. The presence of a seizure, headache, and vomiting after trauma suggests a neurological emergency, not sepsis.

D. Absence seizure:
Absence seizures are brief, non-convulsive seizures characterized by a sudden interruption of consciousness, often with a blank stare and lack of motor activity. These seizures are typically seen in younger individuals and are not associated with symptoms such as a severe headache, vomiting, or unresponsiveness following head trauma. The client’s seizure, along with other concerning signs (headache, vomiting, high blood pressure), suggests a more serious neurological event like a hemorrhagic stroke rather than a simple seizure disorder.

A. The client should report to an urgent care for potential hypokalemia:
While ACE inhibitors like Captopril can increase potassium levels (hyperkalemia) due to their effects on the renin-angiotensin-aldosterone system, they are not typically associated with hypokalemia. The client's complaint of a dry cough is a well-known side effect of ACE inhibitors, not an indication of low potassium levels. Therefore, the recommendation to seek urgent care for hypokalemia is not appropriate in this case.

B. The client should immediately use an epinephrine auto-injector (Epi-Pen) and call 9-1-1:
The use of an epinephrine auto-injector is specifically indicated for severe allergic reactions (anaphylaxis), which typically present with symptoms such as difficulty breathing, swelling of the throat, or anaphylactic shock. A chronic dry cough associated with the use of Captopril is not indicative of an allergic reaction, but rather a known adverse effect of ACE inhibitors. Therefore, this response is inappropriate for the situation described.

C. The client should contact their provider, who may switch them to a different medication:
A chronic dry cough is a common side effect of ACE inhibitors like Captopril, occurring in some individuals due to the accumulation of bradykinin. If the cough is bothersome, the best course of action is for the client to contact their healthcare provider. The provider may consider switching the patient to an angiotensin II receptor blocker (ARB), which does not typically cause this side effect. This is the most appropriate and safe action.

D. The client should stop taking the Lisinopril immediately:
Lisinopril is an ACE inhibitor, similar to Captopril, and shares the same potential side effects, including a chronic dry cough. However, the client should not stop taking their medication without consulting their healthcare provider. Discontinuing the medication abruptly can result in uncontrolled hypertension and other risks. The correct course of action is to contact the provider to discuss possible alternatives, not to stop the medication independently.