When administering an alpha blocker for the first time, it is most important for the nurse to assess the patient for the development of what adverse effect?
Renal failure.
Hypotension.
Blood dyscrasia.
Dysrhythmias.
The Correct Answer is B
Choice A rationale
Alpha blockers primarily exert their effects on the vascular smooth muscle by blocking alpha-1 adrenergic receptors. This action leads to vasodilation, which lowers blood pressure. They do not have a direct mechanism of action that would precipitate acute renal failure upon first dose administration. Renal function, while monitored, is not the most immediate or common adverse effect to assess for.
Choice B rationale
Alpha-1 adrenergic receptors, when blocked by alpha blockers, cause vasodilation of both arteries and veins. This leads to a decrease in peripheral vascular resistance and venous return, causing a significant drop in blood pressure. This effect, known as orthostatic hypotension or "first-dose phenomenon," is a common and critical adverse effect to assess for, as it can cause dizziness and fainting.
Choice C rationale
Blood dyscrasias, or disorders involving the cellular components of blood, are not a typical or immediate adverse effect associated with the first administration of an alpha blocker. While some medications can cause these rare side effects over long-term use, the acute and most common concern with the initial dose is related to its cardiovascular effects on blood pressure.
Choice D rationale
While alpha blockers can indirectly affect the heart rate through baroreceptor reflexes in response to hypotension, they are not typically associated with the direct induction of significant dysrhythmias as a primary adverse effect upon first administration. The immediate and most profound hemodynamic effect is the peripheral vasodilation and subsequent hypotension, which takes precedence in initial assessment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Taking a hypnotic medication with a large meal can delay the absorption and onset of action. For effective treatment of insomnia, these medications should be taken on an empty stomach or with a light snack to ensure rapid absorption and to help the patient fall asleep quickly as intended.
Choice B rationale
Non-benzodiazepine hypnotics are specifically formulated for sleep induction and maintenance. They have a sedative effect and should not be taken during the day, as this would impair daily functioning, alertness, and coordination, posing a significant safety risk to the patient and others.
Choice C rationale
Non-benzodiazepine hypnotics cause sedation, dizziness, and impaired coordination. Patients should be warned to avoid activities that require full alertness, such as driving or operating heavy machinery, after taking the medication to prevent accidents and injuries.
Choice D rationale
Patients should never increase the dose of a prescribed medication without consulting their healthcare provider. Increasing the dose of a hypnotic can lead to increased sedation, potential for overdose, and dependency. The provider needs to assess the patient's response and make any necessary adjustments to the treatment plan.
Correct Answer is B
Explanation
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.
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