A 78-year-old client is admitted to the emergency department with a heart rate of 34 beats/min. Family members tell the nurse that the client may have mistakenly taken several doses of donepezil. The nurse should anticipate what intervention to treat the client's bradycardia?

A) Obstructive sleep apnea (OSA):
Obstructive sleep apnea is a known risk factor for the development of hypertension. During episodes of sleep apnea, breathing repeatedly stops and starts, leading to disruptions in normal sleep patterns and potentially contributing to increased sympathetic nervous system activity, systemic inflammation, and endothelial dysfunction, all of which can elevate blood pressure over time.

B) The choice B was incorrect. While a diet high in potassium is generally associated with lower blood pressure due to its beneficial effects on blood vessel function and fluid balance, it is not considered a risk factor for developing hypertension. In fact, potassium-rich foods like fruits, vegetables, and legumes are often recommended as part of a heart-healthy diet to help manage blood pressure.

C) The choice C was incorrect. A high-density lipoprotein (HDL) level of 70 mg/dL is actually considered beneficial for cardiovascular health. HDL is often referred to as "good" cholesterol because it helps remove LDL (low-density lipoprotein) cholesterol from the bloodstream, reducing the risk of plaque buildup in the arteries. Having a high HDL level is typically associated with a lower risk of cardiovascular disease, including hypertension.

D) The choice D was incorrect. Benazepril is actually an antihypertensive medication, specifically an angiotensin-converting enzyme (ACE) inhibitor. It is used to treat hypertension, not as a risk factor for its development. ACE inhibitors work by relaxing blood vessels, which helps lower blood pressure. While taking certain medications like benazepril may contribute to the management of hypertension, they are not considered risk factors for its development.

E) Cigarette smoking:
Cigarette smoking is a well-established risk factor for the development of hypertension. Smoking cigarettes can lead to the constriction of blood vessels, increased heart rate, and damage to the lining of blood vessels, all of which can elevate blood pressure. Additionally, the chemicals in tobacco smoke can contribute to inflammation and oxidative stress, further exacerbating cardiovascular risk factors. Smoking cessation is an essential component of hypertension management and overall cardiovascular health.

Answer: A. “Syncope episodes may occur when taking this medication.”

Rationale:

A) “Syncope episodes may occur when taking this medication.”
Syncope (fainting) is a possible side effect of donepezil, a cholinesterase inhibitor used to treat Alzheimer’s disease. Donepezil can cause bradycardia, which may lead to a decrease in blood pressure and reduced blood flow to the brain, resulting in syncope. It's important for family members to monitor for episodes of dizziness, fainting, or lightheadedness, particularly when the client changes positions (orthostatic hypotension).

B) “You will need to monitor for constipation.”
Constipation is not commonly associated with donepezil use. In fact, donepezil may cause diarrhea or gastrointestinal upset due to its cholinergic effects. Family members should be more concerned about potential gastrointestinal disturbances such as nausea, vomiting, or diarrhea rather than constipation.

C) “This medication may cause tachycardia.”
Donepezil is more likely to cause bradycardia (a slower-than-normal heart rate) rather than tachycardia (a fast heart rate). Bradycardia is a known side effect because the medication increases acetylcholine, which enhances parasympathetic activity, leading to a slower heart rate.

D) “You should administer the medication each morning.”
Donepezil is typically administered in the evening before bed. This schedule helps reduce the risk of daytime gastrointestinal side effects, like nausea and vomiting, which can interfere with daily activities. Administering the medication at night can also reduce the impact of potential dizziness or syncope during the day.