A client who receives multiple antihypertensive multiple medications experiences syncope due to a drop in blood pressure to 70/40 mm Hg. Which is the rationale for the nurse’s decision to hold the client’s scheduled antihypertensive medications?
Increased urinary clearance of the multiple medications has produced diuresis and lowered blood pressure.
The synergetic effect of the multiple medication has resulted in drug toxicity and resulting hypotension.
The antagonistic interaction among the various blood pressure medications has reduced their effectiveness.
The additive effect of multiple medications has caused the blood pressure to drop too low.
The Correct Answer is D
The client is experiencing syncope (fainting) due to a drop in blood pressure to 70/40 mm Hg, which is too low. This suggests that the client's blood pressure medications are reducing their blood pressure too much, resulting in hypotension. The rationale for the nurse's decision to hold the client's scheduled antihypertensive medications is to prevent further hypotension and allow the client's blood pressure to stabilize at a safer level.
Option a is incorrect because diuresis (increased urine output) is not a likely cause of the client's hypotension.
Option b is incorrect because the client's symptoms suggest hypotension due to reduced blood pressure, rather than drug toxicity.
Option c is incorrect because the antagonistic interaction among blood pressure medications would result in reduced effectiveness but would not necessarily cause hypotension.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Metformin is a medication that can affect kidney function. Since contrast dye used in CT scans is processed through the kidneys, it is important for the nurse to follow up on the client’s use of metformin before the CT scan with contrast. The client may need to temporarily stop taking metformin before and after the procedure to prevent any potential harm to their kidneys.
Correct Answer is B
Explanation
Lactulose is a medication commonly used in the management of hepatic encephalopathy. It works by reducing the absorption of ammonia in the gut, which is a toxin that can accumulate in the blood in patients with liver dysfunction.
Monitoring serum electrolytes and ammonia levels can help the nurse evaluate the effectiveness of lactulose therapy. Elevated ammonia levels can indicate that the medication is not effectively reducing ammonia absorption and may require adjustment in dose or frequency. Additionally, monitoring electrolyte levels can help detect any imbalances that may occur because of lactulose therapy.
Fingerstick glucose levels (option A) are not relevant to evaluating the therapeutic response of lactulose in hepatic encephalopathy.
Stool color and character (option C) may be monitored to assess the side effects of lactulose, such as diarrhea, but are not the best assessments to evaluate therapeutic response.
Serum hepatic enzymes (option D) may be useful in assessing the severity of liver disease but are not the best assessment to evaluate the therapeutic response of lactulose in hepatic encephalopathy.
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