A nurse is evaluating a client who has hypertension and is taking lisinopril, an angiotensin II receptor blocker (ARB). Which of the following outcomes indicates that the medication is effective?
The client has no edema in the lower extremities.
The client has a urine output of 30 mL/hr.
The client has a blood pressure of 120/78 mm Hg.
The client has a serum creatinine level of 1.2 mg/dL.
The Correct Answer is C
The client has a blood pressure of 120/78 mm Hg. This indicates that the medication is effective because it lowers the blood pressure below the hypertensive levels. In adults 60 years of age or older, this is typically defined as a systolic pressure below 150 mm Hg and a diastolic pressure below 90 mm Hg.
Choice A is wrong because the client has no edema in the lower extremities. This is not a specific outcome of lisinopril, an angiotensin II receptor blocker (ARB). Edema can be caused by many factors, such as heart failure, kidney disease, or venous insufficiency. Lisinopril does not directly affect fluid retention or edema.
Choice B is wrong because the client has a urine output of 30 mL/hr. This is a low urine output that may indicate dehydration, kidney impairment, or urinary obstruction. Lisinopril is expected to increase urine output by reducing the blood pressure and improving the renal blood flow.
Choice D is wrong because the client has a serum creatinine level of 1.2 mg/dL. This is a high serum creatinine level that may indicate kidney damage or reduced kidney function. Lisinopril is expected to lower the serum creatinine level by preventing the progression of kidney disease and protecting the kidney from further injury.
Normal ranges of urine output, blood pressure, and serum creatinine are:
• Urine output: 800 to 2000 mL/day or 40 to 80 mL/hr
• Blood pressure: less than 120/80 mm Hg for adults
• Serum creatinine: 0.6 to 1.2 mg/dL for males and 0.5 to 1.1 mg/dL for females
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","E"]
Explanation
Captopril is an angiotensin-converting enzyme (ACE) inhibitor that is used to treat heart failure by lowering blood pressure and reducing the workload on the heart.
The nurse should include the following instructions when teaching a client who is prescribed captopril:
• Avoid salt substitutes that contain potassium.Captopril can increase the potassium levels in the blood, which can lead to hyperkalemia.Salt substitutes that contain potassium can further increase the risk of hyperkalemia, which can cause cardiac arrhythmias and muscle weakness.
• Report any dry cough to the provider.A dry cough is a common side effect of captopril and other ACE inhibitors.It is caused by the accumulation of bradykinin, a substance that dilates blood vessels and causes inflammation in the lungs.
The cough can be annoying and interfere with sleep and quality of life.The provider may switch the client to another type of medication if the cough is bothersome.
• Take the medication on an empty stomach.Food can decrease the absorption and effectiveness of captopril.The client should take the medication at least 1 hour before or 2 hours after meals.
• Rise slowly from a sitting or lying position.Captopril can cause orthostatic hypotension, which is a sudden drop in blood pressure when changing positions.
This can lead to dizziness, fainting, and falls.The client should rise slowly and sit on the edge of the bed for a few minutes before standing up.
Choice D is wrong because drinking at least 3 L of fluids per day is not recommended for clients with heart failure.
Excessive fluid intake can worsen the symptoms of heart failure, such as edema, shortness of breath, and fatigue.The client should limit fluid intake to 2 L or less per day, unless instructed otherwise by the provider.
Correct Answer is E
Explanation
Adrenergic drugs.These are drugs that stimulate the sympathetic nervous system by mimicking or enhancing the effects of epinephrine and norepinephrine, the chemical messengers that activate adrenergic receptors.Adrenergic drugs can increase blood pressure, heart rate, cardiac output, vascular tone, and renin release by acting on different types of adrenergic receptors.
Choice A is wrong because beta blockers are drugs that inhibit the sympathetic nervous system by blocking the beta adrenergic receptors, which are responsible for increasing heart rate and contractility. Beta blockers can lower blood pressure and reduce cardiac workload.
Choice B is wrong because calcium channel blockers are drugs that inhibit the movement of calcium ions across the cell membrane of smooth muscle cells, which are found in blood vessels and the heart.Calcium channel blockers can relax blood vessels and lower blood pressure, as well as reduce heart rate and contractility.
Choice C is wrong because angiotensin II receptor blockers (ARBs) are drugs that block the action of angiotensin II, a hormone that causes vasoconstriction and stimulates the release of aldosterone, which increases sodium and water retention.
ARBs can lower blood pressure by dilating blood
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