A nurse is teaching a client who has heart failure and is prescribed captopril. Which of the following instructions should the nurse include? (Select all that apply.).

Avoid salt substitutes that contain potassium.

Report any dry cough to the provider.

Take the medication on an empty stomach.

Drink at least 3 L of fluids per day.

Rise slowly from a sitting or lying position.

Answer and Explanation

Correct Answer : A,B,C,E

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.

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Correct Answer is A

Explanation

The nurse should monitor the serum potassium level to determine the therapeutic effectiveness of carvedilol (Coreg), which is a beta-blocker that can lower the heart rate and blood pressure. Carvedilol can also cause hyperkalemia, which is a high level of potassium in the blood that can lead to cardiac arrhythmias and muscle weakness.Therefore, the nurse should monitor the serum potassium level and report any values above 5.0 mEq/L to the provider.

Choice B) Serum sodium level is wrong because carvedilol does not affect the sodium level significantly.Sodium level is more relevant for diuretics, which can cause hyponatremia (low sodium) or hypernatremia (high sodium) depending on the type and dose of the medication.

Choice C) Serum magnesium level is wrong because carvedilol does not affect the magnesium level significantly.

Magnesium level is more relevant for digoxin, which is another medication used for heart failure that can cause hypomagnesemia (low magnesium) or hypermagnesemia (high magnesium).Hypomagnesemia can increase the risk of digoxin toxicity, while hypermagnesemia can decrease the effectiveness of digoxin.

Choice D) Serum calcium level is wrong because carvedilol does not affect the calcium level significantly.

Calcium level is more relevant for calcium channel blockers, which are another class of medications used for heart failure that can lower the heart rate and blood pressure by blocking the entry of calcium into the cardiac and vascular smooth muscle cells.

Calcium channel blockers can cause hypocalcemia (low calcium) or hypercalcemia (high calcium), which can affect the cardiac contractility and conduction.

The normal ranges for serum electrolytes are:

• Potassium: 3.5 to 5.0 mEq/L

• Sodium: 135 to 145 mEq/L

• Magnesium: 1.5 to 2.5 mEq/L

• Calcium: 8.5 to 10.5 mg/dL

A. Serum potassium level B. Serum sodium level C. Serum magnesium level D. Serum calcium level.

Correct Answer is A

Explanation

The nurse should monitor the serum potassium level to determine the therapeutic effectiveness of digoxin (Lanoxin), a cardiac glycoside that improves the contractility and pumping ability of the heart. Digoxin has a narrow therapeutic range and can cause toxicity if the serum level is too high or if the patient has hypokalemia (low potassium).Hypokalemia can result from diuretic therapy, which is often prescribed for heart failure patients to reduce fluid overload.

Therefore, the nurse should monitor the serum potassium level and report any abnormal values to the provider.The normal potassium level is 3.5 to 5.0 mEq/L.

Choice B) Serum sodium level is wrong because sodium level is not directly affected by digoxin therapy.

Sodium level may be altered in heart failure patients due to fluid retention or diuretic use, but it does not indicate the effectiveness of digoxin.

Choice C) Serum magnesium level is wrong because magnesium level is not directly affected by digoxin therapy.

Magnesium level may be altered in heart failure patients due to diuretic use or renal impairment, but it does not indicate the effectiveness of digoxin.

Choice D) Serum calcium level is wrong because calcium level is not directly affected by digoxin therapy.

Calcium level may be altered in heart failure patients due to renal impairment or vitamin D deficiency, but it does not indicate the effectiveness of digoxin.

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A nurse is teaching a client who has heart failure and is prescribed captopril. Which of the following instructions should the nurse include? (Select all that apply.).

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has heart failure and is receiving carvedilol (Coreg). The nurse should monitor which of the following laboratory values to determine therapeutic effectiveness of this medication?

Correct Answer is A

Explanation

A nurse is caring for a client who has heart failure and is receiving digoxin (Lanoxin). The nurse should monitor which of the following laboratory values to determine therapeutic effectiveness of this medication?

Correct Answer is A

Explanation

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