A nurse on a medical unit is planning care for an older adult client who takes several medications. Which of the following prescribed medications places the client at risk for orthostatic hypotension? (Select all that apply.)
Duloxetine
Furosemide
Telmisartan
Atorvastatin
Clopidogrel
Correct Answer : A,B,C
A) Duloxetine: Duloxetine, an SNRI (Serotonin-Norepinephrine Reuptake Inhibitor), is commonly used for depression and chronic pain. It can cause orthostatic hypotension, especially in older adults, due to its effects on norepinephrine, which can lead to blood pressure fluctuations upon standing.
B) Furosemide: Furosemide is a loop diuretic that increases urine output, leading to a decrease in blood volume. This reduction in blood volume can result in orthostatic hypotension, particularly when the client changes positions quickly, such as moving from lying down to standing.
C) Telmisartan: Telisartan is an angiotensin II receptor blocker (ARB) used to treat hypertension. It can cause vasodilation and a reduction in blood pressure, which may lead to orthostatic hypotension, especially in older adults who are more sensitive to blood pressure changes.
D) Atorvastatin: Atorvastatin, a statin used to lower cholesterol, does not typically cause orthostatic hypotension. Its primary action is on lipid levels rather than blood pressure, making it less likely to contribute to this condition.
E) Clopidogrel: Clopidogrel is an antiplatelet medication that reduces the risk of blood clots. It does not generally affect blood pressure or cause orthostatic hypotension, as its mechanism of action is related to inhibiting platelet aggregation rather than influencing vascular tone or fluid balance.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A) Wear sterile gloves and break off the neck of the glass ampule with a single snap to the right side:
While wearing gloves can be part of the technique, breaking the ampule to the right side is not standard practice. It is more important to use a sterile gauze pad and break the ampule carefully to avoid glass shards falling into the medication.
B) Tap the bottom of the ampule, place a gauze pad around the ampule neck, and break off the bottom with a forward motion away from the body:
Tapping the bottom of the ampule is not the recommended practice; the top of the ampule should be tapped instead. Additionally, breaking the ampule away from the body is good practice, but it’s crucial to break the top of the ampule, not the bottom.
C) Tap the top of the ampule, place a sterile gauze pad around the ampule neck, and break off the top by bending it toward the body:
This is the correct technique. Tapping the top of the ampule helps to ensure that all the liquid is at the bottom, and placing a sterile gauze pad around the neck protects against glass shards. Breaking the top away from the body reduces the risk of injury and contamination.
D) Wear sterile gloves and break off the neck of the glass ampule with a single snap in a downward motion:
Breaking the ampule downward is not recommended because it can increase the risk of glass shards falling into the medication or causing injury. Proper technique involves breaking the ampule away from the body to ensure safety and avoid contamination.
Correct Answer is B
Explanation
A) "I've had a backache for several days."
A backache is not typically associated with digoxin toxicity. This symptom is more likely related to musculoskeletal issues rather than an adverse effect of digoxin.
B) "I feel nauseated and have no appetite."
Nausea and loss of appetite are common symptoms of digoxin toxicity. Digoxin can cause gastrointestinal disturbances as part of its adverse effects, and these symptoms are important indicators that the medication levels may be too high.
C) "I am urinating more frequently."
Increased urination is not an adverse effect of digoxin itself but may be a result of the diuretic effect of other medications often used in conjunction with digoxin for heart failure. It is not typically a direct sign of digoxin toxicity.
D) "I can walk a mile a day."
The ability to walk a mile a day indicates that the client is experiencing functional improvement, not adverse effects. Digoxin is used to improve symptoms of heart failure, and this statement suggests that the medication may be having a beneficial effect.
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