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

Answer and Explanation

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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Correct Answer is C

Explanation

A) "Crushing the medication is a good idea, and I can mix it in some ice cream for you."
Crushing enteric-coated medications is not advisable as it can disrupt the medication’s intended release mechanism. Enteric coatings are designed to protect the stomach lining and ensure that the medication is released in the intestines. Crushing the medication would bypass these protective mechanisms.

B) "Crushing the medication might cause you to have a stomachache or indigestion."
While this statement is somewhat true, it does not fully address the primary concern. Enteric-coated medications are designed to protect the stomach lining and to ensure proper absorption. Crushing them could lead to other issues beyond just stomachache or indigestion.

C) "Crushing the medication would release all the medication at once, rather than over time."
This is the most accurate response. Enteric-coated aspirin is designed to dissolve in the intestines rather than the stomach, and crushing it would lead to the medication being released all at once, which could potentially cause irritation or harm to the stomach and reduce the medication's effectiveness.

D) "Crushing is unsafe, as it destroys the ingredients in the medication."
While crushing enteric-coated medications can be unsafe, the primary issue is not the destruction of the ingredients but the loss of the medication’s intended release mechanism. This can result in adverse effects or reduced efficacy.

A. Wear sterile gloves and break off the neck of the glass ampule with a single snap to the right side. 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. 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. D. Wear sterile gloves and break off the neck of the glass ampule with a single snap in a downward motion.

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.

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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.)

Nursing Test Bank

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Explanation

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