The nurse administers losartan 50 mg PO to a client. One hour after administration, the client calls the nurse and complains of tingling of the lips. The nurse notes that the client's lips are edematous and recognizes that the client is experiencing anaphylaxis and notifies the healthcare provider. The client requires supplemental oxygen and a fluid bolus. Which statement is true regarding this situation?

The client had an allergic reaction to losartan.

The client had an expected side effect of the medication.

The client should have a prescription change to enalapril.

The client should avoid taking the medication with food.

Answer and Explanation

The Correct Answer is A

Choice A reason: The client had an allergic reaction to losartan, a drug that belongs to the class of angiotensin II receptor blockers (ARBs). ¹ Anaphylaxis is a severe and potentially life-threatening allergic reaction that can cause swelling of the lips, tongue, throat, and face, as well as difficulty breathing, low blood pressure, and shock. ² The client needs immediate medical attention and treatment with oxygen, fluids, and epinephrine. ³

Choice B reason: The client did not have an expected side effect of the medication. Losartan is used to treat high blood pressure and heart failure by blocking the action of angiotensin II, a hormone that causes blood vessels to constrict and retain salt and water. ¹ Some common side effects of losartan include dizziness, headache, fatigue, cough, and nausea. ⁴ Anaphylaxis is not a common or expected side effect of losartan, but a rare and serious adverse reaction.

Choice C reason: The client should not have a prescription change to enalapril. Enalapril is another drug that lowers blood pressure and heart failure, but it belongs to the class of angiotensin-converting enzyme (ACE) inhibitors. ⁵ ACE inhibitors and ARBs have similar mechanisms of action and effects, but they differ in how they block the angiotensin system. However, both classes of drugs can cause allergic reactions and anaphylaxis in some people, especially those who have a history of allergy to either drug. The client should avoid both ACE inhibitors and ARBs and use another type of blood pressure medication.

Choice D reason: The client should not avoid taking the medication with food. Food does not affect the absorption or effectiveness of losartan. ⁴ The client can take the medication with or without food, as directed by the provider. However, the client should avoid grapefruit and grapefruit juice, as they can interact with losartan and increase the risk of side effects.

Nursing Test Bank

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Free Nursing Study Resources

Correct Answer is D

Explanation

Choice A reason: Preparing for endotracheal intubation and ventilatory support is not the action that the nurse should take for a client with thyroid storm. This intervention is indicated for clients with respiratory failure or impending airway obstruction, which are not the case for this client.

Choice B reason: Providing continuous sedation for pain relief is not the action that the nurse should take for a client with thyroid storm. This intervention may worsen the client's condition by suppressing the respiratory drive and lowering the blood pressure. The nurse should administer antithyroid medications, beta blockers, and corticosteroids as prescribed to reduce the thyroid hormone levels and the associated symptoms.

Choice C reason: Initiating cardiac monitoring and assessing for reflex bradycardia is not the action that the nurse should take for a client with thyroid storm. This intervention is indicated for clients with hyperkalemia or digoxin toxicity, which are not the case for this client. The nurse should monitor the client's heart rate and rhythm, but not expect a reflex bradycardia, which is a paradoxical slowing of the heart rate in response to a rapid rise in blood pressure.

Choice D reason: Maintaining IV fluid infusion and assessing adequacy of hydration is the action that the nurse should take for a client with thyroid storm. This intervention is indicated for clients with thyroid storm, as they are at risk of dehydration and electrolyte imbalance due to increased metabolic rate, fever, sweating, vomiting, and diarrhea. The nurse should administer isotonic fluids, such as normal saline, and monitor the client's fluid intake and output, urine specific gravity, and serum electrolytes.

A. Has gained 2 pounds and has pink buccal mucosa B. No longer has paresthesia of the hands and feet C. Realizes eating more iron fortified cereals D. Has stopped drinking any alcoholic beverages

Correct Answer is B

Explanation

Choice A reason: While gaining weight and having pink buccal mucosa can be signs of overall improved health, they are not specific indicators of effective treatment for vitamin B12 deficiency¹².

Choice B reason: Paresthesia (a sensation of tingling, tickling, pricking, or burning of a person's skin) of the hands and feet is a common symptom of vitamin B12 deficiency¹². If the client no longer has this symptom, it could indicate that the treatment for vitamin B12 deficiency has been effective¹².

Choice C reason: Eating more iron-fortified cereals can contribute to overall nutritional health, but it's not directly related to the treatment of vitamin B12 deficiency¹².

Choice D reason: While stopping alcohol consumption can improve overall health, it's not a specific indicator of effective treatment for vitamin B12 deficiency¹²..

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is experiencing a thyroid storm precipitated by a right lower lobe pneumonia. The vital signs are: HR-140/min; RR-28, B/P-196/54; T-101.4°F, Pulse Oximetry-96%. What action should the nurse take?

Correct Answer is D

Explanation

The client diagnosed with vitamin B12 deficiency presents to the outpatient department for the follow-up evaluation. Which nursing assessment finding indicates that the treatment has been effective? The client:

Correct Answer is B

Explanation

The nurse is working collaboratively with the physical therapist to develop an exercise program for a client recently diagnosed with hypertension. Which intervention would be best to assist the client in maintaining the exercise program?

A client who has had long standing hypertension has been prescribed a clonidine patch. Which discharge instruction should the nurse provide?

A client with alcoholism is admitted to a medical-surgical unit with a serum magnesium level of 0.9 mEq/L. Which clinical manifestations would the nurse expect to find in this client?

The nurse administers atenolol 50 mg PO bid to a client who has coronary artery disease. The nurse understands that the therapeutic effect of this medication for this client is to:

Which statement, made by the client with coronary artery disease, alerts the nurse that the client may be experiencing difficulty adapting to the illness?

The nurse, who is caring for a client diagnosed with coronary artery disease, prioritizes the problem of impaired tissue perfusion in the plan of care. Which outcome would be most appropriate? The client will:

In preparation for a patient having a Schilling test, the nurse should explain that the test:

When caring for a client diagnosed with thrombocytopenia, the nurse should plan to: