The nurse is preparing medications for a client with a history of hypertension who is post-op day 3 following hip replacement.

Meds: Atenolol 25 mg PO, Captopril 10 mg PO, Atorvastatin 40 mg PO, and Warfarin 4 mg PO.

Vital signs: blood pressure 138/90, heart rate 52, respiratory rate 18, temperature 99.7, O2 saturation 96% on room air.

Today’s labs: sodium- 143 meq/L, potassium 4.6 mmol/L, Hemoglobin 11.1 gm/dL, white blood count 10.8, INR 2.2

Which medication will the nurse hold?

Choice A reason: This is incorrect because a dry cough is not a common or serious side effect of hydralazine. A dry cough is more likely to occur with angiotensin-converting enzyme (ACE) inhibitors, which are another class of antihypertensive drugs.

Choice B reason: This is incorrect because hydralazine does not cause a low heart rate. In fact, hydralazine can cause a reflex increase in heart rate as a result of lowering the blood pressure. This is why hydralazine is often given with a beta-blocker, which can slow down the heart rate.

Choice C reason: This is incorrect because hydralazine does not interact with birth control. However, the nurse should advise the client to use effective contraception while taking hydralazine, as this medication can cause fetal harm if used during pregnancy.

Choice D reason: This is correct because hydralazine can cause orthostatic hypotension, which is a sudden drop in blood pressure when changing positions. This can lead to dizziness, fainting, and falls. The nurse should instruct the client to avoid getting up too quickly and to ask for assistance if needed.

Choice A reason: This choice is incorrect because sulfa allergy is not a priority assessment for the nurse to make prior to giving nifedipine. Sulfa allergy is a hypersensitivity reaction to drugs that contain sulfonamide, such as antibiotics, diuretics, or antidiabetic agents. Sulfa allergy can cause symptoms such as rash, itching, fever, or anaphylaxis. Nifedipine does not contain sulfonamide and does not cross-react with sulfa drugs. The nurse should ask the client about any drug allergies and document them, but sulfa allergy is not relevant to nifedipine.

Choice B reason: This choice is incorrect because aPTT is not a priority assessment for the nurse to make prior to giving nifedipine. aPTT stands for activated partial thromboplastin time, which is a measure of how long it takes the blood to clot. It is used to monitor the effect of anticoagulant drugs, such as heparin, that prevent blood clots. Nifedipine does not affect the blood clotting time and does not interact with anticoagulant drugs. The nurse should check the aPTT only if the client is taking anticoagulant drugs and has signs of bleeding or clotting.

Choice C reason: This choice is incorrect because hemoglobin is not a priority assessment for the nurse to make prior to giving nifedipine. Hemoglobin is a protein in the red blood cells that carries oxygen to the tissues and organs of the body. Hemoglobin levels can be affected by conditions such as anemia, dehydration, or blood loss. Nifedipine does not affect the hemoglobin levels or the oxygen delivery. The nurse should monitor the hemoglobin levels and the signs of anemia, such as fatigue, pallor, or shortness of breath, but they are not related to nifedipine.

Choice D reason: This choice is correct because blood pressure is the priority assessment for the nurse to make prior to giving nifedipine. Nifedipine is a calcium channel blocker that lowers blood pressure and relaxes the blood vessels. It is used to treat conditions such as hypertension, angina, and Raynaud's phenomenon. However, nifedipine can cause side effects such as hypotension (low blood pressure), dizziness, headache, flushing, and edema (swelling). The nurse should check the client's blood pressure before giving nifedipine and withhold the dose if the blood pressure is too low. The nurse should also monitor the client's blood pressure and the signs of hypotension, such as fainting, weakness, or chest pain.