Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
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.).
A. 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.
B. 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.
C. 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.
D. Drink at least 3 L of fluids per day.
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.
E. 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..
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Full Explanation
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.
Similar Questions
A nurse is assessing a client who has heart failure and is receiving metoprolol. Which of the following statements by the client indicates a therapeutic effect of the medication?
A. “I have less swelling in my ankles.”
Choice A is wrong because “I have less swelling in my ankles.” This statement indicates a possible effect of a diuretic, which is a medication that reduces fluid retention and edema by increasing urine output. Metoprolol does not have a direct diuretic effect, although it may indirectly reduce fluid accumulation by improving cardiac function.
B. “I can walk farther without getting tired.”
The correct answer is choice B. “I can walk farther without getting tired.” This statement indicates a therapeutic effect of metoprolol, which is a beta-blocker that reduces the heart rate, blood pressure, and the workload of the heart. This helps to improve the blood flow and oxygen delivery to the heart and other organs, and reduces the symptoms of heart failure such as fatigue, dyspnea, and edema.
C. “I don’t have chest pain anymore.”
Choice C is wrong because “I don’t have chest pain anymore.” This statement indicates a possible effect of a nitrate, which is a medication that dilates the blood vessels and reduces the oxygen demand of the heart. Metoprolol may also help to prevent or treat angina by lowering the heart rate and blood pressure, but it is not the primary medication for chest pain relief.
D. “I can breathe better at night.”.
Choice D is wrong because “I can breathe better at night.” This statement indicates a possible effect of an oxygen therapy, which is a treatment that delivers supplemental oxygen to the lungs and improves gas exchange. Metoprolol may also help to reduce dyspnea by improving cardiac function and reducing pulmonary congestion, but it is not the primary treatment for respiratory distress.
Full Explanation
The correct answer is choice B. “I can walk farther without getting tired.” This statement indicates a therapeutic effect of metoprolol, which is a beta-blocker that reduces the heart rate, blood pressure, and the workload of the heart. This helps to improve the blood flow and oxygen delivery to the heart and other organs, and reduces the symptoms of heart failure such as fatigue, dyspnea, and edema.
Choice A is wrong because “I have less swelling in my ankles.” This statement indicates a possible effect of a diuretic, which is a medication that reduces fluid retention and edema by increasing urine output. Metoprolol does not have a direct diuretic effect, although it may indirectly reduce fluid accumulation by improving cardiac function.
Choice C is wrong because “I don’t have chest pain anymore.” This statement indicates a possible effect of a nitrate, which is a medication that dilates the blood vessels and reduces the oxygen demand of the heart. Metoprolol may also help to prevent or treat angina by lowering the heart rate and blood pressure, but it is not the primary medication for chest pain relief.
Choice D is wrong because “I can breathe better at night.” This statement indicates a possible effect of an oxygen therapy, which is a treatment that delivers supplemental oxygen to the lungs and improves gas exchange. Metoprolol may also help to reduce dyspnea by improving cardiac function and reducing pulmonary congestion, but it is not the primary treatment for respiratory distress.
A nurse is evaluating a client who has heart failure and is receiving warfarin. Which of the following statements by the client indicates a need for further teaching?
A. “I will use an electric razor for shaving.”
Choice A is wrong because using an electric razor for shaving is a safe practice for a client who is receiving warfarin, as it reduces the risk of bleeding from cuts or nicks.
B. “I will eat more green leafy vegetables.”
Choice B is wrong because “I will eat more green leafy vegetables.” This statement indicates a need for further teaching because green leafy vegetables are high in vitamin K, which can antagonize the effects of warfarin and increase the risk of clotting. The client should be advised to maintain a consistent intake of vitamin K and avoid sudden changes in their diet.
C. “I will check my stools for blood.”
Choice C is wrong because checking stools for blood is an important measure for a client who is receiving warfarin, as it can indicate gastrointestinal bleeding, which is a serious adverse effect of the medication.
D. “I will have my blood drawn regularly.”.
Choice D is wrong because having blood drawn regularly is necessary for a client who is receiving warfarin, as it allows the monitoring of the international normalized ratio (INR), which reflects the degree of anticoagulation and guides the dosage adjustment of the medication.
Full Explanation
Choice B is wrong because “I will eat more green leafy vegetables.” This statement indicates a need for further teaching because green leafy vegetables are high in vitamin K, which can antagonize the effects of warfarin and increase the risk of clotting. The client should be advised to maintain a consistent intake of vitamin K and avoid sudden changes in their diet.
Choice A is wrong because using an electric razor for shaving is a safe practice for a client who is receiving warfarin, as it reduces the risk of bleeding from cuts or nicks.
Choice C is wrong because checking stools for blood is an important measure for a client who is receiving warfarin, as it can indicate gastrointestinal bleeding, which is a serious adverse effect of the medication.
Choice D is wrong because having blood drawn regularly is necessary for a client who is receiving warfarin, as it allows the monitoring of the international normalized ratio (INR), which reflects the degree of anticoagulation and guides the dosage adjustment of the medication.
The normal range for INR for a client who is receiving warfarin is 2 to 3, unless otherwise specified by the provider.
A nurse is planning to administer mannitol to a client who has heart failure and pulmonary edema. Which of the following actions should the nurse take before giving the medication?
A. Check the urine output.
Mannitol is an osmotic diuretic that increases urine output and decreases intracranial pressure and intraocular pressure. The nurse should check the urine output before giving the medication to ensure adequate renal function and prevent fluid overload and electrolyte imbalance. The normal urine output is 0.5 to 1 mL/kg/hr.
B. Check the blood pressure.
Choice B is wrong because checking the blood pressure is not specific to mannitol administration. Mannitol can cause hypotension or hypertension depending on the fluid status of the client, but this is not the priority action before giving the medication.
C. Check the blood glucose.
Choice C is wrong because checking the blood glucose is not relevant to mannitol administration. Mannitol does not affect blood glucose levels.
D. Check the oxygen saturation.
Choice D is wrong because checking the oxygen saturation is not related to mannitol administration. Mannitol does not affect oxygen saturation levels.
Full Explanation
Mannitol is an osmotic diuretic that increases urine output and decreases intracranial pressure and intraocular pressure. The nurse should check the urine output before giving the medication to ensure adequate renal function and prevent fluid overload and electrolyte imbalance. The normal urine output is 0.5 to 1 mL/kg/hr.
Choice B is wrong because checking the blood pressure is not specific to mannitol administration. Mannitol can cause hypotension or hypertension depending on the fluid status of the client, but this is not the priority action before giving the medication.
Choice C is wrong because checking the blood glucose is not relevant to mannitol administration. Mannitol does not affect blood glucose levels.
Choice D is wrong because checking the oxygen saturation is not related to mannitol administration. Mannitol does not affect oxygen saturation levels.