During change-of-shift report, the nurse obtains the following ...

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During change-of-shift report, the nurse obtains the following information about a hypertensive patient who received the first dose of nadolol (Corgard) during the previous shift. Which information indicates that the patient needs immediate intervention?
 
  a. The patient's most recent blood pressure (BP) reading is 158/91 mm Hg.
  b. The patient's pulse has dropped from 68 to 57 beats/minute.
  c. The patient has developed wheezes throughout the lung fields.
  d. The patient complains that the fingers and toes feel quite cold.

Question 2

The nurse has just finished teaching a hypertensive patient about the newly prescribed ramipril (Altace). Which patient statement indicates that more teaching is needed?
 
  a. A little swelling around my lips and face is okay.
  b. The medication may not work as well if I take any aspirin.
  c. The doctor may order a blood potassium level occasionally.
  d. I will call the doctor if I notice that I have a frequent cough.

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Answer to Question 1

ANS: C
The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective -blockers) is occurring. The nurse should immediately obtain an oxygen saturation measurement, apply supplemental oxygen, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes are associated with -receptor blockade but do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated. However, this is not as urgently needed as addressing the bronchospasm.

Answer to Question 2

ANS: A
Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an indication that the ACE inhibitor should be discontinued. The patient should be taught that if any swelling of the face or oral mucosa occurs, the health care provider should be immediately notified because this could be life threatening. The other patient statements indicate that the patient has an accurate understanding of ACE inhibitor therapy.

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