A patient has been taking chlorthalidone to treat hypertension. ...

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A patient has been taking chlorthalidone to treat hypertension. The patient's prescriber has just ordered the addition of spironolactone to the patient's drug regimen. Which statement by the patient indicates a need for further teaching?
 
  a. I should continue following the DASH diet when adding this drug.
  b. I should not take an ACE inhibitor when adding this drug.
  c. I will need to take potassium supplements when adding this drug.
  d. I will not experience a significant increase in diuresis when adding this drug.

Question 2

A nurse is discussing how beta blockers work to decrease blood pressure with a nursing student. Which statement by the student indicates a need for further teaching?
 
  a. Beta blockers block the actions of angiotensin II.
  b. Beta blockers decrease heart rate and contractility.
  c. Beta blockers decrease peripheral vascular resistance.
  d. Beta blockers decrease the release of renin.

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Answer to Question 1

ANS: C
Spironolactone is given in addition to thiazide diuretics to balance potassium loss caused by the thiazide diuretic. Patients should be advised against taking potassium supplements with spironolactone, because hyperkalemia can result. The DASH diet may be continued. ACE inhibitors are contraindicated because they promote hyperkalemia. Spironolactone does not significantly increase diuresis.

Answer to Question 2

ANS: A
Beta blockers reduce the release of renin by blockade of beta1 receptors on juxtaglomerular cells in the kidney, which reduces angiotensin II-mediated vasoconstriction, but do not block the actions of angiotensin II directly. Beta blockers decrease heart rate and cardiac contractility, decrease peripheral vascular resistance, and decrease the release of renin.

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