A 72-year-old female patient is being discharged home from the ...

[burton19126]

A 72-year-old female patient is being discharged home from the hospital on newly prescribed anticholinergic drugs. A referral to the home health nurse has been made.
 
  What priority teaching point will the home health nurse emphasize when discussing the patient's drugs? A) Do not drive or use machinery.
  B) Take lots of hot baths or showers.
  C) Keep the house warm to avoid a chill.
  D) Limit intake of fluids.

Question 2

The nurse cares for a diabetic patient with uncontrolled hypertension who has been prescribed losartan (Cozaar). The health care provider changes this patient's prescription to losartan with hydrochlorothiazide (Hyzaar).
 
  What benefits does the nurse anticipate this patient will receive from this drug therapy? (Select all that apply.) A) Slows progression of diabetic nephropathy in type 2 diabetes
  B) Increases excretion of fluid and sodium resulting in lower blood volume
  C) Alters electrolyte and acidbase balance
  D) Improves control of blood pressure due to combination therapy
  E) Produces far fewer adverse effects resulting from the combination

[jsm54321]

Answer to Question 1

A
Feedback:
Safety precautions may be needed if blurred vision and dizziness occur. The patient should be urged not to drive or perform tasks that require concentration and coordination. The home care nurse would not teach the patient to take hot baths or showers. The patient would be cautioned about inability to perspire in hot environments and to avoid them. Fluid intake should not be limited.

Answer to Question 2

A, B
Feedback:
Many patients require more than one type of antihypertensive to achieve good control of their blood pressure. There are now many fixed-combination drugs available for treating hypertension. This allows for fewer tablets or capsules each day, making it easier for the patient to comply with drug therapy. Losartan slows the progression of diabetic nephropathy in patients with hypertension and type 2 diabetes. Hydrochlorothiazide is a diuretic that will increase excretion of fluid and sodium resulting in a lower circulating blood volume that will help to reduce blood pressure, preload, and afterload. The two drugs will work together to better control the patient's blood pressure. Alteration in electrolytes and acidbase is a reasonable expectation but it is an adverse effect and not a benefit. There are likely to be more adverse effects when taking drugs that are not fixed combinations.