A patient who takes a thiazide diuretic will begin taking an ACE ...

[mspears3]

A patient who takes a thiazide diuretic will begin taking an ACE inhibitor. The primary care NP should counsel the patient to:
 
  a. report wheezing and shortness of breath, which may occur with these drugs.
  b. take care when getting out of bed or a chair after the first dose of the ACE inhibitor.
  c. discuss taking an increased dose of the thiazide diuretic with the cardiologist.
  d. minimize fluid intake for several days when beginning therapy with the ACE inhibitor.

Question 2

A patient who takes an ACE inhibitor and a thiazide diuretic for hypertension will begin taking spironolactone. The primary care NP should counsel this patient to:
 
  a. avoid foods that are high in potassium.
  b. use a salt substitute when seasoning foods.
  c. discuss changing the ACE inhibitor to an ARB with the cardiologist.
  d. avoid taking antacids containing magnesium while taking these drugs.

[cdmart10]

Answer to Question 1

B
ACE inhibitors have a first-dose effect that may cause a precipitous symptomatic fall in blood pressure, particularly in patients receiving diuretics. The patient should be counseled about rising quickly from sitting or lying down. Wheezing and shortness of breath are unlikely. An increased dose of diuretic and a reduction in fluid intake are not indicated and may add to hypotension.

Answer to Question 2

A
Use of potassium-sparing diuretics or salt substitutes can induce hyperkalemia when taking ACE inhibitors, so this patient should be counseled to restrict potassium. Salt substitutes are high in potassium and are contraindicated. It is not necessary to change to an ARB. Antacids are not contraindicated.

[mspears3]

Thanks for the timely response, appreciate it

[kthug]

Excellent