Question

1. Which client is most likely to be diagnosed with secondary hypertension? a. A client whose most recent blood pressure readings were 143/92, 147/94, and 144/94 mm Hg b. A client with peripheral vascular disease C. A client whose body mass index is 31 (obese) d. A client who is being treated for pheochromocytoma 2. The nurse is taking the health history of a 58-year-old man who was taking lovastatin for high cholesterol. What assessment question should the nurse prioritize related to the safe use of this drug? a. "How many alcoholic drinks do you have in a typical day or week?" b. "How would you describe your caffeine intake?" c. "Do you do any physical exercise on a regular basis?" d. "Do you use any over-the-counter medications for headache or colds?" A client taking lovastatin presents to the clinic reporting acute muscle pain not associated with exercise for injury. And nurses ask questions to determine if this client has been taking what contraindicated substance? a. Over the counter (OTC) medications b. Ginseng c. Grapefruit juice d. Saw Palmetto 4. The nurse reviews the laboratory results of a client taking digoxin. What finding creates a risk for digoxin and toxicity? a. Chloride 98 mmol/L b. Sodium 144 mmol/L c. Hemoglobin 133 g/L d. Potassium 2.9 mmol/L

Answer 1

1 .

d ) the client who is treated for Pheochromocytoma

PHEOCHROMOCYTOMA

Pheochromocytoma should be suspected when there are paroxysmal elevations in blood pressure. Other symptoms include the classic triad of headache, palpitations, and sweating.57 Because pheochromocytoma is rare, only patients with these symptoms or adrenal incidentaloma should be evaluated for pheochromocytoma.4 The investigation of adrenal incidentaloma is important because there are associated cardiovascular sequelae, and the hypertension is largely reversible with treatment. Testing for pheochromocytoma can be done by measuring metanephrines in a 24-hour urine sample or by measuring plasma free metanephrines, followed by CT if results are abnormal.

2 .  

c ) Do you do any physical exercise in a regular basis .

3 .  

c ) grapefruit juice

Grapefruit is a great low-calorie source of vitamin C, fiber, and other nutrients. But we've known for several years that this citrus fruit and its juice can interact adversely with many prescription drugs, including some of the statins that are widely used to lower cholesterol. (There's some evidence that pomelos, a fruit that resembles grapefruit, and Seville oranges, which are used in making marmalades, have a similar effect.)

Grapefruit contains compounds that interfere with digestive enzymes that break down (metabolize) various drugs — especially the enzyme CYP34A, which is part of a large family of drug-metabolizing enzymes called cytochrome P450. This increases the amount of drug absorbed and thus the amount in the bloodstream. Other chemicals in grapefruit alter the activity of proteins responsible for transporting some drugs through the wall of the intestine. This also boosts drug absorption and blood levels of the drug

grapefruit juice increases blood levels of calcium-channel blockers, which are used to treat high blood pressure. If you take one of these drugs with grapefruit or grapefruit juice, your blood pressure can fall too low. In the case of statins, higher blood levels could increase their side effects — including fatigue, muscle aches, and even damage to muscle cells.

The more fruit or juice you eat, the greater the effect. And the impact is greatest if you take the drug — in your case, a statin — at the same time as you have the fruit. The effect on drug metabolism can last for several days, so taking your statin at night and your grapefruit juice the next morning won't solve the problem.

People who consume grapefruit or grapefruit juice should check with a pharmacist to find out if any of their medications interact with the fruit. In most cases, another medication can be substituted. With statin drugs, you have some options. Grapefruit is known to affect three of the drugs in this class: simvastatin (Zocor), lovastatin (Mevacor), and atorvastatin (Lipitor). It apparently doesn't interact with others, such as rosuvastatin (Crestor), pravastatin (Pravachol), fluvastatin (Lescol), and pitavastatin (Livalo), so find out from your clinician (and your insurance company) if you can switch to one of these.

Even if you don't change your medication, it's probably safe to consume the fruit in moderation. Most experts believe that you won't increase the risk of adverse effects by consuming up to 8 ounces of grapefruit juice or one-half of a grapefruit per day. Finally, you might consider switching to orange juice, which is loaded with vitamin C and doesn't affect drug metabolism the way grapefruit juice does.

4 .

c ) potassium 2.9 mmol/l

In states of hypokalemia, or low potassium, digoxin toxicity is actually worsened because digoxin normally binds to the ATPase pump on the same site as potassium. When potassium levels are low, digoxin can more easily bind to the ATPase pump, exerting the inhibitory effects.

Digoxin blocks the sodium/potassium ATPase pump. The mechanism by which this decreases AV conduction is not clear but is perhaps due to increased vagal tone. Intracellular calcium within the cardiac myocytes is increased by digoxin, resulting in increased inotropy, or contractility.

Digoxin toxicity causes hyperkalemia, or high potassium. The sodium/potassium ATPase pump normally causes sodium to leave cells and potassium to enter cells. Blocking this mechanism results in higher serum potassium levels.

In states of hypokalemia, or low potassium, digoxin toxicity is actually worsened because digoxin normally binds to the ATPase pump on the same site as potassium. When potassium levels are low, digoxin can more easily bind to the ATPase pump, exerting the inhibitory effects.