Pepito is a hypertensive client who has been placed on captopril (Capoten). He states, “Dr. del Mundo keeps changing my pills and none are working. I feel like a guinea pig.” Which of the following responses by the nurse would be most appropriate?
A. “It often takes a while before the right medication is found.”
B. “The doctor is just trying to help you control your blood pressure.”
C. “The action of this drug is to work on both the arteries and to remove excess fluids.”
D. “This drug is used when other drugs have failed.”
Correct Answer: D. “This drug is used when other drugs have failed.”
This response provides accurate information about the medication. The benefits of captopril in hypertension and heart failure result primarily from suppression of the renin-angiotensin-aldosterone system (RAAS). It is effective alone and in combination with other antihypertensive agents
Option A: This statement placates the client and provides no information about the new medication. Captopril is a widely prescribed drug in clinical medicine. Healthcare workers (physicians and nurse practitioners) who prescribe this medication for hypertension should be aware of its side effects and the need to monitor electrolytes and renal function.
Option B: This statement is defensive. ACE inhibitors reduce preload by causing vasodilation and natriuresis, reduce afterload by inhibiting the formation of angiotensin II. The overall effect is the improvement of cardiac output and reduced blood pressure.
Option C: Although the statement is true, there is no information provided to motivate the client. Inhibition of ACE leads to decreased plasma angiotensin II, leading to vasodilation and decreased aldosterone secretion. Small increases in serum potassium, as well as sodium and fluid loss, may occur due to a decrease in aldosterone secretion. Administration of captopril results in a reduction of peripheral arterial resistance in hypertensive patients.