Question

A nurse is collecting data from a client following his first dose of captopril. The client's blood pressure is 88 / 60 mm Hg. Which of the following actions should the nurse take first? a. Place the client in a supine position b. measure blood pressure with the client sitting. c. check blood pressure with the client standing. d. Administer a 0.9% sodium chloride IV bolus.

Answer 1

Step-by-step explanation:

b. Measure blood pressure with the client sitting.

The nurse should first measure the blood pressure with the client sitting. This is because the client's blood pressure is currently low (88/60 mm Hg), which may be a potential side effect of captopril, an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension. By measuring the blood pressure in a sitting position, the nurse can assess if the client's blood pressure is stable and determine the need for further interventions. Placing the client in a supine position or checking the blood pressure with the client standing may not be appropriate at this time, as the client's blood pressure is already low. Administering a 0.9% sodium chloride IV bolus may be considered if the client's blood pressure remains low and they are symptomatic, but it is not the first action to take in this situation.

Answer 2

The first action a nurse should take when a client has a low blood pressure following captopril is to place the client in a supine position to help increase blood pressure.

Step-by-step explanation:

When a nurse encounters a client with a low blood pressure reading of 88/60 mm Hg following the first dose of captopril, the first action they should take is to place the client in a supine position. This initial measure aims to enhance venous return to the heart and potentially increase the blood pressure. Measuring blood pressure while the client is sitting or standing might be done afterwards to assess for orthostatic hypotension, but the priority is to address the current low blood pressure. An IV bolus of 0.9% sodium chloride might be warranted if the hypotension persists, but only after consulting with the healthcare provider and assessing the patient's overall volume status.