1-A client with long-term hypertension and hypercholesterolemia comes to the clinic for an annual
checkup. The client takes nifedipine, simvastatin, and
... [Show More] spironolactone and reports some occasional
dizziness. Which statement by the client would warrant intervention by the nurse?
1. "I've been better about walking for 20 minutes 3 days a week on my treadmill."
2. "I've been trying to eat more fruits and vegetables. I discovered that I really like
grapefruit."
3. "I've heard that having a glass of red wine with dinner every night is good for my heart."
4. "We no longer add salt when preparing meals. It has really been hard to get used to that."
Explanation:
The nurse should intervene when the client talks about eating grapefruit. Grapefruit inhibits enzyme
CYP3A4. The drugs that are metabolized by the same pathway would not be metabolized, resulting
in higher drug levels and serious side effects. Calcium channel blocker (eg, nifedipine) use with
grapefruit juice can cause severe hypotension; some statins (eg, simvastatin) may result in
myopathy.
(Option 1) The nurse should praise and encourage the client to continue exercising and possibly
increase the amount. This is a positive lifestyle change. The client should engage in moderateintensity aerobic exercise for at least 30 minutes most days of the week or vigorous-intensity aerobic
exercise for 20 minutes 3 days a week.
(Option 3) It is thought that red wine in moderation has some beneficial effects on the heart. The
nurse would not encourage a client to start drinking red wine if the client didn't already. Excessive
alcohol consumption is strongly associated with hypertension. The nurse should encourage the client
to discuss alcohol consumption with the health care provider (HCP).
(Option 4) Sodium restriction is important in the management of hypertension. This teaching should
be reinforced and the client should be encouraged to restrict the use of salt.
Educational objective:
The nurse should tell the client not to eat grapefruit or drink grapefruit juice while taking calcium
channel blockers due to the possible development of severe hypotension. The nurse should report
this client's statement to the HCP. [Show Less]