A patient with increasing renal insufficiency and nephrosclerosis is admitted to the unit and is started on oral antihypertensive therapy. Given the patient's medical history, the nurse would question a prescription for
a. propranolol (Inderal).
b. methyldopa (Aldomet).
c. hydralazine (Apresoline).
d. spironolactone (Aldactone).
D
Spironolactone should be avoided, because it is only a mild diuretic with dysfunctional kidneys.
Inderal, Aldomet and Apresoline all are antihypertensive agents and may be used. Although all classes of antihypertensive agents are effective in nephrosclerosis, angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) work best. As a rule, a diuretic also is used. In patients with advanced renal insufficiency, thiazide diuretics are ineffective; a loop diuretic should be used.
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