The nurse plans care for a client starting therapy with an angiotensin-converting enzyme inhibitor (ACEI). Which outcome, timed for 5 days from today, should the nurse include in the client's plan of care?

Question

1. Diastolic blood pressure drops from 90 to 70 mm Hg after walking 50 feet.
2. Systolic blood pressure drops from 130 to 120 mm Hg when client stands up.
3. Diastolic blood pressure increases from 60 to 80 mm Hg when client stands up.
4. Systolic blood pressure increases from 120 to 140 mm Hg after walking 50 feet.

Answer 1

2
2. Antihypertensive therapy and ACEIs, in particular, frequently cause orthostatic hypotension in clients beginning therapy, so the nurse includes an outcome specifying an acceptable range for a drop in the client's blood pressure when changing positions. If the client's systolic blood pressure drops more than 10 mm Hg on standing, the nurse re-evaluates the plan of care because the client continues to have an unac-ceptable drop in blood pressure, potentially leading to client dizziness or injury.
1. Blood pressure is unlikely to fall after exercise because cardiac output increases during exercise. Heart rate and blood pressure determine cardiac output and, during exercise, both increase to meet tissue oxygen demands; therefore, if the cardiac out-put increases, it is the result of an increase in the heart rate or blood pressure.
3. Diastolic blood pressure is unlikely to increase 20 mm Hg on standing because, as the client stands, blood drains by gravity to dependent regions of the body and, and as people age or when beginning antihypertensive therapy, the body is less able to compensate quickly enough to prevent orthostatic hypotension.
4. Blood pressure increases with exercise; however, the nurse does not include in-creasing the blood pressure as an outcome for a client who needs antihypertensive therapy because it is counterproductive to the therapeutic goal.