The client with chronic renal failure who is scheduled for hemodialysis this morning is due to receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this medication:
A. Just before dialysis.
B. During dialysis.
C. On return from dialysis.
D. The day after dialysis.
Correct Answer: C. On return from dialysis
Antihypertensive medications such as enalapril are given to the client following hemodialysis. This prevents the client from becoming hypotensive during dialysis and also from having the medication removed from the bloodstream by dialysis.
Option A: Dosage is an important area that deserves further attention. It is possible that concern about intradialytic hypotension and ability to achieve adequate fluid removal may underlie this conservative approach; whether more aggressive antihypertensive doses result in better BP control during dialysis without significant adverse effects should be studied prospectively.
Option B: To improve BP control in hemodialysis patients, technical advances in our ability to optimize intravascular volume need to be complemented by a better understanding of the pharmacologic treatment of hypertension.
Option D: No rationale exists for waiting a full day to resume the medication. This would lead to ineffective control of the blood pressure. Multidrug antihypertensive therapy was common among hemodialysis patients and was associated with significantly lower BP; calcium-channel blockers were the most frequently prescribed agents.
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