Report joint pain, prolonged fever, malaise, or facial rash suggesting drug-induced lupus.
Before you read
Test yourself first: 1 question
Question 1 of 1
A client with autonomic dysreflexia continues to have a blood pressure of 200/110 after the head of the bed is raised and the bladder is drained. Which medication class would the nurse anticipate administering?
Answer: A. If the blood pressure remains dangerously high after removing the stimulus, a rapid-acting antihypertensive such as a vasodilator (for example, nitrate or hydralazine) is given to prevent stroke or seizure. Vasopressors would worsen the hypertension; antipyretics and stool softeners do not lower the acute pressure quickly.
Keep the streak going with more questions like these, each with a full rationale.
What is hydralazine?
It relaxes arteriolar smooth muscle to reduce afterload and lower blood pressure. Reflex tachycardia is a common, predictable response.
Key points to remember
- Directly relaxes arteriolar smooth muscle, lowering blood pressure and afterload.
- Causes reflex tachycardia, so it is often paired with a beta blocker to blunt the heart-rate increase.
- Long-term high-dose therapy can cause a drug-induced lupus-like syndrome (joint pain, fever, rash).
- Used in pregnancy-related hypertension and preeclampsia as an IV option.
- Combined with isosorbide dinitrate (BiDil) it improves outcomes in heart failure, particularly in self-identified Black patients.
- Orthostatic hypotension and headache are common early effects.
Signs & symptoms
- Reflex tachycardia, palpitations
- Headache, flushing, hypotension
Nursing priorities
- Monitor blood pressure and heart rate before and after dosing; hold for hypotension per parameters.
- Assess for reflex tachycardia and report sustained increases.
- Watch for lupus-like symptoms such as joint pain, fever, and rash during long-term therapy.
- Teach the patient to change positions slowly to avoid orthostatic dizziness.
Patient teaching
- Take your blood pressure and pulse as instructed and report a fast heart rate or dizziness.
- Rise slowly from lying or sitting to prevent fainting.
- Report joint pain, unexplained fever, fatigue, or a new rash, which may signal a lupus-like reaction.
- Take the medication consistently and do not stop suddenly.
- Headache and flushing are common early and usually lessen over time.
Red flags: report now
- Report joint pain, prolonged fever, malaise, or facial rash suggesting drug-induced lupus.
- Report severe hypotension or rapid heart rate with palpitations or chest pain.
- Do not stop abruptly, which can cause rebound hypertension.
References
Clinical references for this topic
