The nurse is caring for a 52-year-old African American male newly diagnosed with hypertension. He has a history of chronic kidney disease and diabetes. The nurse would expect to see which medication order for this client?

  1. enalapril 5 mg PO QD
  2. enalapril 5 mg PO QD and amiloride 5 mg PO QD
  3. enalapril 5 mg PO QD and atenolol 50 mg PO QD
  4. enalapril 5 mg PO QD and amlodipine 2.5 mg PO QD
Number 4 is correct.
Rationale: ACE inhibitors alone are less effective in African American clients unless they are combined with a calcium channel blocker or a thiazide diuretic. Therefore, the client would not be given an ACE inhibitor by itself. Amiloride can cause hyperkalemia in clients with impaired renal function, especially if given in conjunction with ACE inhibitors. Atenolol can increase the incidence of diabetes and mask symptoms of hypoglycemia, as well as delay recovery from hypoglycemic episodes.