A nurse is performing an initial assessment on a client who has an order for Lisinopril (Zestril). The nurse notes hypotension and holds the cardiac medication for a blood pressure of:

Choice A rationale A blood pressure of 128/80 mmHg is considered within the normal to slightly elevated range according to current cardiovascular guidelines. Normal blood pressure is generally defined as less than 120/80 mmHg. Lisinopril, an ACE inhibitor, is indicated for hypertension and would typically be administered at this level to maintain therapeutic control. There is no clinical indication of hypotension at this reading, so holding the medication would be inappropriate for this client. Choice B rationale A blood pressure of 146/70 mmHg indicates isolated systolic hypertension. The systolic pressure is significantly above the target range of less than 120 mmHg. Administering lisinopril is necessary here to reduce systemic vascular resistance and lower the blood pressure toward a safer therapeutic goal. Holding the medication at this level would allow the hypertension to persist, increasing the risk of long-term vascular damage or acute cardiac events for the client. Choice C rationale A blood pressure of 102/58 mmHg is nearing the threshold for hypotension, which is generally defined as a systolic pressure less than 90 mmHg or a diastolic less than 60 mmHg. For a client on antihypertensives like lisinopril, this low reading suggests that further vasodilation could cause symptomatic hypotension or decreased organ perfusion. The nurse should hold the dose and notify the provider to prevent a dangerous drop in blood pressure and syncope. Choice D rationale A reading of 110/82 mmHg is considered a normal or pre-hypertensive blood pressure. It does not meet the criteria for hypotension that would warrant holding a scheduled cardiac medication. Lisinopril works by inhibiting the angiotensin-converting enzyme, which prevents the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. At 110/82 mmHg, the client is stable, and the medication is likely working effectively to maintain these desired cardiovascular parameters.