A client taking losartan for hypertension reports a positive home pregnancy test. Which instruction should the nurse give?
1Continue losartan until the second trimester because fetal risk begins after organ formation.
2Double the losartan dose because pregnancy raises the target blood pressure range.
3Skip prenatal follow-up because losartan prevents pregnancy-related kidney complications.
4Stop losartan and contact the prescriber promptly for a pregnancy-safe treatment plan.✓ Correct answer
Explanation
Losartan acts directly on the renin-angiotensin system and can cause fetal injury or death. Its boxed warning directs discontinuation as soon as pregnancy is detected. The client should stop losartan and contact the prescriber promptly so hypertension can be managed with an appropriate alternative. Continuing, increasing, or relying on losartan for pregnancy-related renal protection is unsafe.
Clinical reasoning Fetal exposure to renin-angiotensin system blockers can reduce fetal renal function and lead to oligohydramnios, pulmonary hypoplasia, skeletal effects, renal failure, or death.
Decision rule A detected pregnancy during losartan therapy requires prompt discontinuation and prescriber contact for alternative blood-pressure management.
Losartan fetal toxicity — Fetal injury caused by renin-angiotensin system blockade, including impaired fetal renal function and oligohydramnios.
Renin-angiotensin system blocker — A drug class that includes angiotensin receptor blockers and requires prompt reassessment when pregnancy is detected.