# A 32-year-old female with chronic hypertension, currently on losartan 50 mg orally daily, presents to the clinic stating, "I just took a home pregnancy test and it was positive — I think I am about 5 weeks along." Which action by the nurse is most important?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374904&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PA

## Question

A 32-year-old female with chronic hypertension, currently on losartan 50 mg orally daily, presents to the clinic stating, "I just took a home pregnancy test and it was positive — I think I am about 5 weeks along." Which action by the nurse is most important?

## Option

1. Hold the next dose, place an urgent call/message to the prescriber, and do not administer further losartan until alternative antihypertensive is ordered. **✔ Correct answer**
2. Advise the client to reduce losartan to 25 mg daily to manage blood pressure while starting prenatal vitamins, as this dose is safer in pregnancy.
3. Schedule the client for a routine obstetric visit at 12 weeks gestation and continue the current losartan prescription without modification.
4. Reassure the client that losartan is generally considered safe during the first trimester, so she can continue taking it as prescribed.

**Correct answer: 1**

## Explanation

RAAS blockers in pregnancy — fetotoxicity
ACE inhibitors and ARBs are contraindicated in all trimesters of pregnancy (FDA Pregnancy Category D — replaced by detailed labels). Exposure causes fetal renal dysgenesis, oligohydramnios, pulmonary hypoplasia, IUGR, skull hypoplasia, and neonatal renal failure; risk is highest in the second and third trimesters but first-trimester exposure is also avoided. Once pregnancy is confirmed (or strongly suspected), the nurse must hold the next dose and contact the prescriber urgently for an immediate transition to a pregnancy-safe antihypertensive (labetalol, methyldopa, nifedipine ER, or hydralazine). Reassurance, half-dosing, or delaying referral all expose the fetus to ongoing teratogenic risk. The client must also be counseled that future pregnancies require pre-conception counseling and medication adjustment.

## In-depth explanation

Clinical reasoning summary
RAAS blockers in pregnancy — fetotoxicity
ACE inhibitors and ARBs are contraindicated in all trimesters of pregnancy (FDA Pregnancy Category D — replaced by detailed labels). Exposure causes fetal renal dysgenesis, oligohydramnios, pulmonary hypoplasia, IUGR, skull hypoplasia, and neonatal renal failure; risk is highest in the second and third trimesters but first-trimester exposure is also avoided. Once pregnancy is confirmed (or strongly suspected), the nurse must hold the next dose and contact the prescriber urgently for an immediate transition to a pregnancy-safe antihypertensive (labetalol, methyldopa, nifedipine ER, or hydralazine). Reassurance, half-dosing, or delaying referral all expose the fetus to ongoing teratogenic risk. The client must also be counseled that future pregnancies require pre-conception counseling and medication adjustment.

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