# A 58-year-old client with hypertension asks the nurse about taking pseudoephedrine 60 mg for nasal congestion from a cold. Which response is most appropriate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391791&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 58-year-old client with hypertension asks the nurse about taking pseudoephedrine 60 mg for nasal congestion from a cold. Which response is most appropriate?

## Option

1. "You can take pseudoephedrine to relieve congestion as long as you closely monitor your blood pressure and report readings above 140/90 to your provider."
2. "Pseudoephedrine is a sympathomimetic that can raise blood pressure and heart rate; avoid it and consider a saline nasal spray or intranasal corticosteroid instead." **✔ Correct answer**
3. "Pseudoephedrine is a nasal decongestant that works locally by constricting blood vessels in the nose, so it does not affect your blood pressure systemically."
4. "If you choose to take pseudoephedrine, it is safer to hold your lisinopril for 24 hours to prevent a potential interaction and then restart it after the pseudoephedrine has worn off."

**Correct answer: 2**

## Explanation

Correct (2): Pseudoephedrine is an alpha-adrenergic agonist (sympathomimetic) — raises BP and HR. Avoid in HTN, CAD, hyperthyroidism. Safer alternatives: saline irrigation, intranasal corticosteroid (fluticasone, mometasone), or short-course topical decongestant. (1) False. (3) Higher dose = greater CV risk. (4) Stopping antihypertensive worsens BP.

## In-depth explanation

Memory Tip Pseudoephedrine = "Pseudo-EPI" — sympathomimetic raises BP. Contraindicated in uncontrolled HTN, CAD, hyperthyroidism, recent MAOI. Available behind-the-counter (PSE law) due to methamphetamine precursor concerns.

## Clinical scenario

Scenario 58-year-old male with controlled hypertension on lisinopril asks if he can take pseudoephedrine 60 mg PO q6h for cold-related nasal congestion.

## Key concepts

- **Sympathomimetic decongestant** — Alpha-agonist causing nasal vasoconstriction; pseudoephedrine, phenylephrine.
- **Cardiovascular contraindications** — Uncontrolled HTN, CAD, recent MI, hyperthyroidism, MAOI use.
- **Safer alternatives** — Saline spray, intranasal corticosteroid, intranasal antihistamine — preferred in HTN.

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