A nurse at an outpatient clinic receives a call from a client who reports experiencing syncope after starting a new prescription for enalapril. Which of the following instructions should the nurse give the client?

Enalapril is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension and heart failure by causing vasodilation and reducing peripheral vascular resistance. One of its common early adverse effects is orthostatic hypotension, especially after the first few doses. This can lead to dizziness or syncope when changing positions quickly. Patient education focuses on preventing falls and managing blood pressure changes safely during therapy initiation. Rationale: A. Rising slowly from a sitting to standing position helps prevent orthostatic hypotension associated with enalapril use. The medication causes vasodilation, which can reduce venous return and blood pressure, especially when changing positions rapidly. Gradual position changes allow the cardiovascular system time to adjust and reduce the risk of syncope and falls. B. Decreasing daily fluid intake is incorrect because adequate hydration helps maintain blood pressure and perfusion. Reducing fluids may worsen hypotension and increase the risk of dizziness or fainting. Patients on antihypertensives should maintain appropriate fluid intake unless otherwise contraindicated. C. Withholding the medication if pulse rate is less than 60/min is not appropriate because enalapril primarily affects blood pressure, not heart rate. Pulse-based holding parameters are more relevant for beta-blockers, not ACE inhibitors. Abrupt discontinuation without provider instruction can lead to uncontrolled hypertension or worsening heart failure. D. Increasing dietary potassium is incorrect because ACE inhibitors like enalapril can increase serum potassium levels by reducing aldosterone secretion. Excess potassium intake may lead to hyperkalemia, which can cause dangerous cardiac dysrhythmias. Patients are usually advised to monitor or limit high-potassium foods unless otherwise prescribed.