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?

A) Withhold the medication if pulse rate is less than 60/min: Enalapril, an ACE inhibitor, primarily affects blood pressure and does not typically require withholding based on pulse rate alone. Withholding enalapril is not recommended unless instructed by the healthcare provider for other reasons, such as a significant drop in blood pressure. The issue at hand is likely related to orthostatic hypotension rather than pulse rate. B) Increase dietary potassium: Enalapril can increase potassium levels in the blood due to its effect on the renin-angiotensin system, potentially leading to hyperkalemia. Clients should avoid excessive potassium intake, especially through supplements or potassium-rich foods, unless advised by their healthcare provider. Increasing potassium may exacerbate any existing risks. C) Decrease daily fluid intake: Decreasing fluid intake is not a recommended intervention for managing syncope related to enalapril. In fact, reducing fluid intake can exacerbate dehydration or low blood pressure, potentially worsening symptoms. Adequate hydration is typically important for managing blood pressure and syncope risk. D) Rise slowly from a sitting position to a standing position: This is the most appropriate advice. Enalapril can cause orthostatic hypotension, a condition in which blood pressure drops when changing positions (such as from sitting to standing). This can lead to dizziness or syncope. Rising slowly from a sitting position helps prevent a sudden drop in blood pressure and reduces the risk of fainting. Clients should be instructed to take this precaution until the body adjusts to the medication’s effects.