The healthcare provider has ordered an angiotensin-converting enzyme (ACE) inhibitor for the client diagnosed with congestive heart failure. Which discharge instructions should the nurse include?

Choice A rationale A persistent, dry, nonproductive cough is a common side effect of ACE inhibitors due to the accumulation of bradykinin in the respiratory tract. However, instructing a client to take a cough suppressant is inappropriate because the cough is a pharmacological side effect that will not respond well to suppressants. If the cough becomes intolerable for the client, the healthcare provider must be notified to potentially switch the medication to an angiotensin II receptor blocker instead of masking the symptom. Choice B rationale Most ACE inhibitors can be taken without regard to food, though some specific ones like captopril have better absorption on an empty stomach. Telling a client to take it with food is not a universal requirement for this class of medication and is not the most critical safety instruction. The priority for discharge teaching focuses on safety and hemodynamic stability, such as managing the vascular changes that occur when the renin-angiotensin-aldosterone system is inhibited by the new medication regimen. Choice C rationale ACE inhibitors promote vasodilation and reduce fluid volume by blocking the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This reduction in peripheral vascular resistance can lead to a significant drop in blood pressure when changing positions. The nurse must instruct the client to rise slowly from a sitting or lying position to prevent falls and injury. This education is vital for safety, as orthostatic hypotension is a frequent and potentially dangerous adverse effect during initial therapy. Choice D rationale ACE inhibitors block the secretion of aldosterone, which normally promotes the excretion of potassium in the kidneys. By inhibiting this process, these medications can lead to hyperkalemia, where potassium levels exceed the normal range of 3.5 to 5.0 mEq/L. Encouraging the consumption of high-potassium foods like bananas increases the risk of developing cardiac arrhythmias due to dangerously high serum potassium levels. Clients should actually be cautioned against using salt substitutes or excessive potassium intake while on this medication.