A client with bipolar disorder is prescribed lithium.
Which statement indicates a need for further teaching?

Choice A rationale

While a dry cough is a common side effect of ACE inhibitors, it should not be simply dismissed. The cough is caused by the accumulation of bradykinin, a substance that is normally degraded by the enzyme that ACE inhibitors block. This cough can be very bothersome to patients, and in some cases, can progress and may warrant a change in medication.

Choice B rationale

Increasing fluid intake is a supportive measure for many types of coughs, but it does not address the underlying pharmacological cause of an ACE inhibitor-induced cough. The cough is a direct result of bradykinin accumulation in the lungs, and simply drinking more water will not reduce this level or resolve the cough. The appropriate action involves addressing the root cause.

Choice C rationale

The cough associated with ACE inhibitors is a known side effect that occurs due to the accumulation of bradykinin. This side effect is often a significant reason for discontinuation. The most appropriate nursing action is to report the finding to the healthcare provider so they can evaluate the patient and consider alternative therapies, such as an angiotensin II receptor blocker (ARB), which does not affect bradykinin levels.

Choice D rationale

Discontinuing the medication immediately is not the appropriate action. While a cough can be bothersome, it is not a life-threatening emergency. Abruptly stopping the medication, especially in a patient with a history of hypertension or heart failure, could lead to a sudden and dangerous increase in blood pressure or a worsening of their underlying condition. The decision to discontinue or change medication must be made by the healthcare provider.

Choice A rationale

Alpha blockers primarily exert their effects on the vascular smooth muscle by blocking alpha-1 adrenergic receptors. This action leads to vasodilation, which lowers blood pressure. They do not have a direct mechanism of action that would precipitate acute renal failure upon first dose administration. Renal function, while monitored, is not the most immediate or common adverse effect to assess for.

Choice B rationale

Alpha-1 adrenergic receptors, when blocked by alpha blockers, cause vasodilation of both arteries and veins. This leads to a decrease in peripheral vascular resistance and venous return, causing a significant drop in blood pressure. This effect, known as orthostatic hypotension or "first-dose phenomenon," is a common and critical adverse effect to assess for, as it can cause dizziness and fainting.

Choice C rationale

Blood dyscrasias, or disorders involving the cellular components of blood, are not a typical or immediate adverse effect associated with the first administration of an alpha blocker. While some medications can cause these rare side effects over long-term use, the acute and most common concern with the initial dose is related to its cardiovascular effects on blood pressure.

Choice D rationale

While alpha blockers can indirectly affect the heart rate through baroreceptor reflexes in response to hypotension, they are not typically associated with the direct induction of significant dysrhythmias as a primary adverse effect upon first administration. The immediate and most profound hemodynamic effect is the peripheral vasodilation and subsequent hypotension, which takes precedence in initial assessment.