A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse tell this patient?

Choice A reason: Jaundice indicates liver dysfunction, but ibuprofen rarely causes hepatotoxicity at standard doses. It’s more associated with gastrointestinal issues due to COX-1 inhibition, reducing protective prostaglandins in the stomach lining. While possible with overdose, jaundice is less common than gastrointestinal bleeding, making this choice less likely.

Choice B reason: Ibuprofen, an NSAID, inhibits COX-1, reducing gastric mucosal protection, which can lead to ulcers or gastrointestinal bleeding. Bloody emesis (hematemesis) indicates severe gastrointestinal damage, a well-documented adverse effect requiring immediate intervention, making this the correct choice for a severe ibuprofen-related complication.

Choice C reason: Itching may indicate a mild allergic reaction or skin irritation, not a severe adverse effect of ibuprofen. While possible, it’s less critical than gastrointestinal bleeding, which poses life-threatening risks due to ibuprofen’s impact on gastric mucosa, making this choice less severe and incorrect.

Choice D reason: Dysmenorrhea (painful periods) is a condition ibuprofen treats, not an adverse effect. By inhibiting prostaglandins, ibuprofen reduces uterine contractions and pain. It doesn’t cause dysmenorrhea, making this choice irrelevant as an indicator of a severe adverse effect of ibuprofen therapy.

Choice A reason: Administering captopril risks angioedema, as the patient’s history of tongue and lip swelling with enalapril (another ACE inhibitor) suggests a class effect due to bradykinin accumulation. This is potentially life-threatening, requiring avoidance, not monitoring, making this choice unsafe and incorrect.

Choice B reason: Fosinopril, another ACE inhibitor, carries the same angioedema risk as captopril and enalapril due to similar bradykinin effects. Switching within the same drug class doesn’t address the patient’s history of adverse reactions, making this choice inappropriate and potentially dangerous.

Choice C reason: Holding captopril and notifying the provider is correct, as the patient’s history of angioedema with enalapril indicates a high risk with captopril, another ACE inhibitor. Alternative classes (e.g., ARBs) should be considered to avoid life-threatening reactions, making this the safest and correct action.

Choice D reason: Angioedema (tongue and lip swelling) is a serious, potentially fatal side effect of ACE inhibitors, not benign. Reassuring the patient minimizes the risk, which could delay intervention. The history warrants avoiding captopril and consulting the provider, making this choice incorrect and unsafe.