A nurse is assisting in the care of a client at the clinic.

Complete the following sentence by using the lists of options.

The client is at risk for

dropdown

due to

dropdown

.

Enalapril is an ACE inhibitor used to manage hypertension and heart failure by reducing angiotensin II–mediated vasoconstriction. A common early adverse effect is orthostatic hypotension due to systemic vasodilation, especially after the first few doses. This can lead to dizziness or syncope when changing positions too quickly. Patient education focuses on safety measures that reduce sudden drops in blood pressure and prevent falls.

Rationale:
A. Withholding the medication based on pulse rate is not appropriate because enalapril does not primarily affect heart rate. It acts on the renin-angiotensin-aldosterone system to lower blood pressure, so monitoring parameters are more related to blood pressure than pulse rate. This instruction is not relevant to the reported adverse effect.

B. Increasing dietary potassium is unsafe because enalapril can increase potassium levels by decreasing aldosterone secretion. This raises the risk of hyperkalemia, which may lead to cardiac dysrhythmias. Clients taking ACE inhibitors are usually advised to avoid excessive potassium intake or potassium supplements.

C. Rising slowly from sitting or lying positions helps prevent orthostatic hypotension, a known effect of Enalapril. Gradual position changes allow the cardiovascular system to adjust and maintain cerebral perfusion, reducing the risk of dizziness and syncope. This is the most appropriate safety instruction for the client.

D. Decreasing daily fluid intake is not recommended because adequate hydration is necessary to maintain blood pressure and renal perfusion. Excessive fluid restriction could worsen hypotension and renal function. Fluid management should be individualized, but routine reduction is not an appropriate response to this medication effect.

Nursing care for clients with burn injuries such as those affecting the lower extremities requires strict infection control because damaged skin barriers significantly increase the risk of microbial invasion. Burn wounds are highly susceptible to contamination due to loss of protective epidermis and exposure of underlying tissues. Care for a client with a partial or full-thickness burn, as seen in Burn injury, focuses on aseptic technique, appropriate wound cleansing, and prevention of infection while promoting healing. Proper dressing technique is essential to reduce complications such as sepsis and delayed wound recovery.

Rationale:
A. Applying dressings with sterile gloves is correct because burn wounds require aseptic or sterile technique to minimize the risk of introducing pathogens into the damaged tissue. The absence of an intact skin barrier makes the client highly vulnerable to infection. Using sterile gloves during dressing application helps maintain a clean environment and supports optimal wound healing.

B. Using hydrogen peroxide for wound cleaning is inappropriate because it is cytotoxic to healthy tissue and can delay wound healing. Although it has antimicrobial properties, it damages fibroblasts and newly forming epithelial cells. Normal saline or prescribed wound cleansers are preferred for burn wound care.

C. Cleaning the most contaminated wounds first is incorrect because it increases the risk of cross-contamination to cleaner wound sites. Standard practice is to clean from the least contaminated area to the most contaminated area. This sequence helps prevent spread of microorganisms to vulnerable tissue.

D. Performing dressing changes every other day is not appropriate for most burn wounds, especially in the acute phase. Burn wounds often require more frequent assessment and dressing changes depending on exudate, infection risk, and type of dressing used. The frequency should be determined by provider orders and wound condition rather than a fixed schedule.