A nurse is discussing risk factors for child maltreatment with a newly licensed nurse. Which of the following examples should the nurse include?

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.

Preoperative nursing care for a client scheduled for laparoscopic management of a confirmed Ectopic pregnancy focuses on stabilizing the client, ensuring surgical readiness, and preventing perioperative complications such as hemorrhage and aspiration. The client has a tubal pregnancy confirmed by ultrasound with declining β-hCG levels, requiring urgent surgical intervention. Nursing priorities include airway safety, vascular access for rapid fluid or blood administration, verification of informed consent, and baseline laboratory evaluation to guide intraoperative management.

Rationale:

A. Reminding the client to remain NPO is essential to reduce the risk of aspiration during general anesthesia. Laparoscopic surgery requires sedation or general anesthesia, which depresses protective airway reflexes. Ensuring an empty stomach decreases the likelihood of regurgitation and aspiration pneumonia during induction of anesthesia.

B. Administering Rh immune globulin prior to surgery is not appropriate at this time without provider order and timing consideration. Rh immune globulin is typically given after delivery or significant fetal-maternal hemorrhage, not preoperatively. The priority is surgical stabilization rather than prophylactic administration at this stage.

C. Explaining the surgical procedure to the client is not the nurse’s role because informed consent and procedural explanation are the responsibility of the provider. The nurse may reinforce understanding but should not introduce or explain the procedure in detail. This could interfere with the legal consent process

D. Preparing for insertion of an 18-gauge peripheral IV is critical because ectopic pregnancy surgery carries a risk of sudden hemorrhage. A large-bore IV line allows rapid administration of fluids, medications, and blood products if needed. This ensures immediate vascular access for hemodynamic stabilization during surgery.

E. Verifying that the consent form is signed is a key legal and safety requirement before any surgical procedure. The nurse ensures that informed consent has been obtained, properly documented, and matches the planned procedure. This confirms patient understanding and protects autonomy before anesthesia is initiated.

F. Obtaining a complete blood count is necessary to establish baseline hematologic status before surgery. The client already demonstrates mild anemia, which may worsen if intraoperative bleeding occurs. Hemoglobin, hematocrit, and platelet levels guide perioperative planning and readiness for possible transfusion.

G. Administering AB positive blood products is inappropriate due to ABO and Rh incompatibility. The client is B negative, and transfusion with incompatible blood could trigger a severe hemolytic reaction. If transfusion becomes necessary, properly matched B negative or O negative blood must be used instead.