A nurse provides discharge instructions for a patient who is taking acetaminophen [Tylenol] after surgery. The nurse should instruct the patient to avoid which product while taking acetaminophen?

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.

Choice A reason: Checking blood sugar daily or more is appropriate for diabetes management with glipizide. This shows understanding, so it is not concerning and incorrect.

Choice B reason: Moderate alcohol (e.g., one glass of wine) is generally safe with glipizide if blood sugar is controlled. This is less concerning than grapefruit, so it’s incorrect.

Choice C reason: Taking glipizide once daily with breakfast is correct, as it enhances insulin release with meals. This is appropriate, so it is not concerning and incorrect.

Choice D reason: Grapefruit juice can inhibit CYP enzymes, potentially increasing glipizide levels and hypoglycemia risk. This misunderstanding is dangerous, making it the correct concerning statement.