A patient with chronic congestive heart failure has repeated hospitalizations despite ongoing treatment with hydrochlorothiazide (HydroDIURIL) and digoxin. The prescriber has ordered spironolactone (Aldactone) to be added to this patient’s drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching?

Choice A reason: ACE inhibitors cause dry cough by inhibiting bradykinin breakdown, which accumulates and irritates the airways. ARBs block angiotensin II receptors without affecting bradykinin, eliminating this side effect. This makes ARBs a suitable alternative for patients experiencing cough, confirming this as the correct choice.

Choice B reason: Hyperkalemia occurs with both ACE inhibitors and ARBs due to reduced aldosterone production, which decreases potassium excretion. Both drug classes affect the renin-angiotensin-aldosterone system similarly, so switching to an ARB does not eliminate this risk, making this choice incorrect for the question.

Choice C reason: Hypotension is a shared side effect of ACE inhibitors and ARBs, as both reduce blood pressure by inhibiting the renin-angiotensin system. ARBs block angiotensin II receptors, causing vasodilation similar to ACE inhibitors, so this side effect persists, making this choice incorrect.

Choice D reason: Angioedema, though rare, can occur with both ACE inhibitors and ARBs. While less common with ARBs, it’s not eliminated, as it may result from mechanisms beyond bradykinin accumulation. Switching to an ARB doesn’t guarantee avoidance of angioedema, making this choice incorrect.

Choice A reason: Salt substitutes contain potassium, which risks hyperkalemia with spironolactone, a potassium-sparing diuretic. This is dangerous, so it’s incorrect for understanding.

Choice B reason: Spironolactone spares potassium, so stopping supplements prevents hyperkalemia, a serious risk. This shows correct understanding, making it the correct choice.

Choice C reason: Spironolactone reduces fluid, not causes overhydration. Monitoring for dehydration is more relevant, so this is incorrect for the medication’s effects.

Choice D reason: Spironolactone’s effects take days to weeks, not hours. Immediate improvement is unrealistic, so this is incorrect for proper patient understanding.