Client #1: 45-year-old male admitted to the hospital for migraine and dehydration Client reports a history of hypertension and has an allergy to codeine

Client #2: 68-year-old client admitted to the hospital with influenza. Client has a history of chronic stable angina

Client #3: 39 year old client admitted to the hospital for spinal surgery. Client has a history of chronic hypertension

Client #4: 54 year old client admitted to the hospital with acute myocardial infarction (MI). Client has allergy to lisinopril.

The nurse is caring for a group of clients with orders for calcium channel blocker. For which client should the nurse question the order?

A. Salivation: Diphenhydramine, an antihistamine with anticholinergic properties, typically reduces salivation rather than increases it. Excessive drooling is not a side effect of this medication.

B. Watery eyes: Diphenhydramine works to relieve allergic symptoms, including watery eyes, so this symptom is more likely to be a reason for taking the medication rather than a side effect.

C. Urinary frequency: Anticholinergic effects of diphenhydramine usually cause urinary retention, not increased frequency. Clients may experience difficulty voiding rather than needing to urinate more often.

D. Constipation: The anticholinergic action of diphenhydramine can slow gastrointestinal motility, leading to constipation. Clients should be advised about this potential side effect and strategies to prevent it, such as increased fluid and fiber intake.

• Hypertension: Benazepril is an angiotensin-converting enzyme (ACE) inhibitor used to lower blood pressure by blocking the conversion of angiotensin I to angiotensin II. This results in vasodilation and reduced aldosterone secretion, which lowers systemic vascular resistance. It is commonly prescribed as first-line or adjunct therapy for chronic hypertension.

• Hyperkalemia: ACE inhibitors decrease aldosterone secretion, leading to reduced potassium excretion by the kidneys. In clients with existing hyperkalemia, benazepril can further elevate potassium levels, increasing the risk of dangerous cardiac dysrhythmias. Serum potassium must be monitored closely in clients receiving this medication.

• Breastfeeding: Benazepril can be excreted into breast milk and may affect neonatal renal function and blood pressure regulation. Infants exposed to ACE inhibitors are at risk for hypotension and renal impairment. Because of these potential effects, benazepril is contraindicated during breastfeeding.