The nurse is monitoring the effectiveness or antiretroviral therapy (ART) for a patient with human immunodeficiency virus (HIV). What laboratory study results indicates the medications are effective?

A. The client should report to an urgent care for potential hypokalemia:
While ACE inhibitors like Captopril can increase potassium levels (hyperkalemia) due to their effects on the renin-angiotensin-aldosterone system, they are not typically associated with hypokalemia. The client's complaint of a dry cough is a well-known side effect of ACE inhibitors, not an indication of low potassium levels. Therefore, the recommendation to seek urgent care for hypokalemia is not appropriate in this case.

B. The client should immediately use an epinephrine auto-injector (Epi-Pen) and call 9-1-1:
The use of an epinephrine auto-injector is specifically indicated for severe allergic reactions (anaphylaxis), which typically present with symptoms such as difficulty breathing, swelling of the throat, or anaphylactic shock. A chronic dry cough associated with the use of Captopril is not indicative of an allergic reaction, but rather a known adverse effect of ACE inhibitors. Therefore, this response is inappropriate for the situation described.

C. The client should contact their provider, who may switch them to a different medication:
A chronic dry cough is a common side effect of ACE inhibitors like Captopril, occurring in some individuals due to the accumulation of bradykinin. If the cough is bothersome, the best course of action is for the client to contact their healthcare provider. The provider may consider switching the patient to an angiotensin II receptor blocker (ARB), which does not typically cause this side effect. This is the most appropriate and safe action.

D. The client should stop taking the Lisinopril immediately:
Lisinopril is an ACE inhibitor, similar to Captopril, and shares the same potential side effects, including a chronic dry cough. However, the client should not stop taking their medication without consulting their healthcare provider. Discontinuing the medication abruptly can result in uncontrolled hypertension and other risks. The correct course of action is to contact the provider to discuss possible alternatives, not to stop the medication independently.

A. A patient with hypertension:
Valproic acid is not contraindicated in patients with hypertension. While it is important to monitor for potential side effects, including those that may affect the liver or blood pressure, hypertension alone does not directly impact the safety or efficacy of valproic acid. Therefore, it is generally considered safe to prescribe in patients with well-controlled hypertension.

B. A patient with diabetes:
Valproic acid is also not contraindicated in patients with diabetes. While it is important to monitor blood glucose levels, as anticonvulsants can sometimes affect metabolic processes, there is no absolute contraindication for valproic acid in diabetic patients. However, appropriate monitoring of blood sugar levels would be necessary to adjust any diabetic treatment as needed.

C. A patient with asthma:
There is no direct contraindication to using valproic acid in a patient with asthma. While asthma medications and their interactions should always be considered, valproic acid does not typically exacerbate asthma symptoms. The prescription would be based on the clinical need for seizure management and monitored for any potential respiratory side effects.

D. A pregnant patient:
Valproic acid is contraindicated in pregnancy due to its high risk of causing fetal harm. It has been associated with an increased risk of birth defects, including neural tube defects, and other complications such as developmental delays. The U.S. FDA classifies valproic acid as a Category D drug for pregnancy, indicating that it should only be used when the potential benefits outweigh the risks. Thus, it should be avoided in pregnant patients unless no safer alternatives are available.