A nurse is caring for a client who is postoperative following hip arthroplasty. The nurse should anticipate which of the following medications for this client?

Choice A reason: Ototoxicity is not a severe reaction to propranolol, but it may occur with some other medications, such as aminoglycosides, loop diuretics, or salicylates. Ototoxicity may damage the inner ear or the auditory nerve and cause hearing loss, tinnitus, or vertigo. The nurse should assess the client's medication history and monitor the client's hearing function.

Choice B reason: Hypokalemia is not a severe reaction to propranolol, but it may occur with some other medications, such as thiazide diuretics, corticosteroids, or insulin. Hypokalemia may cause muscle weakness, cramps, arrhythmias, or cardiac arrest. The nurse should advise the client to eat foods rich in potassium, such as bananas, oranges, or potatoes, and to have regular blood tests to check the electrolyte levels.

Choice C reason: Tachycardia is not a severe reaction to propranolol, but it may be a sign of overdose, withdrawal, or rebound effect. Propranolol is a beta-blocker that lowers the heart rate and blood pressure by blocking the effects of epinephrine and norepinephrine. Propranolol may cause bradycardia, not tachycardia, as a side effect. The nurse should monitor the client's vital signs and advise the client to take the medication as prescribed and not to stop it abruptly.

Choice D reason: Postural hypotension is a severe reaction to propranolol, as it may cause dizziness, fainting, or falls. Postural hypotension occurs when the blood pressure drops significantly when the client changes position, such as from lying to sitting or standing. Propranolol may cause postural hypotension by reducing the vascular tone and the cardiac output. The nurse should instruct the client to change position slowly and to report any symptoms of postural hypotension to the provider.

Choice A reason: Expecting to gain weight while taking this medication is not a correct instruction, as it may discourage the client from adhering to the treatment and may worsen the hypertension. Captopril is an angiotensin-converting enzyme (ACE) inhibitor that lowers the blood pressure by preventing the formation of angiotensin II, a potent vasoconstrictor. Captopril does not cause significant weight gain, but it may cause fluid retention or edema in some cases. The nurse should advise the client to monitor the weight daily and report any sudden or excessive increase to the provider.

Choice B reason: Not using salt substitutes while taking this medication is a correct instruction, as it may prevent the risk of hyperkalemia, a potentially life-threatening condition. Captopril may increase the potassium level in the blood by reducing the secretion of aldosterone, a hormone that regulates the sodium and potassium balance. Salt substitutes may contain potassium chloride, which may further elevate the potassium level. The nurse should advise the client to avoid salt substitutes and high-potassium foods, such as bananas, oranges, or tomatoes, and to have regular blood tests to check the electrolyte levels.

Choice C reason: Counting the pulse rate before taking the medication is not a necessary instruction, as it may not reflect the effect of the medication on the blood pressure. Captopril does not affect the heart rate significantly, but it may lower the blood pressure too much, especially in the first few weeks of treatment or after a dose increase. This may cause hypotension, dizziness, or fainting. The nurse should advise the client to monitor the blood pressure regularly and report any symptoms of hypotension to the provider.

Choice D reason: Taking the medication with food is not a correct instruction, as it may reduce the absorption and effectiveness of the medication. Captopril should be taken on an empty stomach, at least one hour before or two hours after a meal, to ensure optimal bioavailability. The nurse should advise the client to take the medication at the same time every day and to avoid skipping or doubling the doses.