A nurse is teaching a client who has heart failure and is prescribed captopril. Which of the following instructions should the nurse include? (Select all that apply.).

Digoxin (Lanoxin) is a cardiac glycoside that is used to improve the contractility of the heart and slow down the heart rate in patients with chronic heart failure. However, digoxin has a narrow therapeutic range and can cause toxicity if the dose is too high or if the patient has low potassium levels. A normal serum digoxin level is 0.5 to 2 ng/mL and a normal serum potassium level is 3.5 to 5 mEq/L. A low heart rate (less than 60 beats/min) is a sign of digoxin toxicity and the nurse should withhold the medication and report it to the provider. The nurse should also check the patient’s serum digoxin and potassium levels to determine if they are within normal limits.

Choice A is wrong because administering the medication as ordered could worsen the patient’s condition and increase the risk of digoxin toxicity.

Choice C is wrong because checking the patient’s serum digoxin level is not enough to prevent digoxin toxicity. The nurse should also check the patient’s serum potassium level and heart rate before giving digoxin.

Choice D is wrong because giving an additional dose of digoxin could cause a fatal overdose and lead to cardiac arrest. The nurse should never give more than the prescribed dose of digoxin without consulting the provider.

Captopril is an angiotensin-converting enzyme (ACE) inhibitor that is used to treat heart failure by lowering blood pressure and reducing the workload on the heart.

The nurse should include the following instructions when teaching a client who is prescribed captopril:

• Avoid salt substitutes that contain potassium.Captopril can increase the potassium levels in the blood, which can lead to hyperkalemia.Salt substitutes that contain potassium can further increase the risk of hyperkalemia, which can cause cardiac arrhythmias and muscle weakness.

• Report any dry cough to the provider.A dry cough is a common side effect of captopril and other ACE inhibitors.It is caused by the accumulation of bradykinin, a substance that dilates blood vessels and causes inflammation in the lungs.

The cough can be annoying and interfere with sleep and quality of life.The provider may switch the client to another type of medication if the cough is bothersome.

• Take the medication on an empty stomach.Food can decrease the absorption and effectiveness of captopril.The client should take the medication at least 1 hour before or 2 hours after meals.

• Rise slowly from a sitting or lying position.Captopril can cause orthostatic hypotension, which is a sudden drop in blood pressure when changing positions.

This can lead to dizziness, fainting, and falls.The client should rise slowly and sit on the edge of the bed for a few minutes before standing up.

Choice D is wrong because drinking at least 3 L of fluids per day is not recommended for clients with heart failure.

Excessive fluid intake can worsen the symptoms of heart failure, such as edema, shortness of breath, and fatigue.The client should limit fluid intake to 2 L or less per day, unless instructed otherwise by the provider.