ACE inhibitors work on the RAAS to prevent the conversion of angiotensin I to angiotensin II. Because this blocking occurs in the cells in the lung, which is usually the site of this conversion, the use of ACE inhibitors often results in

A) "Reduce intake of potassium-rich foods":
Hydrochlorothiazide is a diuretic medication that can cause potassium loss through increased urinary excretion. Therefore, instructing the client to reduce intake of potassium-rich foods could further decrease potassium levels, leading to hypokalemia. Instead, clients taking hydrochlorothiazide should be encouraged to consume potassium-rich foods to help maintain normal potassium levels, unless otherwise instructed by their healthcare provider.

B) "Take this medication before bedtime":
While hydrochlorothiazide can be taken once daily, it is typically recommended to take it in the morning rather than before bedtime. Taking the medication earlier in the day can help minimize the need to wake up during the night to urinate, as it is a diuretic that increases urine production. Therefore, instructing the client to take hydrochlorothiazide before bedtime is not the optimal recommendation.

C) "Avoid grape juice":
There is no significant interaction between hydrochlorothiazide and grape juice. In general, grapefruit juice is known to interact with certain medications by inhibiting cytochrome P450 enzymes in the liver, affecting drug metabolism. However, grape juice is not known to interact with hydrochlorothiazide, so advising the client to avoid grape juice is not necessary.

D) "Monitor for leg cramps":
This is the correct instruction. Leg cramps can be a potential side effect of hydrochlorothiazide therapy due to electrolyte imbalances, particularly hypokalemia. By monitoring for leg cramps, the client can promptly report any symptoms to their healthcare provider for further evaluation and management. This instruction promotes client safety and awareness of potential adverse effects associated with the medication."

A) Take this medication with food:
Captopril is an ACE inhibitor, known to work best on an empty stomach. Food can reduce its absorption, impacting its effectiveness. Thus, while clients can take captopril with or without food, it's generally recommended to take it on an empty stomach for optimal results.

B) Monitor for a cough:
Captopril, an ACE inhibitor, commonly induces a persistent, dry cough due to the accumulation of bradykinin. This side effect can be bothersome and may necessitate discontinuation of the medication. Therefore, patients should be vigilant for the onset of a cough and promptly report it to their healthcare provider.

C) Avoid bananas:
Although captopril can occasionally lead to hyperkalemia, advising patients to avoid bananas specifically may not be necessary. While bananas are potassium-rich, restricting them alone might not significantly impact potassium levels. However, patients should be educated on monitoring potassium intake and informed of potential dietary modifications if hyperkalemia occurs.

D) Hold medication for heart rate less than 100/min:
Captopril is not known to directly affect heart rate. This instruction may be more applicable to medications like beta-blockers, which can lower heart rate as part of their mechanism of action. Therefore, holding captopril for heart rates below 100/min may not be clinically indicated.