The nurse is preparing medications for a client with a history of hypertension who is post-op day 3 following hip replacement.

Meds: Atenolol 25 mg PO, Captopril 10 mg PO, Atorvastatin 40 mg PO, and Warfarin 4 mg PO.

Vital signs: blood pressure 138/90, heart rate 52, respiratory rate 18, temperature 99.7, O2 saturation 96% on room air.

Today’s labs: sodium- 143 meq/L, potassium 4.6 mmol/L, Hemoglobin 11.1 gm/dL, white blood count 10.8, INR 2.2

Which medication will the nurse hold?

Choice A reason: This is incorrect. Dry cough and nose bleed are not common side effects of gemfibrozil. They may indicate other conditions, such as allergies, infections, or bleeding disorders.

Choice B reason: This is incorrect. Constipation and dry skin are not common side effects of gemfibrozil. They may be caused by dehydration, dietary factors, or other medications.

Choice C reason: This is correct. Abdominal pain and jaundice are serious side effects of gemfibrozil. They may indicate liver damage, which can be fatal if not treated promptly. The client should report these symptoms to the prescriber immediately.

Choice D reason: This is incorrect. Hirsutism and flatulence are not common side effects of gemfibrozil. They may be associated with hormonal imbalances, digestive disorders, or other causes.

Choice A reason: This choice is correct because captopril is an angiotensin-converting enzyme (ACE) inhibitor that can cause fetal harm or death if used during pregnancy. Captopril can affect the development of the baby's kidneys, lungs, skull, and blood vessels. The nurse should advise the patient to use effective contraception while taking captopril and to inform the provider as soon as possible if she becomes pregnant or plans to become pregnant. The provider may switch the patient to a safer medication for blood pressure control during pregnancy.

Choice B reason: This choice is incorrect because facial swelling is a serious side effect of captopril that may indicate angioedema, a life-threatening allergic reaction that causes swelling of the face, lips, tongue, throat, or airway. The nurse should instruct the patient to stop taking captopril and seek emergency medical attention if she develops facial swelling or any signs of difficulty breathing, such as wheezing, stridor, or cyanosis. Reducing the dose of captopril will not prevent or treat angioedema.

Choice C reason: This choice is incorrect because captopril can be taken with or without food, depending on the patient's preference and tolerance. Food may decrease the absorption of captopril, but this effect is not clinically significant for most patients. The nurse should advise the patient to take captopril at the same time each day, preferably one hour before meals, to maintain consistent blood levels and effects.

Choice D reason: This choice is incorrect because captopril is unlikely to cause anaphylaxis, a severe and potentially fatal allergic reaction that involves multiple organ systems. Anaphylaxis can cause symptoms such as hives, itching, flushing, swelling, nausea, vomiting, diarrhea, abdominal pain, low blood pressure, fast heart rate, and shock. The nurse should instruct the patient to carry an epi pen only if she has a history of anaphylaxis or a severe allergy to another substance. .