1Report the persistent cough to the prescriber so the regimen can be evaluated and changed if indicated.✓ Correct answer
2Take an extra lisinopril dose at bedtime because cough indicates inadequate blood pressure control.
3Use a potassium supplement each morning to counteract bradykinin accumulation in the lungs.
4Restrict fluids and remain supine after each dose to reduce irritation of the upper airway.
Explanation
ACE inhibitors can cause a persistent nonproductive cough, likely because bradykinin degradation is inhibited. The nurse should report the symptom so the prescriber can evaluate it and select a different regimen when appropriate. The client should not independently increase or stop lisinopril. Potassium supplementation can be hazardous with ACE inhibition, and fluid restriction or supine positioning does not treat this adverse effect.
Clinical reasoning A dry cough beginning after ACE inhibitor initiation, without infectious or pulmonary findings, points to a class effect rather than inadequate antihypertensive action.
Decision rule Recognize the characteristic cough, assess for competing causes and angioedema, and involve the prescriber in medication changes.
Scenario A client who began lisinopril three weeks ago reports a persistent dry cough without fever, sputum, dyspnea, or abnormal lung sounds.
ACE inhibitor cough — A persistent nonproductive cough associated with reduced breakdown of bradykinin during ACE inhibition.
Bradykinin — A vasoactive peptide whose accumulation contributes to cough and angioedema during ACE inhibitor therapy.