NURSING 6005 CHAPTER 44: DRUGS ACTING ON THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM Test Bank

NURSING 6005 CHAPTER 44: DRUGS ACTING ON THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM Test Bank MULTIPLE CHOICE 1. A patient with hypertension is prescribed an angiotensin-converting enzyme (ACE) inhibitor. The nurse reviewing this patient’s chart before administering the medication will be most concerned about which other disease process? a. Bronchial asthma b. Coronary artery disease c. Diabetes mellitus d. Renal artery stenosis ANS: D ACE inhibitors can cause severe renal insufficiency in patients with bilateral renal artery stenosis or stenosis in the artery to a single remaining kidney. Bronchial asthma, coronary artery disease, and diabetes mellitus are not comorbidities that are contraindications to treatment with an ACE inhibitor. DIF: Cognitive Level: Application REF: Angiotensin-Converting Enzyme Inhibitors | Therapeutic Uses | Adverse Effects TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 2. A nurse administers an ACE inhibitor to a patient who is taking the drug for the first time. What will the nurse do? a. Instruct the patient not to get up without assistance. b. Make sure the patient takes a potassium supplement. c. Report the presence of a dry cough to the prescriber. d. Request an order for a diuretic to counter the side effects of the ACE inhibitor. ANS: A Severe hypotension can result with the first dose of an ACE inhibitor. The patient should be discouraged from getting up without assistance. Potassium supplements are contraindicated. A dry cough is an expected side effect that eventually may cause a patient to discontinue the drug; however, it is not a contraindication to treatment. Diuretics can exacerbate hypotension and should be discontinued temporarily when a patient starts an ACE inhibitor. DIF: Cognitive Level: Application REF: Angiotensin-Converting Enzyme Inhibitors | Adverse Effects TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 3. A patient who has been taking an antihypertensive medication for several years is recovering from a myocardial infarction. The prescriber changes the patient’s medication to an ACE inhibitor. The patient asks the nurse why a new drug is necessary. What is the nurse’s response? a. “ACE inhibitors can prevent or reverse pathologic changes in the heart’s structure.” b. “ACE inhibitors help lower LDL cholesterol and raise HDL cholesterol.” c. “ACE inhibitors increase venous return to the heart, improving cardiac output.” d. “ACE inhibitors regulate electrolytes that affect the cardiac rhythm.” ANS: A ACE inhibitors have many advantages over other antihypertensive medications, the most important of which is their ability to prevent or reverse pathologic changes in the heart and reduce the risk of cardiac mortality caused by hypertension. They are useful in patients with high low-density lipoprotein (LDL) or low high-density lipoprotein (HDL) cholesterol, but they do not directly affect this comorbidity. They reduce venous return to the heart, thereby reducing right heart size. They do not alter serum electrolyte levels. DIF: Cognitive Level: Application REF: Angiotensin-Converting Enzyme Inhibitors | Therapeutic Uses TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 4. A prescriber orders ramipril (Altace) for an obese patient with type 2 diabetes mellitus who has developed hypertension. The nurse provides teaching before dismissing the patient home. Which statement by the patient indicates understanding of the teaching? a. “I am less likely to develop diabetic nephropathy when taking this medication.” b. “I should check my blood sugar more often, because hyperglycemia is a side effect of this drug.” c. “Taking this medication helps reduce my risk of stroke and heart attack.” d. “This medication will probably prevent the development of diabetic retinopathy.” ANS: C Ramipril (Altace) is approved for reducing the risk of stroke and myocardial infarction (MI) in patients at high risk for a major cardiovascular event because they have hypertension in conjunction with a history of stroke or MI or because they have diabetes. ACE inhibitors cannot be used for primary prevention of diabetic nephropathy, but they can delay the onset of overt nephropathy in patients who already have less advanced nephropathy. ACE inhibitors do not affect serum electrolytes or glucose. One ACE inhibitor, enalapril, can reduce the risk of diabetic retinopathy in some patients with type 1 diabetes mellitus. DIF: Cognitive Level: Application REF: Angiotensin-Converting Enzyme Inhibitors | Therapeutic Uses TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 5. A patient begins taking an ACE inhibitor and complains of a dry cough. What does the nurse correctly tell the patient about this symptom? a. It indicates that a serious side effect has occurred. b. It is a common side effect that occurs in almost all patients taking the drug. c. It may be uncomfortable enough that the drug will need to be discontinued. d. It occurs frequently in patients taking the drug but will subside over time. ANS: C A cough occurs in about 10% of patients taking ACE inhibitors and is the most common reason for discontinuing therapy. It does not indicate a serious condition. It occurs in about 10% of all patients and is more common in women, older adults, and those of Asian ancestry. It does not subside until the medication is discontinued