Exam 2: Ace-Inhibitors

Question 1

ACE-inhibitors are a drug class used to lower what?

Answer 1

Lower blood pressure

Question 2

the name ACE stands for Angiotensin Converting Enzyme.

Looking at the name, what bodily system do ACE-inhibitors effect?

Answer 2

the RAAS

Question 3

Which of the following drugs is an ACE-inhibitor (select all)

-Captopril
-Catapress
-Timolol
-Clorazepate
-Ramipril
-Cloradipine
-Felodipine
-Atenolol
-Furosemide

Answer 3

Captopril and Ramipril

ACE-inhibitors often end in “pril”

Question 4

Which med type ends in “pril”

a.) Beta-Blockers
b.) Calcium-Channel Blockers
c.) Thiazides
d.) Loop Diuretics
e.) ARBs
f.) ACE-inhibitors

Answer 4

f.) ACE-inhibitors end with “pril”

Question 5

ACE, secreted by the lungs, converts Angiotensin 1 to Angiotensin 2.

ACE also inactivates an inflammatory substance that is responsible for dilating the blood vessels.

What is the name of the inflammatory substance that an ACE-inhibitor inactivates?

Answer 5

Bradykinin

Bradykinin is inactivated by the RAAS to increase Bp.

By stopping the inactivation of bradykinin, ACE-inhibitors are able to keep blood vessels dilated and lower blood pressure.

Question 6

Angiotensin II is a major vasoconstrictor because it triggers the release of Aldosterone from the adrenal cortex, telling the kidneys to keep Na+ and H2O, which increases Bp.

However, while the kidneys KEEP Na+ and H2O, they piss away another electrolyte.

What do the Kidneys excrete due to Angiotensin II?

Answer 6

K+
Potassium

Question 7

If an ACE inhibitor is given, then there is no Angiotensin II made, because it blocks the secretion of ACE from the lungs.

Because no Angiotensin II is being made, what effect opposite of Angiotensin II will ACE-inhibitors cause in the kidneys?

Answer 7

The body will KEEP K+ and piss away Na+ and H2O

This makes ACE inhibitors a sort of diuretic

Question 8

What electrolyte level should you watch for in a patient taking ACE inhibitors?

Why?

Answer 8

K+ Potassium

ACE inhibitors will cause the body to retain its K+ and excrete Na+ and H2O.

Therefore, the patient may be at risk for Hyperkalemia, so monitor the K+ levels in the blood.

Question 9

What conditions are ACE inhibitors used for?

Answer 9

HTN and HF

Question 10

What effects do ACE inhibitors have on a hearts Afterload and Preload?

Answer 10

ACE inhibitors decrease afterload and preload.

Question 11

When assessing a patient’s blood pressure while they are using an ACE inhibitor, the nurse should monitor signs for:

-Hypertension
-Hypotension

Why?

Answer 11

Hypotension

ACE inhibitors lower blood pressure, so it is important to make sure their blood pressure isn’t too low (>90 SBP)

Question 12

While assessing a patient taking ACE inhibitors, you find that the patient’s EKG is showing tall, peaked t-waves.

As the nurse, you recognize that this means the patients; “blank” levels are too “blank.”

Answer 12

Patients’ K+ potassium levels are too high.

Tall, peaked T-waves on an EKG can mean hyperkalemia in a patient taking ACE inhibitors, due to ACE inhibitors causing K+ retention.

Question 13

A patient taking an ACE inhibitor has a UOP that is >30mL/Hr. You remember that ACE inhibitors affect Na+ and H2O secretion, and so upon seeing this, you order a lab value check for what two labs?

Answer 13

BUN (6-20) and Creatinine (0.7-1.3)

ACE inhibitors affect Na+ and H2O excretion, making them have a diuretic effect. IF the patient is less than 30 ml/Hr, this can mean renal failure.

Check their BUN and Creatinine levels, as these correlate with renal function.

Question 14

With Ace inhibitors, it is important to watch for a patient developing an Angioedema.

This is a serious condition. What is an Angioedema?

Answer 14

Angioedema is a swelling dermis and subcutaneous tissue.

This can be dangerous because it can cause swelling in the face, mouth, extremities and can stop a patients’ breathing.

Question 15

ACE inhibitors can cause a harmless dry cough, but it can become annoying. What are some other side effects of ACE inhibitors too look out for?

Answer 15

-Dizziness (from low BP)
-Hypotension
-Increased K+ retention (Hyperkalemia)
-Angioedema DANGEROUS causes deep tissue swelling of the face, extremities, mouth and can stop breathing

Question 16

When taking ACE inhibitors, a patient should avoid a diet high in Potassium. What are some examples of high potassium foods to avoid?

Answer 16

-Bananas
-Avocadoes
-Potatoes
-Spinach
-Tomatoes
-Pork

Question 17

If a patient develops a dry cough and wants to stop taking an ACE inhibitor, what is the alternative medicine that is similar to an ACE inhibitor that they can take?

Answer 17

ARBs

Question 18

A 65-year-old male patient is prescribed an ACE inhibitor for the treatment of hypertension. Which medication below is an ACE inhibitor?

A. Metoprolol
B. Benazepril
C. Losartan
D. Amlodipine

Answer 18

B.) Benazepril

Question 19

Which statements below CORRECTLY describe how ACE Inhibitors work? Select all that apply:

A. This group of medications inhibits the renin-angiotensin-aldosterone system (RAAS).
B. ACE Inhibitors prevent the conversion of Angiotensin I to Angiotensin II.
C. ACE Inhibitors prevent Angiotensinogen from converting to Angiotensin I.
D. ACE Inhibitors have a positive chronotropic and negative inotropic effect on the heart.

Answer 19

The answers are A and B. ACE inhibitors inhibits the renin-angiotensin-aldosterone system (RAAS), which will prevent the conversion of Angiotensin I to Angiotensin II. Options C and D are false statements about these medications.

Question 20

Angiotensin-converting enzyme (ACE) performs what roles in the body? Select all that apply:

A. Inactivates bradykinin by breaking it down.
B. Dilates vessels.
C. Causes the kidneys to keep sodium and water
D. Converts Angiotensin I to Angiotensin II

Answer 20

The answers are A and D. ACE inactivates bradykinin by breaking it down and converts Angiotensin I to Angiotensin II. Option C describes the role of aldosterone, which is influenced by Angiotensin II, and option D describes how ACE Inhibitors work….remember they block the actions of ACE.

Question 21

Fill in the blanks: Angiotensin II causes ___________ of the vessels and triggers the release of ____________.

A. vasodilation; anti-diuretic hormone (ADH)
B. vasodilation; aldosterone
C. vasoconstriction; aldosterone
D. vasoconstriction; anti-diuretic hormone (ADH)

Answer 21

C.) Vasoconstriction; Aldosterone

Question 22

A patient is prescribed an ACE Inhibitor after experiencing a myocardial infarction. What effects on the body will this medication achieve? Select all that apply:

A. Decreases SVR (systemic vascular resistance) and blood pressure
B. Constriction of the vessels
C. Kidneys will excrete water and sodium
D. Kidneys will retain potassium.
E. Increases SVR (systemic vascular resistance) and blood pressure

Answer 22

The answers are A, C, and D. ACE inhibitors will cause the opposite effects of Angiotensin II, which is a major vasoconstrictor and triggers the release of aldosterone (remember this substance will cause the kidneys to keep sodium and water and excrete potassium). However, ACE Inhibitors will perform the opposite effects by decreasing the blood pressure via vasodilation of vessels (which decreases SVR) and causes the kidneys to excrete water and sodium and retain potassium (hence the nurse must monitor for hyperkalemia).

Question 23

Which patient below would MOST benefit from an ACE Inhibitor?

A. A 50-year-old female with systolic dysfunction heart failure.
B. A 48-year-old male with severe renal failure.
C. A 35-year-old female with chronic hepatitis.
D. A 54-year-old male with hypovolemic shock.

Answer 23

The answer is A. ACE Inhibitors are used to treat patient with hypertension, systolic dysfunction heart failure (the left ventricle is too weak to pump blood forward out of the heart…ACE inhibitors will decrease afterload which will make it easier for the heart to pump blood), and after a myocardial infarction. Patients with renal failure or liver disease are not candidates for ACE inhibitors because of the effects of the drug on the kidneys and how it is cleared in the liver. In option D, the patient will be hypotensive and need fluids or vasopressors….NOT a medication that will lower the blood pressure.

Question 24

Your patient is taking an ACE Inhibitor to manage blood pressure. Which finding below requires immediate nursing action?

A. Urinary output is 190 mL within the past 4 hours.
B. Patient has a persistent, dry cough.
C. EKG shows tall, peaked t-waves.
D. Patient has a negative Chvostek’s sign.

Answer 24

The answer is C. This EKG finding demonstrates hyperkalemia. Remember ACE Inhibitors can cause a high potassium level because the kidneys will keep potassium, but excrete water and sodium (so it has a diuretic effect too).

Question 25

Some patients who take ACE Inhibitors may develop angioedema. What signs and symptoms will you teach the patient to recognize that can present with this adverse reaction? Select all that apply:

A. Hyperkalemia
B. Persistent, dry cough
C. Swelling in the face
D. Thin and shiny skin in the lower extremities
E. Difficulty breathing

Answer 25

The answers are C and E. Angioedema is swelling deep in the skin (dermis and subcutaneous tissue)…..it’s very dangerous! Signs and symptoms include: swelling in face (mouth, eyes, tongue, lips, dyspnea, swelling of extremities). It most commonly occurs in African American patients.

Question 26

A patient states they are experiencing an annoying, persistent dry cough that started once they begin taking an ACE Inhibitor. The patient is not experiencing any other signs and symptoms. As the nurse, your response is?

A. Tell the patient to immediately stop taking the medication and seek medical treatment.
B. Reassure the patient this is a harmless side effect of this medication and to not abruptly stop taking the medication.
C. Recommend the patient start taking the medication at night to decrease the coughing.
D. Reassure the patient that the cough will disappear within 6 months of taking the medication.

Answer 26

The answer is B. A persistent, dry cough can occur in some patients taking ACE Inhibitors and is usually harmless. It is due to how ACE Inhibitors affect bradykinin (an inflammatory substance in the body). A patient should NEVER abruptly stop taking an ACE inhibitor because it can cause rebound hypertension. If the patient cannot tolerate the cough, they should speak with the MD about switching to another type of medication.

Question 27

You’re providing discharge instructions to a patient that will be taking an ACE Inhibitor at home. Which statements by the patient demonstrate they understood your discharge instructions? Select all that apply:

A. “If I feel unwell, it is okay that I miss a dose.”
B. “I will avoid using salt substitutes that contain potassium.”
C. “I will make sure I incorporate a high amount of potatoes, bananas, oranges, and tomatoes into my diet while taking this medication”.
D. “I will regularly check my blood pressure and pulse rate while taking this medication and report any significant changes to my doctor.”

Answer 27

The answers are B and D. It is very important a patient does not miss a dose of this medication (even if they are unwell) because this medication can cause rebound hypertension. Also, the patient should avoid salt substitutes with potassium and AVOID consuming foods high in potassium (like the foods in option C) because this medication causes the kidneys to retain potassium. The patient should monitor their blood pressure and pulse rate regularly and report any significant changes to their doctor.

Question 28

A patient is taking an ACE Inhibitor and Spironolactone. It is priority the nurse teaches the patient?
A. To avoid consuming alcoholic beverages
B. To limit foods high in potassium
C. To limit salt intake
D. To take the medications with food

Answer 28

The answer is B. ACE Inhibitors and spironolactone (it’s a potassium-sparing diuretic) will both cause the kidneys to retain potassium. Therefore, it is very important the nurse teaches the patient to limit foods high in potassium.