The nurse notifies the healthcare provider (HCP) that the client is having trouble remembering to take his second dose of captopril. What angiotensin-converting enzyme (ACE) inhibitors can be given only once per day? Select all that apply.

Captopril is an angiotensin converting enzyme inhibitor that works by vasodilation.

Choice A: Angiotensin Converting Enzyme Inhibitor

Reason:

Captopril is classified as an angiotensin converting enzyme (ACE) inhibitor. ACE inhibitors work by blocking the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. By inhibiting this conversion, ACE inhibitors reduce the levels of angiotensin II, leading to vasodilation, decreased blood pressure, and reduced workload on the heart. This mechanism is particularly beneficial in managing hypertension and heart failure. Additionally, ACE inhibitors like captopril help in reducing the progression of diabetic nephropathy by decreasing glomerular pressure.

Choice B: Aldosterone Agonist

Reason:

Aldosterone agonists are drugs that mimic the action of aldosterone, a hormone that increases sodium and water reabsorption in the kidneys, leading to increased blood volume and blood pressure. This is the opposite of what captopril does. Captopril, as an ACE inhibitor, actually reduces aldosterone secretion, leading to decreased sodium and water retention, which helps lower blood pressure. Therefore, captopril cannot be classified as an aldosterone agonist.

Choice C: Angiotensin II Receptor Blocker

Reason:

Angiotensin II receptor blockers (ARBs) work by blocking the action of angiotensin II at its receptor sites, preventing vasoconstriction and aldosterone secretion. While ARBs and ACE inhibitors both target the renin-angiotensin-aldosterone system (RAAS), they do so at different points. Captopril is an ACE inhibitor, not an ARB. ARBs include drugs like losartan and valsartan, which are used when patients cannot tolerate ACE inhibitors due to side effects like coug.

Choice D: Lowering the Heart Rate

Reason:

Lowering the heart rate is not the primary mechanism of action for captopril. This effect is more commonly associated with beta-blockers, which reduce heart rate and myocardial contractility to lower blood pressure and reduce cardiac workload. Captopril, on the other hand, primarily works through vasodilation by inhibiting the formation of angiotensin II. While it may have some indirect effects on heart rate by reducing blood pressure, this is not its main mechanism.

Choice E: Reducing Inflammation

Reason:

Reducing inflammation is not a primary action of captopril. Anti-inflammatory effects are typically associated with nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. While there is some evidence that ACE inhibitors may have minor anti-inflammatory effects due to their impact on the RAAS, this is not their primary function. Captopril is mainly used for its vasodilatory effects to manage hypertension and heart failure.

Choice F: Diuresis

Reason:

Diuresis, or increased urine production, is not the primary mechanism of action for captopril. Diuretics, such as furosemide or hydrochlorothiazide, are specifically used to promote diuresis by acting on different parts of the renal tubules to increase the excretion of sodium and water. While captopril can lead to mild diuresis by reducing aldosterone levels, this is not its main therapeutic action.

Choice G: Vasodilation

Reason:

Vasodilation is the correct mechanism of action for captopril. By inhibiting the conversion of angiotensin I to angiotensin II, captopril reduces vasoconstriction and promotes vasodilation. This leads to a decrease in blood pressure and an overall reduction in the workload on the heart. Vasodilation is a key therapeutic effect of ACE inhibitors, making them effective in treating conditions like hypertension and heart failure.

Choice A Reason:

Sodium polystyrene sulfonate is used to treat hyperkalemia (high potassium levels) by exchanging sodium ions for potassium ions in the intestines, which are then excreted in the stool. A serum potassium level of 3.8 mEq/L is within the normal range (3.5 to 5 mEq/L), indicating that the medication has effectively reduced the potassium level to a safe range. Monitoring potassium levels is crucial in clients with AKI to prevent complications such as cardiac arrhythmias.

Choice B Reason:

A hemoglobin level of 13.3 g/dL is slightly below the normal range for adults (14 to 18 g/dL for males and 12 to 16 g/dL for females). While it is important to monitor hemoglobin levels, this value does not directly indicate the effectiveness of sodium polystyrene sulfonate, which is specifically used to manage potassium levels.

Choice C Reason:

A serum ammonia level of 30 µg/dL is within the normal range (10 to 80 µg/dL). However, this value does not reflect the effectiveness of sodium polystyrene sulfonate, as the medication is not used to manage ammonia levels. Ammonia levels are more relevant in conditions affecting liver function, such as hepatic encephalopathy.

Choice D Reason:

A serum glucose level of 100 mg/dL is within the normal range (74 to 106 mg/dL). While it is important to monitor glucose levels, this value does not indicate the effectiveness of sodium polystyrene sulfonate. The medication’s primary function is to reduce potassium levels, not to manage glucose levels.