Review Practice Exercise 3

Drugs Used to Treat Hypertension > Pharmacology

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Practice Exercise 3

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Total Questions : 3

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Question 1:

Captopril (Capoten) has been ordered for a patient. The nurse teaches the patient that angiotensin converting enzyme (ACE) inhibitors have which common side effects?

A. Nausea and vomiting B. Dizziness and headaches C. Upset stomach D. Constant, irritating cough

Answer and Explanation

Choice A:

Nausea and vomitingAlthough gastrointestinal upset can occur, nausea and vomiting are not common or characteristic side effects of ACE inhibitors. They may result from unrelated causes or excessive hypotension.

Choice B:

Dizziness and headachesThese symptoms can occur transiently at therapy initiation due to the vasodilatory effect and drop in blood pressure, but they are not considered hallmark side effects of ACE inhibitors. They usually resolve as the body adjusts to the medication.

Choice C:

Upset stomachMild gastrointestinal discomfort can happen but is nonspecific and less common compared to the dry cough. It is not unique to ACE inhibitors and can result from taking the medication on an empty stomach.

Choice D:

Constant, irritating coughACE inhibitors prevent the breakdown of bradykinin and substance P, which are inflammatory mediators that can accumulate in the lungs, stimulating the cough reflex. This cough is nonproductive, persistent, and often described as tickling or irritating. It may develop within days to weeks after therapy begins and is more common in women and individuals of African descent.Rationales for incorrect answers:

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Question 2:

The nurse is preparing to administer the first dose of enalapril (Vasotec). Identify the potential adverse effects of this medication. Select all that apply

A. Reflex hypertension B. Hyperkalemia C. Persistent cough D. Angioedema E. Hypotension

Answer and Explanation

Choice A:

Reflex hypertensionReflex hypertension is not associated with ACE inhibitors. Instead, enalapril lowers blood pressure. Reflex tachycardia may occur with vasodilators such as hydralazine or nitrates, but not with ACE inhibitors, which typically slow the heart rate slightly.

Choice B:

HyperkalemiaBy inhibiting aldosterone secretion, ACE inhibitors decrease potassium excretion in the kidneys, leading to elevated serum potassium levels. This can cause cardiac arrhythmias if left unchecked, making potassium monitoring essential during therapy.

Choice C:

Persistent coughACE inhibitors cause accumulation of bradykinin in the lungs, resulting in a dry, irritating cough that does not respond to cough suppressants. This is a common and often dose-limiting side effect that may require a switch to an ARB (angiotensin II receptor blocker).

Choice D:

AngioedemaA potentially life-threatening allergic reaction, angioedema presents as swelling of the face, lips, tongue, and airway. It results from increased bradykinin levels and requires immediate medical attention to prevent airway obstruction.

Choice E:

HypotensionEnalapril lowers blood pressure by reducing vascular resistance and preload, which can cause first-dose hypotension, particularly in clients who are volume-depleted or on diuretics. Nurses should monitor blood pressure closely after the initial dose.Rationale for incorrect answer:

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Question 3:

A nurse is caring for a client who is starting captopril (Capoten) for hypertension. For which of the following adverse effects should the nurse monitor the client?

A. Hypokalemia B. Hypernatremia C. Neutropenia D. Anemia

Answer and Explanation

Choice A:

HypokalemiaCaptopril tends to cause hyperkalemia, not hypokalemia, because decreased aldosterone secretion reduces potassium excretion by the kidneys. Potassium levels should be monitored, but hypokalemia is not expected.

Choice B:

HypernatremiaACE inhibitors promote sodium and water excretion, which helps lower blood pressure. Therefore, hyponatremia, not hypernatremia, may occur.

Choice C:

NeutropeniaACE inhibitors such as captopril can cause bone marrow suppression, leading to neutropenia or agranulocytosis, especially in clients with renal impairment or autoimmune disorders. The nurse should monitor the white blood cell count and report signs of infection such as fever, sore throat, or fatigue. Early detection is crucial, as untreated neutropenia can lead to severe infection and sepsis.Rationales for incorrect answers:

Choice D:

AnemiaWhile mild anemia can occasionally occur, it is not a typical or major adverse effect of captopril. The nurse’s priority should be monitoring for neutropenia and hyperkalemia.

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Practice Exercise 3

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