The action of an ACE inhibitor interrupts the renin-angiotensin-aldosterone mechanism, thereby producing which of the following?
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Solution
Increased sodium excretion and potassium reabsorption
The inhibition of aldosterone increases sodium excretion and reduces potassium excretion. ACE inhibitors increases renal blood flow. Excretion of sodium and water is enhanced by ACE inhibitors. Peripheral vascular resistance is decreased by vasodilation effect of ACE inhibitors.
Pepito is a hypertensive client who has been placed on captopril (Capoten). He states, “Dr. del Mundo keeps changing my pills and none are working. I feel like a guinea pig.” Which of the following responses by the nurse would be most appropriate?
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Solution
“This drug is used when other drugs have failed.”
This response provides accurate information about the medication. Choice A placates the client and provides no information about the new medication. Choice B is defensive. Although choice C is true, there is no information provided to motivate the client.
Mira is managing her hypertension with an ACE inhibitor. Which of the following statements stated by her indicates a need for further instruction?
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Solution
“I need to increase my intake of orange juice, bananas, and green vegetables.”
The client needs to understand the risk of hyperkalemia and foods to eat in moderation. Taking medications with food will decrease therapeutic effects of ACE inhibitors. Excessive amounts of caffeine should be avoided. Avoidance of salt substitutes that are high in potassium decrease the risk of hyperkalemia.
Nurse Margie just administered an ACE inhibitor to her client. Before ambulating the client for the first time after administration, the nurse should monitor for:
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Solution
Hypotension
ACE inhibitors prevent vasoconstriction and lower blood pressure, placing the client at greater risk for postural (orthostatic) hypotension. ACE inhibitors reduce potassium excretion placing the client at risk for hyperkalemia. ACE inhibitors do not affect heart rate. ACE inhibitor promote sodium excretion thereby decreasing edema.
ACEs participate in the renin-angiotensin-aldosterone system to have which of the following physiologic effects?
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Solution
Promote sodium and water retention
Angiotensin is a potent vasoconstrictor that stimulate the release of aldosterone. Aldosterone release promotes sodium and water retention. The conversion of angiotensin I to II is not inhibited. Aldosterone promotes sodium retention not depletion. Vasoconstriction not vasodilation results.
When teaching about nitrate administration, the nurse should instruct the client to:
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Solution
Change position slowly.
Clients taking nitrates should change position slowly to avoid orthostatic hypotension. It is not necessary to take the pulse before taking this drug. It is also not necessary to change the diet while taking this drug. It is contraindicated to chew sustained-release tablets.
When nitrates are administered early to the acute MI client, the effect is:
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Solution
Reduced mortality
Research has shown that when nitrates are administered early to the acute MI client, the effect is reduced mortality, infarct size, infarct extension, and related complications. Hypotension will result from nitrate administration, but it is not the reason for prescribing the drug. Tachycardia rather than bradycardia is more likely to occur with nitrate administration. The morbidity is already present because the client has the pain.
A student nurse is asked to give an example of a long-acting nitrate. He is correct by saying:
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Solution
isosorbide PO
Isosorbide is one of the most frequently administered long-acting nitrates. PO nitrates are longer acting than IV or SL agents.
A 50-year-old client is prescribed to take nitrate each day for his condition. As a competent nurse, you know the result of nitrate administration is:
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Solution
Decreased myocardial oxygen demand
Nitrate administration will result in reduced preload and a decrease in myocardial oxygen demand and left ventricular end-diastolic volume.
As a knowledgeable nurse, you know that the action of nitrates is:
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Solution
Smooth muscle relaxation
Nitrates cause smooth muscle relaxation, vasodilation, reduction of preload, and improved blood flow to the myocardium. Other choices have opposite effect of nitrates.