When a patient is being taught about the potential adverse effects of an ACE inhibitor, which of these effects should the nurse mention as possibly occurring when this drug is taken to treat hypertension? Select all that apply

Fatigue

Nausea

Dry, nonproductive cough

Diarrhea

Dizziness

Answer and Explanation

Correct Answer : A,C,E

When teaching a client about ACE inhibitors for hypertension, it is important to highlight the potential adverse effects that may occur, including fatigue, dizziness, and a dry, nonproductive cough. Understanding these effects helps clients recognize symptoms early, maintain medication adherence, and seek timely care if complications arise.

Rationale for correct answer:

A. Fatigue
ACE inhibitors can cause vasodilation and a slight decrease in blood pressure, which may lead to feelings of tiredness or fatigue, especially during the initial stages of therapy. Monitoring for fatigue is important as it may affect daily functioning, and dose adjustments or timing changes may be needed.

C. Dry, nonproductive cough
A common adverse effect of ACE inhibitors is a persistent, dry cough caused by accumulation of bradykinin in the respiratory tract. Although not harmful, it can be bothersome enough for clients to request a medication change.

E. Dizziness
Dizziness may occur due to first-dose hypotension or the vasodilatory effects of ACE inhibitors. Clients should be advised to rise slowly from sitting or lying positions to prevent falls and monitor for symptomatic hypotension.

Rationales for incorrect answers:
B. Nausea
Nausea is not a typical adverse effect of ACE inhibitors. Gastrointestinal upset is uncommon and usually mild if it occurs.

D. Diarrhea
Diarrhea is not commonly associated with ACE inhibitor therapy and is not a primary teaching point when discussing adverse effects for hypertension management.

Take-home points:
• ACE inhibitors may cause fatigue, dizziness, and a dry cough, which clients should monitor and report if severe.
• Bradykinin accumulation is responsible for the characteristic dry, nonproductive cough.
• Clients should rise slowly from sitting or lying positions to reduce dizziness from hypotension.

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Correct Answer is B

Explanation

Atenolol (Tenormin) is a beta-adrenergic blocker that decreases heart rate, cardiac output, and renin release, while doxazosin (Cardura) is an alpha-adrenergic blocker that causes vasodilation by relaxing vascular smooth muscle. Combining these two antihypertensive agents targets different mechanisms involved in blood pressure regulation, allowing for synergistic blood pressure reduction while minimizing side effects associated with higher doses of a single medication.

Rationale for correct answer:

B. Lower doses of both drugs may be given with fewer adverse effects.
Combination therapy allows each drug to complement the other’s mechanism of action—atenolol reduces cardiac workload and renin secretion, while doxazosin reduces peripheral vascular resistance. This dual approach enables the use of lower doses of both drugs, enhancing efficacy and reducing the risk of dose-related adverse effects such as bradycardia (from beta blockers) or postural hypotension (from alpha blockers).

Rationales for incorrect answers:

A. The blood pressure will decrease faster.
The goal of combination therapy is safe and sustained blood pressure control, not a rapid decrease. A sudden drop in BP can lead to hypotension, dizziness, or syncope, especially in older adults.

C. There is less daily medication dosing.
Combination therapy often involves multiple doses or separate tablets, not necessarily fewer doses. The purpose is enhanced control, not dosing convenience.

D. Combination therapy will treat the patient’s other medical conditions.
Although atenolol may help with cardiac conditions like angina, combination therapy in this context is specifically aimed at improving blood pressure control, not managing unrelated diseases.

Take-home points:
• Combining antihypertensive drugs with different mechanisms enhances blood pressure control and limits side effects.
• Lower doses of each drug in combination therapy improve tolerability and adherence.
• The goal is balanced, sustained blood pressure reduction, not rapid or multi-condition treatment.

A. Diuretics B. Beta blockers C. Aldosterone receptor antagonist D. Angiotensin II receptor blockers E. Calcium channel blockers F. ACE inhibitors G. Direct renin inhibitors H. Alpha-1 adrenergic blockers

Correct Answer is ["A","D","E","F"]

Explanation

The initial pharmacologic management of hypertension typically involves agents that target different mechanisms controlling blood pressure, such as fluid volume, vascular resistance, and cardiac output. Evidence-based guidelines recommend beginning therapy with drugs from the following four classes: diuretics, ACE inhibitors, angiotensin II receptor blockers (ARBs), and calcium channel blockers (CCBs). These medications effectively reduce blood pressure, decrease cardiovascular risk, and are well-tolerated for long-term therapy.

Rationale for correct answers:

A. Diuretics
Thiazide-type diuretics (e.g., hydrochlorothiazide) are often the first-line agents for hypertension. They lower blood pressure by reducing blood volume through sodium and water excretion and by decreasing peripheral vascular resistance. They are particularly effective in older adults and clients with salt-sensitive hypertension.

D. Angiotensin II receptor blockers (ARBs)
ARBs (e.g., losartan, valsartan) block the binding of angiotensin II to its receptors, leading to vasodilation and reduced aldosterone-mediated sodium retention. They are often used when clients cannot tolerate ACE inhibitors due to cough or angioedema.

E. Calcium channel blockers (CCBs)
CCBs (e.g., amlodipine, diltiazem) lower blood pressure by inhibiting calcium influx into vascular smooth muscle and cardiac cells, causing arterial relaxation and vasodilation. They are particularly effective in African American clients and those with isolated systolic hypertension.

F. ACE inhibitors
ACE inhibitors (e.g., lisinopril, captopril) inhibit the conversion of angiotensin I to angiotensin II, leading to vasodilation, reduced aldosterone secretion, and decreased afterload. They are especially beneficial for clients with diabetes or chronic kidney disease due to their renal-protective effects.

Rationales for incorrect answers:

B. Beta blockers
Although beta blockers (e.g., propranolol, metoprolol) can lower blood pressure, they are no longer considered first-line therapy for uncomplicated hypertension. They are more commonly used when there are coexisting conditions such as heart failure, post-MI, or arrhythmias.

C. Aldosterone receptor antagonist
These agents (e.g., spironolactone, eplerenone) are not first-line drugs but are used as add-on therapy in resistant hypertension or when hyperaldosteronism is suspected.

G. Direct renin inhibitors
Aliskiren inhibits renin activity and decreases angiotensin II production but is not typically first-line due to limited long-term outcome data and potential for adverse renal effects when combined with ACE inhibitors or ARBs.

H. Alpha-1 adrenergic blockers
These medications (e.g., doxazosin, prazosin) are used as adjuncts, mainly in clients with benign prostatic hyperplasia (BPH). They are not preferred as initial therapy because of risks of orthostatic hypotension.

Take-home points:
• First-line antihypertensive agents include diuretics, ACE inhibitors, ARBs, and calcium channel blockers.
• Combination therapy is often required to achieve target blood pressure control.
• Drug selection should be individualized based on comorbidities, age, and drug tolerance

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When a patient is being taught about the potential adverse effects of an ACE inhibitor, which of these effects should the nurse mention as possibly occurring when this drug is taken to treat hypertension? Select all that apply

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The client is taking atenolol (Tenormin) and doxazosin (Cardura). What is the rationale for combining two antihypertensive drugs?

Correct Answer is B

Explanation

The nurse explains to the patient, who needs to start initial drug therapy for hypertension, that treatment usually includes one or more agents from which four drug classes? Select all that apply

Correct Answer is ["A","D","E","F"]

Explanation

The nurse is administering antihypertensive drugs to older adult patients. The nurse knows that which adverse effect is of most concern for these patients?

A nurse is reviewing the health record of a client who is starting propranolol (Inderal) to treat hypertension. Which of the following conditions is a contraindication for taking propranolol?

A client with significant hypertension unresponsive to other medications is given a prescription for hydralazine (Apresoline). An additional prescription of propranolol (Inderal) is also given to the client. The client inquires why two drugs are needed. What is the nurse’s best response?

A nurse is planning to administer a first dose of captopril (Capoten) to a hospitalized client who has hypertension. Which of the following medications can intensify early adverse effects of captopril? Select all that apply

A patient has a new prescription for an ACE inhibitor. During a review of the patient's list of current medications, which would cause concern for a possible interaction with this new prescription? Select all that apply

An African-American patient has developed hypertension. The nurse is aware that which group(s) of antihypertensive drugs are less effective in African-American patients?

The nurse knows that which diuretic is most frequently combined with an antihypertensive drug?

When giving antihypertensive drugs, the nurse will consider giving the first dose at bedtime for which class of drugs?