Deck 22: ACE Inhibitors and Angiotensin Receptor Blockers

Question 1

A patient who takes an ACE inhibitor and a thiazide diuretic for hypertension will begin taking spironolactone.The primary care NP should counsel this patient to:

A) avoid foods that are high in potassium.
B) use a salt substitute when seasoning foods.
C) discuss changing the ACE inhibitor to an ARB with the cardiologist.
D) avoid taking antacids containing magnesium while taking these drugs.

Answer 1

avoid foods that are high in potassium.

Question 2

A patient who takes a thiazide diuretic will begin taking an ACE inhibitor.The primary care NP should counsel the patient to:

A) report wheezing and shortness of breath, which may occur with these drugs.
B) take care when getting out of bed or a chair after the first dose of the ACE inhibitor.
C) discuss taking an increased dose of the thiazide diuretic with the cardiologist.
D) minimize fluid intake for several days when beginning therapy with the ACE inhibitor.

Answer 2

take care when getting out of bed or a chair after the first dose of the ACE inhibitor.

Question 3

The primary care NP is considering prescribing captopril (Capoten)for a patient.The NP learns that the patient has decreased renal function and has renal artery stenosis in the right kidney.The NP should:

A) initiate ACE inhibitor therapy at a low dose.
B) consider a different drug class to treat this patient's symptoms.
C) give the captopril with a thiazide diuretic to improve renal function.
D) order lisinopril (Zestril) instead of captopril to avoid increased nephropathy.

Answer 3

initiate ACE inhibitor therapy at a low dose.

Question 4

A patient with a previous history of myocardial infarction (MI)who takes nitroglycerin for angina develops hypertension.The primary care NP is considering ordering an ACE inhibitor.Preliminary laboratory tests reveal decreased renal function.The NP should:

A) begin therapy with a low-dose ACE inhibitor.
B) choose an ARB instead.
C) add a low-dose thiazide diuretic to the drug regimen.
D) order a renal perfusion study before starting treatment.

Question 5

A patient who has type 2 diabetes is seen by a primary care NP for a physical examination.The NP notes a blood pressure of 140/95 mm Hg on three occasions.A urinalysis reveals macroalbuminuria.The patient's serum creatinine is 1.9 mg/dL.Adhering to evidence-based practice,the NP should prescribe:

A) losartan (Cozaar).
B) captopril (Capoten).
C) enalapril maleate (Vasotec).
D) fosinopril sodium (Monopril).

Question 6

A patient who is taking an ACE inhibitor sees the primary care NP for a follow-up visit.The patient reports having a persistent cough.The NP should:

A) consider changing the medication to an ARB.
B) order a bronchodilator to counter the bronchospasm caused by this drug.
C) ask whether the patient has had any associated facial swelling with this cough.
D) reassure the patient that tolerance to this adverse effect will develop over time.

Question 7

An African-American patient is taking captopril (Capoten)25 mg twice daily.When performing a physical examination,the primary care nurse practitioner (NP)learns that the patient continues to have blood pressure readings of 135/90 mm Hg.The NP should:

A) increase the captopril dose to 50 mg twice daily.
B) add a thiazide diuretic to this patient's regimen.
C) change the drug to losartan (Cozaar) 50 mg once daily.
D) recommend a low-sodium diet in addition to the medication.