PHARM CH 31

The angiotensin-converting enzyme (ACE) converts angiotensin I almost instantly to which substance? 1. Angiotensin II 2. Aldosterone 3. Angiotensinogen 4. Renin

Correct Answer: 1 Global Rationale: ACE converts angiotensin I to angiotensin II. This happens almost immediately because ACE lies on the membranes of the blood vessels. ACE does not convert angiotensin I to aldosterone, angiotensinogen, or renin.

Which are the most common adverse effects of lisinopril therapy? 1. Hypotension, cough, and rash 2. Rash, hypokalemia, and constipation 3. Hypertension, hypokalemia, and productive cough 4. Hypotension, hyperkalemia, and urinary frequency

Correct Answer: 1 Global Rationale: Lisinopril can cause hypotension, cough, and a rash. Lisinopril can cause a rash but not hypokalemia or constipation. Lisinopril does not cause hypertension, hyperkalemia, or a productive cough. Lisinopril can cause hypotension and hyperkalemia but does not cause urinary frequency.

An adult client is prescribed lisinopril therapy for hypertension. Why is it important to rule out pregnancy prior to starting this medication? 1. Lisinopril is pregnancy category C and D. 2. Lisinopril can cause hyperkalemia in pregnant women. 3. Lisinopril is pregnancy category B. 4. Lisinopril can cause hypotension in late pregnancy.

Correct Answer: 1 Global Rationale: Lisinopril is pregnancy category C in the first trimester and category D in the second and third trimesters. Lisinopril is not to be given to pregnant women; it can cause hyperkalemia in all clients. Lisinopril is not pregnancy category B, but C and D. Lisinopril does not cause hypotension in late pregnancy; it should not be used in pregnant women for other reasons.

The client is starting on lisinopril therapy for hypertension and heart failure. The nurse instructs the client to return for laboratory monitoring because of the risk of which adverse effect? 1. Hyperkalemia 2. Hyponatremia 3. Hypernatremia 4. Hypokalemia

Correct Answer: 1 Global Rationale: Lisinopril therapy can increase the risk of hyperkalemia because it is a potassium-sparing drug. Clients with heart failure are at higher risk. Lisinopril therapy does not increase the risk of hyponatremia, hypernatremia, or hypokalemia.

The kidneys respond to which occurrences in the body by releasing renin? 1. Lowered blood pressure; dehydration 2. Lowered blood pressure; decreased cardiac output 3. Increased blood pressure; increased peripheral resistance 4. Increased blood pressure; stress, anxiety

Correct Answer: 1 Global Rationale: Lowered blood pressure causes the kidney to release renin. Renin secretion is turned on by loss of blood volume, not by decreased cardiac output. Increased blood pressure turns off renin secretion.

Which organ has the primary responsibility in converting angiotensin I to angiotensin II? 1. The lungs 2. The kidneys 3. The heart 4. The liver

Correct Answer: 1 Global Rationale: The lungs are responsible for the conversion of angiotensin I to angiotensin II because they possess a large number of capillaries. The kidneys, the heart, and the liver are not responsible for the conversion of angiotensin I to angiotensin II.

A nursing student asks the nurse educator why the actions of aldosterone lead to high blood pressure. Which of the educator's responses explain this phenomenon? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Aldosterone increases sodium reabsorption and the excretion of potassium and hydrogen by acting on the distal tubules." 2. "Aldosterone increases sodium reabsorption and the excretion of potassium and hydrogen by acting on the collecting tubules." 3. "Aldosterone increases sodium reabsorption and the excretion of potassium and hydrogen by acting on Bowman's capsule." 4. "Aldosterone increases sodium reabsorption and the excretion of potassium and hydrogen by acting on the glomerulus." 5. "Aldosterone increases sodium reabsorption and the excretion of potassium and hydrogen by acting on the Loop of Henle."

Correct Answer: 1,2 Rationale 1: Aldosterone acts on the distal tubules of the nephron to increase Na+ reabsorption and K+ and H+ excretion. The enhanced sodium reabsorption from both direct and indirect actions of angiotensin II causes the body to retain water, thus increasing blood volume and raising blood pressure. Rationale 2: Aldosterone acts on the collecting tubules of the nephron to increase Na+ reabsorption and K+ and H+ excretion. The enhanced sodium reabsorption from both direct and indirect actions of angiotensin II causes the body to retain water, thus increasing blood volume and raising blood pressure. Rationale 3: Aldosterone does not increase blood pressure by acting on Bowman's capsule. Rationale 4: Aldosterone does not increase blood pressure by acting on the glomerulus. Rationale 5: Aldosterone does not increase blood pressure by acting on the Loop of Henle. Global Rationale: Aldosterone acts on the distal tubules and the collecting tubules of the nephron to increase Na+ reabsorption and K+ and H+ excretion. The enhanced sodium reabsorption from both direct and indirect actions of angiotensin II causes the body to retain water, thus increasing blood volume and raising blood pressure. Aldosterone does not increase blood pressure by acting on Bowman's capsule, the glomerulus, or on the Loop of Henle.

The arterioles of which organ are most sensitive to the vasopressin action of angiotensin II? 1. The lungs 2. The liver 3. The kidneys 4. The heart

Correct Answer: 3 Global Rationale: The arterioles of the kidneys are the most sensitive to the vasopressin action of angiotensin II. The arterioles of the lungs, liver, and heart are not the most sensitive to angiotensin II effects.

The nurse knows that the secretion of renin is controlled by which items? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Juxtaglomerular (JG) cells 2. Macula densa 3. Sympathetic nervous system 4. Parasympathetic nervous system 5. Cardiovascular system

Correct Answer: 1,2,3 Global Rationale: Renin is an enzyme that is synthesized, stored, and secreted by specialized cells in the kidney known as juxtaglomerular (JG) cells. The macula densa recognizes the slow flow rate (and less sodium) and sends a chemical message to the JG cells to release more renin. The activation of the sympathetic nervous system controls the release of renin. The parasympathetic nervous system and the cardiovascular system do not control the release of renin.

A seasoned nurse is explaining the multiple mechanisms by which angiotensin II raises blood pressure to a novice nurse. What should the seasoned nurse include in the explanation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Direct vasoconstriction 2. Increased sympathetic nervous system activity 3. Cardiac remodeling 4. Direct effect on the kidneys 5. Direct increase on the reabsorption of sodium

Correct Answer: 1,2,3,5 Global Rationale: Angiotensin II increases blood pressure through direct vasocontstriction, increased activity of the sympathetic nervous system, cardiac remodeling, and the reabsorption of sodium. Aldosterone, not angiotensin II, increases blood pressure by having a direct effect on the kidneys.

The nurse knows it is essential to monitor which laboratory values while a client is being treated with ACE inhibitors and ARBs? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Electrolyte levels 2. Liver function 3. BUN and creatinine levels 4. Lipid profiles 5. ECG

Correct Answer: 1,2,4 Rationale 1: Electrolyte levels, especially potassium, need to be monitored while a client is taking ACE inhibitors. Rationale 2: Liver function needs to be monitored while a client is taking ACE inhibitors and ARBs. Rationale 3: BUN and creatinine levels do not need to be monitored while a client is taking ACE inhibitors and ARBs. Rationale 4: It is important to monitor a client's lipid profile while taking ACE Inhibitors and ARBs. Rationale 5: Although it is important to monitor the client's heart rate while taking ACE inhibitors and ARBs, an ECG is not considered a laboratory test.

Angiotensin-converting enzyme (ACE) inhibitor drugs function in the control of blood pressure by which mechanism of action? 1. Blocking the effects of angiotensin II 2. Blocking the conversion of angiotensin I to angiotensin II 3. Blocking the conversion of angiotensin II to angiotensinogen 4. Directly inhibiting renin

Correct Answer: 2 Global Rationale: ACE inhibitors prevent conversion of angiotensin I to angiotensin II which controls blood pressure. ACE inhibitors do not block the effects of angiotensin II. Angiotensin II does not convert to angiotensinogen. ACE inhibitors do not block renin.

Aldosterone antagonist drugs work to lower blood pressure by which mechanism of action? 1. Blocking the formation of renin in the RAAS pathway 2. Blocking receptors for aldosterone in the kidneys 3. Blocking receptors for aldosterone in the adrenal glands 4. Blocking the AT1 receptors in the RAAS pathway

Correct Answer: 2 Global Rationale: Aldosterone antagonists block aldosterone receptors in the kidneys, which lowers blood pressure. Aldosterone antagonists do not block the formation of renin; does not block the aldosterone receptors in the adrenal gland; do not block AT1 receptors.

Angiotensinogen is a protein that is continuously circulating in the blood stream. Where is it synthesized in the body? 1. The lungs 2. The liver 3. The gallbladder 4. The kidneys

Correct Answer: 2 Global Rationale: The liver synthesizes the protein angiotensinogen. The lungs, the liver, and the gallbladder do not synthesize angiotensinogen.

The nurse knows there are _____ key enzymatic steps in the renin-angiotensin-aldosterone system. Standard Text: Round the answer to the nearest whole number. .

Correct Answer: 2 Rationale: There are two key enzymatic steps in the renin-angiotensin-aldosterone system. Global Rationale: There are two key enzymatic steps in the renin-angiotensin-aldosterone system

The nurse is reviewing the primary functions of the angiotensin-converting enzyme (ACE). The nurse knows that which is the primary function of this enzyme? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Forming angiotensin I 2. Forming angiotensin II 3. Breaking down bradykinin 4. Breaking down histamine 5. Forming kininase

Correct Answer: 2,3 Global Rationale: ACE is responsible for the formation of angiotensin II and breaking down bradykinin. ACE is not responsible for the formation of angiotensin I, breaking down histamine, or for the formation of kininase (kininase II).

Angiotensin receptor blockers (ARBs) work in the body to lower blood pressure by which mechanism of action? 1. Inhibiting the stimulation of aldosterone secretion 2. Blocking the conversion of angiotensin I to angiotensin II 3. Blocking AT1 receptors, which prevent angiotensin from raising blood pressure 4. Blocking the formation of renin in the RAAS system

Correct Answer: 3 Global Rationale: By blocking the AT1 receptors, the ARBs prevent angiotensin from raising blood pressure. ARBs do not block the stimulation of aldosterone secretion. Aldosterone antagonist drugs work in this way. ARBs do not prevent the conversion of angiotensin I to angiotensin II. ACE inhibitor drugs work at this stage of the pathway. ARBs do not block the formation of renin in the RAAS system.

A client who is prescribed losartan for hypertension is instructed to avoid using alcohol because of the risk of which adverse reaction? 1. Alcohol intoxication 2. Angioedema 3. Lowered blood pressure 4. Increased blood pressure

Correct Answer: 3 Global Rationale: Combining alcohol with losartan causes lowered blood pressure, which can lead to dizziness and faintness. Combining alcohol with losartan does not cause alcohol intoxication. Although there is a risk of angioedema with losartan therapy, combining the drug with alcohol does not increase the risk. Losartan does not raise blood pressure.

Which group of cells in the kidneys makes up the apparatus that helps control renin secretion? 1. The red blood cells and slit pores 2. The nephron and Bowman's capsule 3. The juxtaglomerular (JG) cells and the macula densa 4. The tubular and the glomerulus

Correct Answer: 3 Global Rationale: The JG cells and the macula densa are the cells that help control renin secretion. The red blood cells and the slit pores do not help control renin secretion in the kidneys. The nephron and Bowman's capsule do not help control renin secretion. The tubular and glomerulus of the kidneys do not help control renin secretion.

The nurse is reviewing the diet history of a client prescribed lisinopril therapy for hypertension. Which part of the client's current dietary intake must be altered while on lisinopril therapy? 1. Use of fish oil supplements 2. Use of calcium supplements 3. Use of potassium supplements 4. Use of multiple vitamins

Correct Answer: 3 Global Rationale: Use of potassium supplements is contraindicated with lisinopril therapy because of the risk of hyperkalemia. Lisinopril is a potassium-sparing drug. Use of fish oil supplements is not contraindicated with lisinopril therapy. Fish oil supplements might be beneficial to the hypertensive client. Use of calcium supplements and a multivitamin is not contraindicated in lisinopril therapy.

Question 20 Type: MCMA The nurse is reviewing a list of medications that decrease blood pressure. Which medications decrease blood pressure by blocking the receptors for aldosterone in the kidneys? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Benazepril (Lotensin) 2. Azilsartan (Edarbi) 3. Eplerenone (Inspra) 4. Aliskiren (Tekturna) 5. Spironolactone (Aldactone)

Correct Answer: 3,5 Global Rationale: Eplereone (Inspra) and spironolactone (Aldactone) are both aldosterone antagonists which decrease blood pressure by blocking the receptors for aldosterone in the kidneys. Benazepril (Lotensin) is an ACE inhibitor that blocks the conversion of angiotensin I to angiotensin II to decrease blood pressure. After angiotensin II is formed, it must interact with its receptors on target cells to cause its biologic actions. There are two receptor subtypes, known as AT1 and AT2 receptors. Blocking AT1 receptors prevents angiotensin from raising blood pressure and from causing cardiac remodeling. Axilsartan (Edarbi) is an ARB that intervenes at this step in the RAAS by blocking the AT1 receptor. Aliskiren (Tekturna) is a renin inhibitor, not an aldosterone inhibitor.

Which clinical manifestations occur as the result of the cardiac remodeling caused by angiotensin II? 1. Hypotrophy of myocyte cells 2. A breakdown of fatty plaque deposits 3. Hypotension and dehydration 4. Myocardial infarction and cerebrovascular accident

Correct Answer: 4 Global Rationale: Angiotensin II causes cardiac remodeling of hypertrophy of myocardial cells and promotes collagen deposits, which increase the risk of myocardial infarction and cerebrovascular accident. Hypotrophy of myocyte cells, a breakdown of fatty plaque deposits, hypotension, and dehydration do not occur as a result of the cardiac remodeling caused by angiotensin II.

Which peptide circulating in the blood can cause profound vasoconstriction? 1. Fibrogen 2. Sodium 3. Kinase 4. Angiotensin II

Correct Answer: 4 Global Rationale: Angiotensin is a peptide that causes vasoconstriction. Fibrogen does not cause vasoconstriction. Sodium and kinase are not peptides.

How do additional amounts of aldosterone secreted by the kidneys raise blood pressure? 1. Excretion of sodium and chloride to retain water 2. Excretion of potassium and hydrogen to retain water 3. Decreasing sodium absorption, which increases blood volume 4. Enhanced sodium reabsorption, which increases blood volume

Correct Answer: 4 Global Rationale: By enhancing sodium reabsorption, the body retains water, which increases blood volume and raises blood pressure. Excretion of sodium and chloride and the excretion of potassium and hydrogen do not cause retention of water to raise blood pressure. Increasing sodium absorption, not decreasing it, will raise blood volume.

The major difference in adverse effect profile between ACE inhibitors and ARBs is that ARBs do not cause which clinical manifestation? 1. Headache 2. Dizziness 3. Angioedema 4. Cough

Correct Answer: 4 Global Rationale: Since ARBs do not promote accumulation of bradykinin, they do not cause a cough. ARBs and ACE inhibitors both can cause headaches and dizziness. There is a risk of angioedema with ARB therapy, but it is less than that with ACE inhibitor therapy.

The secretion, storage, and synthesizing of renin are controlled in which cells of the kidney? 1. The distal loop 2. The baroreceptors 3. Henle's loop 4. The juxtaglomerular cells

Correct Answer: 4 Global Rationale: The juxtaglomerular cells (JG) are responsible for the secretion, storage, and synthesizing of renin. The distal loop and Henle's loop are both sections of the kidneys, not a group of cells. The baroreceptors are located in the heart, not the kidneys.

A nurse educator is teaching a group of students about the prototype medication lisinopril. The nurse tells the students that hyperkalemia is a common adverse reaction that occurs in 2 to ______ % of clients taking the medication. Standard Text: Round answer to the nearest whole number.

Correct Answer: 4 Rationale: Of the clients that are taking lisinopril, 2 to 4 percent often experience the adverse effect of hyperkalemia. Global Rationale: Of the clients that are taking lisinopril, 2 to 4 percent often experience the adverse effect of hyperkalemia.