Pharm Chapter 31

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

Answer: 1 Explanation: ACE converts angiotensin I to angiotensin II. This happens almost immediately because ACE lies on the membranes of the blood vessels. Page Ref: 524

22) 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

Answer: 1 Explanation: Lisinopril can cause hypotension, cough, and a rash. Page Ref: 529

21) 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.

Answer: 1 Explanation: Lisinopril is pregnancy category C in the first trimester and category D in the second and third trimesters. Page Ref: 529

25) 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

Answer: 1 Explanation: Lisinopril therapy can increase the risk of hyperkalemia because it is a potassium- sparing drug. Clients with heart failure are at higher risk. Page Ref: 529

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

Answer: 1 Explanation: The lungs are responsible for the conversion of angiotensin I to angiotensin II because they possess a large number of capillaries. Page Ref: 524

6) 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

Answer: 1 NURSINGTB.COM Explanation: Lowered blood pressure causes the kidney to release renin. Page Ref: 525

16) 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. 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."

Answer: 1, 2 Explanation: 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. 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. Page Ref: 527

8) 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. Select all that apply. 1. Juxtaglomerular (JG) cells 2. Macula densa 3. Sympathetic nervous system 4. Parasympathetic nervous system 5. Cardiovascular system

Answer: 1, 2, 3 Explanation: 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 a 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. Page Ref: 524

14) 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? 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

Answer: 1, 2, 3, 5 Explanation: Angiotensin II causes direct vasoconstriction, which increases blood pressure. Angiotensin II causes increased sympathetic nervous system activity, which increases blood pressure. Angiotensin II causes cardiac remodeling, which increases blood pressure. Angiotensin II increases the reabsorption of sodium, which increases blood pressure. Page Ref: 526

28) 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. Select all that apply. 1. Electrolyte levels 2. Liver function 3. BUN and creatinine levels 4. Lipid profiles 5. ECG

Answer: 1, 2, 4 Explanation: Electrolyte levels, especially potassium, need to be monitored while a client is taking ACE inhibitors. Liver function needs to be monitored while a client is taking ACE inhibitors and ARBs. It is important to monitor a client's lipid profile while taking ACE inhibitors and ARBs. Page Ref: 529, 532

17) 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

Answer: 2 Explanation: ACE inhibitors prevent conversion of angiotensin I to angiotensin II, which controls blood pressure. Page Ref: 527

10) Angiotensin-converting enzyme (ACE) inhibitor drugs prevent ACE from breaking down which substances, resulting in some of the serious adverse effects of the ACE inhibitors? 1. Aldosterone 2. Bradykinin 3. Renin NURSINGTB.COM 4. RAAS

Answer: 2 Explanation: ACE, with several other enzymes, breaks down bradykinin, which, if it accumulates, can cause cough and angioedema. Page Ref: 526

19) 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

Answer: 2 Explanation: Aldosterone antagonists block aldosterone receptors in the kidneys, which lowers blood pressure. Page Ref: 534

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

Answer: 2 Explanation: The liver synthesizes the protein angiotensinogen. Page Ref: 524

4) The nurse knows there are ________ key enzymatic steps in the renin-angiotensin-aldosterone system. Record your answer rounding to the nearest whole number.

Answer: 2 Explanation: There are two key enzymatic steps in the renin-angiotensin-aldosterone system. Page Ref: 524

11) 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. Select all that apply. 1. Forming angiotensin I 2. Forming angiotensin II 3. Breaking down bradykinin 4. Breaking down histamine 5. Forming kininase

Answer: 2, 3 Explanation: ACE is responsible for the formation of angiotensin II. ACE is responsible for breaking down bradykinin. Page Ref: 526

18) 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 angiotensiNnUIRtoSIaNnGgTiBot.CenOsMin II 3. Blocking AT1 receptors, which prevent angiotensin from raising blood pressure 4. Blocking the formation of renin in the RAAS system

Answer: 3 Explanation: By blocking the AT1 receptors, the ARBs prevent angiotensin from raising blood pressure. Page Ref: 531

26) 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

Answer: 3 Explanation: Combining alcohol with losartan causes lowered blood pressure, which can lead to dizziness and faintness. Page Ref: 532

7) 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 filtrate and the glomerulus

Answer: 3 Explanation: The JG cells and the macula densa are the cells that help control renin secretion. Page Ref: 525

12) 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

Answer: 3 Explanation: The arterioles of the kidneys are the most sensitive to the vasopressin action of angiotensin II. Page Ref: 526

27) 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

Answer: 3 Explanation: Use of potassium supplements is contraindicated with lisinopril therapy because of the risk of hyperkalemia. Lisinopril is a potassium-sparing drug. Page Ref: 529

20) 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. Select all that apply. 1. Benazepril (Lotensin) 2. Azilsartan (Edarbi) 3. Eplerenone (Inspra) 4. Aliskiren (Tekturna) 5. Spironolactone (Aldactone)

Answer: 3, 5 Explanation: Eplerenone (Inspra) is an aldosterone antagonist. Spironolactone (Aldactone) is an aldosterone antagonist. Page Ref: 534

13) 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

Answer: 4 Explanation: Angiotensin II causes cardiac remodeling of hypertrophy of myocardial cells and promotes collagen deposits, which increase the risk of myocardial infarction and cerebrovascular accident. Page Ref: 526

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

Answer: 4 Explanation: Angiotensin is a peptide that causes vasoconstriction. Page Ref: 524

15) How do additional amounts of aldosterone secreted by the kidneys raise blood pressure? 1. By excreting sodium and chloride to retain water 2. By excreting potassium and hydrogen to retain water 3. By decreasing sodium absorption, which increases blood volume 4. By enhancing sodium reabsorption, which increases blood volume

Answer: 4 Explanation: By enhancing sodium reabsorption, the body retains water, which increases blood volume and raises blood pressure. Page Ref: 527

24) 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 .Record your answer rounding to the nearest whole number.

Answer: 4 Explanation: Of the clients that are taking lisinopril, 2% to 4% often experience the adverse effect of hyperkalemia. Page Ref: 529

23) 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

Answer: 4 Explanation: Since ARBs do not promote accumulation of bradykinin, they do not cause a cough. Page Ref: 529

5) 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

Answer: 4 Explanation: The juxtaglomerular (JG) cells are responsible for the secretion, storage, and synthesizing of renin. Page Ref: 524