👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-08-23🏷️ Pharmacological Therapies🔖 Free to read, print, and share
Also known as: ACE inhibitors · lisinopril · enalapril · captopril · pril drugs · blood pressure medicine
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Use this quick-reference guide to spot, treat, and prevent ACE Inhibitors on the NCLEX. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
🧪 Meds
Lisinopril, enalapril, captopril
Block angiotensin II → ↓ BP
🩺 Signs
Dry hacking cough (switch to ARB)
First-dose hypotension, dizziness
📌 Avoid
Hyperkalemia → no K+ salt subs
Teratogenic → not in pregnancy
🚩 Report
Angioedema = STOP, airway risk
Monitor K+ and renal function
📚 ACE Inhibitors — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
ACE inhibitors (drugs ending in -pril such as lisinopril, enalapril, captopril, ramipril) block angiotensin-converting enzyme, preventing formation of angiotensin II, which lowers blood pressure and reduces aldosterone. They are first-line for hypertension, heart failure, and protection of the kidneys in diabetes. Memory aid: the 'pril' drugs cause a dry cough and raise potassium.
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Key points
Understand these first
They cause vasodilation and decrease aldosterone, lowering blood pressure and decreasing sodium and water retention.
A persistent dry, hacking cough is a classic side effect caused by bradykinin buildup and is a common reason for switching to an ARB (-sartan).
They cause potassium retention, so hyperkalemia is a key risk, especially with potassium supplements or potassium-sparing diuretics.
Angioedema (swelling of the face, lips, tongue, and airway) is a rare but life-threatening reaction.
First-dose hypotension can occur, particularly in volume-depleted patients on diuretics.
They are kidney-protective in diabetics but are contraindicated in pregnancy due to fetal harm.
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Nursing priorities
What to do, in order
Monitor blood pressure before and after dosing, especially with the first dose.
Monitor serum potassium and renal function (BUN, creatinine).
Assess for cough and report a persistent dry cough to the provider.
Hold the dose and notify the provider for any facial or airway swelling.
Caution patients about salt substitutes, which are high in potassium.
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Red flags — report now
Escalate immediately
Angioedema with swelling of the lips, tongue, throat, or difficulty breathing requires immediate intervention and airway management.
Serum potassium above 5.0 mEq/L or rising creatinine.
Severe first-dose hypotension causing dizziness or syncope.
Never give to a pregnant patient because of fetal renal damage and death.
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Labs & values
Numbers to know
Potassium (3.5-5.0 mEq/L) for hyperkalemia
Creatinine (0.6-1.2 mg/dL) for renal function
BUN (10-20 mg/dL)
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Patient teaching
What patients must know
A dry cough is common; report it but do not stop the drug on your own.
Avoid potassium-based salt substitutes and high-potassium supplements.
Report any swelling of the face, lips, or tongue immediately.
❓ ACE Inhibitors: NCLEX FAQs
What are the priority nursing interventions for ACE Inhibitors?
Monitor blood pressure before and after dosing, especially with the first dose. Monitor serum potassium and renal function (BUN, creatinine). Assess for cough and report a persistent dry cough to the provider. Hold the dose and notify the provider for any facial or airway swelling.
What are the warning signs of ACE Inhibitors a nurse must report?
Angioedema with swelling of the lips, tongue, throat, or difficulty breathing requires immediate intervention and airway management. Serum potassium above 5.0 mEq/L or rising creatinine. Severe first-dose hypotension causing dizziness or syncope. Never give to a pregnant patient because of fetal renal damage and death.
What do I need to know about ACE Inhibitors for the NCLEX?
They cause vasodilation and decrease aldosterone, lowering blood pressure and decreasing sodium and water retention. A persistent dry, hacking cough is a classic side effect caused by bradykinin buildup and is a common reason for switching to an ARB (-sartan). They cause potassium retention, so hyperkalemia is a key risk, especially with potassium supplements or potassium-sparing diuretics. Angioedema (swelling of the face, lips, tongue, and airway) is a rare but life-threatening reaction.
What patient teaching is important for ACE Inhibitors?
A dry cough is common; report it but do not stop the drug on your own. Avoid potassium-based salt substitutes and high-potassium supplements. Report any swelling of the face, lips, or tongue immediately.
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Quick Tip
They cause vasodilation and decrease aldosterone, lowering blood pressure and decreasing sodium and water retention.