They cause vasodilation and decrease aldosterone, lowering blood pressure and decreasing sodium and water retention.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client with heart failure is started on lisinopril, an ACE inhibitor. Which adverse effect should the nurse teach the client to report?
Answer: B. A persistent dry, nonproductive cough is a classic adverse effect of ACE inhibitors due to bradykinin accumulation and may warrant switching to an ARB. Angioedema and hyperkalemia are also concerns. Increased appetite is not associated; ACE inhibitors lower (not raise) blood pressure, so hypertension is not the expected effect.
Question 2 of 5
A client newly prescribed an ACE inhibitor (lisinopril) for heart failure should be taught to report which symptom that may indicate a serious adverse effect?
Answer: B. Swelling of the face, lips, or tongue (angioedema) is a serious, potentially life-threatening reaction to ACE inhibitors that must be reported immediately. A persistent dry, nonproductive cough from bradykinin accumulation is also common but less emergent. Increased appetite, occasional hiccups, and a metallic taste are not characteristic warning signs of ACE inhibitors.
Question 3 of 5
A client started on lisinopril develops swelling of the lips and tongue. The nurse should:
Answer: B. Lip/tongue swelling is angioedema, a medical emergency with ACE inhibitors — stop the drug, assess the airway, and notify the provider immediately. A persistent dry cough is a milder, common ACE-inhibitor effect.
Question 4 of 5
A client with Parkinson disease is prescribed selegiline, a monoamine oxidase type B (MAO-B) inhibitor. Which teaching point is essential for the nurse to include?
Answer: A. MAO-B inhibitors such as selegiline at higher doses or MAO-A inhibition can interact with tyramine-rich foods and certain medications to cause a hypertensive reaction, so the nurse teaches the client about dietary and drug interactions and to report severe headache. The drug is not taken to lower blood pressure, is not an antibiotic, and does not require fluid restriction as a primary teaching point.
Question 5 of 5
A client taking an ACE inhibitor for hypertension develops swelling of the lips, tongue, and face. What is the nurse's priority action?
Answer: C. These findings indicate angioedema, a rare but life-threatening reaction to ACE inhibitors that can obstruct the airway. The priority is to assess and protect the airway and obtain emergency help, as the medication must be stopped immediately. Continuing the drug, simply documenting, or applying a cold compress would delay critical airway management.
Keep the streak going with more questions like these, each with a full rationale.
What is ace inhibitors?
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.
Key points to remember
- 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.
Signs & symptoms
- Dry hacking cough (switch to ARB)
- First-dose hypotension, dizziness
Nursing priorities
- 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.
Labs & values
Patient teaching
- 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.
Red flags: report now
- 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.
References
Clinical references for this topic
