The patient is prescribed an ACE inhibitor. What primary mechanism of ACE inhibitors will the nurse understand as the therapeutic action?

Correct Answer: C

Rationale: ACE inhibitors work by inhibiting the enzyme angiotensin-converting enzyme (ACE) in the renin-angiotensin-aldosterone system (RAAS). By inhibiting ACE, the conversion of angiotensin I to angiotensin II is blocked. Angiotensin II is a potent vasoconstrictor and also stimulates the release of aldosterone from the adrenal glands. Aldosterone is a hormone that acts on the kidneys to increase reabsorption of sodium and water, leading to increased blood volume and pressure. By inhibiting aldosterone secretion, ACE inhibitors reduce blood volume and lower blood pressure, making them effective in treating hypertension and heart failure.

Correct Answer: D

Rationale: Nesiritide is a synthetic form of brain natriuretic peptide (BNP) that is used for the treatment of acutely decompensated heart failure (HF) in patients who have dyspnea at rest. It works by vasodilating veins and arteries, leading to decreased preload and afterload, thus improving the symptoms of HF such as dyspnea and edema. Nesiritide is typically reserved for patients who are hospitalized with acute decompensated HF and severe symptoms like dyspnea at rest. Patients needing initial treatment for HF or those with atrial fibrillation may not necessarily benefit from nesiritide therapy. Patients with reduced cardiac output may benefit from other therapies aimed at improving cardiac function rather than nesiritide alone.

Correct Answer: D

Rationale: Milrinone and furosemide are two medications that are known to interact when mixed together in the same intravenous line. Milrinone is a phosphodiesterase inhibitor that works to increase cardiac contractility and output, while furosemide is a loop diuretic used to promote diuresis. When mixed together, the pH level of the solution can become altered, leading to potential precipitation or inactivation of one or both drugs.

Correct Answer: C

Rationale: Propranolol is the drug that undergoes extensive first-pass hepatic metabolism. First-pass metabolism refers to the metabolism of a drug by the liver before it enters the systemic circulation. In the case of propranolol, a significant portion of the drug is metabolized by the liver before reaching the systemic circulation, leading to reduced bioavailability. This is why propranolol is often given in higher doses to achieve the desired therapeutic effect. Heparin, insulin, nitroglycerine, and warfarin do not undergo significant first-pass metabolism by the liver.

Correct Answer: A

Rationale: Common side effects of iron supplements include constipation, upset stomach, and nausea. Iron supplements can cause gastrointestinal side effects such as constipation, upset stomach, and nausea. These side effects usually improve over time or can be managed by taking the supplement with food or adjusting the dosage. It is important to speak with a healthcare provider if these side effects persist or worsen.