26. A client is diagnosed with heart failure and has an ejection fraction of 30% and is receiving an angiotensin-converting enzyme (ACE) inhibitor. Which finding would be an expected drug effect?
26. A client is diagnosed with heart failure and has an ejection fraction of 30% and is receiving an angiotensin-converting enzyme (ACE) inhibitor. Which finding would be an expected drug effect?
. Increases cardiac preload.
. Decreases cardiac afterload.
. Discontinues the need for diuretics.
. Promotes diuresis.
Test-Taking Tip
Because ACE inhibitors are not diuretics, first eliminate the two options pertaining to diuretic/diuresis. Know the action of ACE inhibitors. When unsure, eliminate Answers 1 and 3 as undesirable actions for a client with congestive heart failure; Answer 4 is not the action of an antihypertensive. Note two contradictory options: "increase" (Answer 1) versus "decrease" (Answer 2). Select the logical choice of "decreases cardiac afterload."
Content Area: Adult Health, Cardiovascular; Integrated Process: Nursing Process, Analysis; Cognitive Level: Comprehension; Client Need/Subneed: Physiological Integrity/Pharmacological and Parenteral Therapies/Expected Effects/Outcomes
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Answer 1 is incorrect because the action of ACE inhibitors is to decrease venous return (decrease preload) as a result of vasodilation. Answer 2 is correct because ACE inhibitors (potent vasodilators) are used to lower the BP by decreasing both cardiac afterload and workload, actions that are essential for a client with a low ejection fraction. A systolic BP of 90 mm Hg would be acceptable in these clients as long as they remain asymptomatic. Answer 3 is incorrect because the use of an ACE inhibitor decreases aldosterone formation and sodium is excreted by the kidney along with water, and potassium increases, which may be a serious side effect. Answer 4 is incorrect because ACE inhibitors actually have a diuretic action. In heart failure, they improve the ejection fraction by reducing venous volume and arterial pressure.