Angiotensin II Receptor Blockers (ARBs)

Every question here, with the answer

1. A client stopped taking an ACE inhibitor because of a chronic cough, and the provider switches the client to losartan. The client asks why. What is the nurse's best response?

   1. ARBs are less likely than ACE inhibitors to cause a chronic cough.
   2. ARBs cannot cause angioedema.
   3. ARBs have no effect on potassium.
   4. ARBs do not lower blood pressure, so they have fewer side effects.

   Answer: ARBs are less likely than ACE inhibitors to cause a chronic cough.

   ARBs are less likely than ACE inhibitors to cause a chronic cough. They still lower blood pressure, the risk of angioedema is only decreased, not absent, and hyperkalemia remains a serious adverse effect.

2. A 72-year-old client is starting valsartan. Which order would the nurse expect for the initial dose?

   1. The maximum dose from the first day
   2. A dose given only when blood pressure is high
   3. A low initial dose
   4. A loading dose to reach effect quickly

   Answer: A low initial dose

   Older adults (65 and older) and clients with hepatic impairment should start on a low initial dose because ARBs are metabolized by the liver. A loading or maximum dose ignores this, and the drug is taken regularly, not only when the pressure is high.

3. A client with a history of depression has been started on an ARB. Which nursing action is most important?

   1. Teach the client to take the ARB with a high-potassium snack.
   2. Check the client's blood glucose before every dose.
   3. Monitor the client closely for suicidal ideation.
   4. Hold the ARB whenever the client feels sad.

   Answer: Monitor the client closely for suicidal ideation.

   ARB use may be associated with an increased risk of suicide, so clients with a history of or risk for mood disturbances are monitored closely for suicidal ideation. High-potassium foods should be avoided, and holding doses or checking glucose is not described.

4. A nurse is teaching a client who is going home on an ARB. Which instructions should the nurse include? Select all that apply.

   1. Avoid salt substitutes.
   2. Report a change in the amount of urine you produce.
   3. Eat extra bananas and other high-potassium foods.
   4. Report swelling of the lips or face.
   5. Tell your provider if you are planning to become pregnant.

   Answer: Avoid salt substitutes., Report a change in the amount of urine you produce., Report swelling of the lips or face., Tell your provider if you are planning to become pregnant.

   Clients on ARBs avoid salt substitutes and high-potassium foods, report swelling of the lips or face, tell the provider about pregnancy plans, and report changes in urine output. Eating extra high-potassium foods raises the risk of hyperkalemia.

5. Which findings should the nurse monitor for in a client taking an ARB? Select all that apply.

   1. Angioedema
   2. Hyperkalemia
   3. Hypoglycemia
   4. Hypercalcemia
   5. Hypotension

   Answer: Angioedema, Hyperkalemia, Hypotension

   Serious adverse effects of ARBs include angioedema, hypotension, hepatic impairment, and hyperkalemia. Hypercalcemia and hypoglycemia are not listed as adverse effects of ARBs in this section.

6. A client of childbearing age is prescribed an ARB for hypertension. What is the most important teaching point?

   1. Stop the drug only in the third trimester if you become pregnant.
   2. Avoid becoming pregnant, because ARBs can harm the fetus.
   3. Pregnancy increases the dose you will need.
   4. ARBs are the safest blood pressure drugs in pregnancy.

   Answer: Avoid becoming pregnant, because ARBs can harm the fetus.

   ARBs can have teratogenic effects and carry a black box warning that they can harm or even kill a fetus, so clients should avoid being pregnant while taking them. The other options wrongly suggest they are safe or only a late-pregnancy concern.