A nurse should monitor a client, who is taking an angiotensin converting enzyme (ACE) inhibitor, for evidence of therapeutic effects, which include

• A. Increased cardiac workload
• B. Increased exercise tolerance
• C. Increased peripheral vascular resistance
• D. Increased respiratory effort

Answer: (B)

The key idea is that ACE inhibitors improve cardiac function by reducing afterload and preload, which lowers the work the heart must do and helps perfusion. By blocking angiotensin II formation, these drugs cause vasodilation and reduce aldosterone-driven sodium and water retention. The result is better forward flow and less congestion, so a patient can engage in more activity without becoming as fatigued or short of breath. Therefore, increased exercise tolerance reflects improved cardiac performance and is a true therapeutic effect of ACE inhibitors.

In contrast, increased cardiac workload would mean the heart is having to work harder, which ACE inhibitors are meant to lessen. Increased peripheral vascular resistance would oppose the drug’s effect, since ACE inhibitors lower vascular resistance. Increased respiratory effort would suggest worsening respiratory status or pulmonary edema, not a therapeutic improvement.