A nurse is caring for a client who is taking Lisinopril (Prinivil, Zestril). Which of the following outcomes indicates a therapeutic effect of the medication?

Choice A rationale An increase of high-density lipoprotein (HDL) cholesterol is not the primary therapeutic effect of Lisinopril, which is an Angiotensin-Converting Enzyme (ACE) inhibitor and is not typically prescribed as a lipid-modifying agent. While improving overall cardiovascular health may indirectly benefit lipid profiles over time, the main pharmacological action is the inhibition of the renin-angiotensin-aldosterone system. Choice B rationale An increased heart rate is an undesirable and non-therapeutic effect of Lisinopril; in fact, ACE inhibitors are often used to manage conditions like heart failure where a decreased heart rate is sometimes a goal. Lisinopril works primarily on vascular smooth muscle to cause vasodilation, which ultimately lowers peripheral vascular resistance and does not directly increase cardiac chronotropy. Choice C rationale Decreased blood pressure is the primary and expected therapeutic outcome of Lisinopril, as it inhibits the conversion of Angiotensin I to the potent vasoconstrictor Angiotensin II. This inhibition leads to systemic vasodilation, reduced peripheral vascular resistance, and decreased aldosterone secretion, all contributing to a reduction in both systolic and diastolic blood pressure. Choice D rationale An increased blood pressure would indicate a lack of therapeutic effect or a potential failure of the medication to control the client's hypertension, necessitating a dose adjustment or change in antihypertensive regimen. Lisinopril is specifically prescribed to lower elevated blood pressure, making this outcome the opposite of the desired pharmacological action for hypertension management.