Karch’s Focus on Nursing
Pharmacology
9th Edition
Author(s)Rebecca G. Tucker
TEST BANK
Question 1
Clinical Scenario A 54-year-old male patient with newly
diagnosed primary hypertension has been prescribed lisinopril.
The nurse is preparing to administer the first dose.
Question Which assessment finding requires the nurse to hold
the medication and contact the healthcare provider
immediately?
,Options A. Blood pressure of 142/88 mmHg B. Serum
potassium level of 5.6 mEq/L C. Presence of a dry, hacking
cough D. Serum sodium level of 136 mEq/L
Correct Answer B
Rationale Lisinopril is an Angiotensin-Converting Enzyme (ACE)
inhibitor. ACE inhibitors block the conversion of angiotensin I to
angiotensin II, leading to decreased aldosterone secretion.
Since aldosterone promotes potassium excretion, blocking it
causes potassium retention. A serum potassium level of 5.6
mEq/L indicates hyperkalemia (normal range: 3.5–5.0 mEq/L).
Administering an ACE inhibitor to a patient with pre-existing
hyperkalemia can lead to life-threatening cardiac arrhythmias.
Why the Other Options Are Incorrect A. A blood pressure of
142/88 mmHg is elevated and represents the indication for the
medication, not a contraindication. C. A dry, hacking cough is a
well-known adverse effect of ACE inhibitors due to bradykinin
accumulation, but it typically develops after prolonged use. If
present before therapy starts, it should be noted, but it is not
an immediate contraindication to a first dose compared to
severe hyperkalemia. D. A serum sodium level of 136 mEq/L is
within normal limits (135–145 mEq/L) and does not require
holding the medication.
Learning Objective Identify critical laboratory contraindications
before administering an ACE inhibitor.
,Bloom's Taxonomy Analyze
Difficulty Easy
NCLEX Client Needs Category Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill Recognize Cues
Question 2
Clinical Scenario A 62-year-old female patient has been taking
diltiazem sustained-release for the management of
hypertension for the past two weeks. She presents to the
outpatient clinic for a follow-up visit.
Question Which teaching point should the nurse emphasize
during this visit to ensure medication safety?
Options A. "Swallow the capsule whole; do not crush or chew
it." B. "Discontinue the medication immediately if you feel
dizzy." C. "Increase your dietary intake of potassium-rich foods
like bananas." D. "Take this medication with a full glass of
grapefruit juice each morning."
Correct Answer A
Rationale Diltiazem sustained-release is a calcium channel
blocker formulated to release the active drug slowly over an
extended period. Crushing or chewing sustained-release (SR,
ER, or XL) formulations destroys the delivery system, causing
, immediate absorption of a toxic dose ("dose dumping"), which
can lead to profound hypotension and bradycardia.
Why the Other Options Are Incorrect B. Antihypertensive
medications should never be discontinued abruptly due to the
risk of rebound hypertensive crisis. Dizziness should be
reported, but instructions to stop taking the drug are incorrect.
C. Calcium channel blockers do not cause potassium wasting or
retention; dietary adjustments for potassium are not routinely
required for diltiazem as they would be for certain diuretics. D.
Grapefruit juice inhibits the CYP3A4 enzyme system, which
metabolizes diltiazem, leading to dangerously high serum levels
of the drug and increased toxic risk.
Learning Objective Apply safety guidelines regarding the
administration of sustained-release calcium channel blockers.
Bloom's Taxonomy Apply
Difficulty Easy
NCLEX Client Needs Category Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill Take Action
Question 3
Clinical Scenario A 45-year-old patient is prescribed metoprolol
tartrate for the management of hypertension. The nurse is
Pharmacology
9th Edition
Author(s)Rebecca G. Tucker
TEST BANK
Question 1
Clinical Scenario A 54-year-old male patient with newly
diagnosed primary hypertension has been prescribed lisinopril.
The nurse is preparing to administer the first dose.
Question Which assessment finding requires the nurse to hold
the medication and contact the healthcare provider
immediately?
,Options A. Blood pressure of 142/88 mmHg B. Serum
potassium level of 5.6 mEq/L C. Presence of a dry, hacking
cough D. Serum sodium level of 136 mEq/L
Correct Answer B
Rationale Lisinopril is an Angiotensin-Converting Enzyme (ACE)
inhibitor. ACE inhibitors block the conversion of angiotensin I to
angiotensin II, leading to decreased aldosterone secretion.
Since aldosterone promotes potassium excretion, blocking it
causes potassium retention. A serum potassium level of 5.6
mEq/L indicates hyperkalemia (normal range: 3.5–5.0 mEq/L).
Administering an ACE inhibitor to a patient with pre-existing
hyperkalemia can lead to life-threatening cardiac arrhythmias.
Why the Other Options Are Incorrect A. A blood pressure of
142/88 mmHg is elevated and represents the indication for the
medication, not a contraindication. C. A dry, hacking cough is a
well-known adverse effect of ACE inhibitors due to bradykinin
accumulation, but it typically develops after prolonged use. If
present before therapy starts, it should be noted, but it is not
an immediate contraindication to a first dose compared to
severe hyperkalemia. D. A serum sodium level of 136 mEq/L is
within normal limits (135–145 mEq/L) and does not require
holding the medication.
Learning Objective Identify critical laboratory contraindications
before administering an ACE inhibitor.
,Bloom's Taxonomy Analyze
Difficulty Easy
NCLEX Client Needs Category Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill Recognize Cues
Question 2
Clinical Scenario A 62-year-old female patient has been taking
diltiazem sustained-release for the management of
hypertension for the past two weeks. She presents to the
outpatient clinic for a follow-up visit.
Question Which teaching point should the nurse emphasize
during this visit to ensure medication safety?
Options A. "Swallow the capsule whole; do not crush or chew
it." B. "Discontinue the medication immediately if you feel
dizzy." C. "Increase your dietary intake of potassium-rich foods
like bananas." D. "Take this medication with a full glass of
grapefruit juice each morning."
Correct Answer A
Rationale Diltiazem sustained-release is a calcium channel
blocker formulated to release the active drug slowly over an
extended period. Crushing or chewing sustained-release (SR,
ER, or XL) formulations destroys the delivery system, causing
, immediate absorption of a toxic dose ("dose dumping"), which
can lead to profound hypotension and bradycardia.
Why the Other Options Are Incorrect B. Antihypertensive
medications should never be discontinued abruptly due to the
risk of rebound hypertensive crisis. Dizziness should be
reported, but instructions to stop taking the drug are incorrect.
C. Calcium channel blockers do not cause potassium wasting or
retention; dietary adjustments for potassium are not routinely
required for diltiazem as they would be for certain diuretics. D.
Grapefruit juice inhibits the CYP3A4 enzyme system, which
metabolizes diltiazem, leading to dangerously high serum levels
of the drug and increased toxic risk.
Learning Objective Apply safety guidelines regarding the
administration of sustained-release calcium channel blockers.
Bloom's Taxonomy Apply
Difficulty Easy
NCLEX Client Needs Category Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill Take Action
Question 3
Clinical Scenario A 45-year-old patient is prescribed metoprolol
tartrate for the management of hypertension. The nurse is
