Karch’s Focus on Nursing
Pharmacology
9th Edition
Author(s)Rebecca G. Tucker
TEST BANK
Question 1
Clinical Scenario
A 52-year-old patient with newly diagnosed primary
hypertension is prescribed lisinopril. During the initial nursing
assessment, the nurse provides education about potential
adverse effects.
,Question
Which adverse effect should the nurse instruct the patient to
report immediately to the healthcare provider due to its life-
threatening nature?
Options
A. A dry, persistent cough
B. Swelling of the lips, tongue, or glottis
C. A mild, transient dizziness when standing up
D. A slight increase in serum potassium levels
Correct Answer
B. Swelling of the lips, tongue, or glottis
Rationale
Swelling of the lips, tongue, face, or glottis indicates
angioedema, a rare but life-threatening adverse effect of
angiotensin-converting enzyme (ACE) inhibitors like lisinopril.
Angioedema can compromise the patient's airway and requires
immediate emergency intervention and permanent
discontinuation of the drug.
Why the Other Options Are Incorrect
A. A dry, persistent cough is a common side effect of ACE
inhibitors caused by the accumulation of bradykinin in the
,respiratory tract. While bothersome and a frequent reason for
switching medications, it is not immediately life-threatening.
C. Mild, transient dizziness when standing up indicates
orthostatic hypotension, which is common when initiating
antihypertensive therapy. Patients should be taught to change
positions slowly, but it does not require emergency reporting
unless accompanied by syncope or injury.
D. ACE inhibitors can cause potassium retention due to
decreased aldosterone secretion. A slight increase requires
monitoring but is not an immediate life-threatening emergency
compared to airway compromise from angioedema.
Learning Objective
Identify life-threatening adverse reactions to ACE inhibitors and
formulate appropriate patient safety education.
Bloom's Taxonomy
Apply
Difficulty
Easy
NCLEX Client Needs Category
Physiological Integrity: Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill
, Recognize Cues
Question 2
Clinical Scenario
A nurse is preparing to administer the morning medications to a
68-year-old patient admitted with hypertension. The patient's
current medication administration record includes metoprolol
50 mg orally twice daily.
Question
Prior to administering metoprolol, which assessment finding
would require the nurse to hold the medication and
immediately notify the healthcare provider?
Options
A. Blood pressure of 134/82 mmHg
B. Heart rate of 48 beats per minute
C. Respiratory rate of 14 breaths per minute
D. Temperature of 98.9°F (37.2°C)
Correct Answer
B. Heart rate of 48 beats per minute
Rationale
Metoprolol is a beta-1 selective adrenergic antagonist (beta-
blocker) that exerts a negative chronotropic effect, slowing the
Pharmacology
9th Edition
Author(s)Rebecca G. Tucker
TEST BANK
Question 1
Clinical Scenario
A 52-year-old patient with newly diagnosed primary
hypertension is prescribed lisinopril. During the initial nursing
assessment, the nurse provides education about potential
adverse effects.
,Question
Which adverse effect should the nurse instruct the patient to
report immediately to the healthcare provider due to its life-
threatening nature?
Options
A. A dry, persistent cough
B. Swelling of the lips, tongue, or glottis
C. A mild, transient dizziness when standing up
D. A slight increase in serum potassium levels
Correct Answer
B. Swelling of the lips, tongue, or glottis
Rationale
Swelling of the lips, tongue, face, or glottis indicates
angioedema, a rare but life-threatening adverse effect of
angiotensin-converting enzyme (ACE) inhibitors like lisinopril.
Angioedema can compromise the patient's airway and requires
immediate emergency intervention and permanent
discontinuation of the drug.
Why the Other Options Are Incorrect
A. A dry, persistent cough is a common side effect of ACE
inhibitors caused by the accumulation of bradykinin in the
,respiratory tract. While bothersome and a frequent reason for
switching medications, it is not immediately life-threatening.
C. Mild, transient dizziness when standing up indicates
orthostatic hypotension, which is common when initiating
antihypertensive therapy. Patients should be taught to change
positions slowly, but it does not require emergency reporting
unless accompanied by syncope or injury.
D. ACE inhibitors can cause potassium retention due to
decreased aldosterone secretion. A slight increase requires
monitoring but is not an immediate life-threatening emergency
compared to airway compromise from angioedema.
Learning Objective
Identify life-threatening adverse reactions to ACE inhibitors and
formulate appropriate patient safety education.
Bloom's Taxonomy
Apply
Difficulty
Easy
NCLEX Client Needs Category
Physiological Integrity: Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill
, Recognize Cues
Question 2
Clinical Scenario
A nurse is preparing to administer the morning medications to a
68-year-old patient admitted with hypertension. The patient's
current medication administration record includes metoprolol
50 mg orally twice daily.
Question
Prior to administering metoprolol, which assessment finding
would require the nurse to hold the medication and
immediately notify the healthcare provider?
Options
A. Blood pressure of 134/82 mmHg
B. Heart rate of 48 beats per minute
C. Respiratory rate of 14 breaths per minute
D. Temperature of 98.9°F (37.2°C)
Correct Answer
B. Heart rate of 48 beats per minute
Rationale
Metoprolol is a beta-1 selective adrenergic antagonist (beta-
blocker) that exerts a negative chronotropic effect, slowing the
