Lehne's Pharmacology for Nursing
Care
12th Edition
• Author(s)Jacqueline Rosenjack
Burchum; Laura D. Rosenthal
,TEST BANK
QUESTION 1
Type: MCQ
Clinical Scenario:
A 68-year-old African American male with a history of
hypertension, type 2 diabetes, and chronic kidney disease
(stage 3) presents to the clinic with a blood pressure of 152/94
mmHg. He has been adherent to his current regimen of
lisinopril 20 mg daily for the past 6 months but reports
persistent fatigue and a dry, hacking cough that has worsened
over the last 3 weeks. His serum creatinine is 1.8 mg/dL, and
potassium is 5.1 mEq/L.
Question Stem:
Which medication change would the nurse anticipate the
healthcare provider will prescribe based on this patient's clinical
presentation?
Answer Options:
A. Continue lisinopril and add hydrochlorothiazide 12.5 mg daily
B. Discontinue lisinopril and initiate amlodipine 5 mg daily
C. Increase lisinopril to 40 mg daily and monitor potassium
,levels
D. Discontinue lisinopril and initiate losartan 50 mg daily
Correct Answer:
B. Discontinue lisinopril and initiate amlodipine 5 mg daily
Detailed Rationale:
This patient is experiencing adverse effects from lisinopril (an
ACE inhibitor), specifically a dry cough (bradykinin-mediated)
and hyperkalemia (potassium level 5.1 mEq/L). ACE inhibitors
are known to cause hyperkalemia, particularly in patients with
renal impairment (CKD stage 3) and diabetes. The presence of a
chronic cough and elevated potassium indicates the need for
medication change. Amlodipine, a calcium channel blocker, is an
appropriate alternative that does not cause cough or directly
affect potassium levels. Additionally, calcium channel blockers
are particularly effective in African American patients, who tend
to have lower renin levels and respond better to CCBs and
diuretics than to ACE inhibitors alone.
Incorrect Option Analysis:
A. Continue lisinopril and add hydrochlorothiazide 12.5 mg
daily
Why It Is Incorrect: Adding a diuretic would not address the
persistent cough (an adverse effect of ACE inhibitors) and could
worsen potassium abnormalities, especially since the patient
already has elevated potassium.
, Common Clinical Misconception: The misconception that adding
another antihypertensive is always the best approach for
inadequate BP control, without addressing medication adverse
effects.
Potential Medication Safety Risk: Hyperkalemia could worsen if
a potassium-sparing or potassium-wasting diuretic is added
inappropriately.
Appropriate Nursing Consideration: Always evaluate patient
symptoms and laboratory values before adjusting therapy; a
medication that causes intolerable side effects may need to be
changed, not augmented.
C. Increase lisinopril to 40 mg daily and monitor potassium
levels
Why It Is Incorrect: Increasing the dose of lisinopril would not
address the cough and could further increase potassium levels,
potentially leading to dangerous hyperkalemia.
Common Clinical Misconception: The belief that dose escalation
is always the appropriate response when BP is not at goal,
ignoring adverse effects and laboratory abnormalities.
Potential Medication Safety Risk: Severe hyperkalemia
(potassium >6.0 mEq/L) can cause cardiac arrhythmias and
death.
Appropriate Nursing Consideration: Dose adjustments should
consider both efficacy and safety; in this case, safety
Care
12th Edition
• Author(s)Jacqueline Rosenjack
Burchum; Laura D. Rosenthal
,TEST BANK
QUESTION 1
Type: MCQ
Clinical Scenario:
A 68-year-old African American male with a history of
hypertension, type 2 diabetes, and chronic kidney disease
(stage 3) presents to the clinic with a blood pressure of 152/94
mmHg. He has been adherent to his current regimen of
lisinopril 20 mg daily for the past 6 months but reports
persistent fatigue and a dry, hacking cough that has worsened
over the last 3 weeks. His serum creatinine is 1.8 mg/dL, and
potassium is 5.1 mEq/L.
Question Stem:
Which medication change would the nurse anticipate the
healthcare provider will prescribe based on this patient's clinical
presentation?
Answer Options:
A. Continue lisinopril and add hydrochlorothiazide 12.5 mg daily
B. Discontinue lisinopril and initiate amlodipine 5 mg daily
C. Increase lisinopril to 40 mg daily and monitor potassium
,levels
D. Discontinue lisinopril and initiate losartan 50 mg daily
Correct Answer:
B. Discontinue lisinopril and initiate amlodipine 5 mg daily
Detailed Rationale:
This patient is experiencing adverse effects from lisinopril (an
ACE inhibitor), specifically a dry cough (bradykinin-mediated)
and hyperkalemia (potassium level 5.1 mEq/L). ACE inhibitors
are known to cause hyperkalemia, particularly in patients with
renal impairment (CKD stage 3) and diabetes. The presence of a
chronic cough and elevated potassium indicates the need for
medication change. Amlodipine, a calcium channel blocker, is an
appropriate alternative that does not cause cough or directly
affect potassium levels. Additionally, calcium channel blockers
are particularly effective in African American patients, who tend
to have lower renin levels and respond better to CCBs and
diuretics than to ACE inhibitors alone.
Incorrect Option Analysis:
A. Continue lisinopril and add hydrochlorothiazide 12.5 mg
daily
Why It Is Incorrect: Adding a diuretic would not address the
persistent cough (an adverse effect of ACE inhibitors) and could
worsen potassium abnormalities, especially since the patient
already has elevated potassium.
, Common Clinical Misconception: The misconception that adding
another antihypertensive is always the best approach for
inadequate BP control, without addressing medication adverse
effects.
Potential Medication Safety Risk: Hyperkalemia could worsen if
a potassium-sparing or potassium-wasting diuretic is added
inappropriately.
Appropriate Nursing Consideration: Always evaluate patient
symptoms and laboratory values before adjusting therapy; a
medication that causes intolerable side effects may need to be
changed, not augmented.
C. Increase lisinopril to 40 mg daily and monitor potassium
levels
Why It Is Incorrect: Increasing the dose of lisinopril would not
address the cough and could further increase potassium levels,
potentially leading to dangerous hyperkalemia.
Common Clinical Misconception: The belief that dose escalation
is always the appropriate response when BP is not at goal,
ignoring adverse effects and laboratory abnormalities.
Potential Medication Safety Risk: Severe hyperkalemia
(potassium >6.0 mEq/L) can cause cardiac arrhythmias and
death.
Appropriate Nursing Consideration: Dose adjustments should
consider both efficacy and safety; in this case, safety
