Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1: Multiple-Choice Question (MCQ)
Clinical Scenario
A 68-year-old male with a history of chronic obstructive
pulmonary disease (COPD) and severe chronic plaque psoriasis
is admitted to the telemetry unit with acute decompensated
heart failure and a newly diagnosed rapid ventricular response
due to atrial fibrillation. The admitting physician prescribes a
non-selective beta-adrenergic antagonist, carvedilol, to manage
the patient's heart rate and provide long-term cardioprotection.
Question Stem
Which action should the telemetry nurse prioritize before
administering the first dose of carvedilol to this patient?
• A. Hold the medication and contact the provider to
question the prescription due to the patient's history of
COPD.
• B. Assess the patient's skin integrity and document the
baseline distribution of psoriasis plaques.
• C. Administer the medication as prescribed and recheck
the heart rate exactly 4 hours post-administration.
• D. Ensure the patient has consumed a high-potassium
meal to mitigate potential hypokalemia.
Correct Answer
,A. Hold the medication and contact the provider to question
the prescription due to the patient's history of COPD.
Comprehensive Rationale
Carvedilol is a non-selective beta-blocker that antagonizes beta-
1, beta-2, and alpha-1 adrenergic receptors. While beta-1
blockade slows the heart rate and decreases myocardial oxygen
demand (highly beneficial in atrial fibrillation and heart failure),
beta-2 blockade inhibits adrenergic bronchodilation,
precipitating severe bronchoconstriction and bronchospasm in
patients with reactive airway diseases like COPD or asthma. In
patients with respiratory comorbidities requiring beta-blocker
therapy, a cardioselective beta-1 antagonist (such as metoprolol
or atenolol) is strictly preferred, though still used with extreme
caution. Keeping the patient safe demands that the nurse
recognize this critical contraindication and collaborate with the
provider for an alternative agent.
Distractor Analysis
• B is incorrect. While assessing skin integrity is a standard
nursing action, carvedilol does not acutely exacerbate or
interact catastrophically with plaque psoriasis in a life-
threatening manner compared to the risk of respiratory
failure from bronchospasm.
• C is incorrect. Administering a non-selective beta-blocker
to a symptomatic COPD patient poses an immediate threat
, of acute airway obstruction. Waiting 4 hours to evaluate
the patient is an unsafe delay in monitoring.
• D is incorrect. Beta-blockers can cause mild hyperkalemia
(via suppression of renin and aldosterone secretion), not
hypokalemia. Encouraging a high-potassium meal is
pathophysiologically incorrect and increases the risk of
hyperkalemia.
Nursing Process Integration
• Primary Focus: Implementation. The nurse exerts clinical
judgment by withholding an unsafe medication rather than
blindly administering it.
• Other Steps: Assessment identifies the COPD history.
Nursing Diagnosis focuses on the Risk for Ineffective
Airway Clearance. Planning involves collaborating with the
interprofessional team to change the prescription, and
Evaluation confirms the substitution of a safer,
cardioselective agent without respiratory compromise.
NCLEX Clinical Judgment Measurement Model (NCJMM)
• Take Action: The nurse protects the patient by actively
withholding a contraindicated medication and initiating
interprofessional communication.
Metadata
• Difficulty Level: Moderate
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1: Multiple-Choice Question (MCQ)
Clinical Scenario
A 68-year-old male with a history of chronic obstructive
pulmonary disease (COPD) and severe chronic plaque psoriasis
is admitted to the telemetry unit with acute decompensated
heart failure and a newly diagnosed rapid ventricular response
due to atrial fibrillation. The admitting physician prescribes a
non-selective beta-adrenergic antagonist, carvedilol, to manage
the patient's heart rate and provide long-term cardioprotection.
Question Stem
Which action should the telemetry nurse prioritize before
administering the first dose of carvedilol to this patient?
• A. Hold the medication and contact the provider to
question the prescription due to the patient's history of
COPD.
• B. Assess the patient's skin integrity and document the
baseline distribution of psoriasis plaques.
• C. Administer the medication as prescribed and recheck
the heart rate exactly 4 hours post-administration.
• D. Ensure the patient has consumed a high-potassium
meal to mitigate potential hypokalemia.
Correct Answer
,A. Hold the medication and contact the provider to question
the prescription due to the patient's history of COPD.
Comprehensive Rationale
Carvedilol is a non-selective beta-blocker that antagonizes beta-
1, beta-2, and alpha-1 adrenergic receptors. While beta-1
blockade slows the heart rate and decreases myocardial oxygen
demand (highly beneficial in atrial fibrillation and heart failure),
beta-2 blockade inhibits adrenergic bronchodilation,
precipitating severe bronchoconstriction and bronchospasm in
patients with reactive airway diseases like COPD or asthma. In
patients with respiratory comorbidities requiring beta-blocker
therapy, a cardioselective beta-1 antagonist (such as metoprolol
or atenolol) is strictly preferred, though still used with extreme
caution. Keeping the patient safe demands that the nurse
recognize this critical contraindication and collaborate with the
provider for an alternative agent.
Distractor Analysis
• B is incorrect. While assessing skin integrity is a standard
nursing action, carvedilol does not acutely exacerbate or
interact catastrophically with plaque psoriasis in a life-
threatening manner compared to the risk of respiratory
failure from bronchospasm.
• C is incorrect. Administering a non-selective beta-blocker
to a symptomatic COPD patient poses an immediate threat
, of acute airway obstruction. Waiting 4 hours to evaluate
the patient is an unsafe delay in monitoring.
• D is incorrect. Beta-blockers can cause mild hyperkalemia
(via suppression of renin and aldosterone secretion), not
hypokalemia. Encouraging a high-potassium meal is
pathophysiologically incorrect and increases the risk of
hyperkalemia.
Nursing Process Integration
• Primary Focus: Implementation. The nurse exerts clinical
judgment by withholding an unsafe medication rather than
blindly administering it.
• Other Steps: Assessment identifies the COPD history.
Nursing Diagnosis focuses on the Risk for Ineffective
Airway Clearance. Planning involves collaborating with the
interprofessional team to change the prescription, and
Evaluation confirms the substitution of a safer,
cardioselective agent without respiratory compromise.
NCLEX Clinical Judgment Measurement Model (NCJMM)
• Take Action: The nurse protects the patient by actively
withholding a contraindicated medication and initiating
interprofessional communication.
Metadata
• Difficulty Level: Moderate
