Abrams' Clinical Drug Therapy
Rationales for Nursing Practice
13th Edition
• Author(s)Geralyn Frandsen;
Sandra Pennington
TEST BANK
,Question 1
A patient with a new prescription for an angiotensin-converting
enzyme (ACE) inhibitor reports a persistent, dry, hacking cough
that has developed over the past week. The patient is
concerned and asks if the medication should be stopped. What
is the nurse’s most appropriate initial response?
A. Instruct the patient to stop the medication immediately and
contact the provider.
B. Advise the patient to take an over-the-counter antitussive to
manage the symptom.
C. Explain that this is a known side effect and notify the
provider for evaluation.
D. Reassure the patient that the cough will subside within 24 to
48 hours.
Correct Answer: C
Rationale: A persistent, dry cough is a well-documented adverse
effect of ACE inhibitors, occurring in up to 20% of patients due
to the accumulation of bradykinin. The nurse should
acknowledge this as a potential side effect and notify the
provider, who may consider switching to an angiotensin II
receptor blocker (ARB). Stopping the medication abruptly
without provider guidance (A) is unsafe and could lead to
rebound hypertension. Antitussives (B) will not address the
underlying mechanism and may mask the symptom, delaying
necessary action. The cough typically resolves within 1 to 4
,weeks after discontinuation, not 24 to 48 hours (D), so
reassurance of a rapid resolution is inaccurate.
Question 2
A patient is receiving intravenous vancomycin for a methicillin-
resistant Staphylococcus aureus infection. The nurse assesses
the patient’s vital signs and notes a sudden drop in blood
pressure, flushing of the neck and face, and a maculopapular
rash on the upper trunk. Which nursing action is the priority?
A. Stop the infusion and notify the healthcare provider
immediately.
B. Slow the infusion rate to half the current rate and continue
monitoring.
C. Administer diphenhydramine as a standing order for allergic
reaction.
D. Obtain a blood culture to rule out sepsis before any
intervention.
Correct Answer: A
Rationale: The patient is exhibiting signs of Red Man Syndrome,
a hypersensitivity reaction caused by rapid infusion of
vancomycin. The priority action is to stop the infusion to
prevent further histamine release and cardiovascular
compromise, and then notify the provider. Slowing the infusion
(B) is a management strategy for mild reactions but is not the
priority when acute hemodynamic changes are present.
, Administering diphenhydramine (C) may be ordered, but it
should not precede stopping the drug. Obtaining a blood
culture (D) is not indicated for this drug-specific reaction and
delays critical intervention.
Question 3
A nurse is teaching a patient who has just started taking
phenytoin for a seizure disorder. Which statement by the
patient indicates a correct understanding of the medication’s
administration and monitoring?
A. "I can take my medication with milk or antacids if I have
stomach upset."
B. "I will need to have my blood drawn regularly to check the
level of this drug."
C. "I should stop taking this medication if I notice my gums are
swelling."
D. "I can expect my urine to turn a harmless orange-red color
while on this drug."
Correct Answer: B
Rationale: Phenytoin has a narrow therapeutic index, and
serum levels must be monitored regularly (therapeutic range
10-20 mcg/mL) to prevent toxicity or subtherapeutic effects.
Milk and antacids (A) contain calcium and magnesium, which
can bind phenytoin and reduce absorption, decreasing its
efficacy. Stopping the medication abruptly due to gingival
Rationales for Nursing Practice
13th Edition
• Author(s)Geralyn Frandsen;
Sandra Pennington
TEST BANK
,Question 1
A patient with a new prescription for an angiotensin-converting
enzyme (ACE) inhibitor reports a persistent, dry, hacking cough
that has developed over the past week. The patient is
concerned and asks if the medication should be stopped. What
is the nurse’s most appropriate initial response?
A. Instruct the patient to stop the medication immediately and
contact the provider.
B. Advise the patient to take an over-the-counter antitussive to
manage the symptom.
C. Explain that this is a known side effect and notify the
provider for evaluation.
D. Reassure the patient that the cough will subside within 24 to
48 hours.
Correct Answer: C
Rationale: A persistent, dry cough is a well-documented adverse
effect of ACE inhibitors, occurring in up to 20% of patients due
to the accumulation of bradykinin. The nurse should
acknowledge this as a potential side effect and notify the
provider, who may consider switching to an angiotensin II
receptor blocker (ARB). Stopping the medication abruptly
without provider guidance (A) is unsafe and could lead to
rebound hypertension. Antitussives (B) will not address the
underlying mechanism and may mask the symptom, delaying
necessary action. The cough typically resolves within 1 to 4
,weeks after discontinuation, not 24 to 48 hours (D), so
reassurance of a rapid resolution is inaccurate.
Question 2
A patient is receiving intravenous vancomycin for a methicillin-
resistant Staphylococcus aureus infection. The nurse assesses
the patient’s vital signs and notes a sudden drop in blood
pressure, flushing of the neck and face, and a maculopapular
rash on the upper trunk. Which nursing action is the priority?
A. Stop the infusion and notify the healthcare provider
immediately.
B. Slow the infusion rate to half the current rate and continue
monitoring.
C. Administer diphenhydramine as a standing order for allergic
reaction.
D. Obtain a blood culture to rule out sepsis before any
intervention.
Correct Answer: A
Rationale: The patient is exhibiting signs of Red Man Syndrome,
a hypersensitivity reaction caused by rapid infusion of
vancomycin. The priority action is to stop the infusion to
prevent further histamine release and cardiovascular
compromise, and then notify the provider. Slowing the infusion
(B) is a management strategy for mild reactions but is not the
priority when acute hemodynamic changes are present.
, Administering diphenhydramine (C) may be ordered, but it
should not precede stopping the drug. Obtaining a blood
culture (D) is not indicated for this drug-specific reaction and
delays critical intervention.
Question 3
A nurse is teaching a patient who has just started taking
phenytoin for a seizure disorder. Which statement by the
patient indicates a correct understanding of the medication’s
administration and monitoring?
A. "I can take my medication with milk or antacids if I have
stomach upset."
B. "I will need to have my blood drawn regularly to check the
level of this drug."
C. "I should stop taking this medication if I notice my gums are
swelling."
D. "I can expect my urine to turn a harmless orange-red color
while on this drug."
Correct Answer: B
Rationale: Phenytoin has a narrow therapeutic index, and
serum levels must be monitored regularly (therapeutic range
10-20 mcg/mL) to prevent toxicity or subtherapeutic effects.
Milk and antacids (A) contain calcium and magnesium, which
can bind phenytoin and reduce absorption, decreasing its
efficacy. Stopping the medication abruptly due to gingival
