A nurse is discussing how beta blockers work to decrease blood pressure with a nursing student. Which statement by the student indicates a need for further teaching?

Choice A reason: Administering captopril risks angioedema, as the patient’s history of tongue and lip swelling with enalapril (another ACE inhibitor) suggests a class effect due to bradykinin accumulation. This is potentially life-threatening, requiring avoidance, not monitoring, making this choice unsafe and incorrect.

Choice B reason: Fosinopril, another ACE inhibitor, carries the same angioedema risk as captopril and enalapril due to similar bradykinin effects. Switching within the same drug class doesn’t address the patient’s history of adverse reactions, making this choice inappropriate and potentially dangerous.

Choice C reason: Holding captopril and notifying the provider is correct, as the patient’s history of angioedema with enalapril indicates a high risk with captopril, another ACE inhibitor. Alternative classes (e.g., ARBs) should be considered to avoid life-threatening reactions, making this the safest and correct action.

Choice D reason: Angioedema (tongue and lip swelling) is a serious, potentially fatal side effect of ACE inhibitors, not benign. Reassuring the patient minimizes the risk, which could delay intervention. The history warrants avoiding captopril and consulting the provider, making this choice incorrect and unsafe.

Choice A reason: Hyperthyroidism involves elevated T3 and T4 with low TSH due to excessive thyroid hormone production. The patient’s low T3/T4 and high TSH indicate reduced thyroid activity, not overactivity, as the pituitary increases TSH to stimulate the underactive thyroid, making this choice incorrect.

Choice B reason: Hypothyroidism is characterized by low T3 and T4 levels due to underactive thyroid function, prompting the pituitary to secrete more TSH to stimulate hormone production. This matches the patient’s lab results (low T3/T4, high TSH), often seen in primary hypothyroidism, making this the correct choice.

Choice C reason: Thyroid cancer may alter thyroid function but typically doesn’t present with consistently low T3/T4 and high TSH. It’s more likely to cause nodules or abnormal growths, not this specific hormonal pattern, which aligns with hypothyroidism, making this choice less likely.

Choice D reason: Pituitary adenoma causing secondary hypothyroidism would lower TSH, T3, and T4 due to impaired pituitary function. High TSH with low T3/T4 suggests primary thyroid failure, not pituitary dysfunction, making this choice incorrect for the patient’s hormonal profile.