A provider has ordered captopril [Capoten] for a patient who has hypertension. The patient reports a history of swelling of the tongue and lips after taking enalapril [Vasotec] in the past. Which action by the nurse is correct?

Administer the captopril and monitor for adverse effects

Request an order to administer fosinopril instead of captopril

Hold the dose and notify the provider

Reassure the patient that this is not a serious side effect

Answer and Explanation

The Correct Answer is C

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.

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Correct Answer is B

Explanation

Choice A reason: Metabolic acidosis involves low pH (<7.35) and low HCO3- (<22 mEq/L). Here, pH is 7.48 (alkalotic) and HCO3- is 29 mEq/L (high), indicating alkalosis, not acidosis. PaCO2 (44 mm Hg) is normal, ruling out respiratory causes, making this choice incorrect.

Choice B reason: pH 7.48 (high), PaCO2 44 mm Hg (normal), and HCO3- 29 mEq/L (high) indicate metabolic alkalosis, likely from conditions like vomiting or diuretic use, increasing bicarbonate. No respiratory compensation (normal PaCO2) confirms uncompensated metabolic alkalosis, making this the correct choice.

Choice C reason: Respiratory acidosis requires high PaCO2 (>45 mm Hg) and low pH. Here, PaCO2 is 44 mm Hg (normal) and pH is 7.48 (alkalotic), with high HCO3-, pointing to a metabolic cause, not respiratory, making this choice incorrect for the ABG values.

Choice D reason: Respiratory alkalosis involves low PaCO2 (<35 mm Hg) and high pH. With PaCO2 at 44 mm Hg (normal) and high HCO3- (29 mEq/L), the alkalosis is metabolic, not respiratory. This choice doesn’t match the ABG profile, making it incorrect.

A. I should notify my child’s pediatrician if I notice mood changes in my child. B. I will give this medication to my child if I hear them wheezing. C. This medication can cure my child’s asthma. D. I should give this medication twice daily.

Correct Answer is A

Explanation

Choice A reason: Montelukast can cause mood changes or neuropsychiatric effects in children. Recognizing this side effect and notifying the pediatrician shows understanding, making this the correct statement.

Choice B reason: Montelukast is a daily maintenance drug, not for acute wheezing, which requires albuterol. This misunderstanding of its use makes it incorrect for proper administration.

Choice C reason: Montelukast controls asthma symptoms but does not cure asthma, a chronic condition. This incorrect belief about its purpose makes it wrong for understanding the medication.

Choice D reason: Montelukast is dosed once daily, typically at bedtime, not twice daily. This dosing error indicates a lack of understanding, making it incorrect for the parent’s statement.

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A provider has ordered captopril [Capoten] for a patient who has hypertension. The patient reports a history of swelling of the tongue and lips after taking enalapril [Vasotec] in the past. Which action by the nurse is correct?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Name the imbalance using the following Arterial Blood Gas (ABG) values: pH 7.48, PaCO2 44, HCO3- 29

Correct Answer is B

Explanation

A 7-year-old child with asthma uses a daily inhaled glucocorticoid and an albuterol MDI as needed. The provider has added montelukast (Singulair) to the child’s regimen. Which statement by the child’s parent indicates understanding of this medication?

Correct Answer is A

Explanation

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