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: Hydrochlorothiazide is for chronic hypertension, not acute pulmonary edema. Furosemide acts rapidly to relieve fluid overload, so this is incorrect for emergency use.

Choice B reason: Furosemide is the drug of choice for pulmonary edema, rapidly reducing fluid overload and relieving symptoms like frothy sputum. This is the correct choice.

Choice C reason: Mannitol is used for cerebral edema, not pulmonary edema. Furosemide targets acute fluid overload in the lungs, so this is incorrect for this scenario.

Choice D reason: Spironolactone is for chronic heart failure, not acute pulmonary edema. Furosemide’s rapid diuresis is needed, so this is incorrect for immediate treatment.

A. Intravenous theophylline, oxygen, and fluticasone [Flovent HFA] 220 mcg B. Four puffs of albuterol, oxygen, and intravenous theophylline C. Intravenous glucocorticoids, nebulized albuterol and ipratropium, and oxygen D. Intramuscular glucocorticoids and salmeterol by metered-dose inhaler

Correct Answer is C

Explanation

Choice A reason: Theophylline is rarely used due to toxicity risks and less efficacy compared to beta-agonists. Increasing fluticasone dose doesn’t address acute exacerbations, as inhaled corticosteroids act slowly. Oxygen is appropriate, but this regimen lacks rapid-acting bronchodilators, making it inadequate for acute asthma management.

Choice B reason: Four puffs of albuterol via inhaler may be insufficient for severe asthma (90% saturation, wheezes). Theophylline is outdated, and nebulized treatments are more effective in emergencies. Oxygen is needed, but this combination lacks systemic steroids for inflammation, making it less optimal.

Choice C reason: Intravenous glucocorticoids reduce airway inflammation rapidly, nebulized albuterol and ipratropium provide synergistic bronchodilation, and oxygen corrects hypoxia (90% saturation). This aligns with guidelines for acute asthma exacerbations, addressing inflammation, bronchoconstriction, and oxygenation, making it the correct and comprehensive treatment choice.

Choice D reason: Intramuscular glucocorticoids are slower than intravenous for acute asthma. Salmeterol, a long-acting beta-agonist, is inappropriate for acute exacerbations, as it lacks rapid onset. Oxygen is needed, but this regimen doesn’t address immediate bronchoconstriction effectively, making it incorrect for emergency management.

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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

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Correct Answer is B

Explanation

Correct Answer is C

Explanation

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