The nurse compares independent outpatient records. Every client takes amlodipine, lisinopril and metoprolol, with no other new medicine. Attribute each new pattern to the most likely contributor, using the timeline and accompanying findings. This is attribution for review, not permission to stop therapy without evaluation. Place every record once; categories accept multiple records and have no stated quotas.
Matrix Multiple Choice
Choose your responses, then check the answer.
Explanation
Amlodipine: dependent edema and gingival enlargement. Metoprolol: symptomatic sinus slowing and AV block. Lisinopril: cough, hyperkalemia and angioedema. The record must connect a medication mechanism to objective findings and exclude close alternatives. For example edema without congestion differs from worsening heart failure, and fatigue with marked slowing differs from nonspecific fatigue alone.
Correct answer Amlodipine: dependent edema and gingival enlargement. Metoprolol: symptomatic sinus slowing and AV block. Lisinopril: cough, hyperkalemia and angioedema.
Why this is correct The record must connect a medication mechanism to objective findings and exclude close alternatives. For example edema without congestion differs from worsening heart failure, and fatigue with marked slowing differs from nonspecific fatigue alone.
Clinical picture These records belong to different clients. Airway swelling, marked bradycardia, conduction block or confirmed hyperkalemia warrants prompt clinical escalation; identifying the likely medicine does not complete the safety assessment.
Memory hook Vascular dilation, conduction slowing and renin-angiotensin effects form three different causal routes. Use the route plus the actual examination, not one symptom in isolation.
NCLEX decision rule Correlate the change with objective findings and competing explanations before assigning an adverse-effect report. Treat serious findings urgently while the cause is evaluated.
Why the alternatives are wrong Record 1 fits dihydropyridine-related edema; stable weight and absence of congestion argue against fluid-overload heart failure. Record 2 uses sinus slowing to distinguish beta-blockade from vasodilator hypotension. Record 3 fits ACE-inhibitor cough rather than pulmonary infection. Record 4 provides a distinct conduction abnormality instead of repeating a fatigue item. Record 5 supports ACE-related potassium retention after excluding sample error and common exogenous contributors. Record 6 distinguishes gingival overgrowth from ankle edema and excludes other common medicine classes. Record 7 supports ACE-associated angioedema rather than an urticarial allergy. Amlodipine does not characteristically suppress AV conduction; metoprolol does not explain the ACE-associated cough pattern.
Practice transfer: These records belong to different clients. Airway swelling, marked bradycardia, conduction block or confirmed hyperkalemia warrants prompt clinical escalation; identifying the likely medicine does not complete the safety assessment.
Dependent edema — Swelling most evident in body areas affected by gravity.
AV block — Delayed or interrupted conduction from atria to ventricles.
Angioedema — Deeper tissue swelling that can threaten the airway.