A pharmacist and nurse review separate clients receiving heparin, furosemide and lisinopril. For each record, identify the medicine most strongly implicated by the entire pattern. The records are independent, and no unlisted new medicine has been started. Serious findings are being escalated. Assign each record once; each category may receive several records without a fixed quota.
Matrix Multiple Choice
Choose your responses, then check the answer.
Explanation
Heparin: the timed platelet decline with thrombosis and the excessive-infusion bleeding record. Furosemide: volume depletion and electrolyte-loss records. Lisinopril: potassium retention, cough and angioedema. One medicine may cause distinct adverse mechanisms: immune HIT differs from excess anticoagulation, and volume loss differs from electrolyte loss. The contextual laboratory and examination pattern prevents a single symptom from driving every assignment.
Correct answer Heparin: the timed platelet decline with thrombosis and the excessive-infusion bleeding record. Furosemide: volume depletion and electrolyte-loss records. Lisinopril: potassium retention, cough and angioedema.
Why this is correct One medicine may cause distinct adverse mechanisms: immune HIT differs from excess anticoagulation, and volume loss differs from electrolyte loss. The contextual laboratory and examination pattern prevents a single symptom from driving every assignment.
Clinical picture Drug attribution is part of investigation, not a substitute for immediate care of airway swelling, bleeding, thrombosis or arrhythmia. The cases deliberately separate these findings across different clients.
Memory hook Separate the mechanism before naming the medicine: clotting despite falling platelets is different from bleeding with excessive anticoagulation.
NCLEX decision rule Use baseline-to-current changes, timing and objective findings. Eliminate competing medication and sampling explanations where the question claims a uniquely most likely contributor.
Why the alternatives are wrong Record 1 reflects diuretic-associated volume depletion rather than isolated ACE-related hypotension because brisk fluid loss and dry mucosa accompany improving congestion. Record 2 supports immune HIT rather than simply a high anticoagulant dose. Record 3 supports ACE-related potassium retention with major confounders excluded. Record 4 favors ACE cough rather than persistent congestion. Record 5 supports renal electrolyte loss after diuresis rather than the potassium-retaining effect in record 3. Record 6 identifies excessive anticoagulation without the platelet trajectory of HIT. Record 7 describes ACE-associated angioedema and appears only once, avoiding duplicate lip/tongue-swelling items.
Sources
DailyMed lisinopril DailyMed furosemide ASH HIT guideline
Practice transfer: Drug attribution is part of investigation, not a substitute for immediate care of airway swelling, bleeding, thrombosis or arrhythmia. The cases deliberately separate these findings across different clients.