# 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.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=569391&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

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.

**1.** After a recent dose adjustment, dependent ankle swelling developed; weight, lung examination and jugular venous pressure remain unchanged.

Select a category
Amlodipine
Lisinopril
Metoprolol

**2.** Fatigue begins after a recent dose adjustment; ECG shows sinus rate 46/min, whereas BP and hemoglobin remain near baseline.

Select a category
Amlodipine
Lisinopril
Metoprolol

**3.** A persistent nonproductive cough began several weeks after this regimen began; chest imaging, temperature and oxygenation are unchanged.

Select a category
Amlodipine
Lisinopril
Metoprolol

**4.** New lightheadedness follows an increase in rate-control therapy; the PR interval lengthens and intermittent second-degree AV block appears.

Select a category
Amlodipine
Lisinopril
Metoprolol

**5.** Potassium rises to 5.7 mEq/L (3.5-5.0) several weeks after treatment begins; repeat nonhemolyzed sampling confirms it, with no supplements or salt substitutes.

Select a category
Amlodipine
Lisinopril
Metoprolol

**6.** Gum enlargement emerges over several months despite regular dental care; the client has no anticonvulsant or immunosuppressant exposure.

Select a category
Amlodipine
Lisinopril
Metoprolol

**7.** Painless tongue swelling develops while taking this regimen without hives or an allergen exposure; the airway is immediately assessed.

Select a category
Amlodipine
Lisinopril
Metoprolol

## 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.

## In-depth explanation

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.

Sources
DailyMed amlodipine
DailyMed metoprolol
DailyMed lisinopril

## Clinical scenario

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.

## Key concepts

- **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.

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