# 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.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=569396&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

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.

**1.** After intensified diuresis, weight falls 2.4 kg in 24 hours; postural dizziness and dry mucosa appear while pulmonary crackles resolve.

Select a category
Heparin
Furosemide
Lisinopril

**2.** On treatment day 7, platelets fall by 62% and ultrasound confirms a new venous clot; no infection or alternative strong cause is identified.

Select a category
Heparin
Furosemide
Lisinopril

**3.** A nonhemolyzed potassium result rises from 4.2 to 5.8 mEq/L (3.5-5.0) several weeks after this regimen begins; supplements and potassium-sparing drugs are absent.

Select a category
Heparin
Furosemide
Lisinopril

**4.** A sustained nonproductive cough develops despite resolved congestion, normal chest imaging and no infectious symptoms.

Select a category
Heparin
Furosemide
Lisinopril

**5.** Potassium falls to 2.9 mEq/L (3.5-5.0) and magnesium to 1.4 mg/dL (1.7-2.2) after brisk urine losses; ventricular ectopy appears.

Select a category
Heparin
Furosemide
Lisinopril

**6.** The infusion pump is found above the prescribed anticoagulant rate; aPTT exceeds the protocol range and venipuncture sites ooze, with platelets stable.

Select a category
Heparin
Furosemide
Lisinopril

**7.** The tongue and lips enlarge without hives while taking this regimen; no new food, antibiotic or other allergen exposure is reported.

Select a category
Heparin
Furosemide
Lisinopril

## 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.

## In-depth explanation

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

## Clinical scenario

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.

## Key concepts

- **Volume depletion** — Reduced effective circulating fluid volume.
- **aPTT** — A coagulation test used in some unfractionated-heparin monitoring protocols.
- **Electrolyte depletion** — Loss of ions needed for normal cellular and electrical function.

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