| Course | NSG 124 Pharmacology |
|---|---|
| Unit | Unit 6 |
| Paper type | Adverse effect escalation chart |
| Length | About 480 words, 4 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 124 Unit 6
Expected, or Worth a Call? An Escalation Chart for Ten Effects Seen After Starting an ACE Inhibitor, Each Sorted With Its Reason
Student Name
Department of Nursing, Herzing University
NSG 124: Pharmacology
Instructor Name
February 19, 2026
Expected, or Worth a Call? An Escalation Chart for Ten Effects Seen After Starting an ACE Inhibitor, Each Sorted With Its Reason
Medication and Setting
The chart concerns lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, started for high blood pressure in a composite 59-year-old Black man, a school bus mechanic, with type 2 diabetes and normal kidney function at baseline. Each row records an effect as a nurse would write it, by what is seen, heard, or reported. The two sorting columns say whether the course reading treats it as an expected effect of this drug or as a reason to call someone. The reason column carries the argument (Burchum & Rosenthal, 2022).
The Chart
An X marks the column; EITHER marks an effect that could belong to both.
| Effect, as recorded | Expected on this drug | Prompts a call | Reason |
|---|---|---|---|
| Dry, tickly cough, no sputum, began three weeks after starting | X | Common with ACE inhibitors, reported in 5 to 35% of treated patients, probably from bradykinin building up in the airways (Dicpinigaitis, 2006). It causes no harm, yet people often quit the medicine over it, so it is reported at the next routine contact rather than urgently. | |
| Lightheaded on standing in the first days | X | Blood pressure falls as the drug takes effect, most at the start. Expected if mild and settling. | |
| Fainted or nearly fainted | X | More than the expected fall in pressure; risk of injury; may mean the dose is too strong or fluid is low. | |
| Puffy lips or tongue, facial swelling, or swelling in the throat | X (emergency) | Angioedema. In a large trial of an ACE inhibitor, it occurred in 0.68% of patients, more often early in treatment, and Black patients had nearly three times the odds (Kostis et al., 2005). Throat swelling can block the airway. | |
| Hoarse voice or feeling that the throat is tight | X (emergency) | May be angioedema affecting the larynx even without visible facial swelling. | |
| Swelling of one lip only, mild, no breathing problem, resolved in hours | EITHER | Could be minor, but angioedema can recur and worsen with continued use; the prescriber needs to know before the next dose even if it has gone. | |
| Muscle weakness, palpitations, or an irregular pulse | X | Possible high potassium; ACE inhibitors reduce aldosterone, so the kidneys keep more potassium, and diabetes adds risk. | |
| Rise in creatinine on the first check after starting | EITHER | A small rise is expected as pressure inside the kidney's filters falls; a larger rise needs the prescriber's review. The size of the rise decides the column, so the result is passed on with the baseline. | |
| Passing much less urine than usual | X | Could signal kidney injury, especially if he is also dehydrated or taking NSAIDs. | |
| Metallic or changed taste | X | Listed as a less common effect; not dangerous; reported routinely if it bothers him or affects eating. |
Rows That Needed the Most Thought
The cough is expected, yet it matters. It sits in the expected column because it is common and harmless, but it is the effect most likely to make him stop the medicine on his own. Recording it and passing it on means the prescriber can consider switching to another drug class rather than losing blood pressure control.
The single swollen lip that has already resolved is the hardest row. Because the swelling went away, it could be recorded and forgotten. But angioedema from ACE inhibitors can recur while the drug continues, and later episodes can be worse, so it goes in both columns: expected in the sense that it is a known effect, but always worth a call before the next dose. His risk is higher because of the finding in the trial above.
The creatinine row depends on a number the nurse does not decide alone. The chart does not set a threshold; it records that the result is passed on with the baseline so the prescriber can judge the size of the change.
What Is Recorded
For rows in the expected column, the record is shorter but still specific: the effect, when it began, whether it is getting better or worse, and whether it is affecting his willingness to keep taking the medicine. A cough recorded only as "cough" cannot be compared at the next visit; a cough recorded as dry, worse at night, starting in week three, and making him consider stopping can be. Expected effects are also taught to him at the start, so that a cough or early lightheadedness does not frighten him into stopping, and so that he knows which changes, above all any swelling of the face or throat, mean he should call emergency services rather than wait.
For any row in the call column, the record carries the time the effect was noticed, the exact description, vital signs, whether he took his dose that day, and who was called and what they said. The patient is a composite; the sorting follows the course pharmacology text and the sources cited.
References
Burchum, J. R., & Rosenthal, L. D. (2022). Lehne's pharmacology for nursing care (11th ed.). Elsevier.
Dicpinigaitis, P. V. (2006). Angiotensin-converting enzyme inhibitor-induced cough: ACCP evidence-based clinical practice guidelines. Chest, 129(1 Suppl.), 169S-173S. https://doi.org/10.1378/chest.129.1_suppl.169S
Kostis, J. B., Kim, H. J., Rusnak, J., Casale, T., Kaplan, A., Corren, J., & Levy, E. (2005). Incidence and characteristics of angioedema associated with enalapril. Archives of Internal Medicine, 165(14), 1637-1642. https://doi.org/10.1001/archinte.165.14.1637
The Herzing NSG 124 Unit 6 instructions
Unit 6 asks you to sort a medication's adverse effects into those that are expected and those needing escalation. Expect to state the drug and setting, chart each effect, explain the difficult rows and say what is recorded. Many versions ask how many effects to include and how to handle effects that could go either way. Check whether your section names the drug. Expected effects still need recording and may still matter, such as a cough that leads to stopping. Serious effects, such as angioedema, always need escalation. Some effects depend on degree, such as a small or large rise in creatinine. Name thresholds where possible. Recording should be specific for both columns.
Inside the NSG 124 Unit 6 example
The chart opens with the drug and setting. The table lists ten effects with marks for expected, call or either. The difficult rows section explains the cough, the potassium rise, dizziness and the creatinine change, each with the threshold that would move it. Angioedema is explained as an emergency regardless of timing, including the higher risk in some groups. The recording section explains what to document for each column. The chart is compact and could sit beside a medication record. The reasoning section makes the judgment visible, so a nurse can see why each mark sits where it does rather than memorizing the chart. Each row also notes when the effect usually appears.
Reading the NSG 124 Unit 6 rubric
Herzing's rubric for an escalation chart typically covers accuracy of effects, correct sorting, thresholds for either effects, explanation of difficult rows and recording. Sorting is checked row by row, and a dangerous effect in the expected column costs heavily. Accuracy points reward effects the drug actually causes. Threshold criteria look for numbers that move an effect to the call column, such as a rise in creatinine above a set percentage. Explanation earns credit for reasoning on hard rows. Recording points go to specific documentation for both columns. Timing, such as angioedema appearing months after starting, is often credited. A clear key helps. Kostis's study of angioedema with ACE inhibitors supports the call column.
NSG 124 Unit 6 help before you submit
Escalation charts in Unit 6 commonly lose points by placing angioedema anywhere but the call column. Another frequent problem is treating expected effects as unimportant, though a cough often ends treatment. Students often give no thresholds for potassium or creatinine. Difficult rows are not explained. Recording is vague. Effects the drug does not cause are included. Timing is ignored, though angioedema can appear months later. Dizziness on standing is not linked to first-dose effects. Pregnancy, where ACE inhibitors are avoided, is left out. Finally, give thresholds for effects that depend on degree, because graders reward a chart that tells a nurse exactly when a small change becomes a reason to call.
Get a NSG 124 Unit 6 example written to your instructions
Send the Unit 6 instructions and the rubric from your NSG 124 classroom, and name the medication or class the chart has to cover. We write a custom example that lists the effects before sorting them, keeps every row an observation, argues each placement in line and marks the ambiguous ones. First custom sample free, returned in 24 to 48 hours.
More NSG 124 papers and BSN samples
- NSG 124 Unit 1: Route and form comparison
- NSG 124 Unit 2: Dose calculation worksheet
- NSG 124 Unit 3: Administration rights walkthrough
- NSG 124 Unit 4: Pre-dose assessment record
- NSG 124 Unit 5: Monitoring and counseling brief
- NSG 124 Unit 7: High alert medication file
- NSG 124 Unit 8: Drug classification table
- NSG 120 Unit 6: Condition study set
- NSG 121 Unit 6: Documentation practice set
- NSG 122 Unit 6: Safety and mobility plan
- NSG 123 Unit 6: Condition and nursing response paper
NSG 124 Unit 6 questions, answered
How do I decide which column an effect belongs in?
From your reading rather than from instinct, and say which reading in the row. Sources differ about where a particular effect sits, and settings differ again about when somebody would be called, so a placement with an attribution behind it survives a question that a confident one does not. Where two of your sources disagree, put the row in the marked group and explain the disagreement.
Is it acceptable for the ambiguous group to be large?
Within reason, yes, and a chart with none at all usually reads as tidied. Real effects overlap, and a writer who shows where the line is genuinely unclear demonstrates more control than one who sorts everything cleanly. Keep the group argued rather than open-ended, so each row explains what would move it into one column or the other.
Can I include effects I saw during my clinical hours?
No. Anything you observed on a real patient is the placement's and the patient's, never material for an assignment, and a graded file is the wrong place for it. A composite patient built from what your reading describes can show every row the chart needs, and it costs you nothing, since the credit here sits in the reasons.
Where can I find a free NSG 124 Unit 6 sample paper?
This page carries the complete NSG 124 Unit 6 lisinopril chart at no cost, ten effects sorted with thresholds and recording. A chart for another drug can be prepared on request.
Is a cough from lisinopril dangerous?
A dry cough is a common expected effect and not dangerous, but it often leads people to stop the drug, so it should be reported. Swelling of the lips or tongue is different and needs urgent care, as this sample explains.