NCLEX-RN Pharmacology Cardiovascular
System Exam |
20 Original NGN-Style Practice Questions
with Detailed Rationales |
ATI Pharmacology Made Easy Nursing
Study Guide
Question 11
Clinical Scenario
A 63-year-old man is admitted with acute decompensated heart
failure. The provider prescribes an intravenous nitroglycerin
infusion. Before initiating therapy, the nurse reviews the patient's
history. Current assessment findings include BP 138/82 mm Hg, HR
92/min, RR 20/min, and SpO₂ 95% on 2 L/min via nasal cannula.
Question Stem
Which finding requires the nurse to question the prescription
before starting the nitroglycerin infusion?
A. The client took sildenafil approximately 8 hours ago.
B. The client has a history of hypertension.
C. The client reports mild ankle edema.
D. The client has an ejection fraction of 35%.
,Correct Answer
Correct Answer: A. The client took sildenafil approximately 8
hours ago.
Detailed Rationale
Nitroglycerin is a potent vasodilator that reduces preload and
myocardial oxygen demand by relaxing vascular smooth muscle.
However, concurrent use with phosphodiesterase-5 (PDE-5)
inhibitors such as sildenafil is contraindicated because both
medications increase cyclic guanosine monophosphate (cGMP),
producing profound systemic vasodilation. This interaction can lead
to severe hypotension, syncope, myocardial ischemia, stroke, or
death. Because sildenafil was taken only 8 hours earlier, the nurse
should withhold the infusion and notify the provider immediately.
Option B is incorrect because hypertension is a common indication
for intravenous vasodilator therapy in selected patients with heart
failure. Option C is expected in heart failure and does not
contraindicate nitroglycerin administration. Option D is also
consistent with heart failure and supports the need for therapies
that reduce cardiac workload.
The nurse should continuously monitor blood pressure, heart rate,
chest pain, and symptoms of hypotension during nitroglycerin
therapy. Patients should also be educated never to combine nitrates
with PDE-5 inhibitors without explicit provider guidance and to
inform healthcare professionals of all prescription medications
before receiving emergency treatment.
Learning Objectives
, After completing this question, the learner should be able to:
• Identify absolute contraindications to nitrate therapy.
• Recognize dangerous cardiovascular drug interactions.
• Prioritize assessment before administering intravenous
vasodilators.
• Educate patients regarding nitrate safety.
Medication Safety Focus
Drug interaction
Question 12
Clinical Scenario
A 75-year-old woman with heart failure is receiving her morning
medications, including digoxin and furosemide. During
assessment, she reports fatigue, nausea, and seeing "yellow halos"
around lights. Her vital signs are BP 112/68 mm Hg and apical pulse
58/min. Laboratory results include potassium 3.0 mEq/L and serum
digoxin concentration 2.6 ng/mL.
Question Stem
Which nursing action is the priority?
A. Administer both medications with breakfast.
B. Hold digoxin, notify the provider, and continue cardiac
monitoring.
System Exam |
20 Original NGN-Style Practice Questions
with Detailed Rationales |
ATI Pharmacology Made Easy Nursing
Study Guide
Question 11
Clinical Scenario
A 63-year-old man is admitted with acute decompensated heart
failure. The provider prescribes an intravenous nitroglycerin
infusion. Before initiating therapy, the nurse reviews the patient's
history. Current assessment findings include BP 138/82 mm Hg, HR
92/min, RR 20/min, and SpO₂ 95% on 2 L/min via nasal cannula.
Question Stem
Which finding requires the nurse to question the prescription
before starting the nitroglycerin infusion?
A. The client took sildenafil approximately 8 hours ago.
B. The client has a history of hypertension.
C. The client reports mild ankle edema.
D. The client has an ejection fraction of 35%.
,Correct Answer
Correct Answer: A. The client took sildenafil approximately 8
hours ago.
Detailed Rationale
Nitroglycerin is a potent vasodilator that reduces preload and
myocardial oxygen demand by relaxing vascular smooth muscle.
However, concurrent use with phosphodiesterase-5 (PDE-5)
inhibitors such as sildenafil is contraindicated because both
medications increase cyclic guanosine monophosphate (cGMP),
producing profound systemic vasodilation. This interaction can lead
to severe hypotension, syncope, myocardial ischemia, stroke, or
death. Because sildenafil was taken only 8 hours earlier, the nurse
should withhold the infusion and notify the provider immediately.
Option B is incorrect because hypertension is a common indication
for intravenous vasodilator therapy in selected patients with heart
failure. Option C is expected in heart failure and does not
contraindicate nitroglycerin administration. Option D is also
consistent with heart failure and supports the need for therapies
that reduce cardiac workload.
The nurse should continuously monitor blood pressure, heart rate,
chest pain, and symptoms of hypotension during nitroglycerin
therapy. Patients should also be educated never to combine nitrates
with PDE-5 inhibitors without explicit provider guidance and to
inform healthcare professionals of all prescription medications
before receiving emergency treatment.
Learning Objectives
, After completing this question, the learner should be able to:
• Identify absolute contraindications to nitrate therapy.
• Recognize dangerous cardiovascular drug interactions.
• Prioritize assessment before administering intravenous
vasodilators.
• Educate patients regarding nitrate safety.
Medication Safety Focus
Drug interaction
Question 12
Clinical Scenario
A 75-year-old woman with heart failure is receiving her morning
medications, including digoxin and furosemide. During
assessment, she reports fatigue, nausea, and seeing "yellow halos"
around lights. Her vital signs are BP 112/68 mm Hg and apical pulse
58/min. Laboratory results include potassium 3.0 mEq/L and serum
digoxin concentration 2.6 ng/mL.
Question Stem
Which nursing action is the priority?
A. Administer both medications with breakfast.
B. Hold digoxin, notify the provider, and continue cardiac
monitoring.
