NCLEX-RN Cardiovascular Pharmacology
Exam Questions & Rationales |
20 NGN-Style Medication Safety MCQs |
ATI Pharmacology Review
Question 1
Clinical Scenario
A 62-year-old male with hypertension is prescribed lisinopril 10 mg
daily. During a follow-up visit, he reports a persistent dry cough that
began 3 weeks after starting the medication. Blood pressure is
128/78 mm Hg, and renal function is normal.
Question Stem
Which action should the nurse anticipate?
A. Continue lisinopril and reassure the client that the cough is
unrelated
B. Notify the provider because the cough may be an adverse effect
of lisinopril
C. Administer a cough suppressant before each dose
D. Instruct the client to discontinue the medication immediately
Correct Answer
,Correct Answer: B. Notify the provider because the cough may
be an adverse effect of lisinopril
Detailed Rationale
ACE inhibitors such as lisinopril commonly cause a persistent,
nonproductive cough due to accumulation of bradykinin. Although
not usually life-threatening, the cough can significantly affect
adherence and quality of life. The nurse should notify the provider
because an alternative medication, such as an angiotensin II
receptor blocker (ARB), may be prescribed.
Option A is incorrect because the cough is a known adverse effect.
Option C may mask symptoms but does not address the underlying
cause. Option D is incorrect because abrupt discontinuation
without provider guidance may lead to uncontrolled hypertension.
The nurse should also monitor renal function, potassium levels, and
signs of angioedema. Patient teaching should include reporting
swelling of the face, lips, or tongue immediately because
angioedema is a potentially life-threatening adverse effect.
Learning Objective
After completing this question, the learner should be able to:
• Recognize common adverse effects of ACE inhibitors.
• Differentiate expected versus reportable medication reactions.
• Identify appropriate nursing actions for medication-related
cough.
Medication Safety Focus
, Adverse Effect Monitoring
Question 2
Clinical Scenario
A 75-year-old female is admitted with heart failure and receives
digoxin 0.125 mg daily. Morning assessment reveals nausea,
decreased appetite, and yellow-green halos around lights. Apical
pulse is 54/min.
Question Stem
Which action should the nurse take first?
A. Administer the scheduled digoxin dose
B. Encourage oral fluids
C. Hold the medication and notify the provider
D. Obtain a blood pressure reading
Correct Answer
Correct Answer: C. Hold the medication and notify the provider
Detailed Rationale
The client exhibits classic signs of digoxin toxicity, including visual
disturbances, nausea, anorexia, and bradycardia. An apical pulse
below 60/min is generally a reason to withhold digoxin and notify the
provider. Digoxin toxicity is more common in older adults due to
decreased renal clearance.
Option A is unsafe because administering another dose may worsen
toxicity. Option B is not the priority intervention. Option D may
Exam Questions & Rationales |
20 NGN-Style Medication Safety MCQs |
ATI Pharmacology Review
Question 1
Clinical Scenario
A 62-year-old male with hypertension is prescribed lisinopril 10 mg
daily. During a follow-up visit, he reports a persistent dry cough that
began 3 weeks after starting the medication. Blood pressure is
128/78 mm Hg, and renal function is normal.
Question Stem
Which action should the nurse anticipate?
A. Continue lisinopril and reassure the client that the cough is
unrelated
B. Notify the provider because the cough may be an adverse effect
of lisinopril
C. Administer a cough suppressant before each dose
D. Instruct the client to discontinue the medication immediately
Correct Answer
,Correct Answer: B. Notify the provider because the cough may
be an adverse effect of lisinopril
Detailed Rationale
ACE inhibitors such as lisinopril commonly cause a persistent,
nonproductive cough due to accumulation of bradykinin. Although
not usually life-threatening, the cough can significantly affect
adherence and quality of life. The nurse should notify the provider
because an alternative medication, such as an angiotensin II
receptor blocker (ARB), may be prescribed.
Option A is incorrect because the cough is a known adverse effect.
Option C may mask symptoms but does not address the underlying
cause. Option D is incorrect because abrupt discontinuation
without provider guidance may lead to uncontrolled hypertension.
The nurse should also monitor renal function, potassium levels, and
signs of angioedema. Patient teaching should include reporting
swelling of the face, lips, or tongue immediately because
angioedema is a potentially life-threatening adverse effect.
Learning Objective
After completing this question, the learner should be able to:
• Recognize common adverse effects of ACE inhibitors.
• Differentiate expected versus reportable medication reactions.
• Identify appropriate nursing actions for medication-related
cough.
Medication Safety Focus
, Adverse Effect Monitoring
Question 2
Clinical Scenario
A 75-year-old female is admitted with heart failure and receives
digoxin 0.125 mg daily. Morning assessment reveals nausea,
decreased appetite, and yellow-green halos around lights. Apical
pulse is 54/min.
Question Stem
Which action should the nurse take first?
A. Administer the scheduled digoxin dose
B. Encourage oral fluids
C. Hold the medication and notify the provider
D. Obtain a blood pressure reading
Correct Answer
Correct Answer: C. Hold the medication and notify the provider
Detailed Rationale
The client exhibits classic signs of digoxin toxicity, including visual
disturbances, nausea, anorexia, and bradycardia. An apical pulse
below 60/min is generally a reason to withhold digoxin and notify the
provider. Digoxin toxicity is more common in older adults due to
decreased renal clearance.
Option A is unsafe because administering another dose may worsen
toxicity. Option B is not the priority intervention. Option D may
