NCLEX-RN Cardiovascular Pharmacology
Exam Questions & Answers |
20 Original NGN Practice MCQs with Detailed
Rationales |
ATI Pharmacology Made Easy Style | Nursing
Pharmacology Study Guide
Question 11
Clinical Scenario
A 67-year-old man is admitted to the telemetry unit with worsening
heart failure. His medical history includes hypertension, chronic
kidney disease (stage 3), and a prior myocardial infarction. The
provider prescribes the first dose of sacubitril/valsartan 49/51 mg
orally twice daily. During medication reconciliation, the nurse
notes that the client took lisinopril earlier that morning.
Question Stem
Which nursing action is the priority?
A. Administer sacubitril/valsartan as prescribed.
B. Hold sacubitril/valsartan and notify the healthcare provider.
C. Administer both medications with food to reduce gastrointestinal
upset.
,D. Reduce the dose of sacubitril/valsartan by half and administer it.
Correct Answer
Correct Answer: B. Hold sacubitril/valsartan and notify the
healthcare provider.
Detailed Rationale
Sacubitril/valsartan is an angiotensin receptor-neprilysin inhibitor
(ARNI) indicated for selected patients with heart failure with
reduced ejection fraction. Sacubitril inhibits neprilysin, increasing
beneficial natriuretic peptides, while valsartan blocks angiotensin II
receptors, reducing vasoconstriction and aldosterone secretion.
A 36-hour washout period is required when switching from an ACE
inhibitor (such as lisinopril) to sacubitril/valsartan. Administering
the medications too closely together substantially increases the risk
of life-threatening angioedema because both therapies increase
bradykinin activity. Since the client received lisinopril that morning,
the nurse should withhold the medication and immediately notify
the healthcare provider.
Option A is unsafe because it ignores a major contraindication.
Option C is incorrect because food does not eliminate the
interaction.
Option D is inappropriate because lowering the dose does not
reduce the risk of angioedema associated with inadequate washout.
, The nurse should also monitor blood pressure, renal function, and
serum potassium during therapy and educate patients to report
facial swelling, tongue swelling, or difficulty breathing immediately.
Learning Objectives
After completing this question, the learner should be able to:
• Identify contraindications to sacubitril/valsartan therapy.
• Explain the rationale for the 36-hour ACE inhibitor washout
period.
• Prioritize medication safety during medication reconciliation.
Medication Safety Focus
Medication reconciliation
Question 12
Clinical Scenario
A 59-year-old woman with chronic stable angina is prescribed a
transdermal nitroglycerin patch to prevent episodes of chest pain.
During a home health visit, the nurse reviews her medication
routine.
The client states that she applies a new patch every morning and
leaves the old patch in place because she believes "more
medication provides better protection."
Question Stem
Which nursing response is most appropriate?
Exam Questions & Answers |
20 Original NGN Practice MCQs with Detailed
Rationales |
ATI Pharmacology Made Easy Style | Nursing
Pharmacology Study Guide
Question 11
Clinical Scenario
A 67-year-old man is admitted to the telemetry unit with worsening
heart failure. His medical history includes hypertension, chronic
kidney disease (stage 3), and a prior myocardial infarction. The
provider prescribes the first dose of sacubitril/valsartan 49/51 mg
orally twice daily. During medication reconciliation, the nurse
notes that the client took lisinopril earlier that morning.
Question Stem
Which nursing action is the priority?
A. Administer sacubitril/valsartan as prescribed.
B. Hold sacubitril/valsartan and notify the healthcare provider.
C. Administer both medications with food to reduce gastrointestinal
upset.
,D. Reduce the dose of sacubitril/valsartan by half and administer it.
Correct Answer
Correct Answer: B. Hold sacubitril/valsartan and notify the
healthcare provider.
Detailed Rationale
Sacubitril/valsartan is an angiotensin receptor-neprilysin inhibitor
(ARNI) indicated for selected patients with heart failure with
reduced ejection fraction. Sacubitril inhibits neprilysin, increasing
beneficial natriuretic peptides, while valsartan blocks angiotensin II
receptors, reducing vasoconstriction and aldosterone secretion.
A 36-hour washout period is required when switching from an ACE
inhibitor (such as lisinopril) to sacubitril/valsartan. Administering
the medications too closely together substantially increases the risk
of life-threatening angioedema because both therapies increase
bradykinin activity. Since the client received lisinopril that morning,
the nurse should withhold the medication and immediately notify
the healthcare provider.
Option A is unsafe because it ignores a major contraindication.
Option C is incorrect because food does not eliminate the
interaction.
Option D is inappropriate because lowering the dose does not
reduce the risk of angioedema associated with inadequate washout.
, The nurse should also monitor blood pressure, renal function, and
serum potassium during therapy and educate patients to report
facial swelling, tongue swelling, or difficulty breathing immediately.
Learning Objectives
After completing this question, the learner should be able to:
• Identify contraindications to sacubitril/valsartan therapy.
• Explain the rationale for the 36-hour ACE inhibitor washout
period.
• Prioritize medication safety during medication reconciliation.
Medication Safety Focus
Medication reconciliation
Question 12
Clinical Scenario
A 59-year-old woman with chronic stable angina is prescribed a
transdermal nitroglycerin patch to prevent episodes of chest pain.
During a home health visit, the nurse reviews her medication
routine.
The client states that she applies a new patch every morning and
leaves the old patch in place because she believes "more
medication provides better protection."
Question Stem
Which nursing response is most appropriate?
