NCLEX-RN Cardiovascular Pharmacology Exam
|
20 NGN Practice Questions with Rationales |
Medication Safety & Clinical Judgment
Question 11 (Moderate)
Clinical Scenario
A 66-year-old man is admitted with worsening hypertension despite
lifestyle modifications. The provider prescribes amlodipine 5 mg orally
once daily. During discharge teaching, the patient asks what adverse
effects he should expect. His vital signs are BP 156/90 mm Hg, HR
76/min, RR 18/min, and no evidence of heart failure is noted.
Question Stem
Which adverse effect should the nurse instruct the patient to monitor
and report as a common effect of amlodipine therapy?
A. Persistent dry cough
B. Bilateral ankle swelling
C. Black, tarry stools
D. Tinnitus
Correct Answer
Correct Answer: B. Bilateral ankle swelling
,Detailed Rationale
Amlodipine is a dihydropyridine calcium channel blocker that relaxes
vascular smooth muscle, causing arterial vasodilation and reduced
systemic vascular resistance. A common adverse effect is peripheral
edema, particularly swelling of the ankles and feet. This occurs because
precapillary arteriolar dilation increases hydrostatic pressure within
capillaries, allowing fluid to move into surrounding tissues. Although
usually not dangerous, increasing edema should be reported because
dosage adjustment or medication changes may be necessary.
Option A is incorrect because a persistent dry cough is commonly
associated with ACE inhibitors rather than calcium channel blockers.
Option C is incorrect because black, tarry stools suggest gastrointestinal
bleeding and are not expected adverse effects of amlodipine.
Option D is incorrect because tinnitus is not a typical adverse effect of
amlodipine.
Nursing care includes monitoring blood pressure, assessing for
dizziness, encouraging slow position changes to reduce orthostatic
symptoms, and evaluating edema during follow-up visits. Patients
should avoid abruptly discontinuing antihypertensive therapy and
continue lifestyle modifications alongside medication use.
Learning Objectives
After completing this question, the learner should be able to:
• Identify common adverse effects of dihydropyridine calcium
channel blockers.
, • Educate patients regarding expected versus concerning
medication effects.
• Monitor patients for peripheral edema during therapy.
• Reinforce adherence to antihypertensive treatment.
Medication Safety Focus: Patient Education
Question 12 (Moderate)
Clinical Scenario
A 58-year-old woman is receiving an intravenous heparin infusion for
treatment of a pulmonary embolism. Six hours after therapy begins,
laboratory results reveal:
• aPTT: 102 seconds
• Platelets: 248,000/mm³
• Hemoglobin: 13.5 g/dL
The institution's therapeutic aPTT range is 60–80 seconds.
Question Stem
Which nursing action is the priority?
A. Increase the infusion rate.
B. Continue the infusion without changes.
C. Follow the heparin protocol by temporarily stopping or reducing the
infusion and notifying the provider.
D. Administer the scheduled warfarin dose immediately.
|
20 NGN Practice Questions with Rationales |
Medication Safety & Clinical Judgment
Question 11 (Moderate)
Clinical Scenario
A 66-year-old man is admitted with worsening hypertension despite
lifestyle modifications. The provider prescribes amlodipine 5 mg orally
once daily. During discharge teaching, the patient asks what adverse
effects he should expect. His vital signs are BP 156/90 mm Hg, HR
76/min, RR 18/min, and no evidence of heart failure is noted.
Question Stem
Which adverse effect should the nurse instruct the patient to monitor
and report as a common effect of amlodipine therapy?
A. Persistent dry cough
B. Bilateral ankle swelling
C. Black, tarry stools
D. Tinnitus
Correct Answer
Correct Answer: B. Bilateral ankle swelling
,Detailed Rationale
Amlodipine is a dihydropyridine calcium channel blocker that relaxes
vascular smooth muscle, causing arterial vasodilation and reduced
systemic vascular resistance. A common adverse effect is peripheral
edema, particularly swelling of the ankles and feet. This occurs because
precapillary arteriolar dilation increases hydrostatic pressure within
capillaries, allowing fluid to move into surrounding tissues. Although
usually not dangerous, increasing edema should be reported because
dosage adjustment or medication changes may be necessary.
Option A is incorrect because a persistent dry cough is commonly
associated with ACE inhibitors rather than calcium channel blockers.
Option C is incorrect because black, tarry stools suggest gastrointestinal
bleeding and are not expected adverse effects of amlodipine.
Option D is incorrect because tinnitus is not a typical adverse effect of
amlodipine.
Nursing care includes monitoring blood pressure, assessing for
dizziness, encouraging slow position changes to reduce orthostatic
symptoms, and evaluating edema during follow-up visits. Patients
should avoid abruptly discontinuing antihypertensive therapy and
continue lifestyle modifications alongside medication use.
Learning Objectives
After completing this question, the learner should be able to:
• Identify common adverse effects of dihydropyridine calcium
channel blockers.
, • Educate patients regarding expected versus concerning
medication effects.
• Monitor patients for peripheral edema during therapy.
• Reinforce adherence to antihypertensive treatment.
Medication Safety Focus: Patient Education
Question 12 (Moderate)
Clinical Scenario
A 58-year-old woman is receiving an intravenous heparin infusion for
treatment of a pulmonary embolism. Six hours after therapy begins,
laboratory results reveal:
• aPTT: 102 seconds
• Platelets: 248,000/mm³
• Hemoglobin: 13.5 g/dL
The institution's therapeutic aPTT range is 60–80 seconds.
Question Stem
Which nursing action is the priority?
A. Increase the infusion rate.
B. Continue the infusion without changes.
C. Follow the heparin protocol by temporarily stopping or reducing the
infusion and notifying the provider.
D. Administer the scheduled warfarin dose immediately.
