NCLEX-RN Cardiovascular Pharmacology
Practice Questions |
20 NGN-Style MCQs with Rationales |
ATI Pharmacology Made Easy Exam Prep
NCLEX-RN Pharmacology Practice Exam – Cardiovascular System (Part
3)
Questions 11–15
Question 11
Clinical Scenario
A 64-year-old man with chronic stable angina arrives at the emergency
department complaining of substernal chest pressure rated 7/10. His
home medications include aspirin, atorvastatin, metoprolol, and
sublingual nitroglycerin. Vital signs are BP 90/58 mm Hg, HR 56/min, RR
18/min, and SpO₂ 97% on room air. The provider prescribes one
sublingual nitroglycerin tablet.
Question Stem
What is the nurse's priority action before administering the medication?
A. Administer the nitroglycerin immediately because chest pain is
present.
,B. Assess the patient's pain score again after administering the
medication.
C. Verify the blood pressure and notify the healthcare provider of the
hypotension.
D. Encourage the patient to drink water before receiving the
medication.
Correct Answer
Correct Answer: C. Verify the blood pressure and notify the healthcare
provider of the hypotension.
Detailed Rationale
Nitroglycerin causes venous and arterial vasodilation, reducing preload
and myocardial oxygen demand. However, it is contraindicated or
should be used with extreme caution in patients with significant
hypotension, as additional vasodilation may lead to cardiovascular
collapse and reduced coronary perfusion. This patient's BP of 90/58
mm Hg is already low, making administration potentially dangerous.
The nurse should first verify the blood pressure, assess for symptoms of
poor perfusion, and notify the healthcare provider before giving the
medication.
Option A: Although relieving chest pain is important, administering
nitroglycerin without evaluating hypotension could worsen the patient's
condition.
Option B: Pain reassessment is appropriate after administration but is
not the priority before giving the medication.
, Option D: Drinking water will not correct medication-induced
hypotension and delays appropriate clinical intervention.
Nursing care includes continuous cardiac monitoring, reassessment of
vital signs, evaluation for contraindications such as recent PDE-5
inhibitor use, and preparation for alternative interventions if
nitroglycerin is withheld.
Learning Objectives
After completing this question, the learner should be able to:
• Identify contraindications to nitroglycerin administration.
• Prioritize nursing assessment before administering nitrates.
• Recognize hypotension as a safety concern.
• Apply clinical judgment in medication administration.
Medication Safety Focus
Contraindication
Question 12
Clinical Scenario
A 76-year-old woman with heart failure has been taking digoxin and
furosemide for several months. During morning rounds, she reports
increasing fatigue and intermittent palpitations. Laboratory results
reveal potassium 3.1 mEq/L, magnesium 1.5 mg/dL, creatinine 1.8
mg/dL, and digoxin level 1.8 ng/mL.
Question Stem
Practice Questions |
20 NGN-Style MCQs with Rationales |
ATI Pharmacology Made Easy Exam Prep
NCLEX-RN Pharmacology Practice Exam – Cardiovascular System (Part
3)
Questions 11–15
Question 11
Clinical Scenario
A 64-year-old man with chronic stable angina arrives at the emergency
department complaining of substernal chest pressure rated 7/10. His
home medications include aspirin, atorvastatin, metoprolol, and
sublingual nitroglycerin. Vital signs are BP 90/58 mm Hg, HR 56/min, RR
18/min, and SpO₂ 97% on room air. The provider prescribes one
sublingual nitroglycerin tablet.
Question Stem
What is the nurse's priority action before administering the medication?
A. Administer the nitroglycerin immediately because chest pain is
present.
,B. Assess the patient's pain score again after administering the
medication.
C. Verify the blood pressure and notify the healthcare provider of the
hypotension.
D. Encourage the patient to drink water before receiving the
medication.
Correct Answer
Correct Answer: C. Verify the blood pressure and notify the healthcare
provider of the hypotension.
Detailed Rationale
Nitroglycerin causes venous and arterial vasodilation, reducing preload
and myocardial oxygen demand. However, it is contraindicated or
should be used with extreme caution in patients with significant
hypotension, as additional vasodilation may lead to cardiovascular
collapse and reduced coronary perfusion. This patient's BP of 90/58
mm Hg is already low, making administration potentially dangerous.
The nurse should first verify the blood pressure, assess for symptoms of
poor perfusion, and notify the healthcare provider before giving the
medication.
Option A: Although relieving chest pain is important, administering
nitroglycerin without evaluating hypotension could worsen the patient's
condition.
Option B: Pain reassessment is appropriate after administration but is
not the priority before giving the medication.
, Option D: Drinking water will not correct medication-induced
hypotension and delays appropriate clinical intervention.
Nursing care includes continuous cardiac monitoring, reassessment of
vital signs, evaluation for contraindications such as recent PDE-5
inhibitor use, and preparation for alternative interventions if
nitroglycerin is withheld.
Learning Objectives
After completing this question, the learner should be able to:
• Identify contraindications to nitroglycerin administration.
• Prioritize nursing assessment before administering nitrates.
• Recognize hypotension as a safety concern.
• Apply clinical judgment in medication administration.
Medication Safety Focus
Contraindication
Question 12
Clinical Scenario
A 76-year-old woman with heart failure has been taking digoxin and
furosemide for several months. During morning rounds, she reports
increasing fatigue and intermittent palpitations. Laboratory results
reveal potassium 3.1 mEq/L, magnesium 1.5 mg/dL, creatinine 1.8
mg/dL, and digoxin level 1.8 ng/mL.
Question Stem
