NCLEX-RN Pharmacology Cardiovascular
System Practice Questions |
20 Exam-Style MCQs with Rationales,
Medication Safety & Clinical Judgment Guide
Question 6
Clinical Scenario
A 72-year-old client with acute decompensated heart failure is
receiving furosemide 40 mg IV twice daily. During the morning
assessment, the nurse notes the following:
• BP: 102/64 mm Hg
• HR: 88/min
• Urine output: 2,800 mL over 24 hours
• Potassium: 2.9 mEq/L
• Reports muscle weakness and leg cramps
Question Stem
Which nursing action is the priority?
• Administer the scheduled dose of furosemide.
, • Hold the medication and notify the provider about the
potassium level.
• Encourage the client to increase fluid intake immediately.
• Place the client in a supine position and reassess in 1 hour.
Correct Answer
B. Hold the medication and notify the provider about the
potassium level.
Detailed Rationale
Furosemide is a loop diuretic that promotes excretion of
sodium, chloride, and water, but it also causes significant
potassium loss. A potassium level of 2.9 mEq/L represents
clinically significant hypokalemia and places the client at risk for
ventricular dysrhythmias, especially in older adults and those
with heart disease. Muscle weakness and leg cramps are
additional manifestations of potassium depletion.
The nurse should hold the next dose and notify the provider so
potassium replacement and further evaluation can occur before
additional diuresis worsens the imbalance.
Option A is unsafe because continued diuresis could further
decrease potassium levels.
Option C is inappropriate because fluid intake does not correct
severe hypokalemia and may worsen heart failure if excessive.
,Option D does not address the underlying electrolyte
abnormality that poses the greatest immediate risk.
Nursing priorities include continuous cardiac monitoring if
indicated, assessment for dysrhythmias, monitoring urine
output, and reviewing concurrent medications such as digoxin,
which becomes more toxic in the presence of hypokalemia.
Learning Objective
• Recognize hypokalemia as a serious adverse effect of loop
diuretics.
• Prioritize electrolyte assessment before diuretic
administration.
• Identify symptoms associated with potassium depletion.
• Implement appropriate nursing interventions for diuretic-
induced electrolyte imbalance.
Medication Safety Focus
Monitoring: Electrolytes during loop diuretic therapy.
Question 7
Clinical Scenario
A 63-year-old client is admitted with rapid atrial fibrillation and
is receiving an amiodarone IV infusion. The nurse reviews the
telemetry strip and current assessment findings:
, • HR: 52/min
• BP: 94/58 mm Hg
• QT interval appears prolonged on telemetry
• Client reports lightheadedness
Question Stem
Which nursing action is the priority?
• Continue the infusion and document the findings.
• Slow the infusion rate and reassess in 30 minutes.
• Stop the infusion and notify the provider immediately.
• Encourage the client to ambulate to improve circulation.
Correct Answer
C. Stop the infusion and notify the provider immediately.
Detailed Rationale
Amiodarone is a class III antiarrhythmic that prolongs
repolarization and can cause bradycardia, hypotension, and QT
prolongation. The combination of symptomatic bradycardia,
hypotension, and prolonged QT interval suggests excessive
antiarrhythmic effect and increased risk for serious ventricular
dysrhythmias such as torsades de pointes.
System Practice Questions |
20 Exam-Style MCQs with Rationales,
Medication Safety & Clinical Judgment Guide
Question 6
Clinical Scenario
A 72-year-old client with acute decompensated heart failure is
receiving furosemide 40 mg IV twice daily. During the morning
assessment, the nurse notes the following:
• BP: 102/64 mm Hg
• HR: 88/min
• Urine output: 2,800 mL over 24 hours
• Potassium: 2.9 mEq/L
• Reports muscle weakness and leg cramps
Question Stem
Which nursing action is the priority?
• Administer the scheduled dose of furosemide.
, • Hold the medication and notify the provider about the
potassium level.
• Encourage the client to increase fluid intake immediately.
• Place the client in a supine position and reassess in 1 hour.
Correct Answer
B. Hold the medication and notify the provider about the
potassium level.
Detailed Rationale
Furosemide is a loop diuretic that promotes excretion of
sodium, chloride, and water, but it also causes significant
potassium loss. A potassium level of 2.9 mEq/L represents
clinically significant hypokalemia and places the client at risk for
ventricular dysrhythmias, especially in older adults and those
with heart disease. Muscle weakness and leg cramps are
additional manifestations of potassium depletion.
The nurse should hold the next dose and notify the provider so
potassium replacement and further evaluation can occur before
additional diuresis worsens the imbalance.
Option A is unsafe because continued diuresis could further
decrease potassium levels.
Option C is inappropriate because fluid intake does not correct
severe hypokalemia and may worsen heart failure if excessive.
,Option D does not address the underlying electrolyte
abnormality that poses the greatest immediate risk.
Nursing priorities include continuous cardiac monitoring if
indicated, assessment for dysrhythmias, monitoring urine
output, and reviewing concurrent medications such as digoxin,
which becomes more toxic in the presence of hypokalemia.
Learning Objective
• Recognize hypokalemia as a serious adverse effect of loop
diuretics.
• Prioritize electrolyte assessment before diuretic
administration.
• Identify symptoms associated with potassium depletion.
• Implement appropriate nursing interventions for diuretic-
induced electrolyte imbalance.
Medication Safety Focus
Monitoring: Electrolytes during loop diuretic therapy.
Question 7
Clinical Scenario
A 63-year-old client is admitted with rapid atrial fibrillation and
is receiving an amiodarone IV infusion. The nurse reviews the
telemetry strip and current assessment findings:
, • HR: 52/min
• BP: 94/58 mm Hg
• QT interval appears prolonged on telemetry
• Client reports lightheadedness
Question Stem
Which nursing action is the priority?
• Continue the infusion and document the findings.
• Slow the infusion rate and reassess in 30 minutes.
• Stop the infusion and notify the provider immediately.
• Encourage the client to ambulate to improve circulation.
Correct Answer
C. Stop the infusion and notify the provider immediately.
Detailed Rationale
Amiodarone is a class III antiarrhythmic that prolongs
repolarization and can cause bradycardia, hypotension, and QT
prolongation. The combination of symptomatic bradycardia,
hypotension, and prolonged QT interval suggests excessive
antiarrhythmic effect and increased risk for serious ventricular
dysrhythmias such as torsades de pointes.
