NCLEX-RN Cardiovascular Pharmacology
Practice Questions |
20 NCLEX-Style MCQs with Rationales |
ATI & NGN Exam Prep
Question 6
Clinical Scenario
A 66-year-old man with chronic hypertension and stable angina
is prescribed metoprolol tartrate 50 mg orally twice daily.
During morning assessment, the nurse obtains the following
findings: blood pressure 112/68 mm Hg, apical pulse 52/min,
respiratory rate 16/min, oxygen saturation 98% on room air,
and blood glucose 118 mg/dL. The client reports mild fatigue
but denies chest pain or dizziness.
Question Stem
Which nursing action is most appropriate?
A. Administer the medication as prescribed because the blood
pressure is within the target range.
B. Hold the medication and notify the provider due to the
client's heart rate.
,C. Administer the medication with grapefruit juice to improve
absorption.
D. Instruct the client to take an additional dose if chest pain
develops later in the day.
Correct Answer
Correct Answer: B. Hold the medication and notify the
provider due to the client's heart rate.
Detailed Rationale
Metoprolol is a cardioselective beta₁-adrenergic blocker that
decreases heart rate, myocardial contractility, and blood
pressure, thereby reducing myocardial oxygen demand. Before
administering beta blockers, nurses should assess both blood
pressure and apical heart rate. An apical pulse of 52 beats/min
is below the commonly accepted threshold (often <60
beats/min) for administering the medication and increases the
risk of symptomatic bradycardia, hypotension, and decreased
cardiac output. The nurse should withhold the dose and notify
the provider for further instructions.
Option A is incorrect because a normal blood pressure does not
outweigh the significance of marked bradycardia.
Option C is incorrect because grapefruit juice does not improve
metoprolol therapy and is not routinely recommended.
,Option D is incorrect because clients should never self-adjust
beta-blocker doses. Sudden dosage changes may lead to
rebound hypertension or angina.
Patient teaching should include checking pulse when instructed,
rising slowly to prevent orthostatic hypotension, avoiding
abrupt discontinuation, and reporting dizziness, syncope, or
worsening fatigue. Continuous monitoring is particularly
important in older adults and clients with conduction
abnormalities.
Learning Objectives
After completing this question, the learner should be able to:
• Assess heart rate before administering beta blockers.
• Recognize when beta-blocker therapy should be withheld.
• Educate clients about safe beta-blocker use.
Medication Safety Focus
Medication Administration
Question 7
Clinical Scenario
A 70-year-old woman with newly diagnosed atrial fibrillation is
started on apixaban 5 mg orally twice daily. During discharge
, teaching, the nurse evaluates the client's understanding of the
medication.
Question Stem
Which client statement indicates a need for further teaching?
A. "I should use a soft-bristled toothbrush."
B. "I will let my dentist know that I take this medication."
C. "If I miss a dose, I will double the next dose."
D. "I should report black or bloody stools immediately."
Correct Answer
Correct Answer: C. "If I miss a dose, I will double the next
dose."
Detailed Rationale
Apixaban is a direct factor Xa inhibitor that reduces thrombus
formation and lowers the risk of stroke in clients with
nonvalvular atrial fibrillation. Because anticoagulants increase
bleeding risk, consistent administration is essential. However,
doubling the next dose after a missed dose is unsafe because it
significantly increases the risk of major bleeding. Clients should
follow the prescribed instructions for missed doses and never
compensate by taking extra medication.
Option A is correct teaching because soft-bristled toothbrushes
help minimize gum trauma and bleeding.
Practice Questions |
20 NCLEX-Style MCQs with Rationales |
ATI & NGN Exam Prep
Question 6
Clinical Scenario
A 66-year-old man with chronic hypertension and stable angina
is prescribed metoprolol tartrate 50 mg orally twice daily.
During morning assessment, the nurse obtains the following
findings: blood pressure 112/68 mm Hg, apical pulse 52/min,
respiratory rate 16/min, oxygen saturation 98% on room air,
and blood glucose 118 mg/dL. The client reports mild fatigue
but denies chest pain or dizziness.
Question Stem
Which nursing action is most appropriate?
A. Administer the medication as prescribed because the blood
pressure is within the target range.
B. Hold the medication and notify the provider due to the
client's heart rate.
,C. Administer the medication with grapefruit juice to improve
absorption.
D. Instruct the client to take an additional dose if chest pain
develops later in the day.
Correct Answer
Correct Answer: B. Hold the medication and notify the
provider due to the client's heart rate.
Detailed Rationale
Metoprolol is a cardioselective beta₁-adrenergic blocker that
decreases heart rate, myocardial contractility, and blood
pressure, thereby reducing myocardial oxygen demand. Before
administering beta blockers, nurses should assess both blood
pressure and apical heart rate. An apical pulse of 52 beats/min
is below the commonly accepted threshold (often <60
beats/min) for administering the medication and increases the
risk of symptomatic bradycardia, hypotension, and decreased
cardiac output. The nurse should withhold the dose and notify
the provider for further instructions.
Option A is incorrect because a normal blood pressure does not
outweigh the significance of marked bradycardia.
Option C is incorrect because grapefruit juice does not improve
metoprolol therapy and is not routinely recommended.
,Option D is incorrect because clients should never self-adjust
beta-blocker doses. Sudden dosage changes may lead to
rebound hypertension or angina.
Patient teaching should include checking pulse when instructed,
rising slowly to prevent orthostatic hypotension, avoiding
abrupt discontinuation, and reporting dizziness, syncope, or
worsening fatigue. Continuous monitoring is particularly
important in older adults and clients with conduction
abnormalities.
Learning Objectives
After completing this question, the learner should be able to:
• Assess heart rate before administering beta blockers.
• Recognize when beta-blocker therapy should be withheld.
• Educate clients about safe beta-blocker use.
Medication Safety Focus
Medication Administration
Question 7
Clinical Scenario
A 70-year-old woman with newly diagnosed atrial fibrillation is
started on apixaban 5 mg orally twice daily. During discharge
, teaching, the nurse evaluates the client's understanding of the
medication.
Question Stem
Which client statement indicates a need for further teaching?
A. "I should use a soft-bristled toothbrush."
B. "I will let my dentist know that I take this medication."
C. "If I miss a dose, I will double the next dose."
D. "I should report black or bloody stools immediately."
Correct Answer
Correct Answer: C. "If I miss a dose, I will double the next
dose."
Detailed Rationale
Apixaban is a direct factor Xa inhibitor that reduces thrombus
formation and lowers the risk of stroke in clients with
nonvalvular atrial fibrillation. Because anticoagulants increase
bleeding risk, consistent administration is essential. However,
doubling the next dose after a missed dose is unsafe because it
significantly increases the risk of major bleeding. Clients should
follow the prescribed instructions for missed doses and never
compensate by taking extra medication.
Option A is correct teaching because soft-bristled toothbrushes
help minimize gum trauma and bleeding.
