NCLEX-RN Cardiovascular Pharmacology Exam
Prep |
20 Original NGN-Style Nursing Practice
Questions with Detailed Rationales
Question 1
Clinical Scenario
A 68-year-old man with hypertension, stable angina, and a
history of myocardial infarction is admitted for blood pressure
management. His medications include aspirin, atorvastatin,
lisinopril, and metoprolol. Before administering the morning
medications, the nurse assesses the following:
• Blood pressure: 118/72 mm Hg
• Heart rate: 48 beats/min
• Respiratory rate: 18 breaths/min
• Oxygen saturation: 98% on room air
• The client reports mild fatigue but denies chest pain or
dizziness.
,Question Stem
Which action should the nurse take regarding the scheduled
dose of metoprolol?
A. Administer the medication as prescribed because the blood
pressure is normal.
B. Hold the medication and notify the health care provider due
to bradycardia.
C. Administer half of the prescribed dose.
D. Encourage the client to ambulate before administering the
medication.
Correct Answer
Correct Answer: B. Hold the medication and notify the health
care provider due to bradycardia.
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 pulse. A heart rate below approximately
50–60 beats/min (depending on institutional policy and
provider parameters) may indicate excessive beta blockade and
warrants withholding the medication until further evaluation.
,Administering metoprolol in this situation could worsen
bradycardia, potentially leading to hypotension, syncope, or
decreased cardiac output.
Option A is incorrect because a normal blood pressure does not
override the significance of marked bradycardia. Option C is
inappropriate because nurses should never independently
adjust prescribed medication doses. Option D is unsafe because
ambulation could increase the risk of dizziness or falls in a client
with significant bradycardia.
The nurse should document the assessment findings, hold the
medication according to protocol, notify the provider, and
continue monitoring heart rate, blood pressure, and symptoms.
Patient teaching should include avoiding abrupt discontinuation
of beta blockers unless directed, as sudden withdrawal may
precipitate rebound hypertension or angina.
Learning Objectives
After completing this question, the learner should be able to:
• Assess heart rate before administering beta blockers.
• Identify when metoprolol should be withheld.
• Prioritize nursing interventions for medication safety.
• Explain appropriate monitoring for beta-blocker therapy.
Medication Safety Focus
, Monitoring Parameters
Question 2
Clinical Scenario
A 59-year-old woman is newly prescribed lisinopril for
hypertension. During discharge teaching, she asks the nurse
what side effects she should report. Her history includes type 2
diabetes and hyperlipidemia. Laboratory values are within
normal limits.
Question Stem
Which statement by the client indicates that further teaching is
needed?
A. "I will notify my provider if I develop swelling of my face or
tongue."
B. "A dry cough may occur while taking this medication."
C. "If I become pregnant, I should contact my provider
immediately."
D. "I should increase my intake of potassium-rich foods every
day."
Correct Answer
Prep |
20 Original NGN-Style Nursing Practice
Questions with Detailed Rationales
Question 1
Clinical Scenario
A 68-year-old man with hypertension, stable angina, and a
history of myocardial infarction is admitted for blood pressure
management. His medications include aspirin, atorvastatin,
lisinopril, and metoprolol. Before administering the morning
medications, the nurse assesses the following:
• Blood pressure: 118/72 mm Hg
• Heart rate: 48 beats/min
• Respiratory rate: 18 breaths/min
• Oxygen saturation: 98% on room air
• The client reports mild fatigue but denies chest pain or
dizziness.
,Question Stem
Which action should the nurse take regarding the scheduled
dose of metoprolol?
A. Administer the medication as prescribed because the blood
pressure is normal.
B. Hold the medication and notify the health care provider due
to bradycardia.
C. Administer half of the prescribed dose.
D. Encourage the client to ambulate before administering the
medication.
Correct Answer
Correct Answer: B. Hold the medication and notify the health
care provider due to bradycardia.
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 pulse. A heart rate below approximately
50–60 beats/min (depending on institutional policy and
provider parameters) may indicate excessive beta blockade and
warrants withholding the medication until further evaluation.
,Administering metoprolol in this situation could worsen
bradycardia, potentially leading to hypotension, syncope, or
decreased cardiac output.
Option A is incorrect because a normal blood pressure does not
override the significance of marked bradycardia. Option C is
inappropriate because nurses should never independently
adjust prescribed medication doses. Option D is unsafe because
ambulation could increase the risk of dizziness or falls in a client
with significant bradycardia.
The nurse should document the assessment findings, hold the
medication according to protocol, notify the provider, and
continue monitoring heart rate, blood pressure, and symptoms.
Patient teaching should include avoiding abrupt discontinuation
of beta blockers unless directed, as sudden withdrawal may
precipitate rebound hypertension or angina.
Learning Objectives
After completing this question, the learner should be able to:
• Assess heart rate before administering beta blockers.
• Identify when metoprolol should be withheld.
• Prioritize nursing interventions for medication safety.
• Explain appropriate monitoring for beta-blocker therapy.
Medication Safety Focus
, Monitoring Parameters
Question 2
Clinical Scenario
A 59-year-old woman is newly prescribed lisinopril for
hypertension. During discharge teaching, she asks the nurse
what side effects she should report. Her history includes type 2
diabetes and hyperlipidemia. Laboratory values are within
normal limits.
Question Stem
Which statement by the client indicates that further teaching is
needed?
A. "I will notify my provider if I develop swelling of my face or
tongue."
B. "A dry cough may occur while taking this medication."
C. "If I become pregnant, I should contact my provider
immediately."
D. "I should increase my intake of potassium-rich foods every
day."
Correct Answer
