This comprehensive test bank contains 280 multiple-choice questions with correct answers
and detailed rationales.
It covers essential topics including angina management, nitroglycerin administration, beta-
blockers, calcium channel blockers, and antianginal pharmacotherapy.
Designed for NP students, it emphasizes clinical reasoning, drug interactions, adverse
effects, contraindications, and patient education.
Ideal for final exam preparation, this resource reinforces key pharmacological concepts
needed for safe and effective prescribing in cardiovascular care.
1. When administering topical nitroglycerin ointment, the nurse should use which technique?
A. The ointment should be applied on the chest over the heart.
B. The ointment should be used only in the case of a mild angina episode.
C. The old ointment should be removed before new ointment is applied.
D. The ointment should be massaged gently into the skin, then covered with plastic wrap.
Answer: C
Rationale: Old ointment must be removed to prevent accumulation and overdose. New
ointment is applied to a clean, hairless area, not over the heart, and should not be
massaged or covered with plastic wrap unless prescribed.
2. The nurse is giving intravenous nitroglycerin to a patient who has just been admitted
because of an acute myocardial infarction. Which statement is true regarding the
administration of the intravenous form of this medication?
A. Specific nonpolyvinylchloride (non-PVC) plastic intravenous bags and tubing must be
used.
B. It is stable for only 24 hours after preparation.
C. It can be given in infusions with other medications.
D. The solution will be slightly colored green or blue.
Answer: A
Rationale: Nitroglycerin adsorbs to PVC, reducing potency. Non-PVC bags and tubing are
required. It is stable for longer than 24 hours, should not be mixed with other drugs, and is
usually clear.
,3. A 53-year-old man has been admitted for evaluation of chest pain. He has been
diagnosed with angina and will be given a prescription for sublingual nitroglycerin
tablets. When teaching the patient how to use sublingual nitroglycerin, what instruction
should the nurse include?
A. Take up to five doses at 15-minute intervals for an angina attack.
B. If the tablet does not dissolve quickly, chew the tablet for maximal effect.
C. If the chest pain is not relieved after one tablet, call 911 immediately to activate
emergency medical services.
D. Wait 1 minute between doses of sublingual tablets, up to three doses.
Answer: C
Rationale: Standard protocol: take one tablet, if pain not relieved in 5 minutes, call 911.
Then take up to two more tablets at 5-minute intervals. Chewing is not recommended.
4. A 74-year-old professional golfer has chest pain that occurs toward the end of his
golfing games. He says the pain usually goes away after 1 or 2 sublingual nitroglycerin
tablets and rest. What type of angina does he have?
A. Classic
B. Variant
C. Unstable
D. Prinzmetal's
Answer: A
Rationale: Classic (chronic stable) angina is triggered by exertion and relieved by rest or
nitroglycerin. Variant/Prinzmetal's occurs at rest due to coronary spasm.
5. A patient arrives in the emergency department with severe chest pain. She says she has
had pain off and on for a week now. Which assessment finding would indicate the need
for cautious use of nitrates and nitrites?
A. Blood pressure of 98/68 mm Hg
B. History of liver disease
C. History of heart failure
D. History of a myocardial infarction 2 years ago
Answer: A
Rationale: Nitrates cause vasodilation and can worsen hypotension. A systolic BP below
100 mm Hg is a relative contraindication.
6. A calcium channel blocker (CCB) is prescribed for a patient, and the nurse provides
instructions to the patient about the medication. What does the nurse tell the patient?
A. The tablet should be chewed for faster release of the medication.
B. To increase the effect of the drug, take it with grapefruit juice.
C. If the adverse effects of chest pain, fainting, or dyspnea occur, discontinue the
medication immediately.
D. A high-fiber diet with plenty of fluids will help prevent the constipation that may occur.
,Answer: D
Rationale: CCBs like verapamil cause constipation. Grapefruit juice increases toxicity, not
effect. Chewing extended-release forms is dangerous. Abrupt withdrawal can cause
rebound effects.
7. When applying transdermal nitroglycerin patches, how will the nurse instruct the
patient?
A. "Use any nonhairy area on the body."
B. "Use only the chest area for application sites."
C. "Temporarily remove the patch if you go swimming."
D. "Apply the patch to the same site consistently."
Answer: A
Rationale: Patches can be applied to any nonhairy, clean, dry area. Sites should be
rotated to prevent skin irritation. They are waterproof and should not be removed for
swimming.
8. A patient has been taking a beta-blocker for 4 weeks as part of his antianginal
therapy. He also has type II diabetes and hyperthyroidism. When discussing possible
adverse effects, the nurse should include which information?
A. "Watch for unusual weight loss."
B. "Monitor your pulse for increased heart rate."
C. "Use the hot tub and sauna at the gym as long as time is limited to 15 minutes."
D. "Monitor your blood glucose levels for possible hypoglycemia or hyperglycemia."
Answer: D
Rationale: Beta-blockers can mask hypoglycemia symptoms (tachycardia, tremors) and
impair glucose metabolism. They cause bradycardia, not tachycardia. Hot tubs can cause
excessive vasodilation.
9. What action is recommended to help reduce the tolerance to transdermal nitroglycerin
therapy that commonly develops?
A. Omit a dose once a week.
B. Leave the patch on for 2 days at a time.
C. Cut the patch in half for a week until the tolerance subsides.
D. Remove the patch at bedtime, then apply a new one in the morning.
Answer: D
Rationale: A nitrate-free interval of 8–12 hours daily helps prevent tolerance. Removing
at night provides that interval. Patches should never be cut.
, 10. While assessing a patient who is taking a beta-blocker for angina, the nurse knows to
monitor for which adverse effect?
A. Nervousness
B. Hypertension
C. Bradycardia
D. Dry cough
Answer: C
Rationale: Beta-blockers decrease heart rate (negative chronotropic effect). Bradycardia
is a common adverse effect. Dry cough is associated with ACE inhibitors.
11. A patient with angina is prescribed diltiazem. The nurse should monitor for which
potential drug interaction?
A. Increased risk of bleeding with warfarin
B. Increased digoxin levels
C. Decreased effect of insulin
D. Increased effect of loop diuretics
Answer: B
Rationale: Diltiazem (a CCB) decreases hepatic clearance of digoxin, increasing its levels
and risk of toxicity.
12. Which of the following beta-blockers is considered cardioselective (beta-1 selective)?
A. Propranolol
B. Nadolol
C. Metoprolol
D. Timolol
Answer: C
Rationale: Metoprolol and atenolol are beta-1 selective. Propranolol, nadolol, and timolol
are non-selective (beta-1 and beta-2).
13. A patient on amlodipine reports peripheral edema. What is the nurse's best response?
A. "This means you are having an allergic reaction."
B. "This is a common side effect and is usually harmless."
C. "You should stop the medication immediately."
D. "This indicates kidney failure."
Answer: B
Rationale: Peripheral edema is a common side effect of dihydropyridine CCBs like
amlodipine due to vasodilation. It is not an allergic reaction or kidney failure and should
not be stopped abruptly.
and detailed rationales.
It covers essential topics including angina management, nitroglycerin administration, beta-
blockers, calcium channel blockers, and antianginal pharmacotherapy.
Designed for NP students, it emphasizes clinical reasoning, drug interactions, adverse
effects, contraindications, and patient education.
Ideal for final exam preparation, this resource reinforces key pharmacological concepts
needed for safe and effective prescribing in cardiovascular care.
1. When administering topical nitroglycerin ointment, the nurse should use which technique?
A. The ointment should be applied on the chest over the heart.
B. The ointment should be used only in the case of a mild angina episode.
C. The old ointment should be removed before new ointment is applied.
D. The ointment should be massaged gently into the skin, then covered with plastic wrap.
Answer: C
Rationale: Old ointment must be removed to prevent accumulation and overdose. New
ointment is applied to a clean, hairless area, not over the heart, and should not be
massaged or covered with plastic wrap unless prescribed.
2. The nurse is giving intravenous nitroglycerin to a patient who has just been admitted
because of an acute myocardial infarction. Which statement is true regarding the
administration of the intravenous form of this medication?
A. Specific nonpolyvinylchloride (non-PVC) plastic intravenous bags and tubing must be
used.
B. It is stable for only 24 hours after preparation.
C. It can be given in infusions with other medications.
D. The solution will be slightly colored green or blue.
Answer: A
Rationale: Nitroglycerin adsorbs to PVC, reducing potency. Non-PVC bags and tubing are
required. It is stable for longer than 24 hours, should not be mixed with other drugs, and is
usually clear.
,3. A 53-year-old man has been admitted for evaluation of chest pain. He has been
diagnosed with angina and will be given a prescription for sublingual nitroglycerin
tablets. When teaching the patient how to use sublingual nitroglycerin, what instruction
should the nurse include?
A. Take up to five doses at 15-minute intervals for an angina attack.
B. If the tablet does not dissolve quickly, chew the tablet for maximal effect.
C. If the chest pain is not relieved after one tablet, call 911 immediately to activate
emergency medical services.
D. Wait 1 minute between doses of sublingual tablets, up to three doses.
Answer: C
Rationale: Standard protocol: take one tablet, if pain not relieved in 5 minutes, call 911.
Then take up to two more tablets at 5-minute intervals. Chewing is not recommended.
4. A 74-year-old professional golfer has chest pain that occurs toward the end of his
golfing games. He says the pain usually goes away after 1 or 2 sublingual nitroglycerin
tablets and rest. What type of angina does he have?
A. Classic
B. Variant
C. Unstable
D. Prinzmetal's
Answer: A
Rationale: Classic (chronic stable) angina is triggered by exertion and relieved by rest or
nitroglycerin. Variant/Prinzmetal's occurs at rest due to coronary spasm.
5. A patient arrives in the emergency department with severe chest pain. She says she has
had pain off and on for a week now. Which assessment finding would indicate the need
for cautious use of nitrates and nitrites?
A. Blood pressure of 98/68 mm Hg
B. History of liver disease
C. History of heart failure
D. History of a myocardial infarction 2 years ago
Answer: A
Rationale: Nitrates cause vasodilation and can worsen hypotension. A systolic BP below
100 mm Hg is a relative contraindication.
6. A calcium channel blocker (CCB) is prescribed for a patient, and the nurse provides
instructions to the patient about the medication. What does the nurse tell the patient?
A. The tablet should be chewed for faster release of the medication.
B. To increase the effect of the drug, take it with grapefruit juice.
C. If the adverse effects of chest pain, fainting, or dyspnea occur, discontinue the
medication immediately.
D. A high-fiber diet with plenty of fluids will help prevent the constipation that may occur.
,Answer: D
Rationale: CCBs like verapamil cause constipation. Grapefruit juice increases toxicity, not
effect. Chewing extended-release forms is dangerous. Abrupt withdrawal can cause
rebound effects.
7. When applying transdermal nitroglycerin patches, how will the nurse instruct the
patient?
A. "Use any nonhairy area on the body."
B. "Use only the chest area for application sites."
C. "Temporarily remove the patch if you go swimming."
D. "Apply the patch to the same site consistently."
Answer: A
Rationale: Patches can be applied to any nonhairy, clean, dry area. Sites should be
rotated to prevent skin irritation. They are waterproof and should not be removed for
swimming.
8. A patient has been taking a beta-blocker for 4 weeks as part of his antianginal
therapy. He also has type II diabetes and hyperthyroidism. When discussing possible
adverse effects, the nurse should include which information?
A. "Watch for unusual weight loss."
B. "Monitor your pulse for increased heart rate."
C. "Use the hot tub and sauna at the gym as long as time is limited to 15 minutes."
D. "Monitor your blood glucose levels for possible hypoglycemia or hyperglycemia."
Answer: D
Rationale: Beta-blockers can mask hypoglycemia symptoms (tachycardia, tremors) and
impair glucose metabolism. They cause bradycardia, not tachycardia. Hot tubs can cause
excessive vasodilation.
9. What action is recommended to help reduce the tolerance to transdermal nitroglycerin
therapy that commonly develops?
A. Omit a dose once a week.
B. Leave the patch on for 2 days at a time.
C. Cut the patch in half for a week until the tolerance subsides.
D. Remove the patch at bedtime, then apply a new one in the morning.
Answer: D
Rationale: A nitrate-free interval of 8–12 hours daily helps prevent tolerance. Removing
at night provides that interval. Patches should never be cut.
, 10. While assessing a patient who is taking a beta-blocker for angina, the nurse knows to
monitor for which adverse effect?
A. Nervousness
B. Hypertension
C. Bradycardia
D. Dry cough
Answer: C
Rationale: Beta-blockers decrease heart rate (negative chronotropic effect). Bradycardia
is a common adverse effect. Dry cough is associated with ACE inhibitors.
11. A patient with angina is prescribed diltiazem. The nurse should monitor for which
potential drug interaction?
A. Increased risk of bleeding with warfarin
B. Increased digoxin levels
C. Decreased effect of insulin
D. Increased effect of loop diuretics
Answer: B
Rationale: Diltiazem (a CCB) decreases hepatic clearance of digoxin, increasing its levels
and risk of toxicity.
12. Which of the following beta-blockers is considered cardioselective (beta-1 selective)?
A. Propranolol
B. Nadolol
C. Metoprolol
D. Timolol
Answer: C
Rationale: Metoprolol and atenolol are beta-1 selective. Propranolol, nadolol, and timolol
are non-selective (beta-1 and beta-2).
13. A patient on amlodipine reports peripheral edema. What is the nurse's best response?
A. "This means you are having an allergic reaction."
B. "This is a common side effect and is usually harmless."
C. "You should stop the medication immediately."
D. "This indicates kidney failure."
Answer: B
Rationale: Peripheral edema is a common side effect of dihydropyridine CCBs like
amlodipine due to vasodilation. It is not an allergic reaction or kidney failure and should
not be stopped abruptly.
