NCLEX-RN Cardiovascular Pharmacology
Practice Questions |
20 NGN-Style MCQs with Rationales |
ATI-Inspired Nursing Exam Prep
Question 11
Clinical Scenario
A 67-year-old man with chronic heart failure is prescribed
spironolactone 25 mg orally daily in addition to furosemide and
metoprolol. During a follow-up clinic visit, the nurse reviews the
patient's medications and diet. Laboratory results include:
• Potassium: 5.7 mEq/L
• Sodium: 138 mEq/L
• Creatinine: 1.6 mg/dL
• Blood pressure: 118/72 mm Hg
The patient states, "I've been using a salt substitute because my
doctor told me to reduce sodium."
Question Stem
Which nursing action is the priority?
,A. Encourage continued use of the salt substitute.
B. Instruct the patient to discontinue the salt substitute and notify
the provider.
C. Recommend increasing foods rich in potassium.
D. Administer the next dose of spironolactone without additional
assessment.
Correct Answer
Correct Answer: B. Instruct the patient to discontinue the salt
substitute and notify the provider.
Detailed Rationale
Spironolactone is a potassium-sparing diuretic and aldosterone
antagonist commonly used in heart failure because it reduces
mortality and limits adverse cardiac remodeling. However, it
increases potassium retention. This patient already has
hyperkalemia (5.7 mEq/L), and many commercially available salt
substitutes contain potassium chloride, which can significantly
worsen potassium levels and increase the risk of life-threatening
dysrhythmias.
Option A is incorrect because continued use of potassium-
containing salt substitutes may further elevate serum potassium.
Option C is incorrect because increasing potassium intake is
contraindicated in this patient.
Option D is incorrect because the elevated potassium level requires
further assessment and provider notification before additional
doses are administered.
, The nurse should educate the patient to avoid potassium
supplements, potassium-containing salt substitutes, and excessive
consumption of high-potassium foods unless specifically instructed
otherwise. Ongoing monitoring should include serum potassium,
renal function, blood pressure, daily weight, and assessment for
muscle weakness, paresthesias, or palpitations. Patients with renal
impairment require especially close monitoring because reduced
potassium excretion substantially increases the risk of
hyperkalemia.
Learning Objectives
After completing this question, the learner should be able to:
• Identify medications that increase potassium levels.
• Recognize dietary contributors to hyperkalemia.
• Prioritize nursing interventions for elevated potassium.
• Educate patients receiving potassium-sparing diuretics.
Medication Safety Focus
Drug-Food Interaction
Question 12
Clinical Scenario
A 63-year-old woman is receiving an intravenous nitroglycerin
infusion for acute coronary syndrome. Thirty minutes after
initiation, the nurse notes the following:
• BP: 84/50 mm Hg
Practice Questions |
20 NGN-Style MCQs with Rationales |
ATI-Inspired Nursing Exam Prep
Question 11
Clinical Scenario
A 67-year-old man with chronic heart failure is prescribed
spironolactone 25 mg orally daily in addition to furosemide and
metoprolol. During a follow-up clinic visit, the nurse reviews the
patient's medications and diet. Laboratory results include:
• Potassium: 5.7 mEq/L
• Sodium: 138 mEq/L
• Creatinine: 1.6 mg/dL
• Blood pressure: 118/72 mm Hg
The patient states, "I've been using a salt substitute because my
doctor told me to reduce sodium."
Question Stem
Which nursing action is the priority?
,A. Encourage continued use of the salt substitute.
B. Instruct the patient to discontinue the salt substitute and notify
the provider.
C. Recommend increasing foods rich in potassium.
D. Administer the next dose of spironolactone without additional
assessment.
Correct Answer
Correct Answer: B. Instruct the patient to discontinue the salt
substitute and notify the provider.
Detailed Rationale
Spironolactone is a potassium-sparing diuretic and aldosterone
antagonist commonly used in heart failure because it reduces
mortality and limits adverse cardiac remodeling. However, it
increases potassium retention. This patient already has
hyperkalemia (5.7 mEq/L), and many commercially available salt
substitutes contain potassium chloride, which can significantly
worsen potassium levels and increase the risk of life-threatening
dysrhythmias.
Option A is incorrect because continued use of potassium-
containing salt substitutes may further elevate serum potassium.
Option C is incorrect because increasing potassium intake is
contraindicated in this patient.
Option D is incorrect because the elevated potassium level requires
further assessment and provider notification before additional
doses are administered.
, The nurse should educate the patient to avoid potassium
supplements, potassium-containing salt substitutes, and excessive
consumption of high-potassium foods unless specifically instructed
otherwise. Ongoing monitoring should include serum potassium,
renal function, blood pressure, daily weight, and assessment for
muscle weakness, paresthesias, or palpitations. Patients with renal
impairment require especially close monitoring because reduced
potassium excretion substantially increases the risk of
hyperkalemia.
Learning Objectives
After completing this question, the learner should be able to:
• Identify medications that increase potassium levels.
• Recognize dietary contributors to hyperkalemia.
• Prioritize nursing interventions for elevated potassium.
• Educate patients receiving potassium-sparing diuretics.
Medication Safety Focus
Drug-Food Interaction
Question 12
Clinical Scenario
A 63-year-old woman is receiving an intravenous nitroglycerin
infusion for acute coronary syndrome. Thirty minutes after
initiation, the nurse notes the following:
• BP: 84/50 mm Hg
