NCLEX-RN Cardiovascular Pharmacology
Practice Questions |
20 Original ATI & NGN-Style MCQs with
Detailed Rationales |
Nursing Exam Prep Study Guide
Question 1
Clinical Scenario
A 68-year-old man with hypertension and stable angina is
admitted for evaluation of intermittent chest discomfort. His
home medications include aspirin 81 mg daily, atorvastatin
40 mg nightly, lisinopril 20 mg daily, and metoprolol tartrate
50 mg twice daily. His blood pressure is 96/58 mm Hg, heart
rate is 48 beats/min, respiratory rate is 16 breaths/min,
oxygen saturation is 98% on room air, and he denies
dizziness or chest pain. The nurse is preparing to administer
the scheduled morning medications.
Question Stem
Which action should the nurse take first?
,A. Administer metoprolol as prescribed because it prevents
myocardial ischemia.
B. Withhold metoprolol and notify the healthcare provider of
the client's heart rate and blood pressure.
C. Administer atropine before giving metoprolol.
D. Give the metoprolol with food to reduce gastrointestinal
upset.
Correct Answer
Correct Answer: B. Withhold metoprolol and notify the
healthcare provider of the client's heart rate and blood
pressure.
Detailed Rationale
Metoprolol is a selective beta₁-adrenergic blocker that
decreases heart rate, myocardial contractility, and cardiac
oxygen demand. Although it is effective for hypertension,
angina, and secondary prevention after myocardial
infarction, administration should be carefully assessed
when the patient has significant bradycardia or hypotension.
A heart rate of 48 beats/min and blood pressure of 96/58 mm
Hg indicate that administering the medication could worsen
bradycardia, reduce cardiac output, and increase the risk for
syncope or cardiogenic complications. The nurse should
,withhold the medication and notify the provider after
completing an appropriate assessment.
Option A is incorrect because beta blockers should not be
administered automatically when assessment findings
indicate potential harm. Option C is incorrect because
atropine is not administered prophylactically; it is reserved
for symptomatic bradycardia or specific emergency
situations. Option D is incorrect because administering the
medication with food may reduce gastrointestinal irritation
but does not address the client's dangerously low heart rate
and blood pressure.
The nurse should continue monitoring heart rate, blood
pressure, signs of poor perfusion, and symptoms such as
dizziness, fatigue, or altered mental status before future
doses.
Learning Objectives
After completing this question, the learner should be able
to:
• Identify assessment findings that warrant withholding a
beta blocker.
• Prioritize nursing actions before administering
cardiovascular medications.
, • Recognize the effects of beta blockers on heart rate and
blood pressure.
• Communicate abnormal assessment findings to the
healthcare provider.
Medication Safety Focus
Monitoring Parameters
Question 2
Clinical Scenario
A 74-year-old woman with chronic heart failure is receiving
digoxin 0.125 mg orally once daily and furosemide 40 mg
daily. During morning assessment, she reports nausea,
decreased appetite, and seeing yellow halos around lights.
Her apical pulse is 54 beats/min. Laboratory results reveal a
serum potassium level of 2.9 mEq/L.
Question Stem
Which nursing action is the priority?
A. Administer the scheduled digoxin dose.
B. Encourage the client to increase fluid intake.
C. Withhold digoxin and notify the healthcare provider
immediately.
Practice Questions |
20 Original ATI & NGN-Style MCQs with
Detailed Rationales |
Nursing Exam Prep Study Guide
Question 1
Clinical Scenario
A 68-year-old man with hypertension and stable angina is
admitted for evaluation of intermittent chest discomfort. His
home medications include aspirin 81 mg daily, atorvastatin
40 mg nightly, lisinopril 20 mg daily, and metoprolol tartrate
50 mg twice daily. His blood pressure is 96/58 mm Hg, heart
rate is 48 beats/min, respiratory rate is 16 breaths/min,
oxygen saturation is 98% on room air, and he denies
dizziness or chest pain. The nurse is preparing to administer
the scheduled morning medications.
Question Stem
Which action should the nurse take first?
,A. Administer metoprolol as prescribed because it prevents
myocardial ischemia.
B. Withhold metoprolol and notify the healthcare provider of
the client's heart rate and blood pressure.
C. Administer atropine before giving metoprolol.
D. Give the metoprolol with food to reduce gastrointestinal
upset.
Correct Answer
Correct Answer: B. Withhold metoprolol and notify the
healthcare provider of the client's heart rate and blood
pressure.
Detailed Rationale
Metoprolol is a selective beta₁-adrenergic blocker that
decreases heart rate, myocardial contractility, and cardiac
oxygen demand. Although it is effective for hypertension,
angina, and secondary prevention after myocardial
infarction, administration should be carefully assessed
when the patient has significant bradycardia or hypotension.
A heart rate of 48 beats/min and blood pressure of 96/58 mm
Hg indicate that administering the medication could worsen
bradycardia, reduce cardiac output, and increase the risk for
syncope or cardiogenic complications. The nurse should
,withhold the medication and notify the provider after
completing an appropriate assessment.
Option A is incorrect because beta blockers should not be
administered automatically when assessment findings
indicate potential harm. Option C is incorrect because
atropine is not administered prophylactically; it is reserved
for symptomatic bradycardia or specific emergency
situations. Option D is incorrect because administering the
medication with food may reduce gastrointestinal irritation
but does not address the client's dangerously low heart rate
and blood pressure.
The nurse should continue monitoring heart rate, blood
pressure, signs of poor perfusion, and symptoms such as
dizziness, fatigue, or altered mental status before future
doses.
Learning Objectives
After completing this question, the learner should be able
to:
• Identify assessment findings that warrant withholding a
beta blocker.
• Prioritize nursing actions before administering
cardiovascular medications.
, • Recognize the effects of beta blockers on heart rate and
blood pressure.
• Communicate abnormal assessment findings to the
healthcare provider.
Medication Safety Focus
Monitoring Parameters
Question 2
Clinical Scenario
A 74-year-old woman with chronic heart failure is receiving
digoxin 0.125 mg orally once daily and furosemide 40 mg
daily. During morning assessment, she reports nausea,
decreased appetite, and seeing yellow halos around lights.
Her apical pulse is 54 beats/min. Laboratory results reveal a
serum potassium level of 2.9 mEq/L.
Question Stem
Which nursing action is the priority?
A. Administer the scheduled digoxin dose.
B. Encourage the client to increase fluid intake.
C. Withhold digoxin and notify the healthcare provider
immediately.
