NCLEX-RN Cardiovascular Pharmacology
Practice Questions |
20 Original NGN-Style MCQs with Detailed
Rationales |
ATI Pharmacology Made Easy Review
Question 11
Clinical Scenario
A 67-year-old man is admitted with acute decompensated heart
failure. He is receiving spironolactone 25 mg orally daily in
addition to furosemide and lisinopril. During morning rounds, the
nurse reviews the following laboratory results:
• Potassium: 5.8 mEq/L
• Sodium: 136 mEq/L
• Creatinine: 2.1 mg/dL (baseline 1.1 mg/dL)
• Blood pressure: 116/70 mm Hg
• Heart rate: 78 beats/min
The client reports mild muscle weakness but denies chest pain.
Question Stem
,Which nursing action is the priority?
A. Administer the scheduled dose of spironolactone.
B. Hold the spironolactone and notify the healthcare provider.
C. Encourage the client to eat foods rich in potassium.
D. Restrict fluid intake immediately.
Correct Answer
Correct Answer: B. Hold the spironolactone and notify the
healthcare provider.
Detailed Rationale
Spironolactone is a potassium-sparing diuretic and aldosterone
antagonist commonly used to improve survival in heart failure.
While it helps reduce sodium and water retention, it decreases
potassium excretion, increasing the risk of hyperkalemia. This
client has a potassium level of 5.8 mEq/L, elevated creatinine, and
muscle weakness—all findings concerning for hyperkalemia and
declining renal function.
The nurse should withhold spironolactone and notify the
healthcare provider immediately. Hyperkalemia can lead to life-
threatening cardiac dysrhythmias, particularly in patients taking
ACE inhibitors such as lisinopril, which also increase serum
potassium. Continuous ECG monitoring and repeat laboratory
testing may be indicated.
• Option A is unsafe because another dose could further
increase potassium.
, • Option C is contraindicated because potassium intake should
be limited until hyperkalemia resolves.
• Option D does not address the immediate medication-related
safety concern.
Patient education should include avoiding potassium supplements
and salt substitutes containing potassium unless specifically
prescribed. Regular monitoring of renal function and electrolytes is
essential, especially in older adults and those with chronic kidney
disease.
Learning Objectives
After completing this question, the learner should be able to:
• Identify hyperkalemia associated with potassium-sparing
diuretics.
• Recognize the interaction between spironolactone and ACE
inhibitors.
• Prioritize interventions for abnormal electrolyte values.
• Educate patients regarding potassium restrictions.
Medication Safety Focus
Laboratory Monitoring
Question 12
Clinical Scenario
Practice Questions |
20 Original NGN-Style MCQs with Detailed
Rationales |
ATI Pharmacology Made Easy Review
Question 11
Clinical Scenario
A 67-year-old man is admitted with acute decompensated heart
failure. He is receiving spironolactone 25 mg orally daily in
addition to furosemide and lisinopril. During morning rounds, the
nurse reviews the following laboratory results:
• Potassium: 5.8 mEq/L
• Sodium: 136 mEq/L
• Creatinine: 2.1 mg/dL (baseline 1.1 mg/dL)
• Blood pressure: 116/70 mm Hg
• Heart rate: 78 beats/min
The client reports mild muscle weakness but denies chest pain.
Question Stem
,Which nursing action is the priority?
A. Administer the scheduled dose of spironolactone.
B. Hold the spironolactone and notify the healthcare provider.
C. Encourage the client to eat foods rich in potassium.
D. Restrict fluid intake immediately.
Correct Answer
Correct Answer: B. Hold the spironolactone and notify the
healthcare provider.
Detailed Rationale
Spironolactone is a potassium-sparing diuretic and aldosterone
antagonist commonly used to improve survival in heart failure.
While it helps reduce sodium and water retention, it decreases
potassium excretion, increasing the risk of hyperkalemia. This
client has a potassium level of 5.8 mEq/L, elevated creatinine, and
muscle weakness—all findings concerning for hyperkalemia and
declining renal function.
The nurse should withhold spironolactone and notify the
healthcare provider immediately. Hyperkalemia can lead to life-
threatening cardiac dysrhythmias, particularly in patients taking
ACE inhibitors such as lisinopril, which also increase serum
potassium. Continuous ECG monitoring and repeat laboratory
testing may be indicated.
• Option A is unsafe because another dose could further
increase potassium.
, • Option C is contraindicated because potassium intake should
be limited until hyperkalemia resolves.
• Option D does not address the immediate medication-related
safety concern.
Patient education should include avoiding potassium supplements
and salt substitutes containing potassium unless specifically
prescribed. Regular monitoring of renal function and electrolytes is
essential, especially in older adults and those with chronic kidney
disease.
Learning Objectives
After completing this question, the learner should be able to:
• Identify hyperkalemia associated with potassium-sparing
diuretics.
• Recognize the interaction between spironolactone and ACE
inhibitors.
• Prioritize interventions for abnormal electrolyte values.
• Educate patients regarding potassium restrictions.
Medication Safety Focus
Laboratory Monitoring
Question 12
Clinical Scenario
