NCLEX-RN Cardiovascular
Pharmacology Exam Questions with
Rationales |
20 Original NCLEX NGN Practice MCQs |
ATI Pharmacology Made Easy Nursing
Test Bank Study Guide.
Question 11
Clinical Scenario
A 79-year-old man with chronic heart failure is admitted for
worsening dyspnea and bilateral lower-extremity edema. His home
medications include carvedilol, lisinopril, furosemide,
spironolactone, and aspirin. During the morning assessment, the
nurse obtains the following data:
• Blood pressure: 88/54 mm Hg
• Heart rate: 58 beats/min
• Respiratory rate: 20/min
• Oxygen saturation: 95% on 2 L/min via nasal cannula
, • The client reports dizziness when sitting up.
• Serum creatinine: 1.9 mg/dL (baseline 1.2 mg/dL)
Question Stem
Which prescribed medication should the nurse question before
administration?
A. Aspirin
B. Carvedilol
C. Furosemide
D. Spironolactone
Correct Answer
B. Carvedilol
Detailed Rationale
Carvedilol is a nonselective beta-blocker with additional alpha-1
blocking properties that reduces heart rate and blood pressure
while decreasing myocardial oxygen demand. Although beta-
blockers are a cornerstone of chronic heart failure treatment, they
should be used cautiously in clients with symptomatic hypotension
or clinically significant bradycardia. This client has a blood pressure
of 88/54 mm Hg, a heart rate of 58 beats/min, and reports dizziness,
suggesting inadequate perfusion. Administering carvedilol could
further reduce cardiac output and worsen hypotension. The nurse
should hold the medication and notify the provider for further
instructions.
, Option A is incorrect because low-dose aspirin does not
significantly contribute to the client's immediate hemodynamic
instability.
Option C is incorrect because although furosemide may lower
blood pressure, it is often necessary to relieve pulmonary
congestion. The provider may adjust the dose, but carvedilol
presents the more immediate concern due to its direct chronotropic
and inotropic effects.
Option D is incorrect because spironolactone requires monitoring
of renal function and potassium, but the client's current symptoms
most directly contraindicate beta-blocker administration.
The nurse should reassess vital signs, evaluate for worsening heart
failure, review medication trends, monitor renal function, and
communicate abnormal findings promptly to the provider.
Learning Objectives
After completing this question, the learner should be able to:
• Identify assessment findings requiring withholding a beta-
blocker.
• Recognize signs of symptomatic hypotension.
• Apply nursing assessment before administering cardiovascular
medications.
• Prioritize interventions in heart failure management.
Medication Safety Focus
Medication Administration
Pharmacology Exam Questions with
Rationales |
20 Original NCLEX NGN Practice MCQs |
ATI Pharmacology Made Easy Nursing
Test Bank Study Guide.
Question 11
Clinical Scenario
A 79-year-old man with chronic heart failure is admitted for
worsening dyspnea and bilateral lower-extremity edema. His home
medications include carvedilol, lisinopril, furosemide,
spironolactone, and aspirin. During the morning assessment, the
nurse obtains the following data:
• Blood pressure: 88/54 mm Hg
• Heart rate: 58 beats/min
• Respiratory rate: 20/min
• Oxygen saturation: 95% on 2 L/min via nasal cannula
, • The client reports dizziness when sitting up.
• Serum creatinine: 1.9 mg/dL (baseline 1.2 mg/dL)
Question Stem
Which prescribed medication should the nurse question before
administration?
A. Aspirin
B. Carvedilol
C. Furosemide
D. Spironolactone
Correct Answer
B. Carvedilol
Detailed Rationale
Carvedilol is a nonselective beta-blocker with additional alpha-1
blocking properties that reduces heart rate and blood pressure
while decreasing myocardial oxygen demand. Although beta-
blockers are a cornerstone of chronic heart failure treatment, they
should be used cautiously in clients with symptomatic hypotension
or clinically significant bradycardia. This client has a blood pressure
of 88/54 mm Hg, a heart rate of 58 beats/min, and reports dizziness,
suggesting inadequate perfusion. Administering carvedilol could
further reduce cardiac output and worsen hypotension. The nurse
should hold the medication and notify the provider for further
instructions.
, Option A is incorrect because low-dose aspirin does not
significantly contribute to the client's immediate hemodynamic
instability.
Option C is incorrect because although furosemide may lower
blood pressure, it is often necessary to relieve pulmonary
congestion. The provider may adjust the dose, but carvedilol
presents the more immediate concern due to its direct chronotropic
and inotropic effects.
Option D is incorrect because spironolactone requires monitoring
of renal function and potassium, but the client's current symptoms
most directly contraindicate beta-blocker administration.
The nurse should reassess vital signs, evaluate for worsening heart
failure, review medication trends, monitor renal function, and
communicate abnormal findings promptly to the provider.
Learning Objectives
After completing this question, the learner should be able to:
• Identify assessment findings requiring withholding a beta-
blocker.
• Recognize signs of symptomatic hypotension.
• Apply nursing assessment before administering cardiovascular
medications.
• Prioritize interventions in heart failure management.
Medication Safety Focus
Medication Administration
