NCLEX-RN Cardiovascular Pharmacology
Practice Questions |
20 Original NGN MCQs with Detailed
Rationales |
ATI Style Nursing Exam Prep
Question 11
Clinical Scenario
A 64-year-old man is admitted to the telemetry unit with rapid atrial
fibrillation. The provider prescribes an intravenous diltiazem
infusion after an initial loading dose. Thirty minutes after the
infusion begins, the nurse notes the following:
• BP: 88/54 mm Hg
• HR: 56 beats/min
• RR: 18 breaths/min
• SpO₂: 97% on room air
The client reports dizziness and lightheadedness.
Question Stem
Which nursing action is the priority?
A. Continue the infusion and reassess in 30 minutes.
,B. Increase the infusion rate to improve rhythm control.
C. Stop the infusion and notify the provider immediately.
D. Administer the client's scheduled oral antihypertensive
medication.
Correct Answer
Correct Answer: C. Stop the infusion and notify the provider
immediately.
Detailed Rationale
Diltiazem is a non-dihydropyridine calcium channel blocker that
slows atrioventricular (AV) nodal conduction and decreases heart
rate. It is commonly used for rate control in atrial fibrillation.
However, intravenous diltiazem can cause significant hypotension
and bradycardia, particularly in older adults or those with impaired
cardiac function.
This client has developed symptomatic hypotension (BP 88/54 mm
Hg), bradycardia (HR 56 beats/min), and dizziness shortly after
initiation of the infusion. These findings indicate excessive
pharmacologic effect and require immediate intervention. The nurse
should stop the infusion according to institutional protocol, assess
the client's hemodynamic status, and notify the provider promptly.
Continuous cardiac monitoring should continue, and emergency
medications or supportive measures may be required if instability
worsens.
Option A delays treatment and increases the risk of hemodynamic
compromise. Option B would worsen the adverse effects. Option D
, could further lower blood pressure and is contraindicated in the
current situation.
Patient safety priorities include frequent monitoring of heart rate,
blood pressure, ECG rhythm, and signs of decreased cardiac
output. Nurses should also assess for worsening heart failure, as
calcium channel blockers may exacerbate ventricular dysfunction in
susceptible patients.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize adverse effects of intravenous diltiazem.
• Prioritize interventions for medication-induced hypotension.
• Monitor cardiovascular status during antiarrhythmic therapy.
• Apply clinical judgment to medication administration.
Medication Safety Focus: Monitoring
Question 12
Clinical Scenario
A 58-year-old woman with hypertension is prescribed clonidine 0.1
mg orally twice daily. During a follow-up visit, she reports that she
stopped taking the medication abruptly three days ago because she
"felt better." Today, her blood pressure is 212/116 mm Hg, heart rate
is 118 beats/min, and she complains of a severe headache and
anxiety.
Question Stem
Practice Questions |
20 Original NGN MCQs with Detailed
Rationales |
ATI Style Nursing Exam Prep
Question 11
Clinical Scenario
A 64-year-old man is admitted to the telemetry unit with rapid atrial
fibrillation. The provider prescribes an intravenous diltiazem
infusion after an initial loading dose. Thirty minutes after the
infusion begins, the nurse notes the following:
• BP: 88/54 mm Hg
• HR: 56 beats/min
• RR: 18 breaths/min
• SpO₂: 97% on room air
The client reports dizziness and lightheadedness.
Question Stem
Which nursing action is the priority?
A. Continue the infusion and reassess in 30 minutes.
,B. Increase the infusion rate to improve rhythm control.
C. Stop the infusion and notify the provider immediately.
D. Administer the client's scheduled oral antihypertensive
medication.
Correct Answer
Correct Answer: C. Stop the infusion and notify the provider
immediately.
Detailed Rationale
Diltiazem is a non-dihydropyridine calcium channel blocker that
slows atrioventricular (AV) nodal conduction and decreases heart
rate. It is commonly used for rate control in atrial fibrillation.
However, intravenous diltiazem can cause significant hypotension
and bradycardia, particularly in older adults or those with impaired
cardiac function.
This client has developed symptomatic hypotension (BP 88/54 mm
Hg), bradycardia (HR 56 beats/min), and dizziness shortly after
initiation of the infusion. These findings indicate excessive
pharmacologic effect and require immediate intervention. The nurse
should stop the infusion according to institutional protocol, assess
the client's hemodynamic status, and notify the provider promptly.
Continuous cardiac monitoring should continue, and emergency
medications or supportive measures may be required if instability
worsens.
Option A delays treatment and increases the risk of hemodynamic
compromise. Option B would worsen the adverse effects. Option D
, could further lower blood pressure and is contraindicated in the
current situation.
Patient safety priorities include frequent monitoring of heart rate,
blood pressure, ECG rhythm, and signs of decreased cardiac
output. Nurses should also assess for worsening heart failure, as
calcium channel blockers may exacerbate ventricular dysfunction in
susceptible patients.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize adverse effects of intravenous diltiazem.
• Prioritize interventions for medication-induced hypotension.
• Monitor cardiovascular status during antiarrhythmic therapy.
• Apply clinical judgment to medication administration.
Medication Safety Focus: Monitoring
Question 12
Clinical Scenario
A 58-year-old woman with hypertension is prescribed clonidine 0.1
mg orally twice daily. During a follow-up visit, she reports that she
stopped taking the medication abruptly three days ago because she
"felt better." Today, her blood pressure is 212/116 mm Hg, heart rate
is 118 beats/min, and she complains of a severe headache and
anxiety.
Question Stem
