NCLEX-RN Pharmacology Cardiovascular
System Practice Questions & Answers |
20 NGN-Style Nursing Exam MCQs with
Rationales |
ATI Pharmacology Made Easy Review |
Medication Safety Test Bank
Question 11
Clinical Scenario
A 66-year-old man is admitted to the telemetry unit with
newly diagnosed atrial fibrillation and a rapid ventricular
response. The healthcare provider prescribes an
intravenous diltiazem infusion. Before initiating therapy,
the nurse reviews the client's assessment findings. Vital
signs are BP 108/68 mm Hg, HR 142/min (irregular), RR
20/min, and SpO₂ 96% on room air. The client has a history
of heart failure with reduced ejection fraction (LVEF 30%).
Question Stem
Which assessment finding should prompt the nurse to
question the prescription for intravenous diltiazem?
,A. Blood pressure of 108/68 mm Hg
B. Heart rate of 142/min
C. Left ventricular ejection fraction of 30%
D. Oxygen saturation of 96%
Correct Answer
Correct Answer: C. Left ventricular ejection fraction of
30%
Detailed Rationale
Diltiazem is a non-dihydropyridine calcium channel
blocker that decreases atrioventricular (AV) nodal
conduction, slows the ventricular response in atrial
fibrillation, and reduces myocardial contractility. Although it
is effective for rate control, its negative inotropic effects may
worsen heart failure with reduced ejection fraction
(HFrEF).
An ejection fraction of 30% indicates significant systolic
dysfunction. Administering intravenous diltiazem may
further reduce cardiac output and precipitate acute
decompensated heart failure. The nurse should clarify the
prescription with the healthcare provider before
administration and anticipate an alternative rate-control
agent, such as amiodarone or digoxin, depending on the
clinical situation.
, Option A represents an acceptable blood pressure for
cautious therapy. Option B is the expected indication for
rate-control treatment. Option D is within normal limits and
does not affect the decision to administer the medication.
Nursing responsibilities include continuous ECG monitoring,
frequent assessment of blood pressure and heart rate,
evaluation for signs of worsening heart failure, and patient
education regarding symptoms such as increasing dyspnea,
edema, or fatigue.
Learning Objectives
After completing this question, the learner should be able
to:
• Identify contraindications to non-dihydropyridine
calcium channel blockers.
• Recognize the effects of calcium channel blockers on
myocardial contractility.
• Apply clinical judgment when reviewing medication
prescriptions.
• Monitor patients receiving intravenous antiarrhythmic
therapy.
Medication Safety Focus: Contraindication identification.
System Practice Questions & Answers |
20 NGN-Style Nursing Exam MCQs with
Rationales |
ATI Pharmacology Made Easy Review |
Medication Safety Test Bank
Question 11
Clinical Scenario
A 66-year-old man is admitted to the telemetry unit with
newly diagnosed atrial fibrillation and a rapid ventricular
response. The healthcare provider prescribes an
intravenous diltiazem infusion. Before initiating therapy,
the nurse reviews the client's assessment findings. Vital
signs are BP 108/68 mm Hg, HR 142/min (irregular), RR
20/min, and SpO₂ 96% on room air. The client has a history
of heart failure with reduced ejection fraction (LVEF 30%).
Question Stem
Which assessment finding should prompt the nurse to
question the prescription for intravenous diltiazem?
,A. Blood pressure of 108/68 mm Hg
B. Heart rate of 142/min
C. Left ventricular ejection fraction of 30%
D. Oxygen saturation of 96%
Correct Answer
Correct Answer: C. Left ventricular ejection fraction of
30%
Detailed Rationale
Diltiazem is a non-dihydropyridine calcium channel
blocker that decreases atrioventricular (AV) nodal
conduction, slows the ventricular response in atrial
fibrillation, and reduces myocardial contractility. Although it
is effective for rate control, its negative inotropic effects may
worsen heart failure with reduced ejection fraction
(HFrEF).
An ejection fraction of 30% indicates significant systolic
dysfunction. Administering intravenous diltiazem may
further reduce cardiac output and precipitate acute
decompensated heart failure. The nurse should clarify the
prescription with the healthcare provider before
administration and anticipate an alternative rate-control
agent, such as amiodarone or digoxin, depending on the
clinical situation.
, Option A represents an acceptable blood pressure for
cautious therapy. Option B is the expected indication for
rate-control treatment. Option D is within normal limits and
does not affect the decision to administer the medication.
Nursing responsibilities include continuous ECG monitoring,
frequent assessment of blood pressure and heart rate,
evaluation for signs of worsening heart failure, and patient
education regarding symptoms such as increasing dyspnea,
edema, or fatigue.
Learning Objectives
After completing this question, the learner should be able
to:
• Identify contraindications to non-dihydropyridine
calcium channel blockers.
• Recognize the effects of calcium channel blockers on
myocardial contractility.
• Apply clinical judgment when reviewing medication
prescriptions.
• Monitor patients receiving intravenous antiarrhythmic
therapy.
Medication Safety Focus: Contraindication identification.
