NCLEX-RN Pharmacology Cardiovascular
System Exam |
20 Practice Questions with Detailed
Rationales |
ATI & NGN Style Nursing Test Bank PDF
Question 6
Clinical Scenario
A 67-year-old man is admitted with acute decompensated heart
failure. He has bilateral crackles, 3+ pitting edema in both lower
extremities, jugular venous distention, and dyspnea at rest. His
blood pressure is 154/90 mm Hg, heart rate is 102/min,
respiratory rate is 24/min, and oxygen saturation is 91% on
room air. The provider prescribes furosemide 40 mg IV push.
Laboratory results include sodium 138 mEq/L, potassium 3.4
mEq/L, BUN 32 mg/dL, and creatinine 1.2 mg/dL.
Question Stem
,Which assessment finding requires the nurse's closest
monitoring after administering the medication?
A. Increased urine output
B. Blood glucose of 120 mg/dL
C. Progressive hypokalemia
D. Mild thirst
Correct Answer
Correct Answer: C. Progressive hypokalemia
Detailed Rationale
Furosemide is a loop diuretic that inhibits sodium and chloride
reabsorption in the ascending loop of Henle, producing
significant diuresis. It is highly effective for reducing pulmonary
and peripheral edema associated with heart failure. However, it
also promotes urinary potassium excretion, increasing the risk
of hypokalemia, which can precipitate muscle weakness,
cardiac dysrhythmias, and increased susceptibility to digoxin
toxicity.
This patient already has a potassium level of 3.4 mEq/L, which
is slightly below normal. Following IV furosemide
administration, the nurse should closely monitor electrolyte
levels, cardiac rhythm, muscle strength, blood pressure, daily
weights, intake and output, and signs of dehydration.
,Option A is expected and indicates therapeutic effectiveness.
Option B is not the priority. Although loop diuretics may mildly
affect glucose metabolism, electrolyte disturbances pose a
more immediate risk.
Option D may occur because of fluid loss but is less concerning
than worsening hypokalemia.
Patient teaching includes taking oral doses in the morning,
consuming potassium-rich foods if appropriate, changing
positions slowly to minimize orthostatic hypotension, and
reporting muscle cramps or palpitations promptly.
Learning Objectives
After completing this question, the learner should be able to:
• Explain the mechanism of action of loop diuretics.
• Recognize electrolyte abnormalities associated with
furosemide.
• Prioritize post-administration monitoring.
• Educate patients regarding diuretic safety.
Medication Safety Focus
Monitoring: Monitor serum potassium and cardiac rhythm
during loop diuretic therapy.
, Question 7
Clinical Scenario
A 60-year-old woman with hyperlipidemia has been taking
atorvastatin 40 mg orally each evening for six months. During a
follow-up visit, she reports new-onset generalized muscle pain
and weakness. Laboratory results reveal an elevated creatine
kinase (CK) level.
Question Stem
Which nursing action is the priority?
A. Advise the patient to continue the medication because
muscle pain is expected.
B. Encourage vigorous exercise to improve muscle strength.
C. Hold the medication and notify the provider immediately.
D. Administer acetaminophen before future doses.
Correct Answer
Correct Answer: C. Hold the medication and notify the
provider immediately.
Detailed Rationale
Atorvastatin inhibits HMG-CoA reductase, decreasing
cholesterol synthesis and lowering LDL cholesterol. Although
statins are generally well tolerated, a serious adverse effect is
System Exam |
20 Practice Questions with Detailed
Rationales |
ATI & NGN Style Nursing Test Bank PDF
Question 6
Clinical Scenario
A 67-year-old man is admitted with acute decompensated heart
failure. He has bilateral crackles, 3+ pitting edema in both lower
extremities, jugular venous distention, and dyspnea at rest. His
blood pressure is 154/90 mm Hg, heart rate is 102/min,
respiratory rate is 24/min, and oxygen saturation is 91% on
room air. The provider prescribes furosemide 40 mg IV push.
Laboratory results include sodium 138 mEq/L, potassium 3.4
mEq/L, BUN 32 mg/dL, and creatinine 1.2 mg/dL.
Question Stem
,Which assessment finding requires the nurse's closest
monitoring after administering the medication?
A. Increased urine output
B. Blood glucose of 120 mg/dL
C. Progressive hypokalemia
D. Mild thirst
Correct Answer
Correct Answer: C. Progressive hypokalemia
Detailed Rationale
Furosemide is a loop diuretic that inhibits sodium and chloride
reabsorption in the ascending loop of Henle, producing
significant diuresis. It is highly effective for reducing pulmonary
and peripheral edema associated with heart failure. However, it
also promotes urinary potassium excretion, increasing the risk
of hypokalemia, which can precipitate muscle weakness,
cardiac dysrhythmias, and increased susceptibility to digoxin
toxicity.
This patient already has a potassium level of 3.4 mEq/L, which
is slightly below normal. Following IV furosemide
administration, the nurse should closely monitor electrolyte
levels, cardiac rhythm, muscle strength, blood pressure, daily
weights, intake and output, and signs of dehydration.
,Option A is expected and indicates therapeutic effectiveness.
Option B is not the priority. Although loop diuretics may mildly
affect glucose metabolism, electrolyte disturbances pose a
more immediate risk.
Option D may occur because of fluid loss but is less concerning
than worsening hypokalemia.
Patient teaching includes taking oral doses in the morning,
consuming potassium-rich foods if appropriate, changing
positions slowly to minimize orthostatic hypotension, and
reporting muscle cramps or palpitations promptly.
Learning Objectives
After completing this question, the learner should be able to:
• Explain the mechanism of action of loop diuretics.
• Recognize electrolyte abnormalities associated with
furosemide.
• Prioritize post-administration monitoring.
• Educate patients regarding diuretic safety.
Medication Safety Focus
Monitoring: Monitor serum potassium and cardiac rhythm
during loop diuretic therapy.
, Question 7
Clinical Scenario
A 60-year-old woman with hyperlipidemia has been taking
atorvastatin 40 mg orally each evening for six months. During a
follow-up visit, she reports new-onset generalized muscle pain
and weakness. Laboratory results reveal an elevated creatine
kinase (CK) level.
Question Stem
Which nursing action is the priority?
A. Advise the patient to continue the medication because
muscle pain is expected.
B. Encourage vigorous exercise to improve muscle strength.
C. Hold the medication and notify the provider immediately.
D. Administer acetaminophen before future doses.
Correct Answer
Correct Answer: C. Hold the medication and notify the
provider immediately.
Detailed Rationale
Atorvastatin inhibits HMG-CoA reductase, decreasing
cholesterol synthesis and lowering LDL cholesterol. Although
statins are generally well tolerated, a serious adverse effect is
