NCLEX-RN Cardiovascular Pharmacology Exam
Questions & Rationales |
20 Original NCLEX NGN Practice MCQs |
Nursing Pharmacology Study Guide
Question 6
Clinical Scenario
A 64-year-old man with newly diagnosed hyperlipidemia is
prescribed atorvastatin 40 mg orally each evening. During a
follow-up visit 3 weeks later, he reports generalized muscle
aches and weakness. Laboratory results show AST 38 U/L, ALT
40 U/L, and creatine kinase (CK) 1,280 U/L (reference range:
30–200 U/L). His urine appears dark brown.
Question Stem
Which nursing action is the priority?
A. Encourage the patient to continue taking the medication
because muscle pain is expected.
B. Recommend taking the medication with food to reduce
muscle discomfort.
,C. Hold the atorvastatin and notify the healthcare provider
immediately.
D. Advise the patient to increase physical exercise to strengthen
the muscles.
Correct Answer
Correct Answer: C. Hold the atorvastatin and notify the
healthcare provider immediately.
Detailed Rationale
Atorvastatin inhibits HMG-CoA reductase, decreasing hepatic
cholesterol synthesis and lowering LDL cholesterol. Although
statins are generally well tolerated, they can rarely cause
myopathy and rhabdomyolysis, characterized by muscle pain,
weakness, markedly elevated CK levels, and myoglobinuria
(dark urine). This patient demonstrates findings consistent with
rhabdomyolysis, a potentially life-threatening condition that
may lead to acute kidney injury. The nurse should withhold the
medication, promptly notify the healthcare provider, and
anticipate additional laboratory testing, intravenous hydration,
and renal function monitoring.
Option A is incorrect because significant muscle symptoms with
elevated CK require immediate evaluation rather than
reassurance. Option B does not address the underlying adverse
drug reaction. Option D is inappropriate because exercise may
,worsen muscle injury. Nursing care includes monitoring renal
function, assessing urine output, reviewing concurrent
medications that increase statin concentrations (such as certain
macrolide antibiotics or azole antifungals), and educating
patients to report unexplained muscle pain, weakness, or dark
urine promptly.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize manifestations of statin-induced
rhabdomyolysis.
• Prioritize nursing interventions for serious medication
adverse effects.
• Identify appropriate patient education regarding statin
therapy.
Medication Safety Focus
Adverse Effect Recognition
Question 7
Clinical Scenario
A 70-year-old woman with chronic heart failure is admitted for
increasing shortness of breath. She takes furosemide 40 mg
daily. Assessment reveals bilateral crackles, 2+ lower-extremity
, edema, BP 136/82 mm Hg, HR 92/min, RR 24/min, and oxygen
saturation of 92% on room air. Morning laboratory results
include potassium 3.2 mEq/L and sodium 138 mEq/L.
Question Stem
After administering intravenous furosemide, which finding best
indicates that the medication is achieving the desired
therapeutic effect?
A. Decreased bilateral lung crackles and improved breathing.
B. Increased heart rate to 110/min.
C. Blood glucose decreases to 80 mg/dL.
D. Development of mild muscle cramps.
Correct Answer
Correct Answer: A. Decreased bilateral lung crackles and
improved breathing.
Detailed Rationale
Furosemide is a loop diuretic that inhibits sodium and chloride
reabsorption in the ascending loop of Henle, producing rapid
diuresis. In heart failure, its primary therapeutic goal is reducing
fluid overload, thereby improving pulmonary congestion,
decreasing edema, and relieving dyspnea. Improvement in lung
sounds and respiratory status demonstrates successful
reduction of excess fluid volume and improved cardiac function.
Questions & Rationales |
20 Original NCLEX NGN Practice MCQs |
Nursing Pharmacology Study Guide
Question 6
Clinical Scenario
A 64-year-old man with newly diagnosed hyperlipidemia is
prescribed atorvastatin 40 mg orally each evening. During a
follow-up visit 3 weeks later, he reports generalized muscle
aches and weakness. Laboratory results show AST 38 U/L, ALT
40 U/L, and creatine kinase (CK) 1,280 U/L (reference range:
30–200 U/L). His urine appears dark brown.
Question Stem
Which nursing action is the priority?
A. Encourage the patient to continue taking the medication
because muscle pain is expected.
B. Recommend taking the medication with food to reduce
muscle discomfort.
,C. Hold the atorvastatin and notify the healthcare provider
immediately.
D. Advise the patient to increase physical exercise to strengthen
the muscles.
Correct Answer
Correct Answer: C. Hold the atorvastatin and notify the
healthcare provider immediately.
Detailed Rationale
Atorvastatin inhibits HMG-CoA reductase, decreasing hepatic
cholesterol synthesis and lowering LDL cholesterol. Although
statins are generally well tolerated, they can rarely cause
myopathy and rhabdomyolysis, characterized by muscle pain,
weakness, markedly elevated CK levels, and myoglobinuria
(dark urine). This patient demonstrates findings consistent with
rhabdomyolysis, a potentially life-threatening condition that
may lead to acute kidney injury. The nurse should withhold the
medication, promptly notify the healthcare provider, and
anticipate additional laboratory testing, intravenous hydration,
and renal function monitoring.
Option A is incorrect because significant muscle symptoms with
elevated CK require immediate evaluation rather than
reassurance. Option B does not address the underlying adverse
drug reaction. Option D is inappropriate because exercise may
,worsen muscle injury. Nursing care includes monitoring renal
function, assessing urine output, reviewing concurrent
medications that increase statin concentrations (such as certain
macrolide antibiotics or azole antifungals), and educating
patients to report unexplained muscle pain, weakness, or dark
urine promptly.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize manifestations of statin-induced
rhabdomyolysis.
• Prioritize nursing interventions for serious medication
adverse effects.
• Identify appropriate patient education regarding statin
therapy.
Medication Safety Focus
Adverse Effect Recognition
Question 7
Clinical Scenario
A 70-year-old woman with chronic heart failure is admitted for
increasing shortness of breath. She takes furosemide 40 mg
daily. Assessment reveals bilateral crackles, 2+ lower-extremity
, edema, BP 136/82 mm Hg, HR 92/min, RR 24/min, and oxygen
saturation of 92% on room air. Morning laboratory results
include potassium 3.2 mEq/L and sodium 138 mEq/L.
Question Stem
After administering intravenous furosemide, which finding best
indicates that the medication is achieving the desired
therapeutic effect?
A. Decreased bilateral lung crackles and improved breathing.
B. Increased heart rate to 110/min.
C. Blood glucose decreases to 80 mg/dL.
D. Development of mild muscle cramps.
Correct Answer
Correct Answer: A. Decreased bilateral lung crackles and
improved breathing.
Detailed Rationale
Furosemide is a loop diuretic that inhibits sodium and chloride
reabsorption in the ascending loop of Henle, producing rapid
diuresis. In heart failure, its primary therapeutic goal is reducing
fluid overload, thereby improving pulmonary congestion,
decreasing edema, and relieving dyspnea. Improvement in lung
sounds and respiratory status demonstrates successful
reduction of excess fluid volume and improved cardiac function.
