NCLEX-RN Cardiovascular Pharmacology Exam
Questions & Answers |
20 Original Next Gen NCLEX (NGN) Practice
MCQs with Rationales |
ATI Pharmacology Made Easy Style |
Nursing Test Bank & Study Guide
Question 6
Clinical Scenario
A 59-year-old man is admitted with an acute ST-segment
elevation myocardial infarction (STEMI). Following successful
percutaneous coronary intervention (PCI), the healthcare
provider prescribes nitroglycerin 0.4 mg sublingually every 5
minutes as needed for chest pain (maximum of 3 doses). The
client reports recurrent chest pain rated 8/10. Before
administering the medication, the nurse reviews the history and
current medications. The client states he took sildenafil
approximately 8 hours ago for erectile dysfunction.
Vital signs:
• Blood pressure: 126/76 mmHg
, • Heart rate: 84 beats/min
• Respiratory rate: 20 breaths/min
• Oxygen saturation: 97% on room air
Question Stem
Which action should the nurse take first?
A. Administer the nitroglycerin because the blood pressure is
stable.
B. Hold the nitroglycerin and notify the healthcare provider
immediately.
C. Give the nitroglycerin with the client in a standing position.
D. Administer aspirin instead of notifying the provider.
Correct Answer
Correct Answer: B. Hold the nitroglycerin and notify the
healthcare provider immediately.
Detailed Rationale
Nitroglycerin is a nitrate that causes venous and arterial
vasodilation by increasing nitric oxide production. Although it
effectively relieves myocardial ischemia by reducing preload
and myocardial oxygen demand, it is contraindicated in
patients who have recently taken phosphodiesterase-5 (PDE-5)
inhibitors such as sildenafil. The combination can produce
,profound vasodilation, resulting in severe hypotension,
syncope, myocardial ischemia, or cardiovascular collapse.
The nurse's priority is to withhold nitroglycerin and
immediately notify the healthcare provider so alternative anti-
ischemic therapy can be initiated safely. Sildenafil should
generally not be combined with nitrates within at least 24 hours
(48 hours for tadalafil due to its longer half-life).
Option A is incorrect because a normal blood pressure before
administration does not eliminate the risk of catastrophic
hypotension after combining these medications.
Option C is unsafe because standing increases orthostatic
hypotension and fall risk.
Option D is incorrect because aspirin is appropriate in
myocardial infarction but does not replace prompt
communication regarding a contraindicated medication.
Patient teaching should include avoiding PDE-5 inhibitors while
prescribed nitrates and informing all healthcare providers about
recent medication use.
Learning Objectives
After completing this question, the learner should be able to:
• Identify contraindications to nitrate therapy.
, • Recognize dangerous drug interactions involving PDE-5
inhibitors.
• Prioritize nursing interventions during acute chest pain.
• Educate patients about medication interactions.
Medication Safety Focus
Contraindication
Question 7
Clinical Scenario
A 74-year-old woman with chronic atrial fibrillation is
prescribed apixaban 5 mg orally twice daily to reduce stroke
risk. During discharge, the nurse provides medication
education. The client asks how she will know if the medication
is working.
Question Stem
Which response by the nurse is most appropriate?
A. "You should expect your heart rhythm to return to normal."
B. "The medication prevents harmful blood clots from forming
and lowers your risk of stroke."
C. "You will need weekly INR blood tests to monitor the
medication."
Questions & Answers |
20 Original Next Gen NCLEX (NGN) Practice
MCQs with Rationales |
ATI Pharmacology Made Easy Style |
Nursing Test Bank & Study Guide
Question 6
Clinical Scenario
A 59-year-old man is admitted with an acute ST-segment
elevation myocardial infarction (STEMI). Following successful
percutaneous coronary intervention (PCI), the healthcare
provider prescribes nitroglycerin 0.4 mg sublingually every 5
minutes as needed for chest pain (maximum of 3 doses). The
client reports recurrent chest pain rated 8/10. Before
administering the medication, the nurse reviews the history and
current medications. The client states he took sildenafil
approximately 8 hours ago for erectile dysfunction.
Vital signs:
• Blood pressure: 126/76 mmHg
, • Heart rate: 84 beats/min
• Respiratory rate: 20 breaths/min
• Oxygen saturation: 97% on room air
Question Stem
Which action should the nurse take first?
A. Administer the nitroglycerin because the blood pressure is
stable.
B. Hold the nitroglycerin and notify the healthcare provider
immediately.
C. Give the nitroglycerin with the client in a standing position.
D. Administer aspirin instead of notifying the provider.
Correct Answer
Correct Answer: B. Hold the nitroglycerin and notify the
healthcare provider immediately.
Detailed Rationale
Nitroglycerin is a nitrate that causes venous and arterial
vasodilation by increasing nitric oxide production. Although it
effectively relieves myocardial ischemia by reducing preload
and myocardial oxygen demand, it is contraindicated in
patients who have recently taken phosphodiesterase-5 (PDE-5)
inhibitors such as sildenafil. The combination can produce
,profound vasodilation, resulting in severe hypotension,
syncope, myocardial ischemia, or cardiovascular collapse.
The nurse's priority is to withhold nitroglycerin and
immediately notify the healthcare provider so alternative anti-
ischemic therapy can be initiated safely. Sildenafil should
generally not be combined with nitrates within at least 24 hours
(48 hours for tadalafil due to its longer half-life).
Option A is incorrect because a normal blood pressure before
administration does not eliminate the risk of catastrophic
hypotension after combining these medications.
Option C is unsafe because standing increases orthostatic
hypotension and fall risk.
Option D is incorrect because aspirin is appropriate in
myocardial infarction but does not replace prompt
communication regarding a contraindicated medication.
Patient teaching should include avoiding PDE-5 inhibitors while
prescribed nitrates and informing all healthcare providers about
recent medication use.
Learning Objectives
After completing this question, the learner should be able to:
• Identify contraindications to nitrate therapy.
, • Recognize dangerous drug interactions involving PDE-5
inhibitors.
• Prioritize nursing interventions during acute chest pain.
• Educate patients about medication interactions.
Medication Safety Focus
Contraindication
Question 7
Clinical Scenario
A 74-year-old woman with chronic atrial fibrillation is
prescribed apixaban 5 mg orally twice daily to reduce stroke
risk. During discharge, the nurse provides medication
education. The client asks how she will know if the medication
is working.
Question Stem
Which response by the nurse is most appropriate?
A. "You should expect your heart rhythm to return to normal."
B. "The medication prevents harmful blood clots from forming
and lowers your risk of stroke."
C. "You will need weekly INR blood tests to monitor the
medication."
