NCLEX-RN Cardiovascular Pharmacology Exam
Questions & Answers |
20 NGN Practice MCQs with Detailed
Rationales |
ATI Pharmacology Made Easy Style |
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 68-year-old man is admitted with worsening heart failure. His
medical history includes hypertension, type 2 diabetes mellitus,
and chronic kidney disease stage 3. Current medications include
lisinopril, furosemide, and metformin. Morning assessment
reveals BP 104/68 mm Hg, HR 76/min, RR 18/min, oxygen
saturation 96% on room air, and mild bilateral ankle edema.
Laboratory results include potassium 5.8 mEq/L, creatinine 2.1
mg/dL, and BUN 36 mg/dL. The provider prescribes the
scheduled morning medications.
Question Stem
,Which nursing action is the priority before administering the
prescribed medications?
A. Administer all medications as prescribed because the blood
pressure is stable.
B. Hold the lisinopril and notify the healthcare provider about
the laboratory findings.
C. Administer furosemide first and reassess potassium levels
later.
D. Encourage the client to increase dietary potassium intake.
Correct Answer: B. Hold the lisinopril and notify the
healthcare provider about the laboratory findings.
Detailed Rationale
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor
that decreases aldosterone secretion, which can lead to
potassium retention. This client already has significant
hyperkalemia (5.8 mEq/L) and impaired renal function, placing
him at increased risk for life-threatening cardiac dysrhythmias.
Administering lisinopril could further elevate serum potassium.
The nurse should hold the medication and promptly notify the
healthcare provider for additional evaluation and possible
treatment.
,Option A is incorrect because medication administration should
never proceed without considering laboratory abnormalities
that increase the risk of adverse drug effects.
Option C is partially true because furosemide may lower
potassium levels, but independently deciding to administer it
without addressing the ACE inhibitor and abnormal laboratory
values is inappropriate. The provider should determine the
safest medication plan.
Option D is incorrect because increasing dietary potassium
would worsen hyperkalemia and further increase the risk of
cardiac complications.
Nurses caring for patients receiving ACE inhibitors should
routinely monitor serum potassium, renal function, blood
pressure, and signs of hypotension. Older adults and clients
with chronic kidney disease are particularly susceptible to ACE
inhibitor-induced hyperkalemia. Prompt recognition of
abnormal laboratory values prevents serious medication-related
complications.
Learning Objectives
After completing this question, the learner should be able to:
• Identify contraindications to administering ACE inhibitors.
• Interpret laboratory findings indicating hyperkalemia.
, • Prioritize nursing actions when renal impairment affects
medication safety.
• Recognize monitoring requirements for ACE inhibitor
therapy.
Medication Safety Focus
Contraindication and Laboratory Monitoring
Question 2
Clinical Scenario
A 59-year-old woman with chronic stable angina is prescribed
sublingual nitroglycerin as needed for chest pain. During
discharge teaching, the nurse reviews medication
administration and safety precautions.
Question Stem
Which statement by the client indicates a need for further
teaching?
A. "I will sit down before taking the medication."
B. "If the pain continues after one tablet, I will call emergency
medical services after taking up to three tablets five minutes
apart."
Questions & Answers |
20 NGN Practice MCQs with Detailed
Rationales |
ATI Pharmacology Made Easy Style |
Nursing Pharmacology Study Guide
Question 1
Clinical Scenario
A 68-year-old man is admitted with worsening heart failure. His
medical history includes hypertension, type 2 diabetes mellitus,
and chronic kidney disease stage 3. Current medications include
lisinopril, furosemide, and metformin. Morning assessment
reveals BP 104/68 mm Hg, HR 76/min, RR 18/min, oxygen
saturation 96% on room air, and mild bilateral ankle edema.
Laboratory results include potassium 5.8 mEq/L, creatinine 2.1
mg/dL, and BUN 36 mg/dL. The provider prescribes the
scheduled morning medications.
Question Stem
,Which nursing action is the priority before administering the
prescribed medications?
A. Administer all medications as prescribed because the blood
pressure is stable.
B. Hold the lisinopril and notify the healthcare provider about
the laboratory findings.
C. Administer furosemide first and reassess potassium levels
later.
D. Encourage the client to increase dietary potassium intake.
Correct Answer: B. Hold the lisinopril and notify the
healthcare provider about the laboratory findings.
Detailed Rationale
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor
that decreases aldosterone secretion, which can lead to
potassium retention. This client already has significant
hyperkalemia (5.8 mEq/L) and impaired renal function, placing
him at increased risk for life-threatening cardiac dysrhythmias.
Administering lisinopril could further elevate serum potassium.
The nurse should hold the medication and promptly notify the
healthcare provider for additional evaluation and possible
treatment.
,Option A is incorrect because medication administration should
never proceed without considering laboratory abnormalities
that increase the risk of adverse drug effects.
Option C is partially true because furosemide may lower
potassium levels, but independently deciding to administer it
without addressing the ACE inhibitor and abnormal laboratory
values is inappropriate. The provider should determine the
safest medication plan.
Option D is incorrect because increasing dietary potassium
would worsen hyperkalemia and further increase the risk of
cardiac complications.
Nurses caring for patients receiving ACE inhibitors should
routinely monitor serum potassium, renal function, blood
pressure, and signs of hypotension. Older adults and clients
with chronic kidney disease are particularly susceptible to ACE
inhibitor-induced hyperkalemia. Prompt recognition of
abnormal laboratory values prevents serious medication-related
complications.
Learning Objectives
After completing this question, the learner should be able to:
• Identify contraindications to administering ACE inhibitors.
• Interpret laboratory findings indicating hyperkalemia.
, • Prioritize nursing actions when renal impairment affects
medication safety.
• Recognize monitoring requirements for ACE inhibitor
therapy.
Medication Safety Focus
Contraindication and Laboratory Monitoring
Question 2
Clinical Scenario
A 59-year-old woman with chronic stable angina is prescribed
sublingual nitroglycerin as needed for chest pain. During
discharge teaching, the nurse reviews medication
administration and safety precautions.
Question Stem
Which statement by the client indicates a need for further
teaching?
A. "I will sit down before taking the medication."
B. "If the pain continues after one tablet, I will call emergency
medical services after taking up to three tablets five minutes
apart."
