NCLEX-RN Cardiovascular Pharmacology
Practice Questions & Rationales |
10 Original Case-Based Nursing MCQs |
Medication Safety Study Guide
Question 1
Clinical Scenario
A 64-year-old man with newly diagnosed hypertension is
prescribed lisinopril. His medical history includes type 2
diabetes mellitus and stage 2 chronic kidney disease. During a
follow-up visit 2 weeks later, his blood pressure is 132/80 mm
Hg (previously 156/92 mm Hg). Laboratory results reveal:
potassium 5.6 mEq/L, serum creatinine increased slightly from
1.1 to 1.3 mg/dL. He denies dizziness but reports a persistent
dry cough.
Question Stem
Which assessment finding requires the nurse's priority follow-
up?
A. Blood pressure of 132/80 mm Hg
,B. Persistent dry cough
C. Potassium level of 5.6 mEq/L
D. Slight increase in serum creatinine
Correct Answer
Correct Answer: C. Potassium level of 5.6 mEq/L
Detailed Rationale
ACE inhibitors such as lisinopril reduce angiotensin II production
and decrease aldosterone secretion. Reduced aldosterone
promotes potassium retention, increasing the risk for
hyperkalemia. A serum potassium level of 5.6 mEq/L is clinically
significant because progressive hyperkalemia can precipitate
life-threatening cardiac dysrhythmias. The nurse should
promptly notify the provider, review concurrent medications
that increase potassium, and monitor cardiac status if indicated.
Option A is incorrect because the blood pressure demonstrates
the expected therapeutic response. Option B is incorrect
because a dry cough is a common adverse effect of ACE
inhibitors caused by bradykinin accumulation. Although
bothersome and potentially requiring a medication change, it is
not immediately life-threatening. Option D is incorrect because
a mild rise in creatinine may occur after initiating ACE inhibitor
therapy due to changes in renal perfusion. Small increases are
,often expected but require continued monitoring rather than
immediate intervention.
Patient teaching should include avoiding potassium-containing
salt substitutes unless approved, recognizing symptoms of
hyperkalemia such as muscle weakness or palpitations, and
attending scheduled laboratory monitoring.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize hyperkalemia as a priority adverse effect of ACE
inhibitors.
• Identify expected versus concerning laboratory changes
after ACE inhibitor initiation.
• Educate patients about potassium-containing products.
• Prioritize laboratory monitoring during antihypertensive
therapy.
Medication Safety Focus
Monitoring—Hyperkalemia
Question 2
Clinical Scenario
, A 72-year-old woman with chronic heart failure takes
furosemide each morning. During a clinic visit she reports
fatigue, muscle cramps, and occasional palpitations.
Assessment findings include BP 118/70 mm Hg, HR 88/min, and
mild bilateral ankle edema. Laboratory results show potassium
2.9 mEq/L.
Question Stem
Which nursing action is the priority?
A. Encourage increased fluid intake.
B. Notify the provider about the potassium level.
C. Administer the next scheduled dose of furosemide.
D. Restrict dietary sodium immediately.
Correct Answer
Correct Answer: B. Notify the provider about the potassium
level.
Detailed Rationale
Loop diuretics such as furosemide inhibit sodium and chloride
reabsorption in the loop of Henle, increasing urinary loss of
sodium, water, potassium, magnesium, and calcium. A
potassium level of 2.9 mEq/L indicates significant hypokalemia,
placing the patient at increased risk for ventricular
dysrhythmias, especially if underlying heart disease is present.
Practice Questions & Rationales |
10 Original Case-Based Nursing MCQs |
Medication Safety Study Guide
Question 1
Clinical Scenario
A 64-year-old man with newly diagnosed hypertension is
prescribed lisinopril. His medical history includes type 2
diabetes mellitus and stage 2 chronic kidney disease. During a
follow-up visit 2 weeks later, his blood pressure is 132/80 mm
Hg (previously 156/92 mm Hg). Laboratory results reveal:
potassium 5.6 mEq/L, serum creatinine increased slightly from
1.1 to 1.3 mg/dL. He denies dizziness but reports a persistent
dry cough.
Question Stem
Which assessment finding requires the nurse's priority follow-
up?
A. Blood pressure of 132/80 mm Hg
,B. Persistent dry cough
C. Potassium level of 5.6 mEq/L
D. Slight increase in serum creatinine
Correct Answer
Correct Answer: C. Potassium level of 5.6 mEq/L
Detailed Rationale
ACE inhibitors such as lisinopril reduce angiotensin II production
and decrease aldosterone secretion. Reduced aldosterone
promotes potassium retention, increasing the risk for
hyperkalemia. A serum potassium level of 5.6 mEq/L is clinically
significant because progressive hyperkalemia can precipitate
life-threatening cardiac dysrhythmias. The nurse should
promptly notify the provider, review concurrent medications
that increase potassium, and monitor cardiac status if indicated.
Option A is incorrect because the blood pressure demonstrates
the expected therapeutic response. Option B is incorrect
because a dry cough is a common adverse effect of ACE
inhibitors caused by bradykinin accumulation. Although
bothersome and potentially requiring a medication change, it is
not immediately life-threatening. Option D is incorrect because
a mild rise in creatinine may occur after initiating ACE inhibitor
therapy due to changes in renal perfusion. Small increases are
,often expected but require continued monitoring rather than
immediate intervention.
Patient teaching should include avoiding potassium-containing
salt substitutes unless approved, recognizing symptoms of
hyperkalemia such as muscle weakness or palpitations, and
attending scheduled laboratory monitoring.
Learning Objectives
After completing this question, the learner should be able to:
• Recognize hyperkalemia as a priority adverse effect of ACE
inhibitors.
• Identify expected versus concerning laboratory changes
after ACE inhibitor initiation.
• Educate patients about potassium-containing products.
• Prioritize laboratory monitoring during antihypertensive
therapy.
Medication Safety Focus
Monitoring—Hyperkalemia
Question 2
Clinical Scenario
, A 72-year-old woman with chronic heart failure takes
furosemide each morning. During a clinic visit she reports
fatigue, muscle cramps, and occasional palpitations.
Assessment findings include BP 118/70 mm Hg, HR 88/min, and
mild bilateral ankle edema. Laboratory results show potassium
2.9 mEq/L.
Question Stem
Which nursing action is the priority?
A. Encourage increased fluid intake.
B. Notify the provider about the potassium level.
C. Administer the next scheduled dose of furosemide.
D. Restrict dietary sodium immediately.
Correct Answer
Correct Answer: B. Notify the provider about the potassium
level.
Detailed Rationale
Loop diuretics such as furosemide inhibit sodium and chloride
reabsorption in the loop of Henle, increasing urinary loss of
sodium, water, potassium, magnesium, and calcium. A
potassium level of 2.9 mEq/L indicates significant hypokalemia,
placing the patient at increased risk for ventricular
dysrhythmias, especially if underlying heart disease is present.
