NCLEX-RN Cardiovascular Pharmacology
Practice Questions & Case Studies |
20 ATI-Style MCQs with Rationales,
Medication Safety & Clinical Judgment
Question 1 (Easy)
Clinical Scenario
A 68-year-old man is admitted to a telemetry unit with newly
diagnosed hypertension. His medical history includes stable
coronary artery disease and hyperlipidemia. Current
medications include atorvastatin 40 mg nightly and aspirin 81
mg daily. The provider prescribes metoprolol tartrate 25 mg
orally twice daily.
Assessment findings:
• BP: 154/88 mm Hg
• HR: 54/min
• RR: 18/min
• SpO₂: 98% on room air
, • Temperature: 36.8°C (98.2°F)
The client denies chest pain or dizziness.
Question Stem
Which action should the nurse take before administering the
scheduled dose of metoprolol?
A. Administer the medication as prescribed.
B. Hold the medication and notify the provider of the heart
rate.
C. Give the medication with orange juice to improve absorption.
D. Administer atropine immediately before giving metoprolol.
Correct Answer
Correct Answer: B. Hold the medication and notify the
provider of the heart rate.
Detailed Rationale
Metoprolol is a selective beta₁-adrenergic blocker that
decreases heart rate, myocardial contractility, and blood
pressure by reducing sympathetic stimulation. Before
administration, nurses should assess both blood pressure and
apical pulse. Although institutional policies vary, a heart rate
below 60 beats/min is commonly considered a parameter
requiring the medication to be withheld and the prescriber
notified. Administering metoprolol to this client, whose pulse is
,54/min, could worsen bradycardia and potentially decrease
cardiac output, resulting in dizziness, syncope, or hypotension.
Option A is incorrect because giving the medication despite
significant bradycardia places the client at unnecessary risk.
Option C is incorrect because orange juice does not improve
the drug's therapeutic effect or address the safety concern.
Metoprolol may be taken with or immediately after meals to
improve consistent absorption, but heart rate assessment
remains the priority. Option D is incorrect because prophylactic
atropine administration is not indicated. Atropine is reserved
for symptomatic bradycardia and should not be routinely given
before beta-blockers.
Patient teaching includes not stopping beta-blockers abruptly,
as sudden withdrawal may precipitate rebound hypertension,
angina, or myocardial infarction. The nurse should also monitor
blood pressure, heart rate, signs of worsening heart failure, and
symptoms of hypotension throughout therapy.
Learning Objectives
After completing this question, the learner should be able to:
• Identify assessment parameters required before
administering beta blockers.
• Recognize when bradycardia warrants withholding
medication.
, • Apply clinical judgment to promote safe cardiovascular
medication administration.
Medication Safety Focus
Monitoring Parameters
Question 2 (Moderate)
Clinical Scenario
A 74-year-old woman with chronic heart failure is prescribed
digoxin 0.125 mg orally once daily and furosemide 40 mg orally
daily. During the morning assessment, the nurse notes:
• HR: 58/min
• BP: 118/70 mm Hg
• Potassium: 2.9 mEq/L
• Creatinine: 1.4 mg/dL
• The client reports nausea, decreased appetite, and seeing
"yellow halos" around lights.
Question Stem
Which nursing action is the priority?
A. Administer both medications as scheduled.
B. Hold the digoxin and notify the provider immediately.
Practice Questions & Case Studies |
20 ATI-Style MCQs with Rationales,
Medication Safety & Clinical Judgment
Question 1 (Easy)
Clinical Scenario
A 68-year-old man is admitted to a telemetry unit with newly
diagnosed hypertension. His medical history includes stable
coronary artery disease and hyperlipidemia. Current
medications include atorvastatin 40 mg nightly and aspirin 81
mg daily. The provider prescribes metoprolol tartrate 25 mg
orally twice daily.
Assessment findings:
• BP: 154/88 mm Hg
• HR: 54/min
• RR: 18/min
• SpO₂: 98% on room air
, • Temperature: 36.8°C (98.2°F)
The client denies chest pain or dizziness.
Question Stem
Which action should the nurse take before administering the
scheduled dose of metoprolol?
A. Administer the medication as prescribed.
B. Hold the medication and notify the provider of the heart
rate.
C. Give the medication with orange juice to improve absorption.
D. Administer atropine immediately before giving metoprolol.
Correct Answer
Correct Answer: B. Hold the medication and notify the
provider of the heart rate.
Detailed Rationale
Metoprolol is a selective beta₁-adrenergic blocker that
decreases heart rate, myocardial contractility, and blood
pressure by reducing sympathetic stimulation. Before
administration, nurses should assess both blood pressure and
apical pulse. Although institutional policies vary, a heart rate
below 60 beats/min is commonly considered a parameter
requiring the medication to be withheld and the prescriber
notified. Administering metoprolol to this client, whose pulse is
,54/min, could worsen bradycardia and potentially decrease
cardiac output, resulting in dizziness, syncope, or hypotension.
Option A is incorrect because giving the medication despite
significant bradycardia places the client at unnecessary risk.
Option C is incorrect because orange juice does not improve
the drug's therapeutic effect or address the safety concern.
Metoprolol may be taken with or immediately after meals to
improve consistent absorption, but heart rate assessment
remains the priority. Option D is incorrect because prophylactic
atropine administration is not indicated. Atropine is reserved
for symptomatic bradycardia and should not be routinely given
before beta-blockers.
Patient teaching includes not stopping beta-blockers abruptly,
as sudden withdrawal may precipitate rebound hypertension,
angina, or myocardial infarction. The nurse should also monitor
blood pressure, heart rate, signs of worsening heart failure, and
symptoms of hypotension throughout therapy.
Learning Objectives
After completing this question, the learner should be able to:
• Identify assessment parameters required before
administering beta blockers.
• Recognize when bradycardia warrants withholding
medication.
, • Apply clinical judgment to promote safe cardiovascular
medication administration.
Medication Safety Focus
Monitoring Parameters
Question 2 (Moderate)
Clinical Scenario
A 74-year-old woman with chronic heart failure is prescribed
digoxin 0.125 mg orally once daily and furosemide 40 mg orally
daily. During the morning assessment, the nurse notes:
• HR: 58/min
• BP: 118/70 mm Hg
• Potassium: 2.9 mEq/L
• Creatinine: 1.4 mg/dL
• The client reports nausea, decreased appetite, and seeing
"yellow halos" around lights.
Question Stem
Which nursing action is the priority?
A. Administer both medications as scheduled.
B. Hold the digoxin and notify the provider immediately.
