NURSING PHARMACOLOGY
High-Yield RN Study Guide — Aligned with ATI Exam Topics
Complete Edition — 8 Body Systems
Organized by body system • Nursing considerations • Test Alerts • NCLEX-style practice questions
, Cardiovascular Drugs
Beta Receptors ↓ HR, ↓ BP, ↓
Beta-Blocker
(Heart) Contractility
1. Cardiac Glycosides
Example(s): Digoxin
Action Increases force of contraction (positive inotrope), slows heart rate
Nursing Check apical pulse for 1 full minute before giving — hold if <60 bpm
Considerations (adult)
Watch For N/V, visual disturbances (halos, blurred/yellow vision), bradycardia
Antidote Digoxin immune Fab (Digibind)
▲ TEST ALERT: Narrow therapeutic range (0.5–2.0 ng/mL) — hypokalemia increases
toxicity risk
2. Beta-Blockers
Example(s): Metoprolol, Atenolol, Propranolol ("-olol")
Action Blocks beta receptors → decreases heart rate, BP, and contractility
Nursing Hold if HR <50 bpm or SBP <90; never stop abruptly (rebound
Considerations hypertension/tachycardia)
Watch For Bradycardia, fatigue, masking of hypoglycemia symptoms in diabetics
▲ TEST ALERT: Contraindicated in asthma/COPD (non-selective agents can cause
bronchospasm)
3. ACE Inhibitors
, Example(s): Lisinopril, Enalapril ("-pril")
Action Blocks conversion of angiotensin I → II, causing vasodilation
Nursing Monitor for persistent dry cough, angioedema, hyperkalemia
Considerations
Watch For First-dose hypotension
▲ TEST ALERT: Teratogenic — contraindicated in pregnancy
4. Anticoagulants
Example(s): Warfarin, Heparin
Action Prevents clot formation
Nursing Warfarin → monitor INR (therapeutic 2–3); Heparin → monitor aPTT
Considerations
Watch For Bleeding, bruising
Antidotes Warfarin = Vitamin K; Heparin = Protamine sulfate
▲ TEST ALERT: Warfarin takes days to reach therapeutic effect — often bridged with
heparin initially
Practice Question
A client on digoxin reports seeing yellow halos around lights. What is the nurse's priority action?
A) Administer the next dose as scheduled
B) Hold the dose and notify the provider
C) Increase fluid intake
D) Recheck blood pressure
Answer: B — This is a classic sign of digoxin toxicity, which develops easily because the drug has a narrow
therapeutic range. Continuing the dose (A) risks worsening toxicity, and fluid or blood pressure checks (C, D) don't
address the underlying problem. Holding the dose and notifying the provider allows a digoxin level to be drawn
before any more is given.
High-Yield RN Study Guide — Aligned with ATI Exam Topics
Complete Edition — 8 Body Systems
Organized by body system • Nursing considerations • Test Alerts • NCLEX-style practice questions
, Cardiovascular Drugs
Beta Receptors ↓ HR, ↓ BP, ↓
Beta-Blocker
(Heart) Contractility
1. Cardiac Glycosides
Example(s): Digoxin
Action Increases force of contraction (positive inotrope), slows heart rate
Nursing Check apical pulse for 1 full minute before giving — hold if <60 bpm
Considerations (adult)
Watch For N/V, visual disturbances (halos, blurred/yellow vision), bradycardia
Antidote Digoxin immune Fab (Digibind)
▲ TEST ALERT: Narrow therapeutic range (0.5–2.0 ng/mL) — hypokalemia increases
toxicity risk
2. Beta-Blockers
Example(s): Metoprolol, Atenolol, Propranolol ("-olol")
Action Blocks beta receptors → decreases heart rate, BP, and contractility
Nursing Hold if HR <50 bpm or SBP <90; never stop abruptly (rebound
Considerations hypertension/tachycardia)
Watch For Bradycardia, fatigue, masking of hypoglycemia symptoms in diabetics
▲ TEST ALERT: Contraindicated in asthma/COPD (non-selective agents can cause
bronchospasm)
3. ACE Inhibitors
, Example(s): Lisinopril, Enalapril ("-pril")
Action Blocks conversion of angiotensin I → II, causing vasodilation
Nursing Monitor for persistent dry cough, angioedema, hyperkalemia
Considerations
Watch For First-dose hypotension
▲ TEST ALERT: Teratogenic — contraindicated in pregnancy
4. Anticoagulants
Example(s): Warfarin, Heparin
Action Prevents clot formation
Nursing Warfarin → monitor INR (therapeutic 2–3); Heparin → monitor aPTT
Considerations
Watch For Bleeding, bruising
Antidotes Warfarin = Vitamin K; Heparin = Protamine sulfate
▲ TEST ALERT: Warfarin takes days to reach therapeutic effect — often bridged with
heparin initially
Practice Question
A client on digoxin reports seeing yellow halos around lights. What is the nurse's priority action?
A) Administer the next dose as scheduled
B) Hold the dose and notify the provider
C) Increase fluid intake
D) Recheck blood pressure
Answer: B — This is a classic sign of digoxin toxicity, which develops easily because the drug has a narrow
therapeutic range. Continuing the dose (A) risks worsening toxicity, and fluid or blood pressure checks (C, D) don't
address the underlying problem. Holding the dose and notifying the provider allows a digoxin level to be drawn
before any more is given.
