Cardiovascular pharmacology represents one of the most critical and frequently tested content areas on the NCLEX-RN examination, comprising a significant portion of the Pharmacological and Parenteral Therapies category which accounts for 13-19% of all exam questions. Mastery of cardiovascular medications is essential not only for passing the NCLEX but also for providing safe, effective patient care in clinical practice, as cardiovascular disease remains the leading cause of mortality in the United States. This practice question set focuses on high-yield cardiovascular drugs including antihypertensives, anticoagulants, antiarrhythmics, diuretics, and medications used in acute cardiac emergencies. Understanding the mechanisms of action, therapeutic effects, adverse reactions, nursing considerations, and patient education points for these medications is crucial for success on the exam. The NCLEX tests not just memorization of drug facts, but the ability to apply pharmacological knowledge in clinical scenarios, prioritize interventions, recognize complications, and make sound clinical judgments. These 15 practice questions are designed to mirror the complexity and clinical reasoning required on the actual NCLEX-RN examination. Each question includes detailed rationales explaining both correct and incorrect answer choices, helping you understand the underlying principles rather than simply memorizing facts. Special attention is given to high-alert medications such as anticoagulants, antiarrhythmics, and vasoactive drugs that require careful monitoring and can cause serious adverse effects if not managed properly. By working through these questions and carefully reviewing the explanations, you will strengthen your understanding of cardiovascular pharmacology and build the critical thinking skills necessary for NCLEX success. Remember that cardiovascular medications often interact with each other and with other body systems, so a comprehensive understanding of pathophysiology and pharmacodynamics is essential for safe medication administration and patient advocacy.
Question 1
A nurse is caring for a patient receiving intravenous nitroglycerin for acute myocardial infarction. Which assessment finding requires immediate intervention?
A. Blood pressure 88/52 mmHg
B. Heart rate 78 beats per minute
C. Chest pain rated 3/10
D. Respiratory rate 18 breaths per minute
Correct Answer: A
Explanation: A blood pressure of 88/52 mmHg indicates hypotension, which is a serious adverse effect of nitroglycerin. Nitroglycerin causes vasodilation, which can lead to significant drops in blood pressure. This requires immediate intervention as severe hypotension can compromise perfusion to vital organs. The medication may need to be discontinued or the dose reduced. Options B, C, and D represent normal or improving findings that do not require immediate intervention.
Question 2
A patient with heart failure is prescribed furosemide (Lasix) 40 mg PO daily. Which laboratory value should the nurse monitor most closely?
A. Serum calcium
B. Serum potassium
C. Serum sodium
D. Blood glucose
Correct Answer: B
Explanation: Furosemide is a loop diuretic that causes significant potassium loss through the kidneys. Hypokalemia is one of the most serious adverse effects and can lead to cardiac arrhythmias, especially dangerous in patients with heart failure who may also be taking digoxin. While furosemide can affect sodium levels (option C), potassium monitoring is most critical. Calcium (option A) and blood glucose (option D) are not primary concerns with furosemide therapy.
Question 3
A nurse is teaching a patient newly prescribed metoprolol (Lopressor) for hypertension. Which patient statement indicates understanding of the medication?
A. “I should take this medication with grapefruit juice.”
B. “I can stop taking this medication once my blood pressure is normal.”
C. “I should check my pulse before taking this medication.”
D. “This medication will cure my high blood pressure.”
Correct Answer: C
Explanation: Metoprolol is a beta-blocker that decreases heart rate and blood pressure. Patients should check their pulse before administration and hold the medication if the heart rate is below 60 beats per minute (or as specified by the provider). Option A is incorrect as grapefruit juice can interact with some medications but is not specifically recommended with metoprolol. Option B is dangerous as beta-blockers should never be stopped abruptly due to risk of rebound hypertension and cardiac events. Option D is incorrect as antihypertensive medications manage but do not cure hypertension.
Question 4
A patient receiving digoxin (Lanoxin) reports nausea, vomiting, and seeing yellow-green halos around lights. The nurse should recognize these symptoms as:
A. Expected side effects that will resolve
B. Signs of digoxin toxicity
C. Symptoms of heart failure exacerbation
D. Allergic reaction to digoxin
Correct Answer: B
Explanation: The classic triad of gastrointestinal symptoms (nausea, vomiting) and visual disturbances (yellow-green halos, blurred vision) are hallmark signs of digoxin toxicity. This is a serious condition that requires immediate intervention, including checking digoxin levels and potentially administering digoxin immune fab (Digibind). These are not expected side effects (option A), not related to heart failure worsening (option C), and not allergic reactions (option D).
Question 5
A nurse is preparing to administer warfarin (Coumadin) to a patient. Which laboratory value should be reviewed before administration?
A. aPTT (activated partial thromboplastin time)
B. INR (international normalized ratio)
C. Platelet count
D. Hemoglobin level
Correct Answer: B
Explanation: Warfarin is an oral anticoagulant that requires monitoring of the INR to ensure therapeutic anticoagulation and prevent bleeding complications. The therapeutic INR range is typically 2.0-3.0 for most indications. Option A (aPTT) is used to monitor heparin therapy, not warfarin. While platelet count (option C) and hemoglobin (option D) are important in assessing bleeding risk, INR is the specific test for warfarin monitoring.
Question 6
A patient with atrial fibrillation is prescribed diltiazem (Cardizem). The nurse understands this medication works by:
A. Increasing cardiac contractility
B. Blocking calcium channels in the heart
C. Stimulating beta receptors
D. Increasing sodium reabsorption
Correct Answer: B
Explanation: Diltiazem is a calcium channel blocker that works by blocking calcium channels in cardiac and smooth muscle cells. This action decreases heart rate, reduces cardiac contractility, and causes vasodilation, making it effective for rate control in atrial fibrillation and treatment of hypertension. Option A is incorrect as diltiazem decreases, not increases, contractility. Option C describes beta agonists, not calcium channel blockers. Option D is unrelated to diltiazem’s mechanism of action.
Question 7
A nurse is caring for a patient receiving heparin infusion. Which medication should be readily available as an antidote?
A. Vitamin K (phytonadione)
B. Protamine sulfate
C. Naloxone (Narcan)
D. Flumazenil (Romazicon)
Correct Answer: B
Explanation: Protamine sulfate is the specific antidote for heparin overdose or when rapid reversal of anticoagulation is needed. It works by binding to heparin and neutralizing its anticoagulant effects. Option A (vitamin K) is the antidote for warfarin, not heparin. Options C and D are antidotes for opioids and benzodiazepines, respectively, and are not related to anticoagulation therapy.
Question 8
A patient taking lisinopril (Prinivil) for hypertension reports a persistent dry cough. What is the nurse’s best response?
A. “This is a common side effect of ACE inhibitors and may require changing medications.”
B. “You should take cough suppressants to manage this symptom.”
C. “This indicates you are allergic to the medication.”
D. “The cough will resolve after a few weeks of therapy.”
Correct Answer: A
Explanation: A persistent dry cough is a common and well-known side effect of ACE inhibitors like lisinopril, occurring in 10-20% of patients. It is caused by the accumulation of bradykinin in the lungs. While not dangerous, it can be bothersome enough to warrant switching to an alternative medication class such as an ARB (angiotensin receptor blocker). Option B does not address the underlying cause. Option C is incorrect as this is not an allergic reaction. Option D is misleading as the cough typically does not resolve with continued therapy.
Question 9
A nurse is teaching a patient about newly prescribed atorvastatin (Lipitor). Which instruction is most important?
A. “Take this medication in the morning with breakfast.”
B. “Report any unexplained muscle pain or weakness immediately.”
C. “You can stop taking this once your cholesterol is normal.”
D. “Increase your intake of grapefruit juice for better absorption.”
Correct Answer: B
Explanation: Statins like atorvastatin can cause rhabdomyolysis, a serious condition involving muscle breakdown that can lead to kidney damage. Patients must be instructed to report any unexplained muscle pain, tenderness, or weakness immediately. Option A is incorrect as statins are typically taken in the evening when cholesterol synthesis is highest. Option C is dangerous as statins require long-term therapy. Option D is incorrect as grapefruit juice actually increases statin levels and risk of adverse effects.
Question 10
A patient with heart failure is prescribed spironolactone (Aldactone). The nurse should monitor for which electrolyte imbalance?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypernatremia
Correct Answer: B
Explanation: Spironolactone is a potassium-sparing diuretic that works by blocking aldosterone receptors. Unlike loop and thiazide diuretics, it causes potassium retention, which can lead to hyperkalemia. This is especially important to monitor in patients also taking ACE inhibitors or ARBs, which also increase potassium levels. Option A (hypokalemia) is associated with loop and thiazide diuretics. Options C and D are not primary concerns with spironolactone therapy.
Question 11
A nurse is preparing to administer the first dose of captopril (Capoten) to a patient. Which assessment is most important before administration?
A. Blood glucose level
B. Blood pressure
C. Respiratory rate
D. Temperature
Correct Answer: B
Explanation: Captopril is an ACE inhibitor used to treat hypertension and heart failure. The first dose can cause significant hypotension, known as “first-dose hypotension.” Therefore, it is critical to assess baseline blood pressure before administration and monitor closely afterward. The patient should be advised to change positions slowly and report dizziness. While other vital signs are important, blood pressure is the priority assessment for ACE inhibitor administration.
Question 12
A patient receiving amiodarone (Cordarone) for atrial fibrillation should be monitored for which serious adverse effect?
A. Hyperglycemia
B. Pulmonary toxicity
C. Hyperkalemia
D. Thrombocytopenia
Correct Answer: B
Explanation: Amiodarone is a potent antiarrhythmic medication that can cause serious pulmonary toxicity, including pulmonary fibrosis and pneumonitis. Patients should have baseline and periodic chest X-rays and pulmonary function tests. They should be instructed to report any respiratory symptoms such as dyspnea or cough. Amiodarone can also cause thyroid dysfunction, hepatotoxicity, and corneal deposits, but pulmonary toxicity is one of the most serious adverse effects. Options A, C, and D are not primary concerns with amiodarone therapy.
Question 13
A patient taking clopidogrel (Plavix) after coronary stent placement asks when they can stop taking the medication. What is the nurse’s best response?
A. “You can stop once your chest pain resolves.”
B. “You should continue this medication as prescribed by your cardiologist, typically for at least one year.”
C. “You only need to take this for one month after the procedure.”
D. “You can stop taking this medication once you start feeling better.”
Correct Answer: B
Explanation: Clopidogrel is an antiplatelet medication critical for preventing stent thrombosis after coronary stent placement. Current guidelines recommend dual antiplatelet therapy (aspirin plus clopidogrel) for at least 12 months after drug-eluting stent placement. Premature discontinuation significantly increases the risk of stent thrombosis, which can be fatal. The duration should be determined by the cardiologist based on the type of stent and patient risk factors. Options A, C, and D represent dangerous misconceptions that could lead to serious complications.
Question 14
A nurse is caring for a patient receiving intravenous dopamine. At which infusion rate does dopamine primarily cause vasoconstriction?
A. 1-2 mcg/kg/min
B. 2-5 mcg/kg/min
C. 5-10 mcg/kg/min
D. Greater than 10 mcg/kg/min
Correct Answer: D
Explanation: Dopamine has dose-dependent effects. At low doses (1-2 mcg/kg/min), it stimulates dopaminergic receptors causing renal vasodilation. At moderate doses (2-10 mcg/kg/min), it stimulates beta-1 receptors increasing cardiac contractility and heart rate. At high doses (greater than 10 mcg/kg/min), it stimulates alpha receptors causing vasoconstriction and increased blood pressure. Understanding these dose-dependent effects is crucial for safe administration and monitoring.
Question 15
A patient with hypertension is prescribed hydrochlorothiazide (HCTZ). Which dietary instruction should the nurse provide?
A. “Restrict your intake of potassium-rich foods.”
B. “Increase your intake of foods high in potassium.”
C. “Avoid all sodium in your diet.”
D. “Increase your calcium intake significantly.”
Correct Answer: B
Explanation: Hydrochlorothiazide is a thiazide diuretic that causes potassium loss through the kidneys, leading to hypokalemia. Patients should be instructed to increase dietary intake of potassium-rich foods such as bananas, oranges, potatoes, and spinach, or may require potassium supplementation. Option A is incorrect and dangerous as it would worsen hypokalemia. Option C is too extreme; moderate sodium restriction is recommended, not complete avoidance. Option D is not the primary dietary concern with HCTZ therapy.
Study Tips for NCLEX-RN Cardiovascular Pharmacology
- Focus on drug classifications: Understanding the mechanism of action for each drug class helps you predict side effects and nursing considerations.
- Know high-alert medications: Anticoagulants, antiarrhythmics, and vasoactive drugs require special attention and monitoring.
- Memorize antidotes: Know the reversal agents for common cardiovascular medications (protamine for heparin, vitamin K for warfarin).
- Understand lab monitoring: Know which lab values to monitor for each medication class (INR for warfarin, potassium for diuretics, digoxin levels).
- Practice prioritization: The NCLEX tests your ability to identify which assessment findings require immediate intervention.
- Learn patient education: Be prepared to answer questions about medication teaching and patient safety.
Good luck with your NCLEX-RN preparation!