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Pharmacological and Parenteral Therapies

NCLEX Cardiac Medication Practice Questions

Quick answer

Cardiac medication questions test whether you can safely give, hold, or teach about drugs that change heart rate, rhythm, blood pressure and fluid balance. They sit inside Pharmacological and Parenteral Therapies, which makes up roughly 13 to 19 percent of the exam, and cardiac drugs are one of the most heavily tested groups in that category.

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Cardiac drugs are tested less on what the drug does and more on what the nurse checks before giving it and what the client needs to know at home. You will see a pulse of 56, a potassium of 3.1, a client complaining of leg pain on a statin, or a client who wants to take sildenafil with his nitroglycerin. The trap most students fall into is memorizing side effects as a list instead of linking each drug to one vital sign or lab you check before you hand it over. If you can say "before this drug, I check this number" for every cardiac drug on this page, most of these questions become easy. Work through the 10 below and read every rationale, including the ones you got right.

Practice questions

1

A client with heart failure is scheduled for metoprolol 50 mg by mouth. The morning vital signs are blood pressure 88/54 mm Hg, pulse 52 beats per minute, and respirations 18. Which action should the nurse take first?

  1. AGive the medication and recheck vital signs in 30 minutes
  2. BHold the medication and notify the health care provider
  3. CGive half the dose and document the vital signs
  4. DPlace the client in high Fowler position and give the dose
Show answer

Answer: B

Beta blockers lower both heart rate and blood pressure. A pulse under 60 or a systolic pressure under 90 is a standard hold parameter, and the nurse holds the dose and calls the provider rather than guessing.

Why the others are wrong

Giving the full dose (A) could drop the pulse and pressure further and cause syncope or heart block. The nurse cannot change a prescribed dose on her own (C). Positioning (D) does nothing to fix the underlying problem and still delivers a drug that is contraindicated at these numbers.

2

A client with type 1 diabetes has been started on propranolol for hypertension. Which statement by the client shows the teaching was effective?

  1. A"I will know my sugar is low because my heart will race."
  2. B"Sweating may be the only warning I get that my sugar is low."
  3. C"I can stop checking my blood sugar as often now."
  4. D"This medication will raise my blood sugar, so I need more insulin."
Show answer

Answer: B

Nonselective beta blockers block the adrenaline response, so tachycardia, tremor and anxiety that normally warn of hypoglycemia are hidden. Sweating is not blocked, so it may be the only sign left.

Why the others are wrong

A racing heart is exactly the sign the drug masks (A). The client needs to check blood sugar more often, not less (C). Propranolol does not reliably raise glucose and insulin is never adjusted based on a beta blocker alone (D).

3

A client is receiving diltiazem for atrial fibrillation with rapid ventricular response. Which finding should the nurse report to the health care provider?

  1. AHeart rate 78 beats per minute
  2. BMild ankle edema
  3. CBlood pressure 86/50 mm Hg
  4. DComplaint of a headache rated 2 out of 10
Show answer

Answer: C

Diltiazem is a calcium channel blocker that slows the heart rate and relaxes blood vessels. A systolic pressure of 86 means the client has become hypotensive and the infusion or dose needs review before the client decompensates.

Why the others are wrong

A heart rate of 78 is the goal of therapy, not a problem (A). Mild ankle edema and a mild headache (B and D) are common expected effects of calcium channel blockers and are documented and monitored, not reported urgently.

4

A client with stable angina asks how to use sublingual nitroglycerin at home. Which instruction should the nurse include?

  1. A"Swallow the tablet with a full glass of water."
  2. B"Take one tablet every 5 minutes for up to three tablets. If the pain is not gone after the first tablet, call 911."
  3. C"Keep the tablets in a clear plastic bag in your pocket so they stay warm."
  4. D"Take a tablet every morning to prevent chest pain during the day."
Show answer

Answer: B

Sublingual nitroglycerin goes under the tongue and may be repeated every 5 minutes up to three doses. Current guidance is to call emergency services if the pain is not relieved or gets worse after the first dose, so the client is not sitting at home for 15 minutes with an evolving infarction.

Why the others are wrong

Swallowing the tablet destroys most of it in the liver and it will not work (A). Nitroglycerin breaks down with heat, light and moisture and belongs in the original dark glass bottle (C). Sublingual tablets are for acute chest pain, not daily prevention (D).

5

A 58 year old male with coronary artery disease is prescribed sublingual nitroglycerin as needed. During the admission history he tells the nurse he takes tadalafil a few times a week. Which is the best response by the nurse?

  1. A"That is fine as long as you separate the two by at least 2 hours."
  2. B"Taking the two together can drop your blood pressure to a dangerous level. We need to let your provider know."
  3. C"Tadalafil will make the nitroglycerin work better, so you may need less of it."
  4. D"You should stop the nitroglycerin and keep taking the tadalafil."
Show answer

Answer: B

Nitrates and PDE-5 inhibitors (sildenafil, tadalafil, vardenafil) both cause vasodilation. Together they can cause severe, sometimes fatal hypotension. The provider must know so the plan can be adjusted and the client taught when it is safe to take nitroglycerin.

Why the others are wrong

Two hours is nowhere near enough; nitrates are generally avoided for 24 hours after sildenafil and 48 hours after tadalafil (A). The combination is dangerous, not helpful (C). The client should never be told to stop his antianginal on the nurse's word (D).

6

A client has been taking amiodarone for 8 months for ventricular dysrhythmia. Which finding is most important for the nurse to report?

  1. ABlue gray discoloration on the cheeks and nose
  2. BNew shortness of breath and a dry cough
  3. CThe client reports sensitivity to sunlight
  4. DHeart rate 64 beats per minute
Show answer

Answer: B

Amiodarone can cause pulmonary toxicity, which can progress to permanent lung damage. New dyspnea or a dry cough in a client on long term amiodarone is reported right away so a chest X ray and pulmonary function tests can be done.

Why the others are wrong

Blue gray skin and photosensitivity (A and C) are known cosmetic side effects that need teaching and documentation but are not emergencies. A heart rate of 64 (D) is an acceptable rate on an antiarrhythmic.

7

A client with heart failure receives furosemide 40 mg IV twice a day. The morning labs show potassium 3.0 mEq/L. The client is also prescribed digoxin daily. Which action should the nurse take first?

  1. AGive the furosemide and encourage a banana with breakfast
  2. BHold the furosemide and the digoxin and notify the provider of the potassium level
  3. CGive the digoxin and hold only the furosemide
  4. DGive both medications since the potassium is only slightly low
Show answer

Answer: B

Loop diuretics waste potassium, and a potassium of 3.0 mEq/L is below the normal range. Low potassium makes the heart far more sensitive to digoxin and raises the risk of toxicity and dangerous dysrhythmias, so both drugs are held and the provider is called for replacement orders.

Why the others are wrong

A banana will not correct a potassium of 3.0 and giving more furosemide will drop it further (A). Giving digoxin with a low potassium invites toxicity (C). A potassium of 3.0 in a client on digoxin is not "only slightly low" (D).

8

A client with heart failure is started on spironolactone. The nurse reviews the client's home medication list and diet. Which item should the nurse question?

  1. AThe client uses a salt substitute on all meals
  2. BThe client drinks one cup of coffee each morning
  3. CThe client takes acetaminophen for knee pain
  4. DThe client eats oatmeal for breakfast most days
Show answer

Answer: A

Spironolactone is a potassium sparing diuretic. Most salt substitutes are potassium chloride, and using them freely on top of this drug can push the potassium into a dangerous range and cause dysrhythmias.

Why the others are wrong

One cup of coffee (B) has no meaningful effect on potassium. Acetaminophen (C) does not interact with spironolactone the way NSAIDs do. Oatmeal (D) is a reasonable heart healthy food with no potassium concern.

9

A client who started atorvastatin 3 weeks ago calls the clinic. Which complaint should the nurse tell the client to come in for right away?

  1. AMild upset stomach after taking the pill
  2. BMuscle pain and weakness in both thighs with dark colored urine
  3. CDifficulty remembering to take the pill at bedtime
  4. DA craving for grapefruit juice
Show answer

Answer: B

Unexplained muscle pain with weakness and dark urine points to rhabdomyolysis, a rare but serious breakdown of muscle that can lead to kidney failure. The statin is stopped and a creatine kinase and kidney function are checked.

Why the others are wrong

Mild GI upset (A) is common early on and usually settles. Forgetting a dose (C) is a teaching issue, not an emergency. Grapefruit juice should be limited with some statins, but a craving for it (D) is not a reason for an urgent visit.

10

A client who has had a drug eluting coronary stent placed is prescribed clopidogrel and aspirin. Which statement by the client indicates a need for further teaching?

  1. A"I will tell my dentist I am on these medications before any procedure."
  2. B"I should use a soft toothbrush and an electric razor."
  3. C"I can stop the clopidogrel once I feel better, as long as I keep taking the aspirin."
  4. D"I will report black stools or blood in my urine right away."
Show answer

Answer: C

Stopping an antiplatelet early after a stent can allow a clot to form inside the stent and cause a heart attack. The client must take both drugs for the full prescribed period and never stop without talking to the cardiologist.

Why the others are wrong

Telling the dentist (A), using a soft toothbrush and electric razor (B), and reporting signs of bleeding (D) are all correct and show the client understands the bleeding risk.

Quick tips

  • Pair every drug with its pre dose check: beta blockers and calcium channel blockers get a pulse and blood pressure, diuretics get a potassium, antiplatelets get a bleeding assessment, ACE inhibitors get a potassium and creatinine.
  • Common hold numbers on the exam are pulse under 60 and systolic under 90. If the stem gives you those values and asks what to do first, hold and notify is almost always the answer.
  • ACE inhibitors (the "pril" drugs) can cause angioedema at any time, even years into therapy. Swelling of the lips, tongue or face is an airway emergency, not a rash to document and watch.
  • Nitrates and PDE-5 inhibitors never mix. If a stem mentions sildenafil, tadalafil or vardenafil and a nitrate, the question is about hypotension.
  • Muscle pain on a statin is not something to "wait and see". Ask about weakness and urine color, and think rhabdomyolysis.

Related topics

FAQ

What cardiac meds are most tested on NCLEX?

Beta blockers, digoxin, nitroglycerin, loop and potassium sparing diuretics, ACE inhibitors, anticoagulants and antiplatelets, statins and amiodarone show up the most. The questions usually ask what to check before giving the drug, what to report, or what to teach, not the mechanism.

When do you hold a beta blocker on NCLEX?

The common exam parameters are a heart rate under 60 beats per minute or a systolic blood pressure under 90 mm Hg. Hold the dose, document the vital signs and notify the provider. Never give a reduced dose on your own.

Why is ACE inhibitor angioedema an emergency?

Angioedema from an ACE inhibitor causes swelling of the lips, tongue and throat that can close the airway within minutes. The drug is stopped permanently, the client is never rechallenged, and the nurse stays with the client and prepares for airway support.

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