Cardiovascular questions
27 questions. Choose an answer to see the rationale.
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A patient's apical pulse is 52 before scheduled metoprolol. What should the nurse do first?
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Answer C: Hold the dose and notify the prescriber per the ordered parameters A heart rate below the ordered parameter (often 60) is a reason to hold a beta blocker and notify the prescriber. Never change a dose on your own.
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Which patient condition makes propranolol the most concerning choice?
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Answer B: Asthma Propranolol is nonselective and blocks beta-2 receptors in the lungs, which can cause bronchospasm in a patient with asthma.
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A patient with type 1 diabetes starts a beta blocker. Which teaching point is most important?
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Answer D: Tremor and fast heartbeat may not appear when blood sugar is low Beta blockade masks the adrenergic warning signs of hypoglycemia, such as tachycardia and tremor. Sweating usually persists.
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A patient taking lisinopril reports swelling of the lips and tongue. What is the priority action?
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Answer B: Assess the airway and notify the provider immediately Angioedema can obstruct the airway. It is an emergency: stop the drug, assess and protect the airway, and get help.
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Which lab value should the nurse monitor most closely in a patient on an ACE inhibitor?
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Answer A: Potassium Less aldosterone means the kidney keeps potassium, so hyperkalemia is a key risk.
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A patient on enalapril has a persistent dry cough. Which drug is the prescriber most likely to switch to?
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Answer B: Losartan ARBs such as losartan do not cause bradykinin buildup, so they rarely cause cough. Switching to another ACE inhibitor would not help.
Angiotensin II receptor blockers (ARBs)
Which suffix identifies an angiotensin II receptor blocker?
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Answer C: -sartan ARBs end in -sartan (losartan, valsartan). ACE inhibitors end in -pril.
Angiotensin II receptor blockers (ARBs)
A patient taking losartan tells the nurse she is planning a pregnancy. What is the best response?
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Answer D: Talk to your provider before trying to conceive; this drug must be stopped in pregnancy Drugs acting on the renin-angiotensin system can injure the fetus; they are stopped as soon as pregnancy is planned or detected.
Angiotensin II receptor blockers (ARBs)
Compared with ACE inhibitors, ARBs are less likely to cause which effect?
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Answer A: Dry cough ARBs do not block bradykinin breakdown, so cough is much less common. The other risks are shared.
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A patient on amlodipine has bilateral ankle swelling with clear lungs and stable weight. What is the most likely cause?
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Answer A: An expected effect of vasodilation Peripheral edema is a common effect of dihydropyridine calcium channel blockers and comes from arteriolar dilation, not fluid overload.
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Before giving IV diltiazem for atrial fibrillation, which assessment matters most?
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Answer C: Heart rate and blood pressure Diltiazem slows AV conduction and lowers blood pressure; bradycardia and hypotension are the main risks.
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Which drink should the nurse tell a patient to ask about before using while taking a calcium channel blocker?
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Answer B: Grapefruit juice Grapefruit inhibits CYP3A4 and can raise levels of several calcium channel blockers.
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A patient takes furosemide and digoxin. Which lab result is most important before giving both?
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Answer B: Potassium 3.1 mEq/L Hypokalemia from the loop diuretic increases the risk of digoxin toxicity. A potassium of 3.1 is low and should be reported.
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Which diuretic requires the patient to avoid salt substitutes?
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Answer B: Spironolactone Spironolactone is potassium-sparing. Salt substitutes contain potassium chloride and can cause hyperkalemia.
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What is the most accurate way to evaluate a diuretic's effect on fluid status at home?
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Answer B: Daily weight at the same time each day Daily weight is the most reliable indicator of fluid gain or loss: 1 kg is about 1 liter of fluid.
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Which finding is often the earliest sign of digoxin toxicity in an adult?
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Answer C: Anorexia and nausea GI symptoms such as loss of appetite and nausea are commonly the first signs of digoxin toxicity.
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Which electrolyte imbalance increases the risk of digoxin toxicity?
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Answer D: Hypokalemia Low potassium lets more digoxin bind to the sodium-potassium pump, increasing toxicity. High calcium and low magnesium also raise the risk.
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What is the antidote for life-threatening digoxin toxicity?
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Answer D: Digoxin immune fab Digoxin immune fab (DigiFab) binds digoxin and is used for severe toxicity.
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A patient using sublingual nitroglycerin still has chest pain 5 minutes after the first tablet. What should the patient do?
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Answer B: Call 911 Current guidance is to call 911 if chest pain is unimproved or worse 5 minutes after the first dose, then continue as directed by EMS.
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Which drug taken in the past 24 hours is a contraindication to nitroglycerin?
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Answer C: Sildenafil Phosphodiesterase-5 inhibitors combined with nitrates can cause severe, life-threatening hypotension.
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Why is a nitroglycerin patch removed for 10 to 12 hours each day?
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Answer C: To prevent nitrate tolerance Continuous nitrate exposure leads to tolerance; a daily nitrate-free interval keeps the drug effective.
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How is adenosine given for supraventricular tachycardia?
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Answer C: Rapid IV push followed immediately by a rapid saline flush Adenosine has a half-life of seconds, so it must reach the heart quickly: rapid push close to the heart, then a fast flush.
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A patient on long-term amiodarone reports a new dry cough and shortness of breath. What does the nurse suspect?
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Answer C: Pulmonary toxicity Pulmonary toxicity is one of amiodarone's most serious adverse effects and must be reported.
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Which ECG change is most important to monitor with many antiarrhythmics?
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Answer C: QT prolongation QT prolongation can lead to torsades de pointes, a life-threatening ventricular rhythm.
Statins (HMG-CoA reductase inhibitors)
A patient taking a statin reports muscle pain and dark brown urine. What is the priority?
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Answer B: Hold the statin and notify the provider: possible rhabdomyolysis Muscle pain with dark urine suggests rhabdomyolysis, which can cause kidney failure. CK and kidney function must be checked.
Statins (HMG-CoA reductase inhibitors)
Which statin is traditionally taken in the evening?
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Answer D: Simvastatin Short half-life statins such as simvastatin and lovastatin work best in the evening, when cholesterol synthesis peaks.
Statins (HMG-CoA reductase inhibitors)
Which lab test is used to evaluate the effectiveness of statin therapy?
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Answer A: Lipid panel The lipid panel, especially LDL cholesterol, shows whether the statin is working.