Pharmacology: Pharmacology: Cardiac Drugs Practice Questions
Test yourself on Pharmacology: Cardiac Drugs with 13 original NCLEX-RN practice questions. Pick an answer to see instant feedback and a full explanation.
Free original practice questions for study purposes. Open Exam Prep is an independent study resource and is not affiliated with, endorsed by, or sponsored by the makers of NCLEX-RN.
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1. A client taking digoxin reports nausea, anorexia, and seeing yellow halos around lights. The nurse should first:
Explanation. Anorexia, nausea, and visual changes such as yellow/green halos are classic signs of digoxin toxicity. The nurse should review the serum digoxin level (therapeutic 0.5-2 ng/mL) and potassium, since hypokalemia increases toxicity risk. Giving the next dose could worsen toxicity.
2. Before administering digoxin to an adult client, the nurse counts an apical pulse of 54 beats/min. The most appropriate action is to:
Explanation. Digoxin should be held when the apical heart rate is below 60 beats/min in an adult because of the risk of further slowing conduction (bradycardia/heart block). The nurse holds the dose and notifies the provider.
3. A client is started on a nitroglycerin patch for stable angina. Which instruction is most important to prevent tolerance?
Explanation. Nitrate tolerance develops with continuous exposure. A daily nitrate-free interval of 10-14 hours (commonly removing the patch at night) preserves effectiveness. Rotating sites prevents irritation but does not prevent tolerance.
4. A client taking metoprolol for hypertension should be taught to report which finding?
Explanation. Beta blockers like metoprolol decrease heart rate and contractility. A heart rate of 48 with fatigue suggests excessive bradycardia and should be reported. Clients should also avoid abruptly stopping the drug to prevent rebound tachycardia/hypertension.
5. A client on lisinopril develops a persistent dry cough. The nurse understands this is caused by:
Explanation. ACE inhibitors block breakdown of bradykinin, leading to a dry, nonproductive cough in some clients. This is a common reason for switching to an ARB (e.g., losartan), which does not increase bradykinin.
6. The nurse is teaching a client about furosemide therapy for heart failure. Which statement indicates a need for further teaching?
Explanation. Furosemide is a loop diuretic that WASTES potassium, causing hypokalemia. Clients often need potassium supplements and potassium-rich foods. Believing it 'saves' potassium shows incorrect understanding requiring more teaching.
7. A client receiving IV amiodarone for ventricular dysrhythmia should be monitored for which serious adverse effect with long-term use?
Explanation. Amiodarone can cause pulmonary toxicity/fibrosis, as well as thyroid dysfunction, hepatotoxicity, corneal deposits, and blue-gray skin. Baseline and periodic pulmonary function, thyroid, and liver tests are needed.
8. A client with atrial fibrillation is taking warfarin. The INR is 1.2. The nurse interprets this result as:
Explanation. For atrial fibrillation the target INR is typically 2-3. An INR of 1.2 is subtherapeutic, leaving the client at risk for thromboembolism. Vitamin K is the antidote for excessive (high) INR, not a low one.
9. A client is prescribed nifedipine, a calcium channel blocker. The nurse anticipates which common side effect?
Explanation. Dihydropyridine calcium channel blockers (e.g., nifedipine, amlodipine) cause vasodilation, leading to peripheral edema, headache, flushing, and reflex tachycardia. Bradycardia/constipation are more associated with verapamil/diltiazem.
10. A client receiving IV heparin has an activated partial thromboplastin time (aPTT) more than 2.5 times the control value and shows bleeding gums. The nurse prepares to administer which antidote?
Explanation. Protamine sulfate is the antidote for heparin. A markedly prolonged aPTT with bleeding indicates excessive anticoagulation. Vitamin K reverses warfarin, not heparin.
11. A client taking atorvastatin reports muscle pain and dark urine. The nurse should:
Explanation. Muscle pain plus dark (tea-colored) urine may indicate rhabdomyolysis, a serious statin adverse effect. The nurse should hold the drug and report it; a CK level is checked. Grapefruit juice increases statin levels and toxicity and should be avoided.
12. A nurse administers IV adenosine for supraventricular tachycardia. Which response is expected immediately after the rapid IV push?
Explanation. Adenosine has an extremely short half-life and is given as a rapid IV push followed by a saline flush. It briefly blocks AV node conduction, often causing a few seconds of asystole/sinus pause before sinus rhythm resumes.
13. A client with heart failure is started on spironolactone in addition to other medications. The nurse should monitor closely for:
Explanation. Spironolactone is a potassium-sparing diuretic (aldosterone antagonist), so it can cause hyperkalemia. The nurse monitors serum potassium and teaches the client to avoid salt substitutes and excessive potassium-rich foods/supplements.
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FAQ
How should I memorize the antidotes for cardiac anticoagulants?
Link each drug to its reversal agent: heparin reverses with protamine sulfate, warfarin reverses with vitamin K (and FFP/PCC in emergencies), and dabigatran reverses with idarucizumab. Also pair the lab test with the drug—aPTT for heparin and INR/PT for warfarin—so test trends point you to the right antidote.
What safety parameters should I always check before giving common cardiac drugs?
Check heart rate before digoxin and beta blockers (hold if apical pulse is under 60 in adults), check blood pressure before antihypertensives and nitrates, and check relevant labs—digoxin and potassium levels for digoxin, INR for warfarin, aPTT for heparin, and potassium for diuretics. Building this 'assess before administer' habit prevents many NCLEX errors.
How do I keep diuretic and potassium effects straight?
Loop diuretics (furosemide) and thiazides waste potassium, so watch for hypokalemia and teach potassium-rich foods. Potassium-sparing diuretics (spironolactone) and ACE inhibitors/ARBs retain potassium, so watch for hyperkalemia. Remember that low potassium increases digoxin toxicity risk—this concept is heavily tested.