: Cardiovascular Drugs
1. A client with heart failure is prescribed digoxin. Which finding requires immediate
nursing intervention?
A. Heart rate of 58 bpm
B. Serum potassium of 3.2 mEq/L
C. Nausea and vomiting
D. Blurred yellow vision
Answer: B – Serum potassium of 3.2 mEq/L
Rationale: Hypokalemia increases the risk of digoxin toxicity. Normal potassium is 3.5–5.0
mEq/L. A HR of 58 is acceptable if asymptomatic. Nausea and yellow vision are signs of
toxicity but hypokalemia is the trigger that worsens toxicity.
2. A client on furosemide reports muscle cramps and weakness. Which lab value is most
likely abnormal?
A. Sodium 135 mEq/L
B. Potassium 2.9 mEq/L
C. Calcium 9.5 mg/dL
D. Magnesium 2.1 mEq/L
Answer: B – Potassium 2.9 mEq/L
Rationale: Loop diuretics cause hypokalemia, leading to muscle cramps, weakness, and
arrhythmias. Normal K+ 3.5–5.0.
3. A client is started on lisinopril. Which adverse effect requires immediate
discontinuation?
A. Dry cough
B. Angioedema of the lips and tongue
C. Headache
D. Dizziness
Answer: B – Angioedema
Rationale: Angioedema is a life-threatening allergic reaction. Dry cough is common but not
an emergency. Headache/dizziness are transient.
4. A nurse administers IV metoprolol. The client’s BP drops from 140/88 to 90/60 with HR
52. What is the priority action?
,A. Administer atropine
B. Place client in Trendelenburg
C. Hold the next dose and notify provider
D. Increase IV fluids
Answer: C – Hold next dose and notify provider
Rationale: Beta-blockers can cause bradycardia and hypotension. Holding the next dose
prevents further decline. Atropine if symptomatic bradycardia, but not first step.
5. A client on amiodarone reports shortness of breath and dry cough. What complication
should the nurse suspect?
A. Heart failure
B. Pulmonary fibrosis
C. Bronchospasm
D. Pulmonary edema
Answer: B – Pulmonary fibrosis
Rationale: Amiodarone causes pulmonary toxicity (fibrosis, pneumonitis) with insidious
dyspnea and cough. Requires discontinuation and imaging.
6. Which instruction is correct for a client taking sublingual nitroglycerin for angina?
A. Swallow the tablet whole with water
B. Take up to 3 tablets 5 minutes apart; call 911 if no relief after 3rd
C. Store tablets in a cool, dry, dark place
D. Use after expiration date for best effect
Answer: B – Take up to 3 tablets…
Rationale: Standard protocol: 1 tablet q5min ×3 doses. If pain persists after 3rd, seek
emergency care. Do not swallow sublingual tabs.
7. A client on warfarin has an INR of 4.5 and minor bleeding from a cut. What should the
nurse anticipate?
A. Administer vitamin K
B. Administer protamine sulfate
C. Hold warfarin and recheck INR tomorrow
D. Transfuse platelets
Answer: C – Hold warfarin and recheck INR tomorrow
Rationale: INR 4.5 without major bleeding → hold warfarin, recheck. Vitamin K reserved for
life-threatening bleeding. Protamine for heparin.
8. A client is prescribed clopidogrel after a stent placement. Which herb would increase
bleeding risk?
A. St. John’s wort
B. Garlic
, C. Ginseng
D. Echinacea
Answer: B – Garlic
Rationale: Garlic, ginkgo, ginger, and vitamin E increase bleeding risk with antiplatelets. St.
John’s wort reduces clopidogrel efficacy.
9. A client with hypertension and asthma is prescribed a beta-blocker. Which drug should
the nurse question?
A. Metoprolol
B. Propranolol
C. Atenolol
D. Carvedilol
Answer: B – Propranolol
Rationale: Non-selective beta-blockers (propranolol) block beta-2 receptors, causing
bronchospasm. Cardioselective (metoprolol, atenolol) safer but still use cautiously.
10. A client on spironolactone has a potassium level of 5.9 mEq/L. Which intervention is
most important?
A. Give potassium supplement
B. Hold spironolactone and notify provider
C. Administer calcium gluconate
D. Increase dietary potassium
Answer: B – Hold spironolactone and notify provider
Rationale: Spironolactone is potassium-sparing. K+ >5.5 requires holding the drug to prevent
arrhythmias.
Questions 11–20: Antibiotics & Anti-infectives
11. A client receiving IV vancomycin reports flushing, rash, and hypotension. What is the
nurse’s priority?
A. Stop the infusion and notify provider
B. Slow the infusion rate
C. Administer diphenhydramine as ordered
D. Continue infusion and monitor vital signs
Answer: A – Stop the infusion
Rationale: Red man syndrome (histamine release) – stop infusion, then slow rate after
symptoms resolve if severe.
12. Which adverse effect is unique to linezolid?
A. Nephrotoxicity
1. A client with heart failure is prescribed digoxin. Which finding requires immediate
nursing intervention?
A. Heart rate of 58 bpm
B. Serum potassium of 3.2 mEq/L
C. Nausea and vomiting
D. Blurred yellow vision
Answer: B – Serum potassium of 3.2 mEq/L
Rationale: Hypokalemia increases the risk of digoxin toxicity. Normal potassium is 3.5–5.0
mEq/L. A HR of 58 is acceptable if asymptomatic. Nausea and yellow vision are signs of
toxicity but hypokalemia is the trigger that worsens toxicity.
2. A client on furosemide reports muscle cramps and weakness. Which lab value is most
likely abnormal?
A. Sodium 135 mEq/L
B. Potassium 2.9 mEq/L
C. Calcium 9.5 mg/dL
D. Magnesium 2.1 mEq/L
Answer: B – Potassium 2.9 mEq/L
Rationale: Loop diuretics cause hypokalemia, leading to muscle cramps, weakness, and
arrhythmias. Normal K+ 3.5–5.0.
3. A client is started on lisinopril. Which adverse effect requires immediate
discontinuation?
A. Dry cough
B. Angioedema of the lips and tongue
C. Headache
D. Dizziness
Answer: B – Angioedema
Rationale: Angioedema is a life-threatening allergic reaction. Dry cough is common but not
an emergency. Headache/dizziness are transient.
4. A nurse administers IV metoprolol. The client’s BP drops from 140/88 to 90/60 with HR
52. What is the priority action?
,A. Administer atropine
B. Place client in Trendelenburg
C. Hold the next dose and notify provider
D. Increase IV fluids
Answer: C – Hold next dose and notify provider
Rationale: Beta-blockers can cause bradycardia and hypotension. Holding the next dose
prevents further decline. Atropine if symptomatic bradycardia, but not first step.
5. A client on amiodarone reports shortness of breath and dry cough. What complication
should the nurse suspect?
A. Heart failure
B. Pulmonary fibrosis
C. Bronchospasm
D. Pulmonary edema
Answer: B – Pulmonary fibrosis
Rationale: Amiodarone causes pulmonary toxicity (fibrosis, pneumonitis) with insidious
dyspnea and cough. Requires discontinuation and imaging.
6. Which instruction is correct for a client taking sublingual nitroglycerin for angina?
A. Swallow the tablet whole with water
B. Take up to 3 tablets 5 minutes apart; call 911 if no relief after 3rd
C. Store tablets in a cool, dry, dark place
D. Use after expiration date for best effect
Answer: B – Take up to 3 tablets…
Rationale: Standard protocol: 1 tablet q5min ×3 doses. If pain persists after 3rd, seek
emergency care. Do not swallow sublingual tabs.
7. A client on warfarin has an INR of 4.5 and minor bleeding from a cut. What should the
nurse anticipate?
A. Administer vitamin K
B. Administer protamine sulfate
C. Hold warfarin and recheck INR tomorrow
D. Transfuse platelets
Answer: C – Hold warfarin and recheck INR tomorrow
Rationale: INR 4.5 without major bleeding → hold warfarin, recheck. Vitamin K reserved for
life-threatening bleeding. Protamine for heparin.
8. A client is prescribed clopidogrel after a stent placement. Which herb would increase
bleeding risk?
A. St. John’s wort
B. Garlic
, C. Ginseng
D. Echinacea
Answer: B – Garlic
Rationale: Garlic, ginkgo, ginger, and vitamin E increase bleeding risk with antiplatelets. St.
John’s wort reduces clopidogrel efficacy.
9. A client with hypertension and asthma is prescribed a beta-blocker. Which drug should
the nurse question?
A. Metoprolol
B. Propranolol
C. Atenolol
D. Carvedilol
Answer: B – Propranolol
Rationale: Non-selective beta-blockers (propranolol) block beta-2 receptors, causing
bronchospasm. Cardioselective (metoprolol, atenolol) safer but still use cautiously.
10. A client on spironolactone has a potassium level of 5.9 mEq/L. Which intervention is
most important?
A. Give potassium supplement
B. Hold spironolactone and notify provider
C. Administer calcium gluconate
D. Increase dietary potassium
Answer: B – Hold spironolactone and notify provider
Rationale: Spironolactone is potassium-sparing. K+ >5.5 requires holding the drug to prevent
arrhythmias.
Questions 11–20: Antibiotics & Anti-infectives
11. A client receiving IV vancomycin reports flushing, rash, and hypotension. What is the
nurse’s priority?
A. Stop the infusion and notify provider
B. Slow the infusion rate
C. Administer diphenhydramine as ordered
D. Continue infusion and monitor vital signs
Answer: A – Stop the infusion
Rationale: Red man syndrome (histamine release) – stop infusion, then slow rate after
symptoms resolve if severe.
12. Which adverse effect is unique to linezolid?
A. Nephrotoxicity
