Cardiovascular, respiratory and endocrine drugs

52 NCLEX-RN practice questions on Cardiovascular, respiratory and endocrine drugs, part of Pharmacological and Parenteral Therapies. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard · Select all that apply
The provider prescribes adenosine 6 mg IV for a client in stable supraventricular tachycardia. Which actions should the nurse take?
1. AGive the dose as a rapid push over 1 to 2 seconds
2. BTell the client to expect brief chest pressure or flushing
3. CRecord a continuous rhythm strip during the injection
4. DInject the dose slowly over two minutes
5. EFollow the dose at once with a 20 mL normal saline flush
6. FUse the IV port closest to the client's heart
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Answer: A, B, C, E, F
Adenosine: rapid IV push into a proximal port with an immediate 20 mL saline flush, continuous ECG recording, and warning the client of transient chest pressure and flushing.
- D: A slow injection lets the drug break down before it acts.
Question 2 · Medium · Select all that apply
A client started lisinopril 10 mg daily two weeks ago. Which findings at today's clinic visit require follow-up with the provider?
1. ASerum creatinine 2.0 mg/dL, up from 1.0 mg/dL
2. BSerum potassium 5.8 mEq/L
3. CHeart rate 74/min
4. DPositive home pregnancy test
5. ESerum sodium 138 mEq/L
6. FBlood pressure 124/76 mm Hg
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Answer: A, B, D
After starting an ACE inhibitor, report hyperkalemia, a large creatinine rise and pregnancy; a normal BP, sodium and heart rate need no action.
- C: Lisinopril does not slow the heart; this rate is normal.
- E: This is within the reference range.
- F: This shows the intended antihypertensive effect.
Question 3 · Medium · Matrix
For each drug, indicate whether it mainly raises the risk of hypokalemia or of hyperkalemia.
For each row, choose: Hypokalemia / Hyperkalemia
1. Losartan
2. Furosemide
3. Triamterene
4. Spironolactone
5. Hydrochlorothiazide
6. Albuterol, repeated nebulized doses
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Answer:
- Losartan: Hyperkalemia
- Furosemide: Hypokalemia
- Triamterene: Hyperkalemia
- Spironolactone: Hyperkalemia
- Hydrochlorothiazide: Hypokalemia
- Albuterol, repeated nebulized doses: Hypokalemia
Loop and thiazide diuretics and beta-2 agonists lower potassium; spironolactone, triamterene, ACE inhibitors and ARBs raise it.
- Losartan: ARBs lower aldosterone effect and so retain potassium.
- Furosemide: Loop diuretics increase potassium loss in the urine.
- Triamterene: This potassium-sparing diuretic blocks distal sodium channels and retains potassium.
- Spironolactone: As an aldosterone antagonist it causes the kidney to retain potassium.
- Hydrochlorothiazide: Thiazides increase distal sodium delivery and potassium excretion.
- Albuterol, repeated nebulized doses: Beta-2 stimulation shifts potassium into cells.
Question 4 · Medium · Select all that apply
A client with hypertension and type 2 diabetes is starting metoprolol succinate. Which instructions should the nurse give?
1. ACheck blood glucose if you feel unwell, because a fast heartbeat may not warn you of a low
2. BLearn to check your pulse and know the rate your provider wants reported
3. CGet up slowly from lying or sitting
4. DReport new shortness of breath or swelling of the ankles
5. EDo not stop the drug suddenly, even if you feel well
6. FTake two tablets the next morning if you miss a dose
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Answer: A, B, C, D, E
Beta-blocker teaching: never stop abruptly, change position slowly, hypoglycemia signs may be masked, report breathlessness or edema, and monitor pulse.
- F: A double dose can cause marked bradycardia and hypotension.
Question 5 · Hard · Select all that apply
A client who takes digoxin has a serum digoxin level of 3.4 ng/mL (therapeutic 0.5-2.0 ng/mL), an apical pulse of 44/min with frequent premature ventricular contractions, and a potassium of 3.1 mEq/L. Which actions should the nurse take?
1. AAsk the provider about checking a serum magnesium level
2. BPlace the client on continuous cardiac monitoring
3. CHold the scheduled digoxin dose
4. DGive the prescribed potassium chloride as a rapid IV push
5. EGive half of the usual digoxin dose to avoid withdrawal
6. FPrepare to give digoxin immune fab as prescribed
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Answer: A, B, C, F
For digoxin toxicity: stop the drug, monitor the rhythm, correct potassium and magnesium safely, and give digoxin immune fab for dangerous dysrhythmias or bradycardia.
- D: Potassium is never given by IV push; it can cause fatal cardiac arrest and is infused diluted and slowly.
- E: Digoxin has no withdrawal effect, and any dose adds to the toxic level.
Question 6 · Hard · Select all that apply
The nurse is teaching a client who is going home on oral amiodarone. Which instructions are correct?
1. AUse sunscreen and cover the skin when outdoors
2. BVision changes such as halos are harmless and need no report
3. CReport a new dry cough or shortness of breath right away
4. DStop the drug if you have nausea in the first week
5. EDrink grapefruit juice to help the tablets absorb
Answer and explanation in LearnFree account
Question 7 · Medium · Select all that apply
A client starting levothyroxine also takes several other drugs. Which of these should the nurse teach the client to take at least 4 hours apart from the levothyroxine?
1. AAcetaminophen
2. BMetoprolol succinate
3. CLisinopril
4. DFerrous sulfate
5. ECalcium carbonate
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Question 8 · Hard · Select all that apply
A client has taken hydrochlorothiazide 25 mg daily for a year. Which laboratory changes should the nurse expect this drug can cause?
1. ARaised serum potassium
2. BRaised serum calcium
3. CLow serum potassium
4. DRaised blood glucose
5. ELow serum sodium
6. FLow serum uric acid
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Question 9 · Medium · Select all that apply
A client with chronic stable angina is prescribed a transdermal nitroglycerin patch. Which instructions should the nurse give?
1. AApply each new patch to a different clean, hairless site
2. BCut the patch in half if a lower dose is needed
3. CTreat a mild headache with acetaminophen and keep using the patch
4. DSildenafil can be taken safely while using the patch
5. EApply the patch over a chest hair area for better absorption
6. FRemove the patch for about 10 to 12 hours each day, usually overnight
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Question 10 · Hard · Matrix
The nurse reviews the chart of an older adult who takes digoxin 0.25 mg daily. For each finding, indicate whether it raises the client's risk of digoxin toxicity.
For each row, choose: Raises toxicity risk / Does not raise risk
1. Serum calcium 9.1 mg/dL
2. Serum potassium 3.0 mEq/L
3. Serum sodium 139 mEq/L
4. Serum creatinine 2.3 mg/dL, up from 1.0 mg/dL
5. Verapamil newly added for rate control
6. Serum magnesium 1.3 mg/dL (reference 1.7-2.2 mg/dL)
Answer and explanation in LearnFree account
Question 11 · Hard · Matrix
For each situation, indicate the drug the nurse should anticipate the provider will prescribe first.
For each row, choose: Adenosine / Amiodarone / Atropine
1. Stable, regular narrow-complex tachycardia at 190/min after vagal maneuvers fail
2. Pulseless ventricular tachycardia recurring after two shocks and epinephrine, at the next rhythm check
3. Sinus bradycardia at 38/min with hypotension and confusion
4. Ventricular fibrillation persisting after the third shock and epinephrine
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Question 12 · Easy · Select all that apply
A client with heart failure is going home on digoxin 0.125 mg daily. Which instructions should the nurse include in the discharge teaching?
1. AKeep the follow-up appointments for blood level and potassium checks
2. BCount your pulse for one full minute before each dose
3. CReport nausea, poor appetite or yellow-green halos around lights
4. DTake the tablet together with your antacid to protect the stomach
5. ETake an extra tablet the next day if you miss a dose
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Question 13 · Medium · Select all that apply
A client with acute heart failure received furosemide 40 mg IV four hours ago. Which findings indicate the drug is having its intended effect?
1. ASpO2 risen from 89% to 95% on the same oxygen
2. BJugular venous distension now absent at 45 degrees
3. CCrackles now heard only at the lung bases
4. DUrine output of 1,100 mL since the dose
5. EWeight down 1.2 kg (2.6 lb) from this morning
6. FSerum potassium fallen to 3.1 mEq/L
Answer and explanation in LearnFree account
Question 14 · Hard · Matrix
A client prescribed lisinopril for high blood pressure describes a home routine. Decide whether each remark reflects safe ACE-inhibitor use or calls for further teaching.
For each row, choose: Safe use / Needs further teaching
1. If I get a dry cough, I will just stop the pills.
2. I will get up slowly, especially after the first few doses.
3. I will use a salt substitute to cut down on sodium.
4. I will keep taking it even when my blood pressure is normal.
5. If my lips or tongue swell, I will call 911.
6. I will take ibuprofen every day for my back pain.
Answer and explanation in LearnFree account
Question 15 · Hard · Matrix
A client with Graves disease has taken methimazole for eight weeks. For each finding, indicate whether it is an expected effect of therapy or needs to be reported to the provider.
For each row, choose: Expected effect / Report to provider
1. Sore throat with a temperature of 101.3 °F (38.5 °C)
2. Resting heart rate down from 112/min to 84/min
3. Weight gain of 1 kg (2.2 lb) after earlier weight loss
4. Less sweating and better tolerance of warm rooms
5. Fatigue, cold intolerance and a weight gain of 5 kg (11 lb)
6. Yellow sclera and dark urine
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Question 16 · Easy · Select all that apply
A client with persistent asthma is prescribed an inhaled corticosteroid. Which instructions should the nurse include?
1. AExpect the full benefit to take a week or more
2. BUse a spacer if one is prescribed for the inhaler
3. CStop the inhaler once symptoms have gone for a few days
4. DUse this inhaler first during a sudden asthma attack
5. EUse the inhaler every day, even when breathing is good
6. FRinse the mouth and spit after each use
Answer and explanation in LearnFree account
Question 17 · Hard · Matrix
On a telemetry unit, pre-administration checks are recorded beside each cardiac drug due. Decide, from the paired pulse, pressure or potassium value, whether that dose is safe now.
For each row, choose: Give the dose / Hold and contact provider
1. Digoxin 0.125 mg; apical pulse 72/min; potassium 2.9 mEq/L
2. Lisinopril 20 mg; blood pressure 86/50 mm Hg
3. Furosemide 40 mg; blood pressure 132/80 mm Hg; potassium 3.8 mEq/L
4. Metoprolol tartrate 25 mg; heart rate 70/min; blood pressure 126/78 mm Hg
5. Spironolactone 25 mg; potassium 5.7 mEq/L
6. Digoxin 0.125 mg; apical pulse 64/min; potassium 4.2 mEq/L
Answer and explanation in LearnFree account
Question 18 · Medium · Select all that apply
A client with atrial fibrillation is receiving a diltiazem infusion. Which findings should lead the nurse to hold the infusion and contact the provider?
1. ABlood pressure 84/50 mm Hg
2. BSerum potassium 4.2 mEq/L
3. CHeart rate 48/min
4. DHeart rate 128/min, irregular
5. EBlood glucose 118 mg/dL
Answer and explanation in LearnFree account
Question 19 · Medium · Matrix
A client with COPD and asthma overlap uses three inhaled drugs. For each statement, indicate which drug it describes.
For each row, choose: Albuterol / Ipratropium / Fluticasone
1. Used for quick relief of sudden wheezing
2. Report eye pain or difficulty passing urine
3. Rinse and spit after each dose to prevent oral thrush
4. May cause tremor and a fast heartbeat
5. Taken daily to reduce airway inflammation, not for an acute attack
Answer and explanation in LearnFree account
Question 20 · Medium · Matrix
A client with heart failure started carvedilol 3.125 mg twice daily one week ago. For each finding, indicate whether it is expected or requires follow-up.
For each row, choose: Expected / Requires follow-up
1. Mild lightheadedness when standing up quickly
2. Weight up 2 kg (4.4 lb) in two days with ankle swelling
3. Feels more tired than usual during the first weeks
4. Heart rate of 46/min with a fainting episode
5. Resting heart rate of 64/min
6. New wheezing at night
Answer and explanation in LearnFree account
Question 21 · Easy
A client is starting levothyroxine for hypothyroidism. Which instruction about taking the drug is correct?
1. ATake it only on days when you feel tired or cold
2. BTake it on an empty stomach 30 to 60 minutes before breakfast
3. CTake it together with the calcium tablet at bedtime
4. DTake it with a high-fiber breakfast so it does not upset the stomach
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Question 22 · Hard
A 78-year-old client with heart failure takes digoxin 0.125 mg and furosemide 40 mg each morning. Nurses' notes: reports nausea and no appetite since yesterday. Apical pulse 56/min, irregular; BP 112/70 mm Hg. Results: potassium 3.1 mEq/L (3.5-5.0), digoxin 2.4 ng/mL (0.5-2.0). Which action should the nurse take?
1. AGive the digoxin with crackers to ease the nausea
2. BGive the digoxin and repeat the level tomorrow morning
3. CWithhold the digoxin and report both results to the provider
4. DGive digoxin immune fab from the unit's stock
Answer and explanation in LearnFree account
Question 23 · Medium
A client with chest pain is to start an IV nitroglycerin infusion. Which information from the client is most important for the nurse to report before starting it?
1. ATakes a daily low-dose aspirin for heart protection
2. BTook sildenafil for erectile dysfunction 6 hours ago
3. CHad a mild headache yesterday after mowing the lawn
4. DDrinks two cups of coffee every morning
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Question 24 · Hard
A client is prescribed digoxin 0.125 mg orally once daily. The pharmacy supplies digoxin oral solution 0.05 mg/mL. How many milliliters should the nurse give?
1. A2.5 mL
2. B0.25 mL
3. C0.4 mL
4. D25 mL
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Question 25 · Hard
A 74-year-old client with coronary artery disease started levothyroxine 25 mcg daily, increased to 50 mcg 2 weeks ago. Today the client reports chest tightness when climbing stairs. HR 112/min, BP 148/84 mm Hg, temperature 98.8°F (37.1°C). Which action by the nurse is most appropriate?
1. AHold today's dose and report the symptoms to the provider
2. BGive the dose with a glass of milk to slow absorption
3. CGive the dose and teach the client to rest between stairs
4. DReassure the client that this is the hypothyroidism improving
Answer and explanation in LearnFree account

27 more Cardiovascular, respiratory and endocrine drugs questions

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Cardiovascular, respiratory and endocrine drugs

The provider prescribes adenosine 6 mg IV for a client in stable supraventricular tachycardia. Which actions should the nurse take?

A client started lisinopril 10 mg daily two weeks ago. Which findings at today's clinic visit require follow-up with the provider?

For each drug, indicate whether it mainly raises the risk of hypokalemia or of hyperkalemia.

A client with hypertension and type 2 diabetes is starting metoprolol succinate. Which instructions should the nurse give?

A client who takes digoxin has a serum digoxin level of 3.4 ng/mL (therapeutic 0.5-2.0 ng/mL), an apical pulse of 44/min with frequent premature ventricular contractions, and a potassium of 3.1 mEq/L. Which actions should the nurse take?

The nurse is teaching a client who is going home on oral amiodarone. Which instructions are correct?

A client starting levothyroxine also takes several other drugs. Which of these should the nurse teach the client to take at least 4 hours apart from the levothyroxine?

A client has taken hydrochlorothiazide 25 mg daily for a year. Which laboratory changes should the nurse expect this drug can cause?

A client with chronic stable angina is prescribed a transdermal nitroglycerin patch. Which instructions should the nurse give?

The nurse reviews the chart of an older adult who takes digoxin 0.25 mg daily. For each finding, indicate whether it raises the client's risk of digoxin toxicity.

For each situation, indicate the drug the nurse should anticipate the provider will prescribe first.

A client with heart failure is going home on digoxin 0.125 mg daily. Which instructions should the nurse include in the discharge teaching?

A client with acute heart failure received furosemide 40 mg IV four hours ago. Which findings indicate the drug is having its intended effect?

A client prescribed lisinopril for high blood pressure describes a home routine. Decide whether each remark reflects safe ACE-inhibitor use or calls for further teaching.

A client with Graves disease has taken methimazole for eight weeks. For each finding, indicate whether it is an expected effect of therapy or needs to be reported to the provider.

A client with persistent asthma is prescribed an inhaled corticosteroid. Which instructions should the nurse include?

On a telemetry unit, pre-administration checks are recorded beside each cardiac drug due. Decide, from the paired pulse, pressure or potassium value, whether that dose is safe now.

A client with atrial fibrillation is receiving a diltiazem infusion. Which findings should lead the nurse to hold the infusion and contact the provider?

A client with COPD and asthma overlap uses three inhaled drugs. For each statement, indicate which drug it describes.

A client with heart failure started carvedilol 3.125 mg twice daily one week ago. For each finding, indicate whether it is expected or requires follow-up.

A client is starting levothyroxine for hypothyroidism. Which instruction about taking the drug is correct?

A client with chest pain is to start an IV nitroglycerin infusion. Which information from the client is most important for the nurse to report before starting it?

A client is prescribed digoxin 0.125 mg orally once daily. The pharmacy supplies digoxin oral solution 0.05 mg/mL. How many milliliters should the nurse give?

A 74-year-old client with coronary artery disease started levothyroxine 25 mcg daily, increased to 50 mcg 2 weeks ago. Today the client reports chest tightness when climbing stairs. HR 112/min, BP 148/84 mm Hg, temperature 98.8°F (37.1°C). Which action by the nurse is most appropriate?