Alberta Plumber Apprenticeship
Certification Exam (First Period) Practice
Questions And Answers
EXAM
CATEGORY 1: Cardiovascular Medications (Questions 1-15)
1. A client with heart failure is prescribed digoxin. Which assessment finding
would indicate the client is experiencing digoxin toxicity?
A. Heart rate of 72 bpm and regular
B. Report of blurred vision with yellow-green halos
C. Serum potassium level of 4.0 mEq/L
D. Weight loss of 2 lbs in 24 hours
Answer: B. Report of blurred vision with yellow-green halos
Rationale: Visual disturbances such as blurred vision, seeing yellow-green halos, or
photophobia are classic signs of digoxin toxicity. Other symptoms include nausea,
vomiting, anorexia, and bradycardia. A normal heart rate and potassium are desired
outcomes, not signs of toxicity. Weight loss indicates fluid loss, which is a therapeutic
effect of the medication.
2. The nurse is administering metoprolol to a client with hypertension. What is the
priority assessment before administering the next dose?
A. Blood glucose level
B. Apical heart rate
C. Respiratory rate
D. Deep tendon reflexes
,Answer: B. Apical heart rate
Rationale: Metoprolol is a beta-blocker that works by slowing the heart rate and
decreasing myocardial contractility. The priority assessment is to check the apical heart
rate. If the pulse is less than 60 bpm, the nurse should hold the medication and contact
the healthcare provider.
3. A client is started on enalapril. The nurse teaches the client to immediately
report which potential adverse effect?
A. Dry, nonproductive cough
B. Swelling of the tongue and lips
C. Dizziness when standing up
D. Metallic taste in the mouth
Answer: B. Swelling of the tongue and lips
Rationale: Angioedema (swelling of the tongue, lips, face, or throat) is a rare but life-
threatening adverse effect of ACE inhibitors like enalapril. While a dry cough and
dizziness are common side effects, angioedema requires immediate emergency
intervention.
4. The healthcare provider prescribes furosemide 40 mg IV push for a client with
pulmonary edema. The nurse knows this medication works by acting on which part
of the kidney?
A. Proximal convoluted tubule
B. Loop of Henle
C. Distal convoluted tubule
D. Collecting duct
Answer: B. Loop of Henle
Rationale: Furosemide is a loop diuretic. It acts on the thick ascending limb of the Loop
of Henle to inhibit the reabsorption of sodium and chloride, leading to potent diuresis.
This makes it highly effective in treating pulmonary edema.
,5. A client on warfarin has an INR of 5.2. The nurse anticipates an order for which
medication?
A. Protamine sulfate
B. Vitamin K (phytonadione)
C. Calcium gluconate
D. Heparin
Answer: B. Vitamin K (phytonadione)
Rationale: Warfarin is a vitamin K antagonist. An elevated INR (>4.5) indicates a high risk
of bleeding. Vitamin K is the specific antidote used to reverse the effects of warfarin.
Protamine sulfate reverses heparin.
6. The nurse is administering nitroglycerin sublingually to a client experiencing
chest pain. What should the nurse instruct the client to do?
A. Swallow the tablet whole with a glass of water.
B. Chew the tablet vigorously for rapid absorption.
C. Place the tablet under the tongue and allow it to dissolve.
D. Crush the tablet and sprinkle it under the tongue.
Answer: C. Place the tablet under the tongue and allow it to dissolve.
Rationale: Sublingual administration requires the client to place the tablet under the
tongue and allow it to dissolve completely. This route allows for rapid absorption
through the highly vascular mucous membranes directly into the bloodstream,
bypassing the first-pass effect of the liver.
7. A client is prescribed atorvastatin. Which instruction is most important to
include in the teaching plan?
A. "Take this medication with grapefruit juice to increase absorption."
B. "Report any unexplained muscle pain, tenderness, or weakness."
C. "You should expect to feel the full effect within 24 hours."
D. "This medication will replace the need for diet and exercise."
, Answer: B. "Report any unexplained muscle pain, tenderness, or weakness."
Rationale: Statins like atorvastatin can cause myopathy (muscle pain) and, in rare cases,
rhabdomyolysis, which can lead to kidney failure. Clients must report any unexplained
muscle symptoms immediately. Grapefruit juice should be avoided as it increases the
risk of toxicity.
8. The nurse is caring for a client receiving a heparin infusion. Which laboratory
value requires immediate intervention?
A. Platelets 90,000/mm³
B. aPTT 65 seconds (control 30 seconds)
C. Hemoglobin 14 g/dL
D. INR 1.1
Answer: A. Platelets 90,000/mm³
Rationale: A low platelet count (thrombocytopenia) in a client on heparin may indicate
Heparin-Induced Thrombocytopenia (HIT), a potentially life-threatening immune
reaction that causes thrombosis rather than bleeding. An aPTT of 65 seconds is within
the typical therapeutic range (1.5-2.5 times control).
9. A client with hypertension is started on hydrochlorothiazide. The nurse should
monitor for which potential electrolyte imbalance?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Answer: B. Hypokalemia
Rationale: Hydrochlorothiazide is a thiazide diuretic. It causes loss of potassium along
with sodium and water, leading to hypokalemia. The nurse should monitor potassium
levels and encourage the client to eat potassium-rich foods.
10. Which discharge instruction is essential for a client prescribed amiodarone for
dysrhythmias?
Certification Exam (First Period) Practice
Questions And Answers
EXAM
CATEGORY 1: Cardiovascular Medications (Questions 1-15)
1. A client with heart failure is prescribed digoxin. Which assessment finding
would indicate the client is experiencing digoxin toxicity?
A. Heart rate of 72 bpm and regular
B. Report of blurred vision with yellow-green halos
C. Serum potassium level of 4.0 mEq/L
D. Weight loss of 2 lbs in 24 hours
Answer: B. Report of blurred vision with yellow-green halos
Rationale: Visual disturbances such as blurred vision, seeing yellow-green halos, or
photophobia are classic signs of digoxin toxicity. Other symptoms include nausea,
vomiting, anorexia, and bradycardia. A normal heart rate and potassium are desired
outcomes, not signs of toxicity. Weight loss indicates fluid loss, which is a therapeutic
effect of the medication.
2. The nurse is administering metoprolol to a client with hypertension. What is the
priority assessment before administering the next dose?
A. Blood glucose level
B. Apical heart rate
C. Respiratory rate
D. Deep tendon reflexes
,Answer: B. Apical heart rate
Rationale: Metoprolol is a beta-blocker that works by slowing the heart rate and
decreasing myocardial contractility. The priority assessment is to check the apical heart
rate. If the pulse is less than 60 bpm, the nurse should hold the medication and contact
the healthcare provider.
3. A client is started on enalapril. The nurse teaches the client to immediately
report which potential adverse effect?
A. Dry, nonproductive cough
B. Swelling of the tongue and lips
C. Dizziness when standing up
D. Metallic taste in the mouth
Answer: B. Swelling of the tongue and lips
Rationale: Angioedema (swelling of the tongue, lips, face, or throat) is a rare but life-
threatening adverse effect of ACE inhibitors like enalapril. While a dry cough and
dizziness are common side effects, angioedema requires immediate emergency
intervention.
4. The healthcare provider prescribes furosemide 40 mg IV push for a client with
pulmonary edema. The nurse knows this medication works by acting on which part
of the kidney?
A. Proximal convoluted tubule
B. Loop of Henle
C. Distal convoluted tubule
D. Collecting duct
Answer: B. Loop of Henle
Rationale: Furosemide is a loop diuretic. It acts on the thick ascending limb of the Loop
of Henle to inhibit the reabsorption of sodium and chloride, leading to potent diuresis.
This makes it highly effective in treating pulmonary edema.
,5. A client on warfarin has an INR of 5.2. The nurse anticipates an order for which
medication?
A. Protamine sulfate
B. Vitamin K (phytonadione)
C. Calcium gluconate
D. Heparin
Answer: B. Vitamin K (phytonadione)
Rationale: Warfarin is a vitamin K antagonist. An elevated INR (>4.5) indicates a high risk
of bleeding. Vitamin K is the specific antidote used to reverse the effects of warfarin.
Protamine sulfate reverses heparin.
6. The nurse is administering nitroglycerin sublingually to a client experiencing
chest pain. What should the nurse instruct the client to do?
A. Swallow the tablet whole with a glass of water.
B. Chew the tablet vigorously for rapid absorption.
C. Place the tablet under the tongue and allow it to dissolve.
D. Crush the tablet and sprinkle it under the tongue.
Answer: C. Place the tablet under the tongue and allow it to dissolve.
Rationale: Sublingual administration requires the client to place the tablet under the
tongue and allow it to dissolve completely. This route allows for rapid absorption
through the highly vascular mucous membranes directly into the bloodstream,
bypassing the first-pass effect of the liver.
7. A client is prescribed atorvastatin. Which instruction is most important to
include in the teaching plan?
A. "Take this medication with grapefruit juice to increase absorption."
B. "Report any unexplained muscle pain, tenderness, or weakness."
C. "You should expect to feel the full effect within 24 hours."
D. "This medication will replace the need for diet and exercise."
, Answer: B. "Report any unexplained muscle pain, tenderness, or weakness."
Rationale: Statins like atorvastatin can cause myopathy (muscle pain) and, in rare cases,
rhabdomyolysis, which can lead to kidney failure. Clients must report any unexplained
muscle symptoms immediately. Grapefruit juice should be avoided as it increases the
risk of toxicity.
8. The nurse is caring for a client receiving a heparin infusion. Which laboratory
value requires immediate intervention?
A. Platelets 90,000/mm³
B. aPTT 65 seconds (control 30 seconds)
C. Hemoglobin 14 g/dL
D. INR 1.1
Answer: A. Platelets 90,000/mm³
Rationale: A low platelet count (thrombocytopenia) in a client on heparin may indicate
Heparin-Induced Thrombocytopenia (HIT), a potentially life-threatening immune
reaction that causes thrombosis rather than bleeding. An aPTT of 65 seconds is within
the typical therapeutic range (1.5-2.5 times control).
9. A client with hypertension is started on hydrochlorothiazide. The nurse should
monitor for which potential electrolyte imbalance?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Answer: B. Hypokalemia
Rationale: Hydrochlorothiazide is a thiazide diuretic. It causes loss of potassium along
with sodium and water, leading to hypokalemia. The nurse should monitor potassium
levels and encourage the client to eat potassium-rich foods.
10. Which discharge instruction is essential for a client prescribed amiodarone for
dysrhythmias?
