NURS 180 | NURS180 Final Exam: Pharmacology -
WCU Updated and Latest Questions and Correct
Answers with Rationale
1. A patient with a history of asthma is prescribed Propranolol for hypertension. Which
assessment finding is the most critical for the nurse to monitor?
A. Increased heart rate
B. Peripheral edema
C. Audible wheezing
D. Dry mouth
Correct Answer: C
Expert Explanation: Propranolol is a non-selective beta-blocker that can cause
bronchoconstriction by blocking beta-2 receptors in the lungs. Monitoring for wheezing is
critical because it indicates a potentially life-threatening respiratory complication in
asthma patients. Other options like heart rate changes are expected but less urgent than
respiratory distress. The nurse must prioritize airway and breathing assessments when
non-selective blockers are used. This reflects the standard safety protocol for high-risk
medication administration.
2. A patient is receiving Vancomycin intravenously for an MRSA infection. Which laboratory
result should the nurse prioritize before administering the next dose?
A. White blood cell count
B. Serum sodium
C. Hemoglobin level
D. Serum creatinine
Correct Answer: D
Expert Explanation: Vancomycin is known to be nephrotoxic, making renal function
monitoring essential for patient safety. Serum creatinine and BUN are key indicators of
kidney health that must be evaluated regularly. A rise in creatinine levels suggests
impaired clearance which could lead to drug toxicity. The nurse must also monitor trough
levels to ensure therapeutic range without reaching toxic levels. This evidence-based
practice prevents acute kidney injury during intensive antibiotic therapy.
3. A patient is prescribed Lispro (Humalog) insulin to be administered at 07:30. What is the
most appropriate action for the nurse to take regarding the patient’s breakfast?
A. Administer the insulin 60 minutes before the meal is served.
B. Ensure the breakfast tray is present and the patient is ready to eat.
,C. Withhold the meal until two hours after administration.
D. Check the blood glucose level only after the patient eats.
Correct Answer: B
Expert Explanation: Lispro is a rapid-acting insulin with an onset of 15 to 30 minutes. To
prevent hypoglycemia, the nurse must ensure the patient has food immediately available
before administration. Administering it too early without food could cause a dangerous
drop in blood glucose levels. Clinical reasoning dictates that timing of rapid-acting insulin
must be closely synchronized with carbohydrate intake. This strategy is vital for
maintaining glycemic control and ensuring patient safety.
4. A patient on Warfarin therapy has an INR of 5.5. Which medication does the nurse
anticipate the provider will order?
A. Protamine sulfate
B. Aspirin
C. Enoxaparin
D. Vitamin K
Correct Answer: D
Expert Explanation: Vitamin K is the specific antidote for Warfarin toxicity and is used to
reverse an elevated INR. An INR of 5.5 indicates a high risk for spontaneous bleeding and
requires immediate intervention. Protamine sulfate is the antidote for Heparin, not
Warfarin, and is thus incorrect. The nurse must also educate the patient on maintaining
consistent intake of leafy green vegetables. Prompt reversal of supratherapeutic
anticoagulation is a core principle of medication safety.
5. The nurse is monitoring a patient receiving Digoxin for heart failure. Which electrolyte
imbalance increases the risk for Digoxin toxicity?
A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypernatremia
Correct Answer: A
Expert Explanation: Hypokalemia sensitizes the myocardium to Digoxin, significantly
increasing the risk of life-threatening arrhythmias. Digoxin and potassium compete for the
same binding sites on the Na+/K+ ATPase pump. Low potassium levels allow more Digoxin
to bind, leading to toxic effects even at therapeutic serum levels. The nurse should monitor
serum potassium and encourage intake of potassium-rich foods if appropriate.
, Understanding this interaction is crucial for preventing adverse drug events in cardiac
patients.
6. A patient is prescribed Furosemide (Lasix) for pulmonary edema. Which discharge
instruction is most important for the nurse to include?
A. Limit intake of bananas and orange juice.
B. Take the medication right before going to bed.
C. Change positions slowly to prevent dizziness.
D. Stop taking the medication if you develop a cough.
Correct Answer: C
Expert Explanation: Furosemide is a potent loop diuretic that can cause orthostatic
hypotension due to rapid fluid loss. Patients are at a high risk for falls, especially when
transitioning from sitting to standing positions. Taking the medication at night would cause
nocturia and increase fall risks in the dark. Educating the patient on dietary potassium is
also important, as this drug is potassium-wasting. These instructions are essential
components of safe medication management and injury prevention.
7. A patient with bipolar disorder is taking Lithium. Which laboratory value should the nurse
report to the provider immediately?
A. Sodium level of 128 mEq/L
B. Lithium level of 0.8 mEq/L
C. Creatinine level of 1.0 mg/dL
D. Potassium level of 4.0 mEq/L
Correct Answer: A
Expert Explanation: Low serum sodium levels cause the kidneys to retain Lithium, leading
to toxic accumulation of the drug. A sodium level of 128 mEq/L is significantly below the
normal range and poses a major risk. The therapeutic range for Lithium is narrow, and
toxicity can cause severe neurological and cardiac issues. Patients must be taught to
maintain a consistent salt and fluid intake to avoid these fluctuations. This clinical
reasoning highlights the relationship between electrolyte balance and psychotropic
medication safety.
8. A patient is prescribed Albuterol and Beclomethasone inhalers for asthma. How should the
nurse instruct the patient to use these medications?
A. Use the Beclomethasone first, then wait 5 minutes for the Albuterol.
B. Mix the two medications in a single nebulizer treatment.
C. Use the Albuterol first, then wait 5 minutes for the Beclomethasone.
WCU Updated and Latest Questions and Correct
Answers with Rationale
1. A patient with a history of asthma is prescribed Propranolol for hypertension. Which
assessment finding is the most critical for the nurse to monitor?
A. Increased heart rate
B. Peripheral edema
C. Audible wheezing
D. Dry mouth
Correct Answer: C
Expert Explanation: Propranolol is a non-selective beta-blocker that can cause
bronchoconstriction by blocking beta-2 receptors in the lungs. Monitoring for wheezing is
critical because it indicates a potentially life-threatening respiratory complication in
asthma patients. Other options like heart rate changes are expected but less urgent than
respiratory distress. The nurse must prioritize airway and breathing assessments when
non-selective blockers are used. This reflects the standard safety protocol for high-risk
medication administration.
2. A patient is receiving Vancomycin intravenously for an MRSA infection. Which laboratory
result should the nurse prioritize before administering the next dose?
A. White blood cell count
B. Serum sodium
C. Hemoglobin level
D. Serum creatinine
Correct Answer: D
Expert Explanation: Vancomycin is known to be nephrotoxic, making renal function
monitoring essential for patient safety. Serum creatinine and BUN are key indicators of
kidney health that must be evaluated regularly. A rise in creatinine levels suggests
impaired clearance which could lead to drug toxicity. The nurse must also monitor trough
levels to ensure therapeutic range without reaching toxic levels. This evidence-based
practice prevents acute kidney injury during intensive antibiotic therapy.
3. A patient is prescribed Lispro (Humalog) insulin to be administered at 07:30. What is the
most appropriate action for the nurse to take regarding the patient’s breakfast?
A. Administer the insulin 60 minutes before the meal is served.
B. Ensure the breakfast tray is present and the patient is ready to eat.
,C. Withhold the meal until two hours after administration.
D. Check the blood glucose level only after the patient eats.
Correct Answer: B
Expert Explanation: Lispro is a rapid-acting insulin with an onset of 15 to 30 minutes. To
prevent hypoglycemia, the nurse must ensure the patient has food immediately available
before administration. Administering it too early without food could cause a dangerous
drop in blood glucose levels. Clinical reasoning dictates that timing of rapid-acting insulin
must be closely synchronized with carbohydrate intake. This strategy is vital for
maintaining glycemic control and ensuring patient safety.
4. A patient on Warfarin therapy has an INR of 5.5. Which medication does the nurse
anticipate the provider will order?
A. Protamine sulfate
B. Aspirin
C. Enoxaparin
D. Vitamin K
Correct Answer: D
Expert Explanation: Vitamin K is the specific antidote for Warfarin toxicity and is used to
reverse an elevated INR. An INR of 5.5 indicates a high risk for spontaneous bleeding and
requires immediate intervention. Protamine sulfate is the antidote for Heparin, not
Warfarin, and is thus incorrect. The nurse must also educate the patient on maintaining
consistent intake of leafy green vegetables. Prompt reversal of supratherapeutic
anticoagulation is a core principle of medication safety.
5. The nurse is monitoring a patient receiving Digoxin for heart failure. Which electrolyte
imbalance increases the risk for Digoxin toxicity?
A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypernatremia
Correct Answer: A
Expert Explanation: Hypokalemia sensitizes the myocardium to Digoxin, significantly
increasing the risk of life-threatening arrhythmias. Digoxin and potassium compete for the
same binding sites on the Na+/K+ ATPase pump. Low potassium levels allow more Digoxin
to bind, leading to toxic effects even at therapeutic serum levels. The nurse should monitor
serum potassium and encourage intake of potassium-rich foods if appropriate.
, Understanding this interaction is crucial for preventing adverse drug events in cardiac
patients.
6. A patient is prescribed Furosemide (Lasix) for pulmonary edema. Which discharge
instruction is most important for the nurse to include?
A. Limit intake of bananas and orange juice.
B. Take the medication right before going to bed.
C. Change positions slowly to prevent dizziness.
D. Stop taking the medication if you develop a cough.
Correct Answer: C
Expert Explanation: Furosemide is a potent loop diuretic that can cause orthostatic
hypotension due to rapid fluid loss. Patients are at a high risk for falls, especially when
transitioning from sitting to standing positions. Taking the medication at night would cause
nocturia and increase fall risks in the dark. Educating the patient on dietary potassium is
also important, as this drug is potassium-wasting. These instructions are essential
components of safe medication management and injury prevention.
7. A patient with bipolar disorder is taking Lithium. Which laboratory value should the nurse
report to the provider immediately?
A. Sodium level of 128 mEq/L
B. Lithium level of 0.8 mEq/L
C. Creatinine level of 1.0 mg/dL
D. Potassium level of 4.0 mEq/L
Correct Answer: A
Expert Explanation: Low serum sodium levels cause the kidneys to retain Lithium, leading
to toxic accumulation of the drug. A sodium level of 128 mEq/L is significantly below the
normal range and poses a major risk. The therapeutic range for Lithium is narrow, and
toxicity can cause severe neurological and cardiac issues. Patients must be taught to
maintain a consistent salt and fluid intake to avoid these fluctuations. This clinical
reasoning highlights the relationship between electrolyte balance and psychotropic
medication safety.
8. A patient is prescribed Albuterol and Beclomethasone inhalers for asthma. How should the
nurse instruct the patient to use these medications?
A. Use the Beclomethasone first, then wait 5 minutes for the Albuterol.
B. Mix the two medications in a single nebulizer treatment.
C. Use the Albuterol first, then wait 5 minutes for the Beclomethasone.
