NURS 180 | NURS180 Exam 2: Pharmacology - WCU
Updated and Latest Questions and Correct
Answers with Rationale
1. A patient with heart failure is prescribed Digoxin 0.125 mg daily. Which assessment finding
should the nurse prioritize before administering this medication?
A. Blood pressure reading of 110/70 mmHg
B. Respiratory rate of 18 breaths per minute
C. Apical pulse of 52 beats per minute
D. Serum sodium level of 138 mEq/L
Correct Answer: C
Expert Explanation: Digoxin is a cardiac glycoside that increases the force of contraction
while slowing the heart rate. The nurse must check the apical pulse for one full minute
prior to administration to ensure it is at least 60 beats per minute. An apical pulse of 52 is
too low and indicates the medication should be held to prevent bradycardia. Digitalis
toxicity can occur more easily if the patient is bradycardic or has low potassium levels.
Therefore, notifying the provider about the low heart rate is the most critical nursing
action.
2. A patient is starting Lisinopril for hypertension management. Which adverse effect should
the nurse instruct the patient to report immediately?
A. Persistent dry cough
B. Swelling of the lips and tongue
C. Occasional dizziness when standing
D. Increased frequency of urination
Correct Answer: B
Expert Explanation: Lisinopril is an ACE inhibitor that carries a risk of angioedema, which
is a life-threatening swelling of the airway. Swelling of the lips and tongue is a primary sign
of this hypersensitivity reaction and requires emergent intervention. While a dry cough is a
common side effect of ACE inhibitors, it is not as immediately dangerous as angioedema.
Dizziness is often expected due to the blood-pressure-lowering effects of the drug. The
nurse must emphasize that any facial swelling is a priority emergency over other mild side
effects.
3. Which medication is considered a rescue inhaler for a patient experiencing an acute
asthma attack?
A. Albuterol
,B. Salmeterol
C. Fluticasone
D. Montelukast
Correct Answer: A
Expert Explanation: Albuterol is a short-acting beta-2 agonist (SABA) that provides rapid
bronchodilation during acute bronchospasms. It is the gold standard for rescue therapy
because it acts within minutes to open the airways. Salmeterol is a long-acting beta agonist
and is used for maintenance, not acute symptoms. Fluticasone is a corticosteroid used to
reduce inflammation over time rather than providing immediate relief. Patients must be
taught the specific difference between their rescue and maintenance inhalers to manage
asthma safely.
4. A nurse is teaching a patient about using Nitroglycerin sublingual tablets for stable angina.
Which statement by the patient indicates a need for further teaching?
A. I will keep the tablets in their original dark glass bottle
B. I can take up to three tablets, five minutes apart
C. I should sit or lie down before taking the medication
D. I will swallow the tablet with a full glass of water
Correct Answer: D
Expert Explanation: Nitroglycerin sublingual tablets must be dissolved under the tongue
to bypass the first-pass metabolism in the liver. Swallowing the tablet will render it
ineffective as the medication is destroyed by stomach acid and liver enzymes. Proper
storage in dark glass is essential to prevent the medication from losing potency due to light
exposure. Patients are taught to take one dose every five minutes for a maximum of three
doses. Sitting down helps prevent injury from the common side effect of orthostatic
hypotension.
5. Which laboratory value is the priority to monitor for a patient receiving a continuous
Heparin infusion?
A. Prothrombin Time (PT)
B. International Normalized Ratio (INR)
C. Platelet count
D. Activated Partial Thromboplastin Time (aPTT)
Correct Answer: D
Expert Explanation: The aPTT is the standard laboratory test used to monitor the
effectiveness and safety of unfractionated heparin therapy. A therapeutic aPTT is typically
, 1.5 to 2.5 times the baseline control value. PT and INR are used primarily to monitor
Warfarin therapy, not intravenous Heparin. While monitoring platelet count is important to
detect Heparin-Induced Thrombocytopenia, the aPTT is the direct measure for dosing.
Correct interpretation of aPTT values ensures the patient remains in a therapeutic range to
prevent clots or bleeding.
6. A patient with a history of asthma is diagnosed with hypertension. Which medication
should the nurse question if prescribed for this patient?
A. Propranolol
B. Amlodipine
C. Metoprolol
D. Hydrochlorothiazide
Correct Answer: A
Expert Explanation: Propranolol is a non-selective beta-blocker that blocks both beta-1
and beta-2 adrenergic receptors. Blocking beta-2 receptors can cause bronchoconstriction,
which is extremely dangerous for patients with asthma or COPD. Metoprolol is a selective
beta-1 blocker and is safer, though it must still be used with caution. Amlodipine and
Hydrochlorothiazide do not affect the respiratory system and are safer alternatives for
hypertensive patients with asthma. The nurse must prioritize patient safety by identifying
drugs that trigger respiratory distress.
7. What is the primary mechanism of action of Spironolactone in treating heart failure?
A. Inhibiting the reabsorption of sodium and water in the loop of Henle
B. Directly relaxing the vascular smooth muscles to reduce afterload
C. Blocking the conversion of Angiotensin I to Angiotensin II
D. Antagonizing aldosterone receptors to promote sodium excretion and potassium
retention
Correct Answer: D
Expert Explanation: Spironolactone is a potassium-sparing diuretic that works by
blocking aldosterone receptors in the distal tubule. This action causes the body to excrete
sodium and water while holding onto potassium. It is often used in heart failure to prevent
cardiac remodeling and manage fluid volume. Because it retains potassium, the nurse must
monitor the patient for signs of hyperkalemia. Unlike loop diuretics, Spironolactone does
not cause significant potassium loss, which is a major therapeutic advantage.
8. A patient taking Atorvastatin for high cholesterol reports new onset of muscle aches and
weakness. What is the nurse’s priority action?
A. Instruct the patient to take the medication with food
B. Advise the patient to increase their intake of Vitamin D
Updated and Latest Questions and Correct
Answers with Rationale
1. A patient with heart failure is prescribed Digoxin 0.125 mg daily. Which assessment finding
should the nurse prioritize before administering this medication?
A. Blood pressure reading of 110/70 mmHg
B. Respiratory rate of 18 breaths per minute
C. Apical pulse of 52 beats per minute
D. Serum sodium level of 138 mEq/L
Correct Answer: C
Expert Explanation: Digoxin is a cardiac glycoside that increases the force of contraction
while slowing the heart rate. The nurse must check the apical pulse for one full minute
prior to administration to ensure it is at least 60 beats per minute. An apical pulse of 52 is
too low and indicates the medication should be held to prevent bradycardia. Digitalis
toxicity can occur more easily if the patient is bradycardic or has low potassium levels.
Therefore, notifying the provider about the low heart rate is the most critical nursing
action.
2. A patient is starting Lisinopril for hypertension management. Which adverse effect should
the nurse instruct the patient to report immediately?
A. Persistent dry cough
B. Swelling of the lips and tongue
C. Occasional dizziness when standing
D. Increased frequency of urination
Correct Answer: B
Expert Explanation: Lisinopril is an ACE inhibitor that carries a risk of angioedema, which
is a life-threatening swelling of the airway. Swelling of the lips and tongue is a primary sign
of this hypersensitivity reaction and requires emergent intervention. While a dry cough is a
common side effect of ACE inhibitors, it is not as immediately dangerous as angioedema.
Dizziness is often expected due to the blood-pressure-lowering effects of the drug. The
nurse must emphasize that any facial swelling is a priority emergency over other mild side
effects.
3. Which medication is considered a rescue inhaler for a patient experiencing an acute
asthma attack?
A. Albuterol
,B. Salmeterol
C. Fluticasone
D. Montelukast
Correct Answer: A
Expert Explanation: Albuterol is a short-acting beta-2 agonist (SABA) that provides rapid
bronchodilation during acute bronchospasms. It is the gold standard for rescue therapy
because it acts within minutes to open the airways. Salmeterol is a long-acting beta agonist
and is used for maintenance, not acute symptoms. Fluticasone is a corticosteroid used to
reduce inflammation over time rather than providing immediate relief. Patients must be
taught the specific difference between their rescue and maintenance inhalers to manage
asthma safely.
4. A nurse is teaching a patient about using Nitroglycerin sublingual tablets for stable angina.
Which statement by the patient indicates a need for further teaching?
A. I will keep the tablets in their original dark glass bottle
B. I can take up to three tablets, five minutes apart
C. I should sit or lie down before taking the medication
D. I will swallow the tablet with a full glass of water
Correct Answer: D
Expert Explanation: Nitroglycerin sublingual tablets must be dissolved under the tongue
to bypass the first-pass metabolism in the liver. Swallowing the tablet will render it
ineffective as the medication is destroyed by stomach acid and liver enzymes. Proper
storage in dark glass is essential to prevent the medication from losing potency due to light
exposure. Patients are taught to take one dose every five minutes for a maximum of three
doses. Sitting down helps prevent injury from the common side effect of orthostatic
hypotension.
5. Which laboratory value is the priority to monitor for a patient receiving a continuous
Heparin infusion?
A. Prothrombin Time (PT)
B. International Normalized Ratio (INR)
C. Platelet count
D. Activated Partial Thromboplastin Time (aPTT)
Correct Answer: D
Expert Explanation: The aPTT is the standard laboratory test used to monitor the
effectiveness and safety of unfractionated heparin therapy. A therapeutic aPTT is typically
, 1.5 to 2.5 times the baseline control value. PT and INR are used primarily to monitor
Warfarin therapy, not intravenous Heparin. While monitoring platelet count is important to
detect Heparin-Induced Thrombocytopenia, the aPTT is the direct measure for dosing.
Correct interpretation of aPTT values ensures the patient remains in a therapeutic range to
prevent clots or bleeding.
6. A patient with a history of asthma is diagnosed with hypertension. Which medication
should the nurse question if prescribed for this patient?
A. Propranolol
B. Amlodipine
C. Metoprolol
D. Hydrochlorothiazide
Correct Answer: A
Expert Explanation: Propranolol is a non-selective beta-blocker that blocks both beta-1
and beta-2 adrenergic receptors. Blocking beta-2 receptors can cause bronchoconstriction,
which is extremely dangerous for patients with asthma or COPD. Metoprolol is a selective
beta-1 blocker and is safer, though it must still be used with caution. Amlodipine and
Hydrochlorothiazide do not affect the respiratory system and are safer alternatives for
hypertensive patients with asthma. The nurse must prioritize patient safety by identifying
drugs that trigger respiratory distress.
7. What is the primary mechanism of action of Spironolactone in treating heart failure?
A. Inhibiting the reabsorption of sodium and water in the loop of Henle
B. Directly relaxing the vascular smooth muscles to reduce afterload
C. Blocking the conversion of Angiotensin I to Angiotensin II
D. Antagonizing aldosterone receptors to promote sodium excretion and potassium
retention
Correct Answer: D
Expert Explanation: Spironolactone is a potassium-sparing diuretic that works by
blocking aldosterone receptors in the distal tubule. This action causes the body to excrete
sodium and water while holding onto potassium. It is often used in heart failure to prevent
cardiac remodeling and manage fluid volume. Because it retains potassium, the nurse must
monitor the patient for signs of hyperkalemia. Unlike loop diuretics, Spironolactone does
not cause significant potassium loss, which is a major therapeutic advantage.
8. A patient taking Atorvastatin for high cholesterol reports new onset of muscle aches and
weakness. What is the nurse’s priority action?
A. Instruct the patient to take the medication with food
B. Advise the patient to increase their intake of Vitamin D
