NUR 2474 Exam 2 Practice Exam – Pharmacology
for Professional Nursing – Rasmussen University
1. A client is brought to the emergency department with shortness of breath, respiratory
rate of 30 breaths/minute, intercostal retractions, and frothy pink sputum. The nurse expects
to administer which medication?
A. Hydrochlorothiazide
B. Mannitol
C. Spironolactone
D. Furosemide (Lasix)
Answer: D
Rationale: Furosemide is a loop diuretic indicated for rapid mobilization of fluid in pulmonary
edema. The patient's symptoms indicate severe congestive heart failure with respiratory
distress. Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema due
to slower onset, and mannitol is contraindicated in pulmonary congestion .
2. A client is starting furosemide and asks the nurse, "When is the best time to take this
medication?"
A. 0800 (morning)
B. 1600 (late afternoon)
C. 1900 (evening)
D. 2200 (bedtime)
Answer: A
Rationale: Furosemide should be taken in the morning to avoid nocturia and disrupted sleep
due to its diuretic effect. Taking it later in the day would cause frequent urination during
sleeping hours .
,3. A client on spironolactone asks about necessary self-care measures. What should the
nurse advise?
A. Increase potassium-rich foods in the diet
B. Avoid potassium-rich foods
C. Take the medication at bedtime
D. Discontinue the medication if dizziness occurs
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic, meaning it causes retention of
potassium. Excessive potassium intake can lead to hyperkalemia, a potentially dangerous
condition. Patients should avoid potassium supplements and potassium-rich foods such as
bananas, oranges, and leafy greens .
4. A patient with a pulse of 58 beats/minute is about to receive digoxin. What should the
nurse do?
A. Administer the dose as ordered
B. Hold the dose and notify the provider
C. Double the dose
D. Administer with food
Answer: B
*Rationale: A pulse below 60 beats/minute indicates possible digoxin toxicity, as digoxin
slows the heart rate. The nurse should hold the dose and notify the provider for further
instructions .*
5. What is the antidote for heparin overdose?
A. Vitamin K
B. Protamine sulfate
C. Atropine
D. Naloxone
Answer: B
Rationale: Protamine sulfate is the specific reversal agent that neutralizes the anticoagulant
,effects of heparin. Vitamin K reverses warfarin, atropine reverses bradycardia, and naloxone
reverses opioid overdose .
6. A client on warfarin has an INR of 5.2. What should the nurse expect?
A. Administer additional warfarin
B. Administer vitamin K
C. Continue the current dose
D. Administer heparin
Answer: B
Rationale: An INR of 5.2 indicates excessive anticoagulation and increased bleeding risk.
Vitamin K is the reversal agent for warfarin. The warfarin dose would be held, not increased.
Heparin is not indicated .
7. A patient is prescribed metformin for type 2 diabetes. Which instruction should the nurse
include?
A. "Take this medication on an empty stomach"
B. "You may experience weight gain as a side effect"
C. "Report any unexplained muscle pain or weakness to your provider"
D. "This medication stimulates insulin release from the pancreas"
Answer: C
Rationale: Metformin can cause lactic acidosis, a rare but serious side effect. Unexplained
muscle pain, weakness, malaise, or difficulty breathing should be reported immediately.
Metformin decreases glucose production by the liver and increases insulin sensitivity; it does
not stimulate insulin release .
8. A patient is prescribed warfarin following a mechanical heart valve replacement. Which
patient statement indicates understanding of the medication?
A. "I will take ibuprofen if I have a headache"
B. "I will have my blood drawn regularly to check my INR"
C. "I can eat as many green vegetables as I want"
, D. "I will stop warfarin if I notice bruising"
Answer: B
*Rationale: Warfarin requires regular INR monitoring to maintain therapeutic levels (typically
2.5-3.5 for mechanical valves). Ibuprofen increases bleeding risk. Green leafy vegetables
contain vitamin K, which antagonizes warfarin; consistent intake is important, but "as many
as I want" is unsafe. Stopping warfarin without provider guidance risks thromboembolism .*
9. A patient is receiving a heparin infusion for deep vein thrombosis. Which laboratory value
will the nurse monitor to evaluate therapeutic effect?
A. INR
B. aPTT (activated partial thromboplastin time)
C. Platelet count
D. PT (prothrombin time)
Answer: B
*Rationale: aPTT is used to monitor heparin therapy. Therapeutic goal is typically 1.5-2.5
times the normal control value. INR and PT monitor warfarin. Platelet count monitors for
heparin-induced thrombocytopenia (HIT) but not therapeutic effect .*
10. A patient with heart failure is prescribed digoxin and furosemide. The nurse should
monitor the patient most closely for which electrolyte imbalance?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia
increases the risk of digoxin toxicity because digoxin binds to the same site on the sodium-
potassium pump as potassium. The nurse should monitor potassium levels closely .
for Professional Nursing – Rasmussen University
1. A client is brought to the emergency department with shortness of breath, respiratory
rate of 30 breaths/minute, intercostal retractions, and frothy pink sputum. The nurse expects
to administer which medication?
A. Hydrochlorothiazide
B. Mannitol
C. Spironolactone
D. Furosemide (Lasix)
Answer: D
Rationale: Furosemide is a loop diuretic indicated for rapid mobilization of fluid in pulmonary
edema. The patient's symptoms indicate severe congestive heart failure with respiratory
distress. Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema due
to slower onset, and mannitol is contraindicated in pulmonary congestion .
2. A client is starting furosemide and asks the nurse, "When is the best time to take this
medication?"
A. 0800 (morning)
B. 1600 (late afternoon)
C. 1900 (evening)
D. 2200 (bedtime)
Answer: A
Rationale: Furosemide should be taken in the morning to avoid nocturia and disrupted sleep
due to its diuretic effect. Taking it later in the day would cause frequent urination during
sleeping hours .
,3. A client on spironolactone asks about necessary self-care measures. What should the
nurse advise?
A. Increase potassium-rich foods in the diet
B. Avoid potassium-rich foods
C. Take the medication at bedtime
D. Discontinue the medication if dizziness occurs
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic, meaning it causes retention of
potassium. Excessive potassium intake can lead to hyperkalemia, a potentially dangerous
condition. Patients should avoid potassium supplements and potassium-rich foods such as
bananas, oranges, and leafy greens .
4. A patient with a pulse of 58 beats/minute is about to receive digoxin. What should the
nurse do?
A. Administer the dose as ordered
B. Hold the dose and notify the provider
C. Double the dose
D. Administer with food
Answer: B
*Rationale: A pulse below 60 beats/minute indicates possible digoxin toxicity, as digoxin
slows the heart rate. The nurse should hold the dose and notify the provider for further
instructions .*
5. What is the antidote for heparin overdose?
A. Vitamin K
B. Protamine sulfate
C. Atropine
D. Naloxone
Answer: B
Rationale: Protamine sulfate is the specific reversal agent that neutralizes the anticoagulant
,effects of heparin. Vitamin K reverses warfarin, atropine reverses bradycardia, and naloxone
reverses opioid overdose .
6. A client on warfarin has an INR of 5.2. What should the nurse expect?
A. Administer additional warfarin
B. Administer vitamin K
C. Continue the current dose
D. Administer heparin
Answer: B
Rationale: An INR of 5.2 indicates excessive anticoagulation and increased bleeding risk.
Vitamin K is the reversal agent for warfarin. The warfarin dose would be held, not increased.
Heparin is not indicated .
7. A patient is prescribed metformin for type 2 diabetes. Which instruction should the nurse
include?
A. "Take this medication on an empty stomach"
B. "You may experience weight gain as a side effect"
C. "Report any unexplained muscle pain or weakness to your provider"
D. "This medication stimulates insulin release from the pancreas"
Answer: C
Rationale: Metformin can cause lactic acidosis, a rare but serious side effect. Unexplained
muscle pain, weakness, malaise, or difficulty breathing should be reported immediately.
Metformin decreases glucose production by the liver and increases insulin sensitivity; it does
not stimulate insulin release .
8. A patient is prescribed warfarin following a mechanical heart valve replacement. Which
patient statement indicates understanding of the medication?
A. "I will take ibuprofen if I have a headache"
B. "I will have my blood drawn regularly to check my INR"
C. "I can eat as many green vegetables as I want"
, D. "I will stop warfarin if I notice bruising"
Answer: B
*Rationale: Warfarin requires regular INR monitoring to maintain therapeutic levels (typically
2.5-3.5 for mechanical valves). Ibuprofen increases bleeding risk. Green leafy vegetables
contain vitamin K, which antagonizes warfarin; consistent intake is important, but "as many
as I want" is unsafe. Stopping warfarin without provider guidance risks thromboembolism .*
9. A patient is receiving a heparin infusion for deep vein thrombosis. Which laboratory value
will the nurse monitor to evaluate therapeutic effect?
A. INR
B. aPTT (activated partial thromboplastin time)
C. Platelet count
D. PT (prothrombin time)
Answer: B
*Rationale: aPTT is used to monitor heparin therapy. Therapeutic goal is typically 1.5-2.5
times the normal control value. INR and PT monitor warfarin. Platelet count monitors for
heparin-induced thrombocytopenia (HIT) but not therapeutic effect .*
10. A patient with heart failure is prescribed digoxin and furosemide. The nurse should
monitor the patient most closely for which electrolyte imbalance?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia
increases the risk of digoxin toxicity because digoxin binds to the same site on the sodium-
potassium pump as potassium. The nurse should monitor potassium levels closely .
