Kaplan Pharmacology Integrated Exam
(Forms A, B, C, D) | NGN Questions with
Correct Answer
SECTION 1: CARDIOVASCULAR PHARMACOLOGYa (Questions 1-
30)
Q1. A nurse is administering digoxin to a patient with heart failure.
Which finding requires immediate intervention?
• A) Heart rate of 62 bpm
• B) Serum potassium level of 3.2 mEq/L
• C) Serum digoxin level of 1.0 ng/mL
• D) Blood pressure of 120/80 mmHg
,,,ANSWER,,,: B
Rationale: Hypokalemia (K+ <3.5 mEq/L) increases the risk of digoxin
toxicity, even with normal digoxin levels. HR 62 is acceptable; digoxin
level 1.0 is therapeutic (0.8–2.0 ng/mL) .
Q2. A nurse is about to administer digoxin. Which finding requires
holding the dose?
• A) HR 58 bpm
• B) BP 130/80
• C) RR 18
• D) Temp 98.6°F
,,,,ANSWER,,,: A
Rationale: Bradycardia (HR <60 bpm) increases digoxin toxicity risk. Hold
the dose and notify the provider .
Q3. A patient on warfarin has an INR of 4.5. Which medication should
the nurse prepare to administer?
• A) Vitamin K
• B) Protamine sulfate
• C) Aminocaproic acid
• D) Desmopressin
,,,ANSWER,,,: A
Rationale: Vitamin K reverses warfarin effect. Protamine sulfate reverses
heparin. Desmopressin is for hemophilia/vWD .
Q4. Which medication requires INR monitoring?
• A) Heparin
• B) Warfarin
• C) Aspirin
• D) Metformin
,,,ANSWER,,,: B
Rationale: Warfarin therapy requires regular INR monitoring to maintain
therapeutic range (2-3 for most indications) .
Q5. A patient taking warfarin (Coumadin) has an INR of 5.2. Which
action should the nurse anticipate?
• A) Administering vitamin K (phytonadione)
• B) Administering protamine sulfate
• C) Increasing the next prescribed dose of warfarin
• D) Discontinuing the warfarin and restarting in 24 hours
,,,,ANSWER,,,: A
Rationale: An INR of 5.2 is significantly above the therapeutic range and
indicates high bleeding risk. The antidote is vitamin K. Protamine sulfate
is for heparin reversal .
Q6. A patient is receiving heparin via continuous IV infusion. The aPTT
result is 120 seconds (control 30 seconds). Which nursing action is
most appropriate?
• A) Increase the infusion rate as per protocol
• B) Continue the infusion at the same rate
• C) Stop the infusion and notify the healthcare provider
• D) Assess the patient for signs of myocardial infarction
,,,ANSWER,,,: C
Rationale: With a control of 30 seconds, the target range is 45-75
seconds. An aPTT of 120 seconds is supratherapeutic, placing the
patient at high risk for bleeding. Stop the infusion and notify the provider .
Q7. A patient on ACE inhibitors should be monitored for:
• A) Hyperkalemia
• B) Hypocalcemia
• C) Hypernatremia
• D) Hypoglycemia
,,,ANSWER,,,: A
Rationale: ACE inhibitors reduce aldosterone secretion, leading to
potassium retention. Monitor potassium levels closely, especially in
patients with renal impairment .
Q8. A patient taking lisinopril develops a persistent dry cough. What
is the best nursing action?
• A) Administer codeine
, • B) Switch to losartan
• C) Increase lisinopril dose
• D) Add a diuretic
,,,ANSWER,,,: B
Rationale: Persistent dry cough is a common side effect of ACE inhibitors
due to bradykinin accumulation. Switching to an ARB (losartan) is
appropriate, as ARBs do not cause cough .
Q9. Beta blockers should be held if:
• A) BP 120/80
• B) HR 52 bpm
• C) Temp 98°F
• D) RR 20
,,,ANSWER,,,: B
Rationale: Beta-blockers decrease heart rate. Hold if HR <60 bpm or as
ordered by the provider. Notify the provider of significant bradycardia .
Q10. A patient on verapamil develops constipation. What is the
mechanism?
• A) Beta-1 blockade
• B) Calcium channel blockade in GI smooth muscle
• C) Alpha-1 blockade
• D) Anticholinergic effect
,,,ANSWER,,,: B
Rationale: Verapamil (a calcium channel blocker) inhibits GI smooth
muscle contraction, leading to constipation .
Q11. The nurse is administering sublingual nitroglycerin to a patient
with chest pain. After one dose, the patient's pain is unrelieved. What
is the nurse's priority action?
(Forms A, B, C, D) | NGN Questions with
Correct Answer
SECTION 1: CARDIOVASCULAR PHARMACOLOGYa (Questions 1-
30)
Q1. A nurse is administering digoxin to a patient with heart failure.
Which finding requires immediate intervention?
• A) Heart rate of 62 bpm
• B) Serum potassium level of 3.2 mEq/L
• C) Serum digoxin level of 1.0 ng/mL
• D) Blood pressure of 120/80 mmHg
,,,ANSWER,,,: B
Rationale: Hypokalemia (K+ <3.5 mEq/L) increases the risk of digoxin
toxicity, even with normal digoxin levels. HR 62 is acceptable; digoxin
level 1.0 is therapeutic (0.8–2.0 ng/mL) .
Q2. A nurse is about to administer digoxin. Which finding requires
holding the dose?
• A) HR 58 bpm
• B) BP 130/80
• C) RR 18
• D) Temp 98.6°F
,,,,ANSWER,,,: A
Rationale: Bradycardia (HR <60 bpm) increases digoxin toxicity risk. Hold
the dose and notify the provider .
Q3. A patient on warfarin has an INR of 4.5. Which medication should
the nurse prepare to administer?
• A) Vitamin K
• B) Protamine sulfate
• C) Aminocaproic acid
• D) Desmopressin
,,,ANSWER,,,: A
Rationale: Vitamin K reverses warfarin effect. Protamine sulfate reverses
heparin. Desmopressin is for hemophilia/vWD .
Q4. Which medication requires INR monitoring?
• A) Heparin
• B) Warfarin
• C) Aspirin
• D) Metformin
,,,ANSWER,,,: B
Rationale: Warfarin therapy requires regular INR monitoring to maintain
therapeutic range (2-3 for most indications) .
Q5. A patient taking warfarin (Coumadin) has an INR of 5.2. Which
action should the nurse anticipate?
• A) Administering vitamin K (phytonadione)
• B) Administering protamine sulfate
• C) Increasing the next prescribed dose of warfarin
• D) Discontinuing the warfarin and restarting in 24 hours
,,,,ANSWER,,,: A
Rationale: An INR of 5.2 is significantly above the therapeutic range and
indicates high bleeding risk. The antidote is vitamin K. Protamine sulfate
is for heparin reversal .
Q6. A patient is receiving heparin via continuous IV infusion. The aPTT
result is 120 seconds (control 30 seconds). Which nursing action is
most appropriate?
• A) Increase the infusion rate as per protocol
• B) Continue the infusion at the same rate
• C) Stop the infusion and notify the healthcare provider
• D) Assess the patient for signs of myocardial infarction
,,,ANSWER,,,: C
Rationale: With a control of 30 seconds, the target range is 45-75
seconds. An aPTT of 120 seconds is supratherapeutic, placing the
patient at high risk for bleeding. Stop the infusion and notify the provider .
Q7. A patient on ACE inhibitors should be monitored for:
• A) Hyperkalemia
• B) Hypocalcemia
• C) Hypernatremia
• D) Hypoglycemia
,,,ANSWER,,,: A
Rationale: ACE inhibitors reduce aldosterone secretion, leading to
potassium retention. Monitor potassium levels closely, especially in
patients with renal impairment .
Q8. A patient taking lisinopril develops a persistent dry cough. What
is the best nursing action?
• A) Administer codeine
, • B) Switch to losartan
• C) Increase lisinopril dose
• D) Add a diuretic
,,,ANSWER,,,: B
Rationale: Persistent dry cough is a common side effect of ACE inhibitors
due to bradykinin accumulation. Switching to an ARB (losartan) is
appropriate, as ARBs do not cause cough .
Q9. Beta blockers should be held if:
• A) BP 120/80
• B) HR 52 bpm
• C) Temp 98°F
• D) RR 20
,,,ANSWER,,,: B
Rationale: Beta-blockers decrease heart rate. Hold if HR <60 bpm or as
ordered by the provider. Notify the provider of significant bradycardia .
Q10. A patient on verapamil develops constipation. What is the
mechanism?
• A) Beta-1 blockade
• B) Calcium channel blockade in GI smooth muscle
• C) Alpha-1 blockade
• D) Anticholinergic effect
,,,ANSWER,,,: B
Rationale: Verapamil (a calcium channel blocker) inhibits GI smooth
muscle contraction, leading to constipation .
Q11. The nurse is administering sublingual nitroglycerin to a patient
with chest pain. After one dose, the patient's pain is unrelieved. What
is the nurse's priority action?
