Kaplan Pharmacology Integrated Exam (Forms A, B, C, D) – NGN Style
Questions 1–20: Cardiovascular and Anticoagulant Medications
1. 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
Correct Answer: B
Rationale: Hypokalemia (K+ < 3.5 mEq/L) increases the risk of digoxin toxicity by
enhancing digoxin binding to the Na+/K+ ATPase pump, even with normal digoxin
levels. A heart rate of 62 bpm is acceptable for a patient on digoxin (hold usually
for <60 bpm). A digoxin level of 1.0 ng/mL is within the therapeutic range (0.8–2.0
ng/mL). Blood pressure of 120/80 mmHg is normal.
2. 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
Correct Answer: A
Rationale: Vitamin K is the specific antidote for warfarin reversal. Protamine
sulfate reverses heparin, not warfarin. Aminocaproic acid is an antifibrinolytic
used for bleeding disorders. Desmopressin is used for hemophilia and von
Willebrand disease.
3. 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
Correct Answer: B
,Rationale: The dry cough from ACE inhibitors (lisinopril) is caused by bradykinin
accumulation. Switching to an ARB (losartan) is the appropriate action as ARBs do
not cause bradykinin accumulation and have a lower incidence of cough. Codeine
may suppress the cough but does not address the underlying mechanism, and
increasing the dose or adding a diuretic will not resolve the cough.
4. Which adverse effect is specific to aminoglycosides (e.g., gentamicin)?
A) Ototoxicity
B) Hepatotoxicity
C) Cardiotoxicity
D) Nephrotoxicity only
Correct Answer: A
Rationale: Aminoglycosides cause both nephrotoxicity and ototoxicity, but
ototoxicity (irreversible hearing loss) is a distinguishing key feature. While
hepatotoxicity is rare, the irreversible nature of ototoxicity makes it a defining
adverse effect of this drug class.
5. A patient on metformin is scheduled for an IV contrast CT scan. What should
the nurse do?
, A) Hold metformin 48 hours before the procedure
B) Administer metformin with the contrast
C) Double the metformin dose after the procedure
D) Stop metformin permanently
Correct Answer: A
Rationale: Metformin increases the risk of lactic acidosis when combined with IV
contrast dye due to potential acute kidney injury. The standard protocol is to hold
metformin on the day of the procedure and for 48 hours after, then restart only if
renal function is normal.
6. Which drug requires a "black box warning" for hepatotoxicity?
A) Acetaminophen
B) Ibuprofen
C) Aspirin
D) Naproxen
Correct Answer: A
Questions 1–20: Cardiovascular and Anticoagulant Medications
1. 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
Correct Answer: B
Rationale: Hypokalemia (K+ < 3.5 mEq/L) increases the risk of digoxin toxicity by
enhancing digoxin binding to the Na+/K+ ATPase pump, even with normal digoxin
levels. A heart rate of 62 bpm is acceptable for a patient on digoxin (hold usually
for <60 bpm). A digoxin level of 1.0 ng/mL is within the therapeutic range (0.8–2.0
ng/mL). Blood pressure of 120/80 mmHg is normal.
2. 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
Correct Answer: A
Rationale: Vitamin K is the specific antidote for warfarin reversal. Protamine
sulfate reverses heparin, not warfarin. Aminocaproic acid is an antifibrinolytic
used for bleeding disorders. Desmopressin is used for hemophilia and von
Willebrand disease.
3. 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
Correct Answer: B
,Rationale: The dry cough from ACE inhibitors (lisinopril) is caused by bradykinin
accumulation. Switching to an ARB (losartan) is the appropriate action as ARBs do
not cause bradykinin accumulation and have a lower incidence of cough. Codeine
may suppress the cough but does not address the underlying mechanism, and
increasing the dose or adding a diuretic will not resolve the cough.
4. Which adverse effect is specific to aminoglycosides (e.g., gentamicin)?
A) Ototoxicity
B) Hepatotoxicity
C) Cardiotoxicity
D) Nephrotoxicity only
Correct Answer: A
Rationale: Aminoglycosides cause both nephrotoxicity and ototoxicity, but
ototoxicity (irreversible hearing loss) is a distinguishing key feature. While
hepatotoxicity is rare, the irreversible nature of ototoxicity makes it a defining
adverse effect of this drug class.
5. A patient on metformin is scheduled for an IV contrast CT scan. What should
the nurse do?
, A) Hold metformin 48 hours before the procedure
B) Administer metformin with the contrast
C) Double the metformin dose after the procedure
D) Stop metformin permanently
Correct Answer: A
Rationale: Metformin increases the risk of lactic acidosis when combined with IV
contrast dye due to potential acute kidney injury. The standard protocol is to hold
metformin on the day of the procedure and for 48 hours after, then restart only if
renal function is normal.
6. Which drug requires a "black box warning" for hepatotoxicity?
A) Acetaminophen
B) Ibuprofen
C) Aspirin
D) Naproxen
Correct Answer: A
