NUR 2474 Pharmacology Exam 2, 2026/2027-
Medication Management and Clinical
Application COMPETENCY ASSESSMENT
SECTION 1: CARDIOVASCULAR PHARMACOLOGY
(Questions 1-15)
Question 1
A patient is brought to the emergency department with shortness of breath,
a respiratory rate of 30 breaths per minute, intercostal retractions, and
frothy, pink sputum. The nurse caring for this patient will expect to
administer which drug?
A. Furosemide (Lasix)
B. Hydrochlorothiazide (HydroDIURIL)
C. Mannitol (Osmitrol)
D. Spironolactone (Aldactone)
Correct Answer: A. Furosemide (Lasix)
Rationale: Furosemide, a potent loop diuretic, is indicated when rapid or
massive mobilization of fluid is needed . This patient is presenting with
severe signs of congestive heart failure with pulmonary edema, requiring
immediate diuresis. Hydrochlorothiazide and spironolactone have less rapid
diuretic effects and are not indicated for pulmonary edema. Mannitol is
indicated for increased intracranial pressure, not pulmonary edema.
Subtopic: Diuretics – Loop Diuretics
,Question 2
A patient who is taking digoxin (Lanoxin) is admitted for treatment of
congestive heart failure. The prescriber orders furosemide (Lasix). The nurse
notes an irregular heart rate of 86 beats per minute, crackles in both lungs,
and a blood pressure of 130/82 mm Hg. Which laboratory value causes the
nurse the most concern?
A. Blood glucose level of 120 mg/dL
B. Oxygen saturation of 90%
C. Potassium level of 3.5 mEq/L
D. Sodium level of 140 mEq/L
Correct Answer: C. Potassium level of 3.5 mEq/L
Rationale: A potassium level of 3.5 mEq/L is in the low-normal range but
concerning because furosemide is a potassium-wasting diuretic.
Hypokalemia (K⁺ < 3.5) can trigger fatal dysrhythmias, especially in patients
taking digoxin, as low potassium increases the risk of digoxin toxicity . This
patient has an irregular heart rate, which may be related to hypokalemia.
The potassium level requires immediate attention and possible potassium
supplementation or potassium-sparing diuretic addition.
Subtopic: Diuretics – Electrolyte Monitoring
Question 3
A client has 2+ pitting edema of the lower extremities bilaterally.
Auscultation of the lungs reveals bibasilar crackles, and a serum potassium
level of 6 mEq/L. Which diuretic agent would the nurse clarify with the
prescriber?
A. Furosemide (Lasix)
B. Hydrochlorothiazide (HydroDIURIL)
C. Spironolactone (Aldactone)
D. Mannitol (Osmitrol)
Correct Answer: C. Spironolactone (Aldactone)
Rationale: Spironolactone is a potassium-sparing diuretic. A potassium level
of 6 mEq/L indicates hyperkalemia, which is a contraindication for
spironolactone . Furosemide and hydrochlorothiazide are potassium-wasting
diuretics and would be appropriate for a patient with hyperkalemia. Mannitol
is not indicated for this presentation.
, Subtopic: Diuretics – Potassium-Sparing Agents
Question 4
A patient with chronic hypertension is admitted to the hospital. During the
admission assessment, the nurse notes a heart rate of 96 beats per minute,
a blood pressure of 150/90 mm Hg, bibasilar crackles, 2+ pitting edema of
the ankles, and distension of the jugular veins. The nurse will contact the
provider to request an order for which medication?
A. ACE inhibitor
B. Digoxin (Lanoxin)
C. Furosemide (Lasix)
D. Spironolactone (Aldactone)
Correct Answer: C. Furosemide (Lasix)
Rationale: This patient shows signs of fluid volume overload (crackles,
edema, JVD) and needs a diuretic . Furosemide is a high-ceiling (loop)
diuretic that can produce profound diuresis quickly, even when the
glomerular filtration rate (GFR) is low. An ACE inhibitor will not reduce fluid
volume overload. Digoxin may improve renal perfusion but is not the primary
treatment for fluid overload.
Subtopic: Heart Failure – Diuretic Therapy
Question 5
A client begins taking nifedipine (a calcium channel blocker), along with
metoprolol (a beta blocker), to treat hypertension. Why was metoprolol
added to the medication protocol?
A. To increase heart rate
B. To reduce flushing caused by nifedipine
C. To prevent reflex tachycardia
D. To lower potassium levels
Correct Answer: B. To reduce flushing caused by nifedipine
Medication Management and Clinical
Application COMPETENCY ASSESSMENT
SECTION 1: CARDIOVASCULAR PHARMACOLOGY
(Questions 1-15)
Question 1
A patient is brought to the emergency department with shortness of breath,
a respiratory rate of 30 breaths per minute, intercostal retractions, and
frothy, pink sputum. The nurse caring for this patient will expect to
administer which drug?
A. Furosemide (Lasix)
B. Hydrochlorothiazide (HydroDIURIL)
C. Mannitol (Osmitrol)
D. Spironolactone (Aldactone)
Correct Answer: A. Furosemide (Lasix)
Rationale: Furosemide, a potent loop diuretic, is indicated when rapid or
massive mobilization of fluid is needed . This patient is presenting with
severe signs of congestive heart failure with pulmonary edema, requiring
immediate diuresis. Hydrochlorothiazide and spironolactone have less rapid
diuretic effects and are not indicated for pulmonary edema. Mannitol is
indicated for increased intracranial pressure, not pulmonary edema.
Subtopic: Diuretics – Loop Diuretics
,Question 2
A patient who is taking digoxin (Lanoxin) is admitted for treatment of
congestive heart failure. The prescriber orders furosemide (Lasix). The nurse
notes an irregular heart rate of 86 beats per minute, crackles in both lungs,
and a blood pressure of 130/82 mm Hg. Which laboratory value causes the
nurse the most concern?
A. Blood glucose level of 120 mg/dL
B. Oxygen saturation of 90%
C. Potassium level of 3.5 mEq/L
D. Sodium level of 140 mEq/L
Correct Answer: C. Potassium level of 3.5 mEq/L
Rationale: A potassium level of 3.5 mEq/L is in the low-normal range but
concerning because furosemide is a potassium-wasting diuretic.
Hypokalemia (K⁺ < 3.5) can trigger fatal dysrhythmias, especially in patients
taking digoxin, as low potassium increases the risk of digoxin toxicity . This
patient has an irregular heart rate, which may be related to hypokalemia.
The potassium level requires immediate attention and possible potassium
supplementation or potassium-sparing diuretic addition.
Subtopic: Diuretics – Electrolyte Monitoring
Question 3
A client has 2+ pitting edema of the lower extremities bilaterally.
Auscultation of the lungs reveals bibasilar crackles, and a serum potassium
level of 6 mEq/L. Which diuretic agent would the nurse clarify with the
prescriber?
A. Furosemide (Lasix)
B. Hydrochlorothiazide (HydroDIURIL)
C. Spironolactone (Aldactone)
D. Mannitol (Osmitrol)
Correct Answer: C. Spironolactone (Aldactone)
Rationale: Spironolactone is a potassium-sparing diuretic. A potassium level
of 6 mEq/L indicates hyperkalemia, which is a contraindication for
spironolactone . Furosemide and hydrochlorothiazide are potassium-wasting
diuretics and would be appropriate for a patient with hyperkalemia. Mannitol
is not indicated for this presentation.
, Subtopic: Diuretics – Potassium-Sparing Agents
Question 4
A patient with chronic hypertension is admitted to the hospital. During the
admission assessment, the nurse notes a heart rate of 96 beats per minute,
a blood pressure of 150/90 mm Hg, bibasilar crackles, 2+ pitting edema of
the ankles, and distension of the jugular veins. The nurse will contact the
provider to request an order for which medication?
A. ACE inhibitor
B. Digoxin (Lanoxin)
C. Furosemide (Lasix)
D. Spironolactone (Aldactone)
Correct Answer: C. Furosemide (Lasix)
Rationale: This patient shows signs of fluid volume overload (crackles,
edema, JVD) and needs a diuretic . Furosemide is a high-ceiling (loop)
diuretic that can produce profound diuresis quickly, even when the
glomerular filtration rate (GFR) is low. An ACE inhibitor will not reduce fluid
volume overload. Digoxin may improve renal perfusion but is not the primary
treatment for fluid overload.
Subtopic: Heart Failure – Diuretic Therapy
Question 5
A client begins taking nifedipine (a calcium channel blocker), along with
metoprolol (a beta blocker), to treat hypertension. Why was metoprolol
added to the medication protocol?
A. To increase heart rate
B. To reduce flushing caused by nifedipine
C. To prevent reflex tachycardia
D. To lower potassium levels
Correct Answer: B. To reduce flushing caused by nifedipine
