NURS 6521 MIDTERM EXAM ACTUAL 200 QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES ALREADY A+
GRADE
1. A nurse is preparing to administer a medication that is known to undergo
extensive first-pass metabolism. Which route of administration should the nurse
expect to require the highest dose to achieve a therapeutic effect?
A) Intravenous
B) Intramuscular
C) Oral
D) Sublingual
Answer: C
Rationale: Oral administration subjects a drug to first-pass metabolism in the liver,
where a significant portion is metabolized before reaching systemic circulation.
This reduces bioavailability, requiring higher oral doses compared to parenteral
routes (IV, IM) or sublingual routes that bypass the portal circulation.
2. A patient with myasthenia gravis is prescribed neostigmine. The nurse
understands that this medication works by which mechanism?
A) Blocking acetylcholine receptors at the neuromuscular junction
B) Increasing the production of acetylcholine
C) Inhibiting acetylcholinesterase, thereby increasing acetylcholine availability
D) Decreasing the breakdown of norepinephrine
Answer: C
Rationale: Neostigmine is a cholinesterase inhibitor that prevents the breakdown of
acetylcholine at the neuromuscular junction. This increases the availability of
acetylcholine to bind to receptors, improving muscle strength in patients with
myasthenia gravis.
3. A patient receiving lidocaine IV for a ventricular arrhythmia reports confusion
and tinnitus. Which action should the nurse take first?
A) Administer naloxone as an antidote
B) Stop the lidocaine infusion and notify the healthcare provider
C) Decrease the infusion rate by half and continue monitoring
D) Document the findings as expected side effects
Answer: B
,Rationale: Confusion and tinnitus are early signs of lidocaine toxicity affecting the
central nervous system. The infusion should be stopped immediately to prevent
progression to seizures or respiratory depression, and the provider must be notified.
4. A nurse is administering nesiritide (Natrecor) to a patient with acute
decompensated heart failure. Which finding indicates the medication is producing
a therapeutic effect?
A) Increased blood pressure and heart rate
B) Decreased pulmonary artery pressure and improved dyspnea
C) Increased urine output and hyperkalemia
D) Decreased cardiac output and peripheral edema
Answer: B
Rationale: Nesiritide is a recombinant B-type natriuretic peptide that causes
vasodilation, reduces preload and afterload, and decreases pulmonary artery
pressure. Therapeutic effects include improved dyspnea, decreased pulmonary
congestion, and reduced filling pressures.
5. A patient is prescribed flavoxate hydrochloride (Urispas) for overactive bladder.
Which adverse effect should the nurse include in patient teaching?
A) Increased salivation and diarrhea
B) Dry mouth and blurred vision
C) Hypertension and tachycardia
D) Weight gain and hyperglycemia
Answer: B
Rationale: Flavoxate is an anticholinergic medication that blocks muscarinic
receptors. Common anticholinergic adverse effects include dry mouth, blurred
vision, urinary retention, constipation, and drowsiness.
6. A nurse is reviewing a patient's medication list and notes that the patient takes a
drug with a narrow therapeutic index. Which statement best describes what this
means?
A) The drug has a wide margin of safety
B) The drug requires frequent monitoring because the toxic dose is close to the
therapeutic dose
C) The drug is ineffective at standard doses
D) The drug is only available intravenously
Answer: B
Rationale: A narrow therapeutic index means there is a small difference between
the minimum effective concentration and the toxic concentration. Small changes in
,dose or drug levels can lead to toxicity or therapeutic failure, requiring close
monitoring (e.g., digoxin, warfarin, phenytoin).
7. A patient with heart failure is receiving digoxin and furosemide. The nurse notes
a new onset of nausea, vomiting, and yellow halos around lights. Which laboratory
value should the nurse check first?
A) Serum potassium
B) Serum digoxin level
C) Serum sodium
D) Blood urea nitrogen (BUN)
Answer: B
Rationale: Nausea, vomiting, and visual disturbances (yellow halos) are classic
signs of digoxin toxicity. The nurse should obtain a serum digoxin level
immediately. Hypokalemia from furosemide can potentiate digoxin toxicity, but
digoxin level is the priority.
8. A nurse is teaching a patient about the difference between potency and efficacy
of medications. Which statement by the patient indicates correct understanding?
A) "A more potent drug will always produce a stronger effect than a less potent
drug."
B) "Efficacy is the maximum effect a drug can produce, regardless of dose."
C) "Potency refers to how quickly a drug works after administration."
D) "Efficacy means the drug has no adverse effects."
Answer: B
Rationale: Efficacy is the maximum therapeutic response a drug can produce,
independent of potency. Potency refers to the dose required to produce a given
effect, not the maximum effect. A drug with higher potency may not have higher
efficacy.
9. A patient is prescribed quinapril (Accupril) for hypertension. The nurse should
instruct the patient to report which adverse effect immediately?
A) Dry cough
B) Swelling of the lips or tongue
C) Dizziness upon standing
D) Fatigue
Answer: B
Rationale: Swelling of the lips, tongue, or face (angioedema) is a rare but life-
threatening adverse effect of ACE inhibitors like quinapril. It can cause airway
obstruction and requires immediate medical attention. Dry cough is common but
not immediately dangerous.
, 10. A patient is receiving IV furosemide (Lasix) for pulmonary edema. Which
finding indicates the medication is having the desired effect?
A) Increased blood pressure and heart rate
B) Decreased crackles on lung auscultation and increased urine output
C) Increased peripheral edema and weight gain
D) Decreased serum potassium and sodium levels
Answer: B
Rationale: Furosemide is a loop diuretic that reduces fluid volume. Therapeutic
effects in pulmonary edema include decreased pulmonary congestion (fewer
crackles), increased urine output, decreased dyspnea, and weight loss.
11. A patient with angina is prescribed nitroglycerin sublingual tablets. Which
instruction should the nurse include regarding storage?
A) Store the tablets in the refrigerator to maintain potency
B) Keep the tablets in their original glass container with the cap tightly closed
C) Carry the tablets loosely in a pocket for easy access
D) Replace the tablets every 12 months regardless of use
Answer: B
Rationale: Nitroglycerin sublingual tablets are sensitive to light, heat, and
moisture. They should be stored in their original glass container (not plastic) with a
tight cap. Tablets should be replaced every 3-6 months, not 12 months.
12. A nurse is caring for a patient receiving a continuous lidocaine infusion. Which
assessment finding is most indicative of lidocaine toxicity?
A) Heart rate 110 beats per minute
B) Blood pressure 100/70 mmHg
C) Seizure activity
D) Nausea and vomiting
Answer: C
Rationale: Lidocaine toxicity progresses from CNS effects (confusion, tinnitus,
paresthesias) to more severe effects including seizures and respiratory depression.
Seizure activity requires immediate intervention, including stopping the infusion
and administering benzodiazepines.
13. A patient with heart failure is prescribed carvedilol (Coreg). The nurse
understands that this medication is a beta-blocker and should be used cautiously in
patients with which condition?
A) Hypertension
B) Asthma or COPD
CORRECT ANSWERS WITH RATIONALES ALREADY A+
GRADE
1. A nurse is preparing to administer a medication that is known to undergo
extensive first-pass metabolism. Which route of administration should the nurse
expect to require the highest dose to achieve a therapeutic effect?
A) Intravenous
B) Intramuscular
C) Oral
D) Sublingual
Answer: C
Rationale: Oral administration subjects a drug to first-pass metabolism in the liver,
where a significant portion is metabolized before reaching systemic circulation.
This reduces bioavailability, requiring higher oral doses compared to parenteral
routes (IV, IM) or sublingual routes that bypass the portal circulation.
2. A patient with myasthenia gravis is prescribed neostigmine. The nurse
understands that this medication works by which mechanism?
A) Blocking acetylcholine receptors at the neuromuscular junction
B) Increasing the production of acetylcholine
C) Inhibiting acetylcholinesterase, thereby increasing acetylcholine availability
D) Decreasing the breakdown of norepinephrine
Answer: C
Rationale: Neostigmine is a cholinesterase inhibitor that prevents the breakdown of
acetylcholine at the neuromuscular junction. This increases the availability of
acetylcholine to bind to receptors, improving muscle strength in patients with
myasthenia gravis.
3. A patient receiving lidocaine IV for a ventricular arrhythmia reports confusion
and tinnitus. Which action should the nurse take first?
A) Administer naloxone as an antidote
B) Stop the lidocaine infusion and notify the healthcare provider
C) Decrease the infusion rate by half and continue monitoring
D) Document the findings as expected side effects
Answer: B
,Rationale: Confusion and tinnitus are early signs of lidocaine toxicity affecting the
central nervous system. The infusion should be stopped immediately to prevent
progression to seizures or respiratory depression, and the provider must be notified.
4. A nurse is administering nesiritide (Natrecor) to a patient with acute
decompensated heart failure. Which finding indicates the medication is producing
a therapeutic effect?
A) Increased blood pressure and heart rate
B) Decreased pulmonary artery pressure and improved dyspnea
C) Increased urine output and hyperkalemia
D) Decreased cardiac output and peripheral edema
Answer: B
Rationale: Nesiritide is a recombinant B-type natriuretic peptide that causes
vasodilation, reduces preload and afterload, and decreases pulmonary artery
pressure. Therapeutic effects include improved dyspnea, decreased pulmonary
congestion, and reduced filling pressures.
5. A patient is prescribed flavoxate hydrochloride (Urispas) for overactive bladder.
Which adverse effect should the nurse include in patient teaching?
A) Increased salivation and diarrhea
B) Dry mouth and blurred vision
C) Hypertension and tachycardia
D) Weight gain and hyperglycemia
Answer: B
Rationale: Flavoxate is an anticholinergic medication that blocks muscarinic
receptors. Common anticholinergic adverse effects include dry mouth, blurred
vision, urinary retention, constipation, and drowsiness.
6. A nurse is reviewing a patient's medication list and notes that the patient takes a
drug with a narrow therapeutic index. Which statement best describes what this
means?
A) The drug has a wide margin of safety
B) The drug requires frequent monitoring because the toxic dose is close to the
therapeutic dose
C) The drug is ineffective at standard doses
D) The drug is only available intravenously
Answer: B
Rationale: A narrow therapeutic index means there is a small difference between
the minimum effective concentration and the toxic concentration. Small changes in
,dose or drug levels can lead to toxicity or therapeutic failure, requiring close
monitoring (e.g., digoxin, warfarin, phenytoin).
7. A patient with heart failure is receiving digoxin and furosemide. The nurse notes
a new onset of nausea, vomiting, and yellow halos around lights. Which laboratory
value should the nurse check first?
A) Serum potassium
B) Serum digoxin level
C) Serum sodium
D) Blood urea nitrogen (BUN)
Answer: B
Rationale: Nausea, vomiting, and visual disturbances (yellow halos) are classic
signs of digoxin toxicity. The nurse should obtain a serum digoxin level
immediately. Hypokalemia from furosemide can potentiate digoxin toxicity, but
digoxin level is the priority.
8. A nurse is teaching a patient about the difference between potency and efficacy
of medications. Which statement by the patient indicates correct understanding?
A) "A more potent drug will always produce a stronger effect than a less potent
drug."
B) "Efficacy is the maximum effect a drug can produce, regardless of dose."
C) "Potency refers to how quickly a drug works after administration."
D) "Efficacy means the drug has no adverse effects."
Answer: B
Rationale: Efficacy is the maximum therapeutic response a drug can produce,
independent of potency. Potency refers to the dose required to produce a given
effect, not the maximum effect. A drug with higher potency may not have higher
efficacy.
9. A patient is prescribed quinapril (Accupril) for hypertension. The nurse should
instruct the patient to report which adverse effect immediately?
A) Dry cough
B) Swelling of the lips or tongue
C) Dizziness upon standing
D) Fatigue
Answer: B
Rationale: Swelling of the lips, tongue, or face (angioedema) is a rare but life-
threatening adverse effect of ACE inhibitors like quinapril. It can cause airway
obstruction and requires immediate medical attention. Dry cough is common but
not immediately dangerous.
, 10. A patient is receiving IV furosemide (Lasix) for pulmonary edema. Which
finding indicates the medication is having the desired effect?
A) Increased blood pressure and heart rate
B) Decreased crackles on lung auscultation and increased urine output
C) Increased peripheral edema and weight gain
D) Decreased serum potassium and sodium levels
Answer: B
Rationale: Furosemide is a loop diuretic that reduces fluid volume. Therapeutic
effects in pulmonary edema include decreased pulmonary congestion (fewer
crackles), increased urine output, decreased dyspnea, and weight loss.
11. A patient with angina is prescribed nitroglycerin sublingual tablets. Which
instruction should the nurse include regarding storage?
A) Store the tablets in the refrigerator to maintain potency
B) Keep the tablets in their original glass container with the cap tightly closed
C) Carry the tablets loosely in a pocket for easy access
D) Replace the tablets every 12 months regardless of use
Answer: B
Rationale: Nitroglycerin sublingual tablets are sensitive to light, heat, and
moisture. They should be stored in their original glass container (not plastic) with a
tight cap. Tablets should be replaced every 3-6 months, not 12 months.
12. A nurse is caring for a patient receiving a continuous lidocaine infusion. Which
assessment finding is most indicative of lidocaine toxicity?
A) Heart rate 110 beats per minute
B) Blood pressure 100/70 mmHg
C) Seizure activity
D) Nausea and vomiting
Answer: C
Rationale: Lidocaine toxicity progresses from CNS effects (confusion, tinnitus,
paresthesias) to more severe effects including seizures and respiratory depression.
Seizure activity requires immediate intervention, including stopping the infusion
and administering benzodiazepines.
13. A patient with heart failure is prescribed carvedilol (Coreg). The nurse
understands that this medication is a beta-blocker and should be used cautiously in
patients with which condition?
A) Hypertension
B) Asthma or COPD
