Pharmacology Final Exam REVIEW
Questions with Complete Solutions
6. A patient with atrial fibrillation was started on digoxin, and 1 week later a digoxin
level was drawn. Which result is within normal therapeutic levels for digoxin?
A. 0.4 ng/mL
B. 0.7 ng/mL
C. 2.1 ng/mL
D. 2.6 ng/mL or higher - ANSWER-B. 0.7 ng/mL (normal 0.5 to 2.0 ng/mL
7. When reviewing the list of medications taken by a patient who will be receiving a
new prescription for digoxin, the nurse would be concerned about which medication
that may interact with the digoxin?
A. aspirin
B. acetaminophen (Tylenol)
C. furosemide (Lasix)
D. vitamin K - ANSWER-C. furosemide (Lasix); (loop Diuretics); numerous ones on
page 341
8. The nurse is reviewing discharge teaching for a patient who will be taking digoxin
(Lanoxin) therapy. The patient should be taught to avoid which foods when taking
the digoxin?
A. Leafy green vegetables
B. Dairy products
C. Grapefruit juice
D. Bran muffins - ANSWER-D. Bran muffins
9. In assessing a patient before administration of a cardiac glycoside, the nurse
knows that which lab result can increase the toxicity of the drug?
A. Potassium level 2.8 mEq/L
B. Potassium level 4.9 mEq/L
C. Sodium level 140 mEq/L
D. Calcium level 10 mg/dL - ANSWER-A. Potassium level 2.8 mEq/L (low potassium
normal is 3.5 to 5.0)
10. The nurse administering the phosphodiesterase inhibitor inamrinone recognizes
that this drug should have a positive inotropic effect. This effect will result in
increased
A. heart rate.
B. blood vessel dilation.
C. force of cardiac contraction.
D. conduction of electrical impulses across the heart. - ANSWER-C. force of cardiac
contraction. (increase cAMP) positive inotropic (by more calcium available in
SR)effect and vasodilation, (inodilators)---positive chornotropic effect); USED IN ICU;
,ADVERSE EFFECT...thrombocytopenia, dysrhythmia, ventricular, hypotension and
angina, hypokalemia, tremor.
11. The nurse notes in a patient's medical record that nesiritide has been ordered.
Based on this order, the nurse interprets that the patient has which disorder?
A. Atrial fibrillation
B. Acutely decompensated heart failure with dyspnea at rest
C. Systolic heart failure
D. Long-term treatment of heart failure. - ANSWER-B. Acutely decompensated heart
failure with dyspnea at rest
SELECT ALL THAT APPLY:
1. When a patient is experiencing digoxin toxicity, which clinical situation would
necessitate the use of digoxin immune Fab (Digibind)? Select all that apply.
A. The patient reports seeing colorful halos around lights.
B. The patient's serum potassium level is above 5 mEq/L.
C. The patient is experiencing nausea and anorexia.
D. The patient is experiencing severe sinus bradycardia that does not respond to
cardiac pacing.
E. The patient has taken an overdose of greater than 10 mg of digoxin. - ANSWER-
B. The patient's serum potassium level is above 5 mEq/L.
D. The patient is experiencing severe sinus bradycardia that does not respond to
cardiac pacing. (E) might be right as well a person taking 10mg of digoxin is a
indication of toxicity...page 340 states life threatening digoxin overdose in adults and
4 mg in children)
2. Which drug classes are considered first-line treatment for heart failure? Select all
that apply.
A. Angiotensin converting enzyme (ACE) inhibitors
B. Angiotensin II receptor blockers (ARBs)
C. Digoxin (cardiac glycoside)
D. Beta-blockers
E. Nesiritide (Natrecor), the B-type natriuretic peptide - ANSWER-ACE
ARBS
Beta-blockers
loop diuretics
1.When administering topical nitroglycerin ointment, the nurse should use which
technique?
A. The ointment should be applied on the chest over the heart.
B. The ointment should be used only in the case of a mild angina episode.
C. The old ointment should be removed before new ointment is applied.
D. The ointment should be massaged gently into the skin, then covered with plastic
wrap. - ANSWER-C. The old ointment should be removed before new ointment is
applied.
, 2.The nurse is giving intravenous nitroglycerin to a patient who has just been
admitted because of an acute myocardial infarction. Which statement is true
regarding the administration of the intravenous form of this medication?
A. Specific nonpolyvinylchloride (non-PVC) plastic intravenous bags and tubing must
be used.
B. It is stable for only 24 hours after preparation.
C. It can be given in infusions with other medications.
D. The solution will be slightly colored green or blue. - ANSWER-A. Specific
nonpolyvinylchloride (non-PVC) plastic intravenous bags and tubing must be used.
3.A 53-year-old man has been admitted for evaluation of chest pain. He has been
diagnosed with angina and will be given a prescription for sublingual nitroglycerin
tablets. When teaching the patient how to use sublingual nitroglycerin, what
instruction should the nurse include?
A. Take up to five doses at 15-minute intervals for an angina attack.
B. If the tablet does not dissolve quickly, chew the tablet for maximal effect.
C. If the chest pain is not relieved after one tablet, call 911 immediately to activate
emergency medical services.
D. Wait 1 minute between doses of sublingual tablets, up to three doses. -
ANSWER-C. If the chest pain is not relieved after one tablet, call 911 immediately to
activate emergency medical services.
4.A 74-year-old professional golfer has chest pain that occurs toward the end of his
golfing games. He says the pain usually goes away after 1 or 2 sublingual
nitroglycerin tablets and rest. What type of angina does he have?
A. Classic
B. Variant
C. Unstable
D. Prinzmetal's - ANSWER-A. Classic also called (Chronic stable angina); chest pain
that has as its primary cause arteriosclerosis, which results in a long-term but
relatively stable level of obstruction in one or more coronary arteries.
5.A patient arrives in the emergency department with severe chest pain. She says
she has had pain off and on for a week now. Which assessment finding would
indicate the need for cautious use of nitrates and nitrites?
A. Blood pressure of 98/68 mm Hg
B. History of liver disease
C. History of heart failure
D. History of a myocardial infarction 2 years ago - ANSWER-A. Blood pressure of
98/68 mm Hg
6.A calcium channel blocker (CCB) is prescribed for a patient, and the nurse
provides instructions to the patient about the medication. What does the nurse tell
the patient?
A. The tablet should be chewed for faster release of the medication.
B. To increase the effect of the drug, take it with grapefruit juice.
C. If the adverse effects of chest pain, fainting, or dyspnea occur, discontinue the
medication immediately.
D. A high-fiber diet with plenty of fluids will help prevent the constipation that may
occur. - ANSWER-D. A high-fiber diet with plenty of fluids will help prevent the
Questions with Complete Solutions
6. A patient with atrial fibrillation was started on digoxin, and 1 week later a digoxin
level was drawn. Which result is within normal therapeutic levels for digoxin?
A. 0.4 ng/mL
B. 0.7 ng/mL
C. 2.1 ng/mL
D. 2.6 ng/mL or higher - ANSWER-B. 0.7 ng/mL (normal 0.5 to 2.0 ng/mL
7. When reviewing the list of medications taken by a patient who will be receiving a
new prescription for digoxin, the nurse would be concerned about which medication
that may interact with the digoxin?
A. aspirin
B. acetaminophen (Tylenol)
C. furosemide (Lasix)
D. vitamin K - ANSWER-C. furosemide (Lasix); (loop Diuretics); numerous ones on
page 341
8. The nurse is reviewing discharge teaching for a patient who will be taking digoxin
(Lanoxin) therapy. The patient should be taught to avoid which foods when taking
the digoxin?
A. Leafy green vegetables
B. Dairy products
C. Grapefruit juice
D. Bran muffins - ANSWER-D. Bran muffins
9. In assessing a patient before administration of a cardiac glycoside, the nurse
knows that which lab result can increase the toxicity of the drug?
A. Potassium level 2.8 mEq/L
B. Potassium level 4.9 mEq/L
C. Sodium level 140 mEq/L
D. Calcium level 10 mg/dL - ANSWER-A. Potassium level 2.8 mEq/L (low potassium
normal is 3.5 to 5.0)
10. The nurse administering the phosphodiesterase inhibitor inamrinone recognizes
that this drug should have a positive inotropic effect. This effect will result in
increased
A. heart rate.
B. blood vessel dilation.
C. force of cardiac contraction.
D. conduction of electrical impulses across the heart. - ANSWER-C. force of cardiac
contraction. (increase cAMP) positive inotropic (by more calcium available in
SR)effect and vasodilation, (inodilators)---positive chornotropic effect); USED IN ICU;
,ADVERSE EFFECT...thrombocytopenia, dysrhythmia, ventricular, hypotension and
angina, hypokalemia, tremor.
11. The nurse notes in a patient's medical record that nesiritide has been ordered.
Based on this order, the nurse interprets that the patient has which disorder?
A. Atrial fibrillation
B. Acutely decompensated heart failure with dyspnea at rest
C. Systolic heart failure
D. Long-term treatment of heart failure. - ANSWER-B. Acutely decompensated heart
failure with dyspnea at rest
SELECT ALL THAT APPLY:
1. When a patient is experiencing digoxin toxicity, which clinical situation would
necessitate the use of digoxin immune Fab (Digibind)? Select all that apply.
A. The patient reports seeing colorful halos around lights.
B. The patient's serum potassium level is above 5 mEq/L.
C. The patient is experiencing nausea and anorexia.
D. The patient is experiencing severe sinus bradycardia that does not respond to
cardiac pacing.
E. The patient has taken an overdose of greater than 10 mg of digoxin. - ANSWER-
B. The patient's serum potassium level is above 5 mEq/L.
D. The patient is experiencing severe sinus bradycardia that does not respond to
cardiac pacing. (E) might be right as well a person taking 10mg of digoxin is a
indication of toxicity...page 340 states life threatening digoxin overdose in adults and
4 mg in children)
2. Which drug classes are considered first-line treatment for heart failure? Select all
that apply.
A. Angiotensin converting enzyme (ACE) inhibitors
B. Angiotensin II receptor blockers (ARBs)
C. Digoxin (cardiac glycoside)
D. Beta-blockers
E. Nesiritide (Natrecor), the B-type natriuretic peptide - ANSWER-ACE
ARBS
Beta-blockers
loop diuretics
1.When administering topical nitroglycerin ointment, the nurse should use which
technique?
A. The ointment should be applied on the chest over the heart.
B. The ointment should be used only in the case of a mild angina episode.
C. The old ointment should be removed before new ointment is applied.
D. The ointment should be massaged gently into the skin, then covered with plastic
wrap. - ANSWER-C. The old ointment should be removed before new ointment is
applied.
, 2.The nurse is giving intravenous nitroglycerin to a patient who has just been
admitted because of an acute myocardial infarction. Which statement is true
regarding the administration of the intravenous form of this medication?
A. Specific nonpolyvinylchloride (non-PVC) plastic intravenous bags and tubing must
be used.
B. It is stable for only 24 hours after preparation.
C. It can be given in infusions with other medications.
D. The solution will be slightly colored green or blue. - ANSWER-A. Specific
nonpolyvinylchloride (non-PVC) plastic intravenous bags and tubing must be used.
3.A 53-year-old man has been admitted for evaluation of chest pain. He has been
diagnosed with angina and will be given a prescription for sublingual nitroglycerin
tablets. When teaching the patient how to use sublingual nitroglycerin, what
instruction should the nurse include?
A. Take up to five doses at 15-minute intervals for an angina attack.
B. If the tablet does not dissolve quickly, chew the tablet for maximal effect.
C. If the chest pain is not relieved after one tablet, call 911 immediately to activate
emergency medical services.
D. Wait 1 minute between doses of sublingual tablets, up to three doses. -
ANSWER-C. If the chest pain is not relieved after one tablet, call 911 immediately to
activate emergency medical services.
4.A 74-year-old professional golfer has chest pain that occurs toward the end of his
golfing games. He says the pain usually goes away after 1 or 2 sublingual
nitroglycerin tablets and rest. What type of angina does he have?
A. Classic
B. Variant
C. Unstable
D. Prinzmetal's - ANSWER-A. Classic also called (Chronic stable angina); chest pain
that has as its primary cause arteriosclerosis, which results in a long-term but
relatively stable level of obstruction in one or more coronary arteries.
5.A patient arrives in the emergency department with severe chest pain. She says
she has had pain off and on for a week now. Which assessment finding would
indicate the need for cautious use of nitrates and nitrites?
A. Blood pressure of 98/68 mm Hg
B. History of liver disease
C. History of heart failure
D. History of a myocardial infarction 2 years ago - ANSWER-A. Blood pressure of
98/68 mm Hg
6.A calcium channel blocker (CCB) is prescribed for a patient, and the nurse
provides instructions to the patient about the medication. What does the nurse tell
the patient?
A. The tablet should be chewed for faster release of the medication.
B. To increase the effect of the drug, take it with grapefruit juice.
C. If the adverse effects of chest pain, fainting, or dyspnea occur, discontinue the
medication immediately.
D. A high-fiber diet with plenty of fluids will help prevent the constipation that may
occur. - ANSWER-D. A high-fiber diet with plenty of fluids will help prevent the
