NUR 2474 EXAM 2 PHARMACOLOGY
FOR PROFESSIONAL NURSING
2024/2025 RASMUSSEN (100%
VERIFIED Q&A & RATIONALES)
NUR 2474 Pharmacology Exam 2 Practice Assessment
Question 1
A nurse is preparing to administer an intravenous bolus of furosemide
[Lasix] to a client who presents with severe fluid volume overload, acute
orthopnea, and frothy, pink-tinged sputum. Which baseline assessment
parameter must the nurse evaluate immediately prior to pushing this
high-alert medication?
A. Total fluid intake over the past twenty-four hours to calculate negative
fluid balance.
B. Serum sodium levels to prevent acute neurological changes from rapid
hyponatremia.
C. Serum potassium levels to prevent life-threatening cardiac
arrhythmias.
D. Skin turgor over the sternum to gauge the absolute severity of
systemic peripheral edema.
Rationale: Furosemide is a loop diuretic that causes significant
potassium wasting. Administering it to a patient with unrecognized
hypokalemia can induce fatal cardiac dysrhythmias. This risk is
exponentially increased if the patient concurrently takes digoxin.
Question 2
A home health nurse reviews the medication administration record of an
elderly patient diagnosed with chronic heart failure who is prescribed
both digoxin [Lanoxin] and furosemide [Lasix] daily. The patient reports
experiencing recent blurred vision and a yellow-green halo effect around
household lights. What is the priority nursing action?
A. Advise the patient to increase their daily intake of potassium-rich
foods like bananas.
B. Assess the patient's apical pulse for one full minute and
hold the next scheduled dose.
C. Instruct the patient to visit an optometrist to evaluate for accelerating
,age-related cataracts.
D. Reassure the patient that visual changes are common, expected
adaptations to loop diuretics.
Rationale: Visual disturbances, including yellow-green halos, are
classic signs of digoxin toxicity. Loop diuretics like furosemide cause
hypokalemia, which directly potentiates digoxin toxicity. The nurse
must assess the heart rate and withhold the medication until blood
levels are verified.
Question 3
The medical-surgical nurse is evaluating laboratory values for a patient
who has been taking spironolactone [Aldactone] 50 mg orally twice daily
for the management of hepatic ascites. The nurse notes that the patient's
current serum potassium level is 5.4 mEq/L. Which action should the
nurse take first?
A. Withhold the scheduled dose of spironolactone and notify
the primary healthcare provider.
B. Administer a scheduled dose of oral potassium chloride supplement
immediately.
C. Request an order for an electrocardiogram to check for a shortened
PR interval.
D. Encourage the patient to increase their consumption of leafy green
vegetables and avocados.
Rationale: Spironolactone is a potassium-sparing diuretic. A potassium
level of 5.4 mEq/L indicates hyperkalemia. Administering more
spironolactone or potassium supplements will worsen this condition
and risk cardiac arrest.
Question 4
A nurse is conducting discharge teaching for a patient who is being sent
home with a new prescription for hydrochlorothiazide [Microzide] for
the management of primary hypertension. Which statement by the
patient indicates a correct understanding of the dietary modifications
required for this medication?
A. "I must completely avoid potassium-rich foods because this pill keeps
potassium in my body."
B. "I should drink at least four liters of water every day to make sure my
kidneys do not fail."
C. "I will eat a banana or drink orange juice every day to keep
my potassium from dropping too low."
,D. "I need to replace my regular table salt with a commercial potassium-
based salt substitute."
Rationale: Hydrochlorothiazide is a potassium-wasting thiazide
diuretic. Patients need to consume dietary potassium to counteract mild
wasting. Salt substitutes contain potassium chloride and should not be
used without explicit provider approval.
Question 5
An oncology nurse is caring for a patient who is experiencing severe,
acute chemotherapy-induced nausea and vomiting. The nurse
administers intravenous ondansetron [Zofran] as prescribed. One hour
later, the patient reports a mild-to-moderate generalized headache but
denies any further nausea. Which action is most appropriate?
A. Inform the patient that headache is a common, expected
side effect and offer an ordered analgesic.
B. Immediately stop all future oncology treatments and prepare an
emergency incident report.
C. Document that the patient is experiencing an acute, life-threatening
anaphylactic reaction.
D. Place the patient on strict airborne precautions assuming they have
developed viral meningitis.
Rationale: Headache and dizziness are common, benign, and well-
documented side effects of serotonin (5-HT3) receptor antagonists like
ondansetron. They do not warrant discontinuing a highly effective anti-
emetic therapy.
Question 6
A nurse is performing an admission assessment on an elderly patient
who reports utilizing over-the-counter senna [Senokot] multiple times
per day for the past several years to maintain regular bowel movements.
The nurse should prioritize assessing this patient for which chronic
complication?
A. Accelerating hypertrophy of the smooth muscle walls of the
descending colon.
B. Fluid volume deficit, profound electrolyte depletion, and
loss of natural bowel tone.
C. Acute mechanical small bowel obstruction requiring urgent surgical
intervention.
D. Development of permanent, irreversible systemic neurological
sensory deficits.
, Rationale: Chronic, excessive use of stimulant laxatives like senna
damages the myenteric plexus, leading to a non-functioning "laxative
colon" that lacks natural tone. It also causes chronic fluid and
electrolyte imbalances.
Question 7
A clinical nurse is evaluating a patient who has been taking omeprazole
[Prilosec] for over three years to manage severe gastroesophageal reflux
disease (GERD). The nurse should recognize that long-term suppression
of gastric acid by proton pump inhibitors places the patient at elevated
risk for which conditions?
A. Severe osteoporosis, bone fractures, and Clostridioides
difficile-associated diarrhea.
B. Chronic vitamin C toxicities, iron overload syndrome, and profound
systemic alkalosis.
C. Development of permanent peripheral neuropathies and acute
hemolytic anemia.
D. Rapid-onset idiopathic pulmonary fibrosis and permanent destructive
hepatic failure.
Rationale: Proton pump inhibitors (PPIs) reduce gastric acidity, which
impairs calcium absorption, increasing the risk of osteoporosis and
fractures. Lower gastric acid also allows opportunistic pathogens like
C. difficile to colonize the gut.
Question 8
The nurse on a progressive care unit receives a phone call from the
laboratory stating that a patient's serum digoxin level is 2.4 ng/mL. The
nurse reviews the patient's chart and notes that the next dose of digoxin
is scheduled to be given in thirty minutes. Which action must the nurse
execute?
A. Administer the scheduled dose as planned because the level is within
the safe therapeutic range.
B. Hold the scheduled dose, assess the patient's cardiac
rhythm, and notify the provider of toxicity.
C. Double the scheduled dose to rapidly push the medication into a fully
effective therapeutic steady state.
D. Administer the dose along with a rapid intravenous bolus of normal
saline fluid to dilute the drug.
Rationale: The standard therapeutic range for serum digoxin is 0.5 to
2.0 ng/mL. A level of 2.4 ng/mL indicates toxicity. The nurse must
FOR PROFESSIONAL NURSING
2024/2025 RASMUSSEN (100%
VERIFIED Q&A & RATIONALES)
NUR 2474 Pharmacology Exam 2 Practice Assessment
Question 1
A nurse is preparing to administer an intravenous bolus of furosemide
[Lasix] to a client who presents with severe fluid volume overload, acute
orthopnea, and frothy, pink-tinged sputum. Which baseline assessment
parameter must the nurse evaluate immediately prior to pushing this
high-alert medication?
A. Total fluid intake over the past twenty-four hours to calculate negative
fluid balance.
B. Serum sodium levels to prevent acute neurological changes from rapid
hyponatremia.
C. Serum potassium levels to prevent life-threatening cardiac
arrhythmias.
D. Skin turgor over the sternum to gauge the absolute severity of
systemic peripheral edema.
Rationale: Furosemide is a loop diuretic that causes significant
potassium wasting. Administering it to a patient with unrecognized
hypokalemia can induce fatal cardiac dysrhythmias. This risk is
exponentially increased if the patient concurrently takes digoxin.
Question 2
A home health nurse reviews the medication administration record of an
elderly patient diagnosed with chronic heart failure who is prescribed
both digoxin [Lanoxin] and furosemide [Lasix] daily. The patient reports
experiencing recent blurred vision and a yellow-green halo effect around
household lights. What is the priority nursing action?
A. Advise the patient to increase their daily intake of potassium-rich
foods like bananas.
B. Assess the patient's apical pulse for one full minute and
hold the next scheduled dose.
C. Instruct the patient to visit an optometrist to evaluate for accelerating
,age-related cataracts.
D. Reassure the patient that visual changes are common, expected
adaptations to loop diuretics.
Rationale: Visual disturbances, including yellow-green halos, are
classic signs of digoxin toxicity. Loop diuretics like furosemide cause
hypokalemia, which directly potentiates digoxin toxicity. The nurse
must assess the heart rate and withhold the medication until blood
levels are verified.
Question 3
The medical-surgical nurse is evaluating laboratory values for a patient
who has been taking spironolactone [Aldactone] 50 mg orally twice daily
for the management of hepatic ascites. The nurse notes that the patient's
current serum potassium level is 5.4 mEq/L. Which action should the
nurse take first?
A. Withhold the scheduled dose of spironolactone and notify
the primary healthcare provider.
B. Administer a scheduled dose of oral potassium chloride supplement
immediately.
C. Request an order for an electrocardiogram to check for a shortened
PR interval.
D. Encourage the patient to increase their consumption of leafy green
vegetables and avocados.
Rationale: Spironolactone is a potassium-sparing diuretic. A potassium
level of 5.4 mEq/L indicates hyperkalemia. Administering more
spironolactone or potassium supplements will worsen this condition
and risk cardiac arrest.
Question 4
A nurse is conducting discharge teaching for a patient who is being sent
home with a new prescription for hydrochlorothiazide [Microzide] for
the management of primary hypertension. Which statement by the
patient indicates a correct understanding of the dietary modifications
required for this medication?
A. "I must completely avoid potassium-rich foods because this pill keeps
potassium in my body."
B. "I should drink at least four liters of water every day to make sure my
kidneys do not fail."
C. "I will eat a banana or drink orange juice every day to keep
my potassium from dropping too low."
,D. "I need to replace my regular table salt with a commercial potassium-
based salt substitute."
Rationale: Hydrochlorothiazide is a potassium-wasting thiazide
diuretic. Patients need to consume dietary potassium to counteract mild
wasting. Salt substitutes contain potassium chloride and should not be
used without explicit provider approval.
Question 5
An oncology nurse is caring for a patient who is experiencing severe,
acute chemotherapy-induced nausea and vomiting. The nurse
administers intravenous ondansetron [Zofran] as prescribed. One hour
later, the patient reports a mild-to-moderate generalized headache but
denies any further nausea. Which action is most appropriate?
A. Inform the patient that headache is a common, expected
side effect and offer an ordered analgesic.
B. Immediately stop all future oncology treatments and prepare an
emergency incident report.
C. Document that the patient is experiencing an acute, life-threatening
anaphylactic reaction.
D. Place the patient on strict airborne precautions assuming they have
developed viral meningitis.
Rationale: Headache and dizziness are common, benign, and well-
documented side effects of serotonin (5-HT3) receptor antagonists like
ondansetron. They do not warrant discontinuing a highly effective anti-
emetic therapy.
Question 6
A nurse is performing an admission assessment on an elderly patient
who reports utilizing over-the-counter senna [Senokot] multiple times
per day for the past several years to maintain regular bowel movements.
The nurse should prioritize assessing this patient for which chronic
complication?
A. Accelerating hypertrophy of the smooth muscle walls of the
descending colon.
B. Fluid volume deficit, profound electrolyte depletion, and
loss of natural bowel tone.
C. Acute mechanical small bowel obstruction requiring urgent surgical
intervention.
D. Development of permanent, irreversible systemic neurological
sensory deficits.
, Rationale: Chronic, excessive use of stimulant laxatives like senna
damages the myenteric plexus, leading to a non-functioning "laxative
colon" that lacks natural tone. It also causes chronic fluid and
electrolyte imbalances.
Question 7
A clinical nurse is evaluating a patient who has been taking omeprazole
[Prilosec] for over three years to manage severe gastroesophageal reflux
disease (GERD). The nurse should recognize that long-term suppression
of gastric acid by proton pump inhibitors places the patient at elevated
risk for which conditions?
A. Severe osteoporosis, bone fractures, and Clostridioides
difficile-associated diarrhea.
B. Chronic vitamin C toxicities, iron overload syndrome, and profound
systemic alkalosis.
C. Development of permanent peripheral neuropathies and acute
hemolytic anemia.
D. Rapid-onset idiopathic pulmonary fibrosis and permanent destructive
hepatic failure.
Rationale: Proton pump inhibitors (PPIs) reduce gastric acidity, which
impairs calcium absorption, increasing the risk of osteoporosis and
fractures. Lower gastric acid also allows opportunistic pathogens like
C. difficile to colonize the gut.
Question 8
The nurse on a progressive care unit receives a phone call from the
laboratory stating that a patient's serum digoxin level is 2.4 ng/mL. The
nurse reviews the patient's chart and notes that the next dose of digoxin
is scheduled to be given in thirty minutes. Which action must the nurse
execute?
A. Administer the scheduled dose as planned because the level is within
the safe therapeutic range.
B. Hold the scheduled dose, assess the patient's cardiac
rhythm, and notify the provider of toxicity.
C. Double the scheduled dose to rapidly push the medication into a fully
effective therapeutic steady state.
D. Administer the dose along with a rapid intravenous bolus of normal
saline fluid to dilute the drug.
Rationale: The standard therapeutic range for serum digoxin is 0.5 to
2.0 ng/mL. A level of 2.4 ng/mL indicates toxicity. The nurse must
