NURS 251 Pharmacology Module 1-10 Exam Portage Learning
Question Bank (Latest 2026/2027 Edition) – 100% Correct
Questions, Answers & Detailed Rationales
Q1
A 72-year-old patient with chronic heart failure is prescribed digoxin 0.25 mg daily. The
nurse reviews the patient's current medications and notes they are also taking
furosemide 40 mg daily. Which laboratory value should the nurse monitor most closely
to prevent a life-threatening drug interaction?
A) Serum creatinine
B) Serum potassium
C) Serum albumin
D) Serum bilirubin
Answer: B
Rationales:
● A: Serum creatinine is important for renal function assessment but does not
directly reflect the primary risk of digoxin toxicity when combined with a loop
diuretic.
● B: Furosemide causes potassium loss through the kidneys, and hypokalemia
increases myocardial sensitivity to digoxin, dramatically raising the risk of fatal
dysrhythmias.
● C: Serum albumin affects drug protein binding but is not the critical parameter for
preventing this specific life-threatening interaction.
● D: Serum bilirubin relates to hepatic function and biliary excretion, neither of
which is central to the digoxin-furosemide interaction mechanism.
,Q2
A nurse is administering warfarin 5 mg PO to a patient with atrial fibrillation. The patient
asks why they must avoid eating large amounts of leafy green vegetables. Which
response by the nurse best explains the pharmacological rationale?
A) "Vitamin K in vegetables competes with warfarin at hepatic receptor sites, reducing
anticoagulant efficacy."
B) "Leafy greens increase gastrointestinal motility, decreasing warfarin absorption from
the gut."
C) "Vitamin K is a cofactor for clotting factor synthesis, directly antagonizing warfarin's
mechanism of action."
D) "Fiber in vegetables binds warfarin in the intestinal lumen, forming an insoluble
complex."
Answer: C
Rationales:
● A: Vitamin K does not compete at hepatic receptor sites; rather, it serves as a
necessary cofactor for the synthesis of functional clotting factors that warfarin
inhibits.
● B: Gastrointestinal motility changes do not significantly alter warfarin
bioavailability, and this explanation misrepresents the true drug-nutrient
interaction.
● C: Vitamin K is an essential cofactor for the gamma-carboxylation of clotting
factors II, VII, IX, and X, and increased dietary intake can overcome warfarin's
vitamin K antagonism, reducing therapeutic anticoagulation.
● D: Dietary fiber does not bind warfarin to form insoluble complexes; this
distractor confuses the mechanism with that of certain bile acid sequestrants or
mineral supplements.
Q3
,A patient with type 2 diabetes mellitus is prescribed metformin 1000 mg BID. The nurse
is reviewing the patient's medical history and identifies which condition as an absolute
contraindication to metformin therapy?
A) Mild chronic kidney disease with eGFR 55 mL/min/1.73m²
B) History of congestive heart failure controlled with lisinopril
C) Severe hepatic impairment with elevated liver enzymes
D) History of mild peripheral neuropathy
Answer: C
Rationales:
● A: An eGFR of 55 mL/min/1.73m² represents mild CKD (Stage 2), which is not an
absolute contraindication; metformin is contraindicated when eGFR falls below
30 mL/min/1.73m².
● B: Controlled congestive heart failure is not an absolute contraindication, though
acute decompensated heart failure with hypoperfusion and hypoxia increases
lactic acidosis risk.
● C: Severe hepatic impairment is an absolute contraindication because the liver is
responsible for lactate clearance, and impaired hepatic function combined with
metformin significantly increases the risk of fatal lactic acidosis.
● D: Peripheral neuropathy is a common complication of diabetes itself and has no
pharmacological interaction or contraindication with metformin therapy.
Q4
A 45-year-old patient with a history of peptic ulcer disease is prescribed ibuprofen 600
mg TID for osteoarthritis. The nurse should recommend which adjunctive medication to
reduce the risk of gastrointestinal complications?
A) Omeprazole 20 mg daily
B) Sucralfate 1 g QID
C) Ranitidine 150 mg BID
, D) Metoclopramide 10 mg before meals
Answer: A
Rationales:
● A: Omeprazole, a proton pump inhibitor, provides the most potent and sustained
suppression of gastric acid secretion, offering superior protection against
NSAID-induced gastric and duodenal ulcers.
● B: Sucralfate forms a protective barrier over existing ulcers but does not
effectively prevent NSAID-induced mucosal injury and is not first-line prophylaxis.
● C: Ranitidine, an H2-receptor antagonist, reduces acid secretion but is less
effective than PPIs for NSAID gastroprotection, especially with chronic NSAID
use.
● D: Metoclopramide is a prokinetic agent used for gastroparesis and nausea; it
has no cytoprotective or acid-suppressing properties relevant to NSAID ulcer
prevention.
Q5
A patient receiving morphine via patient-controlled analgesia (PCA) pump reports
severe itching without rash. The nurse recognizes this adverse effect is most likely
caused by which mechanism?
A) Histamine release from mast cell degranulation
B) Direct stimulation of mu-opioid receptors on cutaneous nerve endings
C) Activation of kappa-opioid receptors in the spinal cord
D) Blockade of peripheral H1 histamine receptors
Answer: A
Rationales:
Question Bank (Latest 2026/2027 Edition) – 100% Correct
Questions, Answers & Detailed Rationales
Q1
A 72-year-old patient with chronic heart failure is prescribed digoxin 0.25 mg daily. The
nurse reviews the patient's current medications and notes they are also taking
furosemide 40 mg daily. Which laboratory value should the nurse monitor most closely
to prevent a life-threatening drug interaction?
A) Serum creatinine
B) Serum potassium
C) Serum albumin
D) Serum bilirubin
Answer: B
Rationales:
● A: Serum creatinine is important for renal function assessment but does not
directly reflect the primary risk of digoxin toxicity when combined with a loop
diuretic.
● B: Furosemide causes potassium loss through the kidneys, and hypokalemia
increases myocardial sensitivity to digoxin, dramatically raising the risk of fatal
dysrhythmias.
● C: Serum albumin affects drug protein binding but is not the critical parameter for
preventing this specific life-threatening interaction.
● D: Serum bilirubin relates to hepatic function and biliary excretion, neither of
which is central to the digoxin-furosemide interaction mechanism.
,Q2
A nurse is administering warfarin 5 mg PO to a patient with atrial fibrillation. The patient
asks why they must avoid eating large amounts of leafy green vegetables. Which
response by the nurse best explains the pharmacological rationale?
A) "Vitamin K in vegetables competes with warfarin at hepatic receptor sites, reducing
anticoagulant efficacy."
B) "Leafy greens increase gastrointestinal motility, decreasing warfarin absorption from
the gut."
C) "Vitamin K is a cofactor for clotting factor synthesis, directly antagonizing warfarin's
mechanism of action."
D) "Fiber in vegetables binds warfarin in the intestinal lumen, forming an insoluble
complex."
Answer: C
Rationales:
● A: Vitamin K does not compete at hepatic receptor sites; rather, it serves as a
necessary cofactor for the synthesis of functional clotting factors that warfarin
inhibits.
● B: Gastrointestinal motility changes do not significantly alter warfarin
bioavailability, and this explanation misrepresents the true drug-nutrient
interaction.
● C: Vitamin K is an essential cofactor for the gamma-carboxylation of clotting
factors II, VII, IX, and X, and increased dietary intake can overcome warfarin's
vitamin K antagonism, reducing therapeutic anticoagulation.
● D: Dietary fiber does not bind warfarin to form insoluble complexes; this
distractor confuses the mechanism with that of certain bile acid sequestrants or
mineral supplements.
Q3
,A patient with type 2 diabetes mellitus is prescribed metformin 1000 mg BID. The nurse
is reviewing the patient's medical history and identifies which condition as an absolute
contraindication to metformin therapy?
A) Mild chronic kidney disease with eGFR 55 mL/min/1.73m²
B) History of congestive heart failure controlled with lisinopril
C) Severe hepatic impairment with elevated liver enzymes
D) History of mild peripheral neuropathy
Answer: C
Rationales:
● A: An eGFR of 55 mL/min/1.73m² represents mild CKD (Stage 2), which is not an
absolute contraindication; metformin is contraindicated when eGFR falls below
30 mL/min/1.73m².
● B: Controlled congestive heart failure is not an absolute contraindication, though
acute decompensated heart failure with hypoperfusion and hypoxia increases
lactic acidosis risk.
● C: Severe hepatic impairment is an absolute contraindication because the liver is
responsible for lactate clearance, and impaired hepatic function combined with
metformin significantly increases the risk of fatal lactic acidosis.
● D: Peripheral neuropathy is a common complication of diabetes itself and has no
pharmacological interaction or contraindication with metformin therapy.
Q4
A 45-year-old patient with a history of peptic ulcer disease is prescribed ibuprofen 600
mg TID for osteoarthritis. The nurse should recommend which adjunctive medication to
reduce the risk of gastrointestinal complications?
A) Omeprazole 20 mg daily
B) Sucralfate 1 g QID
C) Ranitidine 150 mg BID
, D) Metoclopramide 10 mg before meals
Answer: A
Rationales:
● A: Omeprazole, a proton pump inhibitor, provides the most potent and sustained
suppression of gastric acid secretion, offering superior protection against
NSAID-induced gastric and duodenal ulcers.
● B: Sucralfate forms a protective barrier over existing ulcers but does not
effectively prevent NSAID-induced mucosal injury and is not first-line prophylaxis.
● C: Ranitidine, an H2-receptor antagonist, reduces acid secretion but is less
effective than PPIs for NSAID gastroprotection, especially with chronic NSAID
use.
● D: Metoclopramide is a prokinetic agent used for gastroparesis and nausea; it
has no cytoprotective or acid-suppressing properties relevant to NSAID ulcer
prevention.
Q5
A patient receiving morphine via patient-controlled analgesia (PCA) pump reports
severe itching without rash. The nurse recognizes this adverse effect is most likely
caused by which mechanism?
A) Histamine release from mast cell degranulation
B) Direct stimulation of mu-opioid receptors on cutaneous nerve endings
C) Activation of kappa-opioid receptors in the spinal cord
D) Blockade of peripheral H1 histamine receptors
Answer: A
Rationales:
