Pharmacology Comprehensive Exam 1
Questions, Answers & Rationales for
2026[Chamberlain]
Question 1
A patient with a new diagnosis of hypertension is prescribed hydrochlorothiazide. The nurse
understands that this medication's primary mechanism of action is to:
A. Block beta-1 adrenergic receptors in the heart.
B. Inhibit the angiotensin-converting enzyme.
C. Act directly on arterial smooth muscle to cause vasodilation.
D. Inhibit the sodium-chloride symporter in the distal convoluted tubule.
Answer: D
Rationale:
A. Incorrect. Beta-blockers, such as metoprolol, block beta-1 receptors.
B. Incorrect. ACE inhibitors, such as lisinopril, inhibit the angiotensin-converting enzyme.
C. Incorrect. Direct vasodilators, like hydralazine, act on arterial smooth muscle.
D. Correct. Hydrochlorothiazide is a thiazide diuretic that inhibits the sodium-chloride cotransporter in
the distal convoluted tubule, leading to increased excretion of sodium, chloride, and water.
Question 2
A patient is receiving furosemide (Lasix) for pulmonary edema. Which of the following laboratory values
should the nurse monitor most closely?
A. Serum sodium and calcium.
B. Serum potassium and magnesium.
C. Serum chloride and bicarbonate.
D. Serum creatinine and BUN.
Answer: B
Rationale:
A. Incorrect. While sodium can be affected, potassium and magnesium are the most critical electrolytes
to monitor due to the risk of hypokalemia and hypomagnesemia.
B. Correct. Furosemide is a loop diuretic that blocks the Na-K-2Cl symporter, leading to significant losses
,of potassium and magnesium, which can precipitate cardiac arrhythmias.
C. Incorrect. These are not the primary electrolytes of concern with furosemide.
D. Incorrect. Renal function should be monitored, but it is not the most specific electrolyte risk
associated with the drug's mechanism.
Question 3
A patient prescribed spironolactone (Aldactone) should be educated to avoid which of the following
foods?
A. Bananas and potatoes.
B. Grapefruit juice.
C. Leafy green vegetables.
D. Milk and cheese.
Answer: A
Rationale:
A. Correct. Spironolactone is a potassium-sparing diuretic. Consuming potassium-rich foods like bananas
and potatoes can lead to hyperkalemia.
B. Incorrect. Grapefruit juice affects CYP3A4, primarily impacting drugs like statins and calcium channel
blockers.
C. Incorrect. Leafy green vegetables are high in vitamin K, which is a concern for patients on warfarin.
D. Incorrect. These are high in calcium and can affect patients on certain antibiotics or those with
hypercalcemia, but not spironolactone.
Question 4
A patient on a beta-blocker for angina reports fatigue and a feeling of "cold hands." What is the nurse's
best response?
A. "These are expected side effects and you will need to get used to them."
B. "This is a sign of an allergic reaction and you should stop the medication immediately."
C. "These symptoms are common but we can discuss them with your provider to see if a change is
needed."
D. "This indicates the medication is not working, and your dose will likely need to be increased."
Answer: C
Rationale:
A. Incorrect. Although these are common side effects, dismissing them is not appropriate. The nurse
should acknowledge and plan to address them.
B. Incorrect. Fatigue and cold extremities are not signs of an allergic reaction (which would be rash,
angioedema, or respiratory distress).
C. Correct. Beta-blockers reduce cardiac output and peripheral circulation, which can cause fatigue and
cold extremities. These are common but should be reported and discussed with the provider.
D. Incorrect. These side effects indicate the drug is having its intended effect on the cardiovascular
system, not that the drug is ineffective.
Question 5
Which of the following is a contraindication for the use of a non-selective beta-blocker like propranolol?
A. Hypertension.
B. Migraine prophylaxis.
,C. Asthma.
D. Angina pectoris.
Answer: C
Rationale:
A. Incorrect. Hypertension is an indication for beta-blockers.
B. Incorrect. Propranolol is used for migraine prophylaxis.
C. Correct. Non-selective beta-blockers block beta-2 receptors in the lungs, which can cause
bronchoconstriction, making them contraindicated in patients with asthma.
D. Incorrect. Angina is an indication for beta-blockers.
Question 6
A patient is prescribed amlodipine (Norvasc). Which side effect is most commonly associated with this
medication?
A. Cough.
B. Hyperkalemia.
C. Peripheral edema.
D. Bradycardia.
Answer: C
Rationale:
A. Incorrect. Cough is a classic side effect of ACE inhibitors.
B. Incorrect. Hyperkalemia is associated with ACE inhibitors and potassium-sparing diuretics.
C. Correct. Amlodipine is a dihydropyridine calcium channel blocker that causes peripheral vasodilation,
leading to a common side effect of peripheral edema.
D. Incorrect. Bradycardia is a side effect of non-dihydropyridine calcium channel blockers like verapamil
and diltiazem.
Question 7
A patient is to be started on lisinopril. The nurse should assess the patient for a history of which
condition that would contraindicate its use?
A. Diabetes mellitus.
B. Heart failure.
C. Angioedema related to an ACE inhibitor.
D. Chronic kidney disease.
Answer: C
Rationale:
A. Incorrect. Diabetes is not a contraindication; in fact, ACE inhibitors are often preferred for their renal
protective effects.
B. Incorrect. Heart failure is a primary indication for ACE inhibitors.
C. Correct. A history of angioedema is a severe, life-threatening contraindication to taking an ACE
inhibitor.
D. Incorrect. While renal function must be monitored, chronic kidney disease is not an absolute
contraindication.
, Question 8
The nurse is teaching a patient about their new prescription for sublingual nitroglycerin. Which
statement by the patient indicates a need for further teaching?
A. "I should take one tablet every 5 minutes for up to 3 doses if the pain doesn't stop."
B. "I should keep the bottle tightly closed to keep it from losing its potency."
C. "I should let it dissolve under my tongue and not swallow it."
D. "I can take it with a sip of water to help it dissolve faster."
Answer: D
Rationale:
A. Incorrect. This is the correct protocol (one tablet q5min x 3 doses).
B. Incorrect. Nitroglycerin is volatile and must be kept in its original, tightly closed container.
C. Incorrect. Sublingual administration requires the tablet to be dissolved under the tongue for rapid
absorption.
D. Correct. The tablet should be dissolved under the tongue. Taking it with water or swallowing it will
delay absorption and render it ineffective.
Question 9
A patient on warfarin (Coumadin) has an INR of 5.5. What is the priority nursing action?
A. Administer vitamin K as ordered.
B. Administer protamine sulfate as ordered.
C. Hold the next dose and decrease the dose.
D. Instruct the patient to avoid green leafy vegetables.
Answer: A
Rationale:
A. Correct. An INR of 5.5 is significantly elevated and indicates a high risk of bleeding. The antidote for
warfarin is vitamin K.
B. Incorrect. Protamine sulfate is the antidote for heparin.
C. Incorrect. While the next dose should be held, the priority is to reverse the anticoagulation if the INR
is this high.
D. Incorrect. This is a teaching point for the future, not a priority intervention for an acute elevation.
Question 10
Heparin is administered to a patient with a pulmonary embolism. The nurse understands that the
therapeutic effect of unfractionated heparin is monitored by which laboratory test?
A. International Normalized Ratio (INR).
B. Prothrombin Time (PT).
C. Activated Partial Thromboplastin Time (aPTT).
D. Platelet count.
Answer: C
Rationale:
A. Incorrect. INR is used to monitor warfarin.
B. Incorrect. PT is used to monitor warfarin.
C. Correct. aPTT is the standard lab test used to monitor the therapeutic effect of unfractionated
heparin.
Questions, Answers & Rationales for
2026[Chamberlain]
Question 1
A patient with a new diagnosis of hypertension is prescribed hydrochlorothiazide. The nurse
understands that this medication's primary mechanism of action is to:
A. Block beta-1 adrenergic receptors in the heart.
B. Inhibit the angiotensin-converting enzyme.
C. Act directly on arterial smooth muscle to cause vasodilation.
D. Inhibit the sodium-chloride symporter in the distal convoluted tubule.
Answer: D
Rationale:
A. Incorrect. Beta-blockers, such as metoprolol, block beta-1 receptors.
B. Incorrect. ACE inhibitors, such as lisinopril, inhibit the angiotensin-converting enzyme.
C. Incorrect. Direct vasodilators, like hydralazine, act on arterial smooth muscle.
D. Correct. Hydrochlorothiazide is a thiazide diuretic that inhibits the sodium-chloride cotransporter in
the distal convoluted tubule, leading to increased excretion of sodium, chloride, and water.
Question 2
A patient is receiving furosemide (Lasix) for pulmonary edema. Which of the following laboratory values
should the nurse monitor most closely?
A. Serum sodium and calcium.
B. Serum potassium and magnesium.
C. Serum chloride and bicarbonate.
D. Serum creatinine and BUN.
Answer: B
Rationale:
A. Incorrect. While sodium can be affected, potassium and magnesium are the most critical electrolytes
to monitor due to the risk of hypokalemia and hypomagnesemia.
B. Correct. Furosemide is a loop diuretic that blocks the Na-K-2Cl symporter, leading to significant losses
,of potassium and magnesium, which can precipitate cardiac arrhythmias.
C. Incorrect. These are not the primary electrolytes of concern with furosemide.
D. Incorrect. Renal function should be monitored, but it is not the most specific electrolyte risk
associated with the drug's mechanism.
Question 3
A patient prescribed spironolactone (Aldactone) should be educated to avoid which of the following
foods?
A. Bananas and potatoes.
B. Grapefruit juice.
C. Leafy green vegetables.
D. Milk and cheese.
Answer: A
Rationale:
A. Correct. Spironolactone is a potassium-sparing diuretic. Consuming potassium-rich foods like bananas
and potatoes can lead to hyperkalemia.
B. Incorrect. Grapefruit juice affects CYP3A4, primarily impacting drugs like statins and calcium channel
blockers.
C. Incorrect. Leafy green vegetables are high in vitamin K, which is a concern for patients on warfarin.
D. Incorrect. These are high in calcium and can affect patients on certain antibiotics or those with
hypercalcemia, but not spironolactone.
Question 4
A patient on a beta-blocker for angina reports fatigue and a feeling of "cold hands." What is the nurse's
best response?
A. "These are expected side effects and you will need to get used to them."
B. "This is a sign of an allergic reaction and you should stop the medication immediately."
C. "These symptoms are common but we can discuss them with your provider to see if a change is
needed."
D. "This indicates the medication is not working, and your dose will likely need to be increased."
Answer: C
Rationale:
A. Incorrect. Although these are common side effects, dismissing them is not appropriate. The nurse
should acknowledge and plan to address them.
B. Incorrect. Fatigue and cold extremities are not signs of an allergic reaction (which would be rash,
angioedema, or respiratory distress).
C. Correct. Beta-blockers reduce cardiac output and peripheral circulation, which can cause fatigue and
cold extremities. These are common but should be reported and discussed with the provider.
D. Incorrect. These side effects indicate the drug is having its intended effect on the cardiovascular
system, not that the drug is ineffective.
Question 5
Which of the following is a contraindication for the use of a non-selective beta-blocker like propranolol?
A. Hypertension.
B. Migraine prophylaxis.
,C. Asthma.
D. Angina pectoris.
Answer: C
Rationale:
A. Incorrect. Hypertension is an indication for beta-blockers.
B. Incorrect. Propranolol is used for migraine prophylaxis.
C. Correct. Non-selective beta-blockers block beta-2 receptors in the lungs, which can cause
bronchoconstriction, making them contraindicated in patients with asthma.
D. Incorrect. Angina is an indication for beta-blockers.
Question 6
A patient is prescribed amlodipine (Norvasc). Which side effect is most commonly associated with this
medication?
A. Cough.
B. Hyperkalemia.
C. Peripheral edema.
D. Bradycardia.
Answer: C
Rationale:
A. Incorrect. Cough is a classic side effect of ACE inhibitors.
B. Incorrect. Hyperkalemia is associated with ACE inhibitors and potassium-sparing diuretics.
C. Correct. Amlodipine is a dihydropyridine calcium channel blocker that causes peripheral vasodilation,
leading to a common side effect of peripheral edema.
D. Incorrect. Bradycardia is a side effect of non-dihydropyridine calcium channel blockers like verapamil
and diltiazem.
Question 7
A patient is to be started on lisinopril. The nurse should assess the patient for a history of which
condition that would contraindicate its use?
A. Diabetes mellitus.
B. Heart failure.
C. Angioedema related to an ACE inhibitor.
D. Chronic kidney disease.
Answer: C
Rationale:
A. Incorrect. Diabetes is not a contraindication; in fact, ACE inhibitors are often preferred for their renal
protective effects.
B. Incorrect. Heart failure is a primary indication for ACE inhibitors.
C. Correct. A history of angioedema is a severe, life-threatening contraindication to taking an ACE
inhibitor.
D. Incorrect. While renal function must be monitored, chronic kidney disease is not an absolute
contraindication.
, Question 8
The nurse is teaching a patient about their new prescription for sublingual nitroglycerin. Which
statement by the patient indicates a need for further teaching?
A. "I should take one tablet every 5 minutes for up to 3 doses if the pain doesn't stop."
B. "I should keep the bottle tightly closed to keep it from losing its potency."
C. "I should let it dissolve under my tongue and not swallow it."
D. "I can take it with a sip of water to help it dissolve faster."
Answer: D
Rationale:
A. Incorrect. This is the correct protocol (one tablet q5min x 3 doses).
B. Incorrect. Nitroglycerin is volatile and must be kept in its original, tightly closed container.
C. Incorrect. Sublingual administration requires the tablet to be dissolved under the tongue for rapid
absorption.
D. Correct. The tablet should be dissolved under the tongue. Taking it with water or swallowing it will
delay absorption and render it ineffective.
Question 9
A patient on warfarin (Coumadin) has an INR of 5.5. What is the priority nursing action?
A. Administer vitamin K as ordered.
B. Administer protamine sulfate as ordered.
C. Hold the next dose and decrease the dose.
D. Instruct the patient to avoid green leafy vegetables.
Answer: A
Rationale:
A. Correct. An INR of 5.5 is significantly elevated and indicates a high risk of bleeding. The antidote for
warfarin is vitamin K.
B. Incorrect. Protamine sulfate is the antidote for heparin.
C. Incorrect. While the next dose should be held, the priority is to reverse the anticoagulation if the INR
is this high.
D. Incorrect. This is a teaching point for the future, not a priority intervention for an acute elevation.
Question 10
Heparin is administered to a patient with a pulmonary embolism. The nurse understands that the
therapeutic effect of unfractionated heparin is monitored by which laboratory test?
A. International Normalized Ratio (INR).
B. Prothrombin Time (PT).
C. Activated Partial Thromboplastin Time (aPTT).
D. Platelet count.
Answer: C
Rationale:
A. Incorrect. INR is used to monitor warfarin.
B. Incorrect. PT is used to monitor warfarin.
C. Correct. aPTT is the standard lab test used to monitor the therapeutic effect of unfractionated
heparin.
