NUR612/NUR612 Exam 2 V1 | Advance
Pharmacology Q&A with Rationale |
William Paterson University
1. A patient is prescribed Lisinopril for the management of hypertension. Which of the
following adverse effects is specifically linked to the accumulation of bradykinin in the lungs?
A. Hyperglycemia
B. Tachycardia
C. Hypokalemia
D. Dry, hacking cough
Answer: D
Rationale: ACE inhibitors like Lisinopril prevent the breakdown of bradykinin, which can
lead to its accumulation in the respiratory tract. This accumulation frequently triggers a
persistent, dry, non-productive cough in approximately 10-20% of patients. If the cough
becomes intolerable, the provider may need to switch the patient to an Angiotensin II
Receptor Blocker (ARB).
2. A patient taking Warfarin (Coumadin) has an International Normalized Ratio (INR) of 5.5
but shows no signs of active bleeding. What is the most appropriate initial pharmacological
action?
A. Administer Protamine Sulfate immediately.
,B. Administer a dose of Heparin to bridge therapy.
C. Increase the dose of Warfarin to stabilize levels.
D. Hold the dose and consider administering Vitamin K.
Answer: D
Rationale: An INR of 5.5 is above the therapeutic range for most conditions, which usually
targets an INR of 2.0 to 3.0. According to clinical guidelines, for INRs between 4.5 and 10
without bleeding, the dose should be withheld and oral Vitamin K may be considered. Close
monitoring for signs of bleeding is essential during this period to ensure patient safety.
3. Why are non-selective beta-blockers, such as Propranolol, generally contraindicated in
patients with a history of bronchial asthma?
A. They cause excessive mucus production in the bronchi.
B. They stimulate Alpha-1 receptors leading to vasoconstriction.
C. They cause a rapid decrease in blood pressure leading to syncope.
D. They block Beta-2 receptors in the lungs, leading to bronchoconstriction.
Answer: D
Rationale: Non-selective beta-blockers inhibit both Beta-1 receptors in the heart and Beta-
2 receptors in the smooth muscles of the bronchi. Blocking Beta-2 receptors can lead to
narrowing of the airways, which is dangerous for patients with pre-existing respiratory
,conditions like asthma or COPD. Selective Beta-1 blockers are usually preferred if a beta-
blocker is strictly necessary for these patients.
4. A patient is starting Atorvastatin (Lipitor) therapy. Which laboratory test should be
monitored periodically to detect potential muscle damage?
A. Serum Creatinine
B. Hemoglobin A1c
C. Blood Urea Nitrogen (BUN)
D. Creatine Kinase (CK)
Answer: D
Rationale: Statins are associated with a rare but serious side effect known as
rhabdomyolysis, which involves the breakdown of muscle tissue. Creatine Kinase (CK)
levels should be checked if the patient reports unexplained muscle pain, tenderness, or
weakness. Monitoring these levels helps clinicians determine if the statin therapy should be
discontinued to prevent renal failure.
5. A diabetic patient is scheduled for a CT scan with intravenous iodinated contrast. Why
must Metformin be held for 48 hours after the procedure?
A. Contrast-induced renal failure can lead to toxic accumulation of Metformin and lactic
acidosis.
B. The dye increases the risk of Metformin-induced hypoglycemia.
C. Metformin reacts with the dye to cause severe allergic reactions.
, D. Metformin neutralizes the contrast dye, making the imaging results unreadable.
Answer: A
Rationale: Metformin is primarily excreted by the kidneys and can cause lactic acidosis if
levels build up. Iodinated contrast media can cause temporary renal impairment, which
would prevent Metformin from being cleared from the body. Holding the medication until
renal function is confirmed to be normal helps mitigate the risk of this life-threatening
metabolic state.
6. A patient with heart failure is prescribed Spironolactone. The nurse should monitor for
which electrolyte imbalance?
A. Hypokalemia
B. Hyponatremia
C. Hyperkalemia
D. Hypocalcemia
Answer: C
Rationale: Spironolactone is a potassium-sparing diuretic that acts as an aldosterone
antagonist in the distal tubule. Because it inhibits the excretion of potassium while
promoting the excretion of sodium and water, the risk of hyperkalemia is significant.
Patients should be advised to avoid salt substitutes that contain potassium to prevent
dangerous cardiac arrhythmias.
Pharmacology Q&A with Rationale |
William Paterson University
1. A patient is prescribed Lisinopril for the management of hypertension. Which of the
following adverse effects is specifically linked to the accumulation of bradykinin in the lungs?
A. Hyperglycemia
B. Tachycardia
C. Hypokalemia
D. Dry, hacking cough
Answer: D
Rationale: ACE inhibitors like Lisinopril prevent the breakdown of bradykinin, which can
lead to its accumulation in the respiratory tract. This accumulation frequently triggers a
persistent, dry, non-productive cough in approximately 10-20% of patients. If the cough
becomes intolerable, the provider may need to switch the patient to an Angiotensin II
Receptor Blocker (ARB).
2. A patient taking Warfarin (Coumadin) has an International Normalized Ratio (INR) of 5.5
but shows no signs of active bleeding. What is the most appropriate initial pharmacological
action?
A. Administer Protamine Sulfate immediately.
,B. Administer a dose of Heparin to bridge therapy.
C. Increase the dose of Warfarin to stabilize levels.
D. Hold the dose and consider administering Vitamin K.
Answer: D
Rationale: An INR of 5.5 is above the therapeutic range for most conditions, which usually
targets an INR of 2.0 to 3.0. According to clinical guidelines, for INRs between 4.5 and 10
without bleeding, the dose should be withheld and oral Vitamin K may be considered. Close
monitoring for signs of bleeding is essential during this period to ensure patient safety.
3. Why are non-selective beta-blockers, such as Propranolol, generally contraindicated in
patients with a history of bronchial asthma?
A. They cause excessive mucus production in the bronchi.
B. They stimulate Alpha-1 receptors leading to vasoconstriction.
C. They cause a rapid decrease in blood pressure leading to syncope.
D. They block Beta-2 receptors in the lungs, leading to bronchoconstriction.
Answer: D
Rationale: Non-selective beta-blockers inhibit both Beta-1 receptors in the heart and Beta-
2 receptors in the smooth muscles of the bronchi. Blocking Beta-2 receptors can lead to
narrowing of the airways, which is dangerous for patients with pre-existing respiratory
,conditions like asthma or COPD. Selective Beta-1 blockers are usually preferred if a beta-
blocker is strictly necessary for these patients.
4. A patient is starting Atorvastatin (Lipitor) therapy. Which laboratory test should be
monitored periodically to detect potential muscle damage?
A. Serum Creatinine
B. Hemoglobin A1c
C. Blood Urea Nitrogen (BUN)
D. Creatine Kinase (CK)
Answer: D
Rationale: Statins are associated with a rare but serious side effect known as
rhabdomyolysis, which involves the breakdown of muscle tissue. Creatine Kinase (CK)
levels should be checked if the patient reports unexplained muscle pain, tenderness, or
weakness. Monitoring these levels helps clinicians determine if the statin therapy should be
discontinued to prevent renal failure.
5. A diabetic patient is scheduled for a CT scan with intravenous iodinated contrast. Why
must Metformin be held for 48 hours after the procedure?
A. Contrast-induced renal failure can lead to toxic accumulation of Metformin and lactic
acidosis.
B. The dye increases the risk of Metformin-induced hypoglycemia.
C. Metformin reacts with the dye to cause severe allergic reactions.
, D. Metformin neutralizes the contrast dye, making the imaging results unreadable.
Answer: A
Rationale: Metformin is primarily excreted by the kidneys and can cause lactic acidosis if
levels build up. Iodinated contrast media can cause temporary renal impairment, which
would prevent Metformin from being cleared from the body. Holding the medication until
renal function is confirmed to be normal helps mitigate the risk of this life-threatening
metabolic state.
6. A patient with heart failure is prescribed Spironolactone. The nurse should monitor for
which electrolyte imbalance?
A. Hypokalemia
B. Hyponatremia
C. Hyperkalemia
D. Hypocalcemia
Answer: C
Rationale: Spironolactone is a potassium-sparing diuretic that acts as an aldosterone
antagonist in the distal tubule. Because it inhibits the excretion of potassium while
promoting the excretion of sodium and water, the risk of hyperkalemia is significant.
Patients should be advised to avoid salt substitutes that contain potassium to prevent
dangerous cardiac arrhythmias.
