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NUR 2474 PHARMACOLOGY EXAM 2 MEDICATION MANAGEMENT AND CLINICAL APPLICATION RESOURCE BUNDLE CONFIRMED PROMPTS
NUR
NUR2474
2474PHARMACOLOGY
PHARMACOLOGYEXAM
EXAM22MEDICATION
MEDICATIONMANAGEMENT AND
ANDCLINICAL
CLINICALAPPLICATION
DETAILED EXPLANATIONS
MANAGEMENT APPLICATIONPLUS EXAMPREP CORRECT ANSWERS
NUR 2474 PHARMACOLOGY
EXPERT
GRADEDGUIDE
A+ EXAM 2 STUDY GUIDE COMPLETE ANSWERS
Comprehensive Medication Management & Clinical Application Competency Assessment
Pharmacology for Professional Nursing | Undergraduate Nursing Programs
2026/2027 Edition | 75 Multiple-Choice Questions | 105 Minutes | Passing Score: 75–
80% (56–60/75)
Aligned with Lehne's Pharmacology for Nursing Care (11th ed.); Lilley's Pharmacology and the Nursing
Process (9th ed.); AACN Essentials; ISMP Guidelines
Instructions: Select the single best answer for each question unless marked [SELECT ALL THAT
APPLY]. Questions assess pharmacologic principles, safe medication administration, dosage calculations,
adverse effect recognition, patient education, and clinical judgment. Basic calculator permitted for dosage
calculations. All answers should reflect evidence-based nursing pharmacology practice aligned with AACN
Essentials and ISMP safety standards.
SECTION 1: CARDIOVASCULAR PHARMACOTHERAPY
Antihypertensives | Antianginals | Heart Failure Medications | Antiarrhythmics
1. A patient is prescribed lisinopril (an ACE inhibitor). Which adverse effect should the
nurse teach the patient to report immediately?
A. Persistent dry cough
B. Angioedema (swelling of face, lips, tongue)
C. Mild headache
D. Fatigue
Correct Answer: B
Rationale: Angioedema is a rare but life-threatening adverse effect of ACE inhibitors caused by
accumulation of bradykinin (which ACE normally degrades). It can cause airway obstruction and
requires emergency treatment. While persistent dry cough (Option A) is a common and bothersome side
effect of ACE inhibitors (also bradykinin-mediated, occurring in up to 20% of patients), it is not
immediately life-threatening. Headache and fatigue are relatively benign. The nurse must teach
patients to seek emergency care for any facial, lip, or tongue swelling. If angioedema occurs, the ACE
inhibitor must be permanently discontinued and an ARB may be considered as an alternative, though
cross-reactivity is possible.
2. Which laboratory value is most important for the nurse to monitor for a patient taking
lisinopril long-term?
A. Serum potassium
B. Serum glucose
C. Serum calcium
D. Serum sodium
Correct Answer: A
Rationale: ACE inhibitors reduce aldosterone secretion by blocking the renin-angiotensin-aldosterone
system (RAAS). Aldosterone normally promotes sodium reabsorption and potassium excretion in the
kidneys; when aldosterone is suppressed, potassium retention can occur, leading to hyperkalemia. This
risk is heightened in patients with renal impairment, those taking potassium-sparing diuretics, or
potassium supplements. Serum potassium should be monitored within 1–2 weeks of starting therapy
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and periodically thereafter. While ACE inhibitors may slightly affect glucose metabolism (improving
insulin sensitivity), and sodium may be mildly affected, potassium monitoring is the priority for patient
safety.
3. A patient with heart failure is prescribed carvedilol, a beta blocker. The nurse
understands that which of the following is the primary rationale for using beta blockers in
heart failure?
A. To increase heart rate and cardiac output
B. To block the harmful effects of chronic sympathetic nervous system activation and promote
cardiac remodeling
C. To cause vasodilation through alpha-1 blockade only
D. To replace the need for diuretics in heart failure management
Correct Answer: B
Rationale: In heart failure, chronic sympathetic activation initially compensates for reduced cardiac
output but eventually damages the myocardium through remodeling, fibrosis, and apoptosis. Beta
blockers interrupt this maladaptive cycle by blocking beta-1 receptors, reducing heart rate, myocardial
oxygen demand, and catecholamine toxicity. Over time, this promotes reverse remodeling
(improvement in LV structure and function). Carvedilol also blocks alpha-1 receptors (causing
vasodilation), but this is secondary to the beta-blockade benefit. Beta blockers decrease heart rate (not
increase), do not replace diuretics, and are initiated at very low doses with slow upward titration in
heart failure patients.
4. A patient taking digoxin has a serum potassium level of 3.0 mEq/L. The nurse should be
most concerned about which potential complication?
A. Digoxin toxicity leading to dysrhythmias
B. Increased therapeutic effect of digoxin
C. Hypernatremia
D. Therapeutic digoxin levels becoming subtherapeutic
Correct Answer: A
Rationale: Hypokalemia significantly increases the risk of digoxin toxicity. Digoxin and potassium
compete for binding sites on the Na+/K+-ATPase pump; when potassium is low, more digoxin binds to
the pump, enhancing its effects and increasing the risk of toxicity (including life-threatening
dysrhythmias such as PVCs, atrial tachycardia with block, and ventricular fibrillation). Patients on
digoxin and diuretics (which cause potassium loss) are especially vulnerable. The nurse should monitor
potassium closely, maintain levels at 4.0–5.0 mEq/L in digoxin patients, and report hypokalemia
promptly. Options B and D are opposite of the correct concern. Hypernatremia is not directly related to
digoxin-potassium interaction.
5. Which of the following is a key difference between ACE inhibitors and ARBs in terms of
adverse effect profiles?
A. ARBs cause more angioedema than ACE inhibitors
B. ARBs do not cause the persistent dry cough commonly associated with ACE inhibitors because
they do not increase bradykinin levels
C. ACE inhibitors cause more hyperkalemia than ARBs
D. ARBs are contraindicated in pregnancy but ACE inhibitors are not
Correct Answer: B
Rationale: ARBs block angiotensin II receptors directly without affecting the kininase II enzyme (which
degrades bradykinin), so bradykinin levels do not accumulate. This is why ARBs do not cause the
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persistent dry cough seen in up to 20% of ACE inhibitor patients. Both drug classes can cause
angioedema (though ARBs less frequently), both cause hyperkalemia through aldosterone suppression
(comparable rates), and both are absolutely contraindicated in pregnancy (Options A, C, and D are
incorrect). ARBs are typically prescribed when patients cannot tolerate the cough from ACE inhibitors,
but both are first-line for hypertension with compelling indications like diabetes or heart failure.
6. A patient taking a thiazide diuretic reports muscle weakness and cramping. Which
electrolyte imbalance should the nurse suspect first?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Correct Answer: B
Rationale: Thiazide diuretics (e.g., hydrochlorothiazide, chlorthalidone) promote sodium and potassium
excretion in the distal convoluted tubule. Hypokalemia is the most common and clinically significant
electrolyte disturbance, causing muscle weakness, cramping, fatigue, and dysrhythmias. Thiazides
actually cause hypercalcemia (not hypocalcemia) by reducing calcium excretion, which is sometimes
therapeutically useful. Hyponatremia (not hypernatremia) can also occur. The nurse should monitor
electrolytes, especially potassium, and may need to supplement or add a potassium-sparing diuretic.
Patient education should include consuming potassium-rich foods (bananas, oranges, potatoes) and
reporting weakness or cramping promptly.
7. The nurse is administering nitroglycerin sublingual tablets for acute angina. Which
patient instruction is correct?
A. Swallow the tablet whole with water
B. Place the tablet under the tongue and let it dissolve; sit or lie down before taking
C. Chew the tablet for faster absorption
D. Take the tablet with food to reduce stomach upset
Correct Answer: B
Rationale: Sublingual nitroglycerin is placed under the tongue where it is absorbed directly through the
oral mucosa into the bloodstream, bypassing first-pass hepatic metabolism and providing rapid onset
(1–3 minutes). The patient should sit or lie down before taking it because nitroglycerin causes
vasodilation, which can lead to orthostatic hypotension and syncope. Swallowing the tablet (Option A)
subjects it to extensive first-pass metabolism, rendering it largely ineffective. Chewing (Option C) is not
the intended route. Taking with food (Option D) is irrelevant for sublingual administration. Patients
should be instructed to take one tablet every 5 minutes for up to 3 doses; if pain persists after 3 tablets,
call 911.
8. According to the Vaughan Williams classification, amiodarone belongs to which
class(es) of antiarrhythmic medications?
A. Class I only
B. Class II only
C. Class III only
D. Classes I, II, III, and IV (multiclass properties)
Correct Answer: D
Rationale: Amiodarone is unique among antiarrhythmics because it exhibits properties of all four
Vaughan Williams classes: Class I (sodium channel blockade—mild), Class II (beta-adrenergic
blockade), Class III (potassium channel blockade—primary mechanism, prolonging action potential
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NUR 2474 PHARMACOLOGY EXAM 2 MEDICATION MANAGEMENT AND CLINICAL APPLICATION RESOURCE BUNDLE CONFIRMED PROMPTS
NUR
NUR2474
2474PHARMACOLOGY
PHARMACOLOGYEXAM
EXAM22MEDICATION
MEDICATIONMANAGEMENT AND
ANDCLINICAL
CLINICALAPPLICATION
DETAILED EXPLANATIONS
MANAGEMENT APPLICATIONPLUS EXAMPREP CORRECT ANSWERS
NUR 2474 PHARMACOLOGY
EXPERT
GRADEDGUIDE
A+ EXAM 2 STUDY GUIDE COMPLETE ANSWERS
Comprehensive Medication Management & Clinical Application Competency Assessment
Pharmacology for Professional Nursing | Undergraduate Nursing Programs
2026/2027 Edition | 75 Multiple-Choice Questions | 105 Minutes | Passing Score: 75–
80% (56–60/75)
Aligned with Lehne's Pharmacology for Nursing Care (11th ed.); Lilley's Pharmacology and the Nursing
Process (9th ed.); AACN Essentials; ISMP Guidelines
Instructions: Select the single best answer for each question unless marked [SELECT ALL THAT
APPLY]. Questions assess pharmacologic principles, safe medication administration, dosage calculations,
adverse effect recognition, patient education, and clinical judgment. Basic calculator permitted for dosage
calculations. All answers should reflect evidence-based nursing pharmacology practice aligned with AACN
Essentials and ISMP safety standards.
SECTION 1: CARDIOVASCULAR PHARMACOTHERAPY
Antihypertensives | Antianginals | Heart Failure Medications | Antiarrhythmics
1. A patient is prescribed lisinopril (an ACE inhibitor). Which adverse effect should the
nurse teach the patient to report immediately?
A. Persistent dry cough
B. Angioedema (swelling of face, lips, tongue)
C. Mild headache
D. Fatigue
Correct Answer: B
Rationale: Angioedema is a rare but life-threatening adverse effect of ACE inhibitors caused by
accumulation of bradykinin (which ACE normally degrades). It can cause airway obstruction and
requires emergency treatment. While persistent dry cough (Option A) is a common and bothersome side
effect of ACE inhibitors (also bradykinin-mediated, occurring in up to 20% of patients), it is not
immediately life-threatening. Headache and fatigue are relatively benign. The nurse must teach
patients to seek emergency care for any facial, lip, or tongue swelling. If angioedema occurs, the ACE
inhibitor must be permanently discontinued and an ARB may be considered as an alternative, though
cross-reactivity is possible.
2. Which laboratory value is most important for the nurse to monitor for a patient taking
lisinopril long-term?
A. Serum potassium
B. Serum glucose
C. Serum calcium
D. Serum sodium
Correct Answer: A
Rationale: ACE inhibitors reduce aldosterone secretion by blocking the renin-angiotensin-aldosterone
system (RAAS). Aldosterone normally promotes sodium reabsorption and potassium excretion in the
kidneys; when aldosterone is suppressed, potassium retention can occur, leading to hyperkalemia. This
risk is heightened in patients with renal impairment, those taking potassium-sparing diuretics, or
potassium supplements. Serum potassium should be monitored within 1–2 weeks of starting therapy
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and periodically thereafter. While ACE inhibitors may slightly affect glucose metabolism (improving
insulin sensitivity), and sodium may be mildly affected, potassium monitoring is the priority for patient
safety.
3. A patient with heart failure is prescribed carvedilol, a beta blocker. The nurse
understands that which of the following is the primary rationale for using beta blockers in
heart failure?
A. To increase heart rate and cardiac output
B. To block the harmful effects of chronic sympathetic nervous system activation and promote
cardiac remodeling
C. To cause vasodilation through alpha-1 blockade only
D. To replace the need for diuretics in heart failure management
Correct Answer: B
Rationale: In heart failure, chronic sympathetic activation initially compensates for reduced cardiac
output but eventually damages the myocardium through remodeling, fibrosis, and apoptosis. Beta
blockers interrupt this maladaptive cycle by blocking beta-1 receptors, reducing heart rate, myocardial
oxygen demand, and catecholamine toxicity. Over time, this promotes reverse remodeling
(improvement in LV structure and function). Carvedilol also blocks alpha-1 receptors (causing
vasodilation), but this is secondary to the beta-blockade benefit. Beta blockers decrease heart rate (not
increase), do not replace diuretics, and are initiated at very low doses with slow upward titration in
heart failure patients.
4. A patient taking digoxin has a serum potassium level of 3.0 mEq/L. The nurse should be
most concerned about which potential complication?
A. Digoxin toxicity leading to dysrhythmias
B. Increased therapeutic effect of digoxin
C. Hypernatremia
D. Therapeutic digoxin levels becoming subtherapeutic
Correct Answer: A
Rationale: Hypokalemia significantly increases the risk of digoxin toxicity. Digoxin and potassium
compete for binding sites on the Na+/K+-ATPase pump; when potassium is low, more digoxin binds to
the pump, enhancing its effects and increasing the risk of toxicity (including life-threatening
dysrhythmias such as PVCs, atrial tachycardia with block, and ventricular fibrillation). Patients on
digoxin and diuretics (which cause potassium loss) are especially vulnerable. The nurse should monitor
potassium closely, maintain levels at 4.0–5.0 mEq/L in digoxin patients, and report hypokalemia
promptly. Options B and D are opposite of the correct concern. Hypernatremia is not directly related to
digoxin-potassium interaction.
5. Which of the following is a key difference between ACE inhibitors and ARBs in terms of
adverse effect profiles?
A. ARBs cause more angioedema than ACE inhibitors
B. ARBs do not cause the persistent dry cough commonly associated with ACE inhibitors because
they do not increase bradykinin levels
C. ACE inhibitors cause more hyperkalemia than ARBs
D. ARBs are contraindicated in pregnancy but ACE inhibitors are not
Correct Answer: B
Rationale: ARBs block angiotensin II receptors directly without affecting the kininase II enzyme (which
degrades bradykinin), so bradykinin levels do not accumulate. This is why ARBs do not cause the
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persistent dry cough seen in up to 20% of ACE inhibitor patients. Both drug classes can cause
angioedema (though ARBs less frequently), both cause hyperkalemia through aldosterone suppression
(comparable rates), and both are absolutely contraindicated in pregnancy (Options A, C, and D are
incorrect). ARBs are typically prescribed when patients cannot tolerate the cough from ACE inhibitors,
but both are first-line for hypertension with compelling indications like diabetes or heart failure.
6. A patient taking a thiazide diuretic reports muscle weakness and cramping. Which
electrolyte imbalance should the nurse suspect first?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Correct Answer: B
Rationale: Thiazide diuretics (e.g., hydrochlorothiazide, chlorthalidone) promote sodium and potassium
excretion in the distal convoluted tubule. Hypokalemia is the most common and clinically significant
electrolyte disturbance, causing muscle weakness, cramping, fatigue, and dysrhythmias. Thiazides
actually cause hypercalcemia (not hypocalcemia) by reducing calcium excretion, which is sometimes
therapeutically useful. Hyponatremia (not hypernatremia) can also occur. The nurse should monitor
electrolytes, especially potassium, and may need to supplement or add a potassium-sparing diuretic.
Patient education should include consuming potassium-rich foods (bananas, oranges, potatoes) and
reporting weakness or cramping promptly.
7. The nurse is administering nitroglycerin sublingual tablets for acute angina. Which
patient instruction is correct?
A. Swallow the tablet whole with water
B. Place the tablet under the tongue and let it dissolve; sit or lie down before taking
C. Chew the tablet for faster absorption
D. Take the tablet with food to reduce stomach upset
Correct Answer: B
Rationale: Sublingual nitroglycerin is placed under the tongue where it is absorbed directly through the
oral mucosa into the bloodstream, bypassing first-pass hepatic metabolism and providing rapid onset
(1–3 minutes). The patient should sit or lie down before taking it because nitroglycerin causes
vasodilation, which can lead to orthostatic hypotension and syncope. Swallowing the tablet (Option A)
subjects it to extensive first-pass metabolism, rendering it largely ineffective. Chewing (Option C) is not
the intended route. Taking with food (Option D) is irrelevant for sublingual administration. Patients
should be instructed to take one tablet every 5 minutes for up to 3 doses; if pain persists after 3 tablets,
call 911.
8. According to the Vaughan Williams classification, amiodarone belongs to which
class(es) of antiarrhythmic medications?
A. Class I only
B. Class II only
C. Class III only
D. Classes I, II, III, and IV (multiclass properties)
Correct Answer: D
Rationale: Amiodarone is unique among antiarrhythmics because it exhibits properties of all four
Vaughan Williams classes: Class I (sodium channel blockade—mild), Class II (beta-adrenergic
blockade), Class III (potassium channel blockade—primary mechanism, prolonging action potential
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