NUR 2474 EXAM 300 ACTUAL QUESTIONS AND
CORRECT ANSWERS WITH RATIONALE
ALREADY GRADED A+
This NUR 2474 Pharmacology Final Exam simulator provides a
comprehensive assessment of nursing pharmacology across all major drug
classifications. Content covers pharmacokinetics, pharmacodynamics,
medication safety, adverse effects, drug interactions, and patient teaching
priorities. Major drug categories include cardiovascular agents
(antihypertensives, diuretics, anticoagulants, antiarrhythmics), endocrine
medications (insulins, oral hypoglycemics, thyroid drugs), psychiatric
medications (antidepressants, antipsychotics, anxiolytics), antimicrobials,
anticonvulsants, and immunosuppressants. The exam emphasizes clinical
application, requiring identification of correct administration techniques, side
effect monitoring, laboratory parameters, and antidotes. Questions integrate
priority nursing actions, black box warnings, and evidence-based medication
management across diverse patient populations.
Question 1
A client is prescribed lisinopril for hypertension. Which adverse effect should the
nurse teach the client to report immediately?
A. Dry cough
B. Dizziness
C. Angioedema
D. Headache
Answer: C
Rationale: Angioedema is a life-threatening reaction to ACE inhibitors like
lisinopril, causing swelling of the face, lips, tongue, and airway. A dry cough is a
common side effect but not immediately life-threatening. Dizziness and headache
are also common but not emergent.
Question 2
A client on warfarin has an international normalized ratio of 4.5. The nurse should
anticipate which intervention?
A. Administer vitamin K
,B. Increase the warfarin dose
C. Continue the current dose
D. Administer protamine sulfate
Answer: A
Rationale: The therapeutic INR for warfarin is typically 2.0 to 3.0. An INR of 4.5
is elevated and increases bleeding risk. Vitamin K is the antidote. Protamine
sulfate is used for heparin. Increasing the dose would worsen the elevation.
Question 3
A client is prescribed metformin for type 2 diabetes. Which instruction should the
nurse include in the teaching plan?
A. Take the medication on an empty stomach
B. Monitor for lactic acidosis with symptoms of muscle pain and fatigue
C. Expect immediate weight gain
D. Take with grapefruit juice to enhance absorption
Answer: B
Rationale: Metformin can cause lactic acidosis, a rare but serious side effect.
Symptoms include muscle pain, fatigue, and dyspnea. It should be taken with
meals to reduce GI upset. Grapefruit juice is not indicated, and weight loss, not
gain, is more common.
Question 4
A client prescribed furosemide for heart failure should be monitored for which
electrolyte imbalance?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting in the distal
tubule. Hypokalemia is a common adverse effect. Hyperkalemia is seen with
potassium-sparing diuretics.
Question 5
A client is prescribed sertraline for major depressive disorder. The nurse should
teach the client to report which symptom that may indicate serotonin syndrome?
A. Dry mouth
B. Agitation, confusion, and diaphoresis
C. Weight gain
D. Sexual dysfunction
,Answer: B
Rationale: Serotonin syndrome is a life-threatening condition caused by excessive
serotonergic activity. Symptoms include agitation, confusion, diaphoresis, tremors,
and hyperthermia. Dry mouth, weight gain, and sexual dysfunction are common
SSRI side effects but are not signs of serotonin syndrome.
Question 6
A client on digoxin has a serum digoxin level of 2.5 ng/mL. The nurse should
assess for which sign of toxicity?
A. Tachycardia
B. Visual disturbances and nausea
C. Hypertension
D. Hyperkalemia
Answer: B
Rationale: The therapeutic range for digoxin is 0.8–2.0 ng/mL. Toxicity presents
with nausea, vomiting, visual disturbances (yellow-green halos), and bradycardia.
Digoxin toxicity can also cause hyperkalemia, but visual changes and nausea are
classic signs.
Question 7
A client is prescribed albuterol for asthma. Which side effect is most common with
this medication?
A. Bradycardia
B. Tachycardia and tremors
C. Hypotension
D. Sedation
Answer: B
Rationale: Albuterol is a beta-2 agonist, but it also has some beta-1 effects, causing
tachycardia and tremors. Bradycardia, hypotension, and sedation are not typical.
Question 8
A client on heparin therapy has a partial thromboplastin time of 120 seconds. The
nurse should prepare to administer which medication?
A. Vitamin K
B. Protamine sulfate
C. Naloxone
D. Flumazenil
Answer: B
, Rationale: Protamine sulfate is the antidote for heparin. The therapeutic PTT is
typically 1.5 to 2.5 times the normal. A PTT of 120 seconds is elevated and
indicates increased bleeding risk. Vitamin K is the antidote for warfarin.
Question 9
A client is prescribed levothyroxine for hypothyroidism. Which instruction is most
important for the nurse to include?
A. Take the medication with food to reduce nausea
B. Take the medication on an empty stomach in the morning
C. Take the medication at bedtime for better sleep
D. Take the medication with calcium supplements
Answer: B
Rationale: Levothyroxine should be taken on an empty stomach, typically 30–60
minutes before breakfast, to maximize absorption. Calcium and iron supplements
should be taken at least 4 hours apart. Food decreases absorption.
Question 10
A client prescribed morphine sulfate is experiencing respiratory depression. Which
medication should the nurse anticipate administering?
A. Naloxone
B. Flumazenil
C. Activated charcoal
D. Atropine
Answer: A
Rationale: Naloxone is a competitive antagonist at opioid receptors and is the
antidote for opioid-induced respiratory depression. Flumazenil is for
benzodiazepine overdose. Atropine is for bradycardia and muscarinic toxicity.
Question 11
A client is prescribed ciprofloxacin. Which instruction is most important regarding
this medication?
A. Take with dairy products to protect the stomach
B. Avoid taking with antacids containing calcium or magnesium
C. Expect a metallic taste in the mouth
D. Take the medication at bedtime
Answer: B
Rationale: Fluoroquinolones like ciprofloxacin bind with divalent cations (calcium,
magnesium, iron, zinc), reducing absorption. They should be taken 2 hours before
or 6 hours after these products. Dairy products are not recommended.
CORRECT ANSWERS WITH RATIONALE
ALREADY GRADED A+
This NUR 2474 Pharmacology Final Exam simulator provides a
comprehensive assessment of nursing pharmacology across all major drug
classifications. Content covers pharmacokinetics, pharmacodynamics,
medication safety, adverse effects, drug interactions, and patient teaching
priorities. Major drug categories include cardiovascular agents
(antihypertensives, diuretics, anticoagulants, antiarrhythmics), endocrine
medications (insulins, oral hypoglycemics, thyroid drugs), psychiatric
medications (antidepressants, antipsychotics, anxiolytics), antimicrobials,
anticonvulsants, and immunosuppressants. The exam emphasizes clinical
application, requiring identification of correct administration techniques, side
effect monitoring, laboratory parameters, and antidotes. Questions integrate
priority nursing actions, black box warnings, and evidence-based medication
management across diverse patient populations.
Question 1
A client is prescribed lisinopril for hypertension. Which adverse effect should the
nurse teach the client to report immediately?
A. Dry cough
B. Dizziness
C. Angioedema
D. Headache
Answer: C
Rationale: Angioedema is a life-threatening reaction to ACE inhibitors like
lisinopril, causing swelling of the face, lips, tongue, and airway. A dry cough is a
common side effect but not immediately life-threatening. Dizziness and headache
are also common but not emergent.
Question 2
A client on warfarin has an international normalized ratio of 4.5. The nurse should
anticipate which intervention?
A. Administer vitamin K
,B. Increase the warfarin dose
C. Continue the current dose
D. Administer protamine sulfate
Answer: A
Rationale: The therapeutic INR for warfarin is typically 2.0 to 3.0. An INR of 4.5
is elevated and increases bleeding risk. Vitamin K is the antidote. Protamine
sulfate is used for heparin. Increasing the dose would worsen the elevation.
Question 3
A client is prescribed metformin for type 2 diabetes. Which instruction should the
nurse include in the teaching plan?
A. Take the medication on an empty stomach
B. Monitor for lactic acidosis with symptoms of muscle pain and fatigue
C. Expect immediate weight gain
D. Take with grapefruit juice to enhance absorption
Answer: B
Rationale: Metformin can cause lactic acidosis, a rare but serious side effect.
Symptoms include muscle pain, fatigue, and dyspnea. It should be taken with
meals to reduce GI upset. Grapefruit juice is not indicated, and weight loss, not
gain, is more common.
Question 4
A client prescribed furosemide for heart failure should be monitored for which
electrolyte imbalance?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting in the distal
tubule. Hypokalemia is a common adverse effect. Hyperkalemia is seen with
potassium-sparing diuretics.
Question 5
A client is prescribed sertraline for major depressive disorder. The nurse should
teach the client to report which symptom that may indicate serotonin syndrome?
A. Dry mouth
B. Agitation, confusion, and diaphoresis
C. Weight gain
D. Sexual dysfunction
,Answer: B
Rationale: Serotonin syndrome is a life-threatening condition caused by excessive
serotonergic activity. Symptoms include agitation, confusion, diaphoresis, tremors,
and hyperthermia. Dry mouth, weight gain, and sexual dysfunction are common
SSRI side effects but are not signs of serotonin syndrome.
Question 6
A client on digoxin has a serum digoxin level of 2.5 ng/mL. The nurse should
assess for which sign of toxicity?
A. Tachycardia
B. Visual disturbances and nausea
C. Hypertension
D. Hyperkalemia
Answer: B
Rationale: The therapeutic range for digoxin is 0.8–2.0 ng/mL. Toxicity presents
with nausea, vomiting, visual disturbances (yellow-green halos), and bradycardia.
Digoxin toxicity can also cause hyperkalemia, but visual changes and nausea are
classic signs.
Question 7
A client is prescribed albuterol for asthma. Which side effect is most common with
this medication?
A. Bradycardia
B. Tachycardia and tremors
C. Hypotension
D. Sedation
Answer: B
Rationale: Albuterol is a beta-2 agonist, but it also has some beta-1 effects, causing
tachycardia and tremors. Bradycardia, hypotension, and sedation are not typical.
Question 8
A client on heparin therapy has a partial thromboplastin time of 120 seconds. The
nurse should prepare to administer which medication?
A. Vitamin K
B. Protamine sulfate
C. Naloxone
D. Flumazenil
Answer: B
, Rationale: Protamine sulfate is the antidote for heparin. The therapeutic PTT is
typically 1.5 to 2.5 times the normal. A PTT of 120 seconds is elevated and
indicates increased bleeding risk. Vitamin K is the antidote for warfarin.
Question 9
A client is prescribed levothyroxine for hypothyroidism. Which instruction is most
important for the nurse to include?
A. Take the medication with food to reduce nausea
B. Take the medication on an empty stomach in the morning
C. Take the medication at bedtime for better sleep
D. Take the medication with calcium supplements
Answer: B
Rationale: Levothyroxine should be taken on an empty stomach, typically 30–60
minutes before breakfast, to maximize absorption. Calcium and iron supplements
should be taken at least 4 hours apart. Food decreases absorption.
Question 10
A client prescribed morphine sulfate is experiencing respiratory depression. Which
medication should the nurse anticipate administering?
A. Naloxone
B. Flumazenil
C. Activated charcoal
D. Atropine
Answer: A
Rationale: Naloxone is a competitive antagonist at opioid receptors and is the
antidote for opioid-induced respiratory depression. Flumazenil is for
benzodiazepine overdose. Atropine is for bradycardia and muscarinic toxicity.
Question 11
A client is prescribed ciprofloxacin. Which instruction is most important regarding
this medication?
A. Take with dairy products to protect the stomach
B. Avoid taking with antacids containing calcium or magnesium
C. Expect a metallic taste in the mouth
D. Take the medication at bedtime
Answer: B
Rationale: Fluoroquinolones like ciprofloxacin bind with divalent cations (calcium,
magnesium, iron, zinc), reducing absorption. They should be taken 2 hours before
or 6 hours after these products. Dairy products are not recommended.
