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NUR 2474 Exam 2: Pharmacology – Comprehensive
Study Guide Covering Pharmacokinetics,
Pharmacodynamics, Medication Classifications, Safe
Medication Administration, Dosage Calculations,
Adverse Drug Reactions, Drug Interactions, Patient
Education, Nursing Considerations, Clinical Decision-
Making, and Exam Preparation Strategies
SUMMARIZED EXAM COVERAGE
This examination encompasses the foundational principles of pharmacokinetics (drug absorption,
distribution, metabolism, and excretion) and pharmacodynamics (drug-receptor interactions and
dose-response relationships), alongside comprehensive medication classifications including
antihypertensives, anticoagulants, antiplatelets, antidepressants, antipsychotics, anxiolytics,
antiparkinsonian agents, antiepileptics, local and general anesthetics, antispasmodics, opioid
analgesics, cardiac glycosides, diuretics, and various other therapeutic categories. The exam
emphasizes safe medication administration protocols, precise dosage calculations, identification
and management of adverse drug reactions, clinically significant drug-drug and drug-food
interactions, comprehensive patient education strategies, nursing considerations across the
lifespan, and clinical decision-making processes essential for safe pharmacological management.
Additional focus areas include hypertension pathophysiology and treatment protocols,
hypertensive emergencies, electrolyte monitoring and management, laboratory value
interpretation, antidote administration, and therapeutic drug level monitoring with appropriate
nursing interventions for both therapeutic and toxic ranges.
ALL THE BEST CHAMP!!
,2
1. A patient with chronic kidney disease and a glomerular filtration rate of 35 mL/min is
prescribed a diuretic for hypertension management, which medication classification would
be most appropriate for this clinical scenario?
a. Thiazide diuretics
b. Potassium-sparing diuretics
c. Loop diuretics
d. Osmotic diuretics
Correct Answer: c. Loop diuretics
RATIONALE: Loop diuretics such as furosemide are the preferred agents when GFR falls
below 50 mL/min because thiazide diuretics lose their effectiveness at reduced GFR levels due to
their site of action in the distal convoluted tubule, which becomes less accessible when renal
perfusion is compromised. Loop diuretics act on the thick ascending limb of the loop of Henle
and maintain their efficacy even with significant renal impairment, making them the appropriate
choice for patients with low GFR who require diuresis for blood pressure control or fluid
management.
2. A patient with atrial fibrillation is receiving digoxin therapy and presents with nausea,
vomiting, visual disturbances, and a heart rate of 45 beats per minute, what laboratory
value should the nurse prioritize for immediate assessment?
a. Serum potassium level
b. Serum creatinine level
c. Serum digoxin level
d. Serum magnesium level
Correct Answer: c. Serum digoxin level
RATIONALE: The patient is exhibiting classic signs of digoxin toxicity including
gastrointestinal symptoms, visual disturbances, and bradycardia, which necessitates immediate
assessment of the serum digoxin level to confirm toxicity, as normal therapeutic range is 0.5-0.8
ng/mL and levels exceeding 2.0 ng/mL typically produce toxic manifestations requiring prompt
intervention to prevent life-threatening cardiac dysrhythmias.
ALL THE BEST CHAMP!!
,3
3. Which medication requires the nurse to assess the patient's international normalized
ratio before administration to ensure therapeutic efficacy and prevent bleeding
complications?
a. Heparin
b. Enoxaparin
c. Warfarin
d. Aspirin
Correct Answer: c. Warfarin
RATIONALE: Warfarin therapy requires regular monitoring of the international normalized
ratio to maintain therapeutic levels between 2.0 and 3.0 for most indications, as this laboratory
value reflects the drug's effect on vitamin K-dependent clotting factors and allows for
appropriate dose adjustments to prevent thromboembolic events while minimizing hemorrhagic
complications.
4. A patient with heart failure prescribed lisinopril develops a persistent dry cough, what
pathophysiological mechanism explains this adverse effect?
a. Accumulation of bradykinin in the pulmonary tissues
b. Direct stimulation of the cough reflex center in the medulla
c. Increased production of angiotensin II in the bronchial tree
d. Inhibition of prostaglandin synthesis in the respiratory tract
Correct Answer: a. Accumulation of bradykinin in the pulmonary tissues
RATIONALE: ACE inhibitors like lisinopril cause cough through accumulation of bradykinin
and substance P in the respiratory tract because ACE is responsible for degrading these peptides,
and when inhibited, these substances accumulate and stimulate cough receptors, producing a dry,
persistent cough that resolves upon discontinuation of the medication and does not respond to
antitussive therapy.
5. When administering intravenous magnesium sulfate to a patient with torsades de
pointes, what assessment finding indicates therapeutic effectiveness of this intervention?
a. Resolution of the atypical ventricular tachydysrhythmia
b. Increase in serum magnesium level to 4.0 mEq/L
ALL THE BEST CHAMP!!
, 4
c. Decrease in blood pressure to normal range
d. Improvement in respiratory effort and oxygen saturation
Correct Answer: a. Resolution of the atypical ventricular tachydysrhythmia
RATIONALE: Magnesium sulfate is administered as first-line therapy for torsades de pointes
because magnesium ions block calcium channels and stabilize cardiac cell membranes, and
therapeutic effectiveness is demonstrated by resolution of the characteristic polymorphic
ventricular tachycardia, which prevents progression to ventricular fibrillation and sudden cardiac
death.
6. A patient with hypertension is prescribed spironolactone, which concurrent condition
would warrant cautious administration and close monitoring of this medication?
a. Hypokalemia
b. Hyperkalemia
c. Hyponatremia
d. Hypocalcemia
Correct Answer: b. Hyperkalemia
RATIONALE: Spironolactone is a potassium-sparing diuretic that acts as an aldosterone
antagonist, preventing sodium and water retention while conserving potassium, so patients with
existing hyperkalemia or conditions predisposing to elevated potassium levels should avoid this
medication due to the risk of life-threatening cardiac arrhythmias from excessive serum
potassium concentrations.
7. The nurse is educating a patient prescribed nitroglycerin sublingual tablets for angina,
what instruction should be prioritized to ensure safe and effective use of this medication?
a. Swallow the tablet with a full glass of water for faster absorption
b. Stop all physical activity and sit down before taking the tablet
c. Take the tablet prophylactically before any physical exertion
d. Chew the tablet thoroughly to enhance sublingual absorption
Correct Answer: b. Stop all physical activity and sit down before taking the tablet
RATIONALE: Patients must stop activity and sit down before taking sublingual nitroglycerin to
decrease myocardial oxygen demand and prevent orthostatic hypotension, as the medication
ALL THE BEST CHAMP!!
NUR 2474 Exam 2: Pharmacology – Comprehensive
Study Guide Covering Pharmacokinetics,
Pharmacodynamics, Medication Classifications, Safe
Medication Administration, Dosage Calculations,
Adverse Drug Reactions, Drug Interactions, Patient
Education, Nursing Considerations, Clinical Decision-
Making, and Exam Preparation Strategies
SUMMARIZED EXAM COVERAGE
This examination encompasses the foundational principles of pharmacokinetics (drug absorption,
distribution, metabolism, and excretion) and pharmacodynamics (drug-receptor interactions and
dose-response relationships), alongside comprehensive medication classifications including
antihypertensives, anticoagulants, antiplatelets, antidepressants, antipsychotics, anxiolytics,
antiparkinsonian agents, antiepileptics, local and general anesthetics, antispasmodics, opioid
analgesics, cardiac glycosides, diuretics, and various other therapeutic categories. The exam
emphasizes safe medication administration protocols, precise dosage calculations, identification
and management of adverse drug reactions, clinically significant drug-drug and drug-food
interactions, comprehensive patient education strategies, nursing considerations across the
lifespan, and clinical decision-making processes essential for safe pharmacological management.
Additional focus areas include hypertension pathophysiology and treatment protocols,
hypertensive emergencies, electrolyte monitoring and management, laboratory value
interpretation, antidote administration, and therapeutic drug level monitoring with appropriate
nursing interventions for both therapeutic and toxic ranges.
ALL THE BEST CHAMP!!
,2
1. A patient with chronic kidney disease and a glomerular filtration rate of 35 mL/min is
prescribed a diuretic for hypertension management, which medication classification would
be most appropriate for this clinical scenario?
a. Thiazide diuretics
b. Potassium-sparing diuretics
c. Loop diuretics
d. Osmotic diuretics
Correct Answer: c. Loop diuretics
RATIONALE: Loop diuretics such as furosemide are the preferred agents when GFR falls
below 50 mL/min because thiazide diuretics lose their effectiveness at reduced GFR levels due to
their site of action in the distal convoluted tubule, which becomes less accessible when renal
perfusion is compromised. Loop diuretics act on the thick ascending limb of the loop of Henle
and maintain their efficacy even with significant renal impairment, making them the appropriate
choice for patients with low GFR who require diuresis for blood pressure control or fluid
management.
2. A patient with atrial fibrillation is receiving digoxin therapy and presents with nausea,
vomiting, visual disturbances, and a heart rate of 45 beats per minute, what laboratory
value should the nurse prioritize for immediate assessment?
a. Serum potassium level
b. Serum creatinine level
c. Serum digoxin level
d. Serum magnesium level
Correct Answer: c. Serum digoxin level
RATIONALE: The patient is exhibiting classic signs of digoxin toxicity including
gastrointestinal symptoms, visual disturbances, and bradycardia, which necessitates immediate
assessment of the serum digoxin level to confirm toxicity, as normal therapeutic range is 0.5-0.8
ng/mL and levels exceeding 2.0 ng/mL typically produce toxic manifestations requiring prompt
intervention to prevent life-threatening cardiac dysrhythmias.
ALL THE BEST CHAMP!!
,3
3. Which medication requires the nurse to assess the patient's international normalized
ratio before administration to ensure therapeutic efficacy and prevent bleeding
complications?
a. Heparin
b. Enoxaparin
c. Warfarin
d. Aspirin
Correct Answer: c. Warfarin
RATIONALE: Warfarin therapy requires regular monitoring of the international normalized
ratio to maintain therapeutic levels between 2.0 and 3.0 for most indications, as this laboratory
value reflects the drug's effect on vitamin K-dependent clotting factors and allows for
appropriate dose adjustments to prevent thromboembolic events while minimizing hemorrhagic
complications.
4. A patient with heart failure prescribed lisinopril develops a persistent dry cough, what
pathophysiological mechanism explains this adverse effect?
a. Accumulation of bradykinin in the pulmonary tissues
b. Direct stimulation of the cough reflex center in the medulla
c. Increased production of angiotensin II in the bronchial tree
d. Inhibition of prostaglandin synthesis in the respiratory tract
Correct Answer: a. Accumulation of bradykinin in the pulmonary tissues
RATIONALE: ACE inhibitors like lisinopril cause cough through accumulation of bradykinin
and substance P in the respiratory tract because ACE is responsible for degrading these peptides,
and when inhibited, these substances accumulate and stimulate cough receptors, producing a dry,
persistent cough that resolves upon discontinuation of the medication and does not respond to
antitussive therapy.
5. When administering intravenous magnesium sulfate to a patient with torsades de
pointes, what assessment finding indicates therapeutic effectiveness of this intervention?
a. Resolution of the atypical ventricular tachydysrhythmia
b. Increase in serum magnesium level to 4.0 mEq/L
ALL THE BEST CHAMP!!
, 4
c. Decrease in blood pressure to normal range
d. Improvement in respiratory effort and oxygen saturation
Correct Answer: a. Resolution of the atypical ventricular tachydysrhythmia
RATIONALE: Magnesium sulfate is administered as first-line therapy for torsades de pointes
because magnesium ions block calcium channels and stabilize cardiac cell membranes, and
therapeutic effectiveness is demonstrated by resolution of the characteristic polymorphic
ventricular tachycardia, which prevents progression to ventricular fibrillation and sudden cardiac
death.
6. A patient with hypertension is prescribed spironolactone, which concurrent condition
would warrant cautious administration and close monitoring of this medication?
a. Hypokalemia
b. Hyperkalemia
c. Hyponatremia
d. Hypocalcemia
Correct Answer: b. Hyperkalemia
RATIONALE: Spironolactone is a potassium-sparing diuretic that acts as an aldosterone
antagonist, preventing sodium and water retention while conserving potassium, so patients with
existing hyperkalemia or conditions predisposing to elevated potassium levels should avoid this
medication due to the risk of life-threatening cardiac arrhythmias from excessive serum
potassium concentrations.
7. The nurse is educating a patient prescribed nitroglycerin sublingual tablets for angina,
what instruction should be prioritized to ensure safe and effective use of this medication?
a. Swallow the tablet with a full glass of water for faster absorption
b. Stop all physical activity and sit down before taking the tablet
c. Take the tablet prophylactically before any physical exertion
d. Chew the tablet thoroughly to enhance sublingual absorption
Correct Answer: b. Stop all physical activity and sit down before taking the tablet
RATIONALE: Patients must stop activity and sit down before taking sublingual nitroglycerin to
decrease myocardial oxygen demand and prevent orthostatic hypotension, as the medication
ALL THE BEST CHAMP!!
