Nightingale College BSN 315 Final Exam (pdf) | 2026/2027 |
Advanced Pharm Q&A | Pharmacology
1. A client on an ACE inhibitor presents with facial swelling, stridor, and
hypotension. What is the priority nursing intervention?
A) Administer an antihistamine
B) Discontinue the drug and secure the airway
C) Administer a beta-blocker
D) Observe and monitor the client
Correct Answer: Discontinue the drug and secure the airway
Rationale: Facial swelling and stridor are signs of angioedema, a life-
threatening allergic reaction to ACE inhibitors. Angioedema can rapidly
progress to airway obstruction, requiring immediate drug discontinuation and
airway protection. Antihistamines are not sufficient for this emergency.
2. A client on loop diuretics has a serum potassium of 2.1 mEq/L and ECG
shows U waves. What is the correct interpretation?
A) Hyperkalemia
B) Severe hypokalemia with arrhythmia risk
C) Normal variant
D) Hypernatremia
Correct Answer: Severe hypokalemia with arrhythmia risk
Rationale: A potassium of 2.1 mEq/L represents severe hypokalemia, which
can cause life-threatening ventricular dysrhythmias. Loop diuretics cause
potassium wasting, and U waves on ECG are a classic sign of hypokalemia
requiring immediate intervention.
,3. Digoxin toxicity is most likely triggered by which electrolyte imbalance?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypermagnesemia
Correct Answer: Hypokalemia
Rationale: Low potassium increases digoxin binding to cardiac Na⁺/K⁺
ATPase, significantly increasing the risk of digoxin toxicity. Clients taking
digoxin should be monitored for hypokalemia, especially those also taking
loop diuretics.
4. A client on warfarin has an INR of 8.0 but no active bleeding. What is the
best action?
A) Increase the warfarin dose
B) Hold warfarin and give vitamin K
C) Continue therapy as ordered
D) Give heparin
Correct Answer: Hold warfarin and give vitamin K
Rationale: An INR of 8.0 is severely elevated and requires reversal even
without active bleeding. Vitamin K is the antidote for warfarin, and holding
the dose prevents further anticoagulation.
5. Heparin-induced thrombocytopenia (HIT) is caused by:
A) Platelet suppression
B) Immune-mediated platelet activation and destruction
,C) Vitamin K deficiency
D) Bone marrow failure
Correct Answer: Immune-mediated platelet activation and destruction
Rationale: HIT is an immune-mediated complication where antibodies
activate platelets, causing thrombosis and low platelet counts. It is a serious
adverse effect of heparin therapy requiring immediate recognition and
alternative anticoagulation.
6. Morphine overdose typically presents with which classic toxidrome?
A) Tachycardia and fever
B) Respiratory depression, pinpoint pupils, and coma
C) Rash and diarrhea
D) Hypertension only
Correct Answer: Respiratory depression, pinpoint pupils, and coma
Rationale: The classic opioid toxidrome includes respiratory depression,
pinpoint pupils, and central nervous system depression. Morphine is an
opioid agonist that depresses the respiratory center in the brainstem.
7. Naloxone is the reversal agent for which type of medication?
A) Benzodiazepines
B) Opioids
C) Warfarin
D) Insulin
, Correct Answer: Opioids
Rationale: Naloxone is a specific opioid receptor antagonist that rapidly
reverses the effects of opioid overdose, including respiratory depression.
Flumazenil reverses benzodiazepines, and vitamin K reverses warfarin.
8. Flumazenil is indicated for overdose of which medication class?
A) Opioids
B) Benzodiazepines
C) Heparin
D) Beta-blockers
Correct Answer: Benzodiazepines
Rationale: Flumazenil is a specific benzodiazepine antagonist used to reverse
the effects of benzodiazepine overdose. It should be used cautiously due to
the risk of seizures in chronic benzodiazepine users.
9. Digoxin toxicity may manifest as which visual disturbance?
A) Yellow-green halos
B) Blurred vision
C) Double vision
D) Night blindness
Correct Answer: Yellow-green halos
Rationale: Yellow-green halos around lights are a classic visual disturbance
associated with digoxin toxicity. Other signs include gastrointestinal
symptoms such as anorexia, nausea, and vomiting.
Advanced Pharm Q&A | Pharmacology
1. A client on an ACE inhibitor presents with facial swelling, stridor, and
hypotension. What is the priority nursing intervention?
A) Administer an antihistamine
B) Discontinue the drug and secure the airway
C) Administer a beta-blocker
D) Observe and monitor the client
Correct Answer: Discontinue the drug and secure the airway
Rationale: Facial swelling and stridor are signs of angioedema, a life-
threatening allergic reaction to ACE inhibitors. Angioedema can rapidly
progress to airway obstruction, requiring immediate drug discontinuation and
airway protection. Antihistamines are not sufficient for this emergency.
2. A client on loop diuretics has a serum potassium of 2.1 mEq/L and ECG
shows U waves. What is the correct interpretation?
A) Hyperkalemia
B) Severe hypokalemia with arrhythmia risk
C) Normal variant
D) Hypernatremia
Correct Answer: Severe hypokalemia with arrhythmia risk
Rationale: A potassium of 2.1 mEq/L represents severe hypokalemia, which
can cause life-threatening ventricular dysrhythmias. Loop diuretics cause
potassium wasting, and U waves on ECG are a classic sign of hypokalemia
requiring immediate intervention.
,3. Digoxin toxicity is most likely triggered by which electrolyte imbalance?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypermagnesemia
Correct Answer: Hypokalemia
Rationale: Low potassium increases digoxin binding to cardiac Na⁺/K⁺
ATPase, significantly increasing the risk of digoxin toxicity. Clients taking
digoxin should be monitored for hypokalemia, especially those also taking
loop diuretics.
4. A client on warfarin has an INR of 8.0 but no active bleeding. What is the
best action?
A) Increase the warfarin dose
B) Hold warfarin and give vitamin K
C) Continue therapy as ordered
D) Give heparin
Correct Answer: Hold warfarin and give vitamin K
Rationale: An INR of 8.0 is severely elevated and requires reversal even
without active bleeding. Vitamin K is the antidote for warfarin, and holding
the dose prevents further anticoagulation.
5. Heparin-induced thrombocytopenia (HIT) is caused by:
A) Platelet suppression
B) Immune-mediated platelet activation and destruction
,C) Vitamin K deficiency
D) Bone marrow failure
Correct Answer: Immune-mediated platelet activation and destruction
Rationale: HIT is an immune-mediated complication where antibodies
activate platelets, causing thrombosis and low platelet counts. It is a serious
adverse effect of heparin therapy requiring immediate recognition and
alternative anticoagulation.
6. Morphine overdose typically presents with which classic toxidrome?
A) Tachycardia and fever
B) Respiratory depression, pinpoint pupils, and coma
C) Rash and diarrhea
D) Hypertension only
Correct Answer: Respiratory depression, pinpoint pupils, and coma
Rationale: The classic opioid toxidrome includes respiratory depression,
pinpoint pupils, and central nervous system depression. Morphine is an
opioid agonist that depresses the respiratory center in the brainstem.
7. Naloxone is the reversal agent for which type of medication?
A) Benzodiazepines
B) Opioids
C) Warfarin
D) Insulin
, Correct Answer: Opioids
Rationale: Naloxone is a specific opioid receptor antagonist that rapidly
reverses the effects of opioid overdose, including respiratory depression.
Flumazenil reverses benzodiazepines, and vitamin K reverses warfarin.
8. Flumazenil is indicated for overdose of which medication class?
A) Opioids
B) Benzodiazepines
C) Heparin
D) Beta-blockers
Correct Answer: Benzodiazepines
Rationale: Flumazenil is a specific benzodiazepine antagonist used to reverse
the effects of benzodiazepine overdose. It should be used cautiously due to
the risk of seizures in chronic benzodiazepine users.
9. Digoxin toxicity may manifest as which visual disturbance?
A) Yellow-green halos
B) Blurred vision
C) Double vision
D) Night blindness
Correct Answer: Yellow-green halos
Rationale: Yellow-green halos around lights are a classic visual disturbance
associated with digoxin toxicity. Other signs include gastrointestinal
symptoms such as anorexia, nausea, and vomiting.
