NURS 305 Exam 3 V1 | NURS 305 Pharmacology | Actual Q&A with
Rationale (NURS305 Exam 3) | Liberty University
1. A patient is prescribed lisinopril for the management of hypertension. Which adverse
effect should the nurse instruct the patient to report immediately?
A. Increased appetite
B. Persistent dry cough
C. Occasional headache
D. Yellowing of the sclera
Answer: B
Explanation: A persistent dry cough is a hallmark side effect of ACE inhibitors like
lisinopril due to the accumulation of bradykinin in the lungs. While often benign, it can be
bothersome enough to require a change in medication class to an ARB. The nurse must
differentiate this from more severe reactions like angioedema which also involves the
respiratory system.
2. When administering digoxin to a patient with heart failure, which clinical finding would
indicate potential digoxin toxicity?
A. Visual disturbances such as yellow-green halos
B. Hyperkalemia
C. Increased urinary output
D. Tachycardia with a heart rate of 110 bpm
Answer: A
Explanation: Digoxin toxicity manifests through various symptoms including
gastrointestinal distress and neurological changes. Visual disturbances, specifically yellow-
green halos or blurred vision, are classic signs of toxicity that require immediate serum
level checking. The nurse should also monitor for bradycardia and anorexia as early
indicators of toxic levels.
3. A patient receiving a heparin infusion has an activated partial thromboplastin time (aPTT)
of 110 seconds. What is the priority nursing action?
A. Stop the infusion and notify the healthcare provider
B. Administer Vitamin K intramuscularly
C. Increase the infusion rate per protocol
D. Document the finding as a therapeutic level
,Answer: A
Explanation: A therapeutic aPTT for a patient on heparin is typically 1.5 to 2.5 times the
control value, which usually falls between 60 and 80 seconds. An aPTT of 110 seconds
indicates a significant risk for spontaneous bleeding and is well above the therapeutic
range. The nurse must halt the infusion to prevent hemorrhage and prepare the antagonist,
protamine sulfate, if ordered.
4. What is the primary mechanism of action for the loop diuretic furosemide?
A. Inhibition of sodium and chloride reabsorption in the ascending limb of the loop of Henle
B. Inhibition of the sodium-chloride symporter in the distal tubule
C. Antagonism of aldosterone receptors in the collecting duct
D. Osmotic pressure increase within the proximal convoluted tubule
Answer: A
Explanation: Furosemide acts specifically on the thick ascending limb of the loop of Henle
by blocking the Na-K-2Cl symporter. This results in significant excretion of water, sodium,
potassium, and calcium, making it a potent diuretic for fluid overload. Nurses must monitor
for hypokalemia and ototoxicity as specific adverse effects of this pharmacological action.
5. A patient is started on warfarin therapy for atrial fibrillation. Which laboratory value will
the nurse monitor to evaluate the effectiveness of this medication?
A. aPTT
B. International Normalized Ratio (INR)
C. Platelet count
D. Serum creatinine
Answer: B
Explanation: The INR is the standardized measurement used to monitor the effectiveness
of warfarin therapy, with a typical target range of 2.0 to 3.0 for atrial fibrillation. Unlike
heparin which uses aPTT, warfarin interferes with the synthesis of vitamin K-dependent
clotting factors. Frequent monitoring is essential to ensure the patient remains within the
narrow therapeutic window to prevent strokes or bleeding.
6. Which teaching point is most important for a patient newly prescribed atorvastatin?
A. Take the medication with grapefruit juice to increase absorption
B. Report any unexplained muscle pain or tenderness immediately
C. Stop taking the medication if you experience a mild headache
D. Avoid all forms of exercise to prevent muscle strain
, Answer: B
Explanation: Muscle pain or weakness in a patient taking a statin may indicate
rhabdomyolysis, a serious condition involving muscle breakdown that can lead to renal
failure. Patients are instructed to report these symptoms so that creatine kinase levels can
be evaluated and the drug potentially discontinued. This monitoring is a critical safety
component of HMG-CoA reductase inhibitor therapy.
7. A patient with Type 1 diabetes is prescribed insulin glargine. What is a unique
characteristic of this specific insulin?
A. It should be administered 15 minutes before meals
B. It must be mixed with NPH insulin to be effective
C. It is the only insulin that can be given intravenously
D. It has no peak action and provides a steady basal rate
Answer: D
Explanation: Insulin glargine is a long-acting basal insulin designed to provide a
continuous level of insulin for 24 hours without a pronounced peak. This helps maintain
stable blood glucose levels overnight and between meals, reducing the risk of
hypoglycemia. It is important to note that glargine cannot be mixed in the same syringe
with any other insulin.
8. The nurse is preparing to administer spironolactone. Which electrolyte abnormality is a
contraindication for this medication?
A. Hypokalemia
B. Hyponatremia
C. Hypocalcemia
D. Hyperkalemia
Answer: D
Explanation: Spironolactone is a potassium-sparing diuretic that acts by antagonizing
aldosterone in the distal tubules. Because it promotes potassium retention, giving it to a
patient who already has high serum potassium (hyperkalemia) can lead to life-threatening
cardiac arrhythmias. The nurse must check the most recent metabolic panel before
administration to ensure patient safety.
9. Which medication is considered the first-line treatment for an acute asthma attack?
A. Salmeterol
B. Montelukast
C. Fluticasone
Rationale (NURS305 Exam 3) | Liberty University
1. A patient is prescribed lisinopril for the management of hypertension. Which adverse
effect should the nurse instruct the patient to report immediately?
A. Increased appetite
B. Persistent dry cough
C. Occasional headache
D. Yellowing of the sclera
Answer: B
Explanation: A persistent dry cough is a hallmark side effect of ACE inhibitors like
lisinopril due to the accumulation of bradykinin in the lungs. While often benign, it can be
bothersome enough to require a change in medication class to an ARB. The nurse must
differentiate this from more severe reactions like angioedema which also involves the
respiratory system.
2. When administering digoxin to a patient with heart failure, which clinical finding would
indicate potential digoxin toxicity?
A. Visual disturbances such as yellow-green halos
B. Hyperkalemia
C. Increased urinary output
D. Tachycardia with a heart rate of 110 bpm
Answer: A
Explanation: Digoxin toxicity manifests through various symptoms including
gastrointestinal distress and neurological changes. Visual disturbances, specifically yellow-
green halos or blurred vision, are classic signs of toxicity that require immediate serum
level checking. The nurse should also monitor for bradycardia and anorexia as early
indicators of toxic levels.
3. A patient receiving a heparin infusion has an activated partial thromboplastin time (aPTT)
of 110 seconds. What is the priority nursing action?
A. Stop the infusion and notify the healthcare provider
B. Administer Vitamin K intramuscularly
C. Increase the infusion rate per protocol
D. Document the finding as a therapeutic level
,Answer: A
Explanation: A therapeutic aPTT for a patient on heparin is typically 1.5 to 2.5 times the
control value, which usually falls between 60 and 80 seconds. An aPTT of 110 seconds
indicates a significant risk for spontaneous bleeding and is well above the therapeutic
range. The nurse must halt the infusion to prevent hemorrhage and prepare the antagonist,
protamine sulfate, if ordered.
4. What is the primary mechanism of action for the loop diuretic furosemide?
A. Inhibition of sodium and chloride reabsorption in the ascending limb of the loop of Henle
B. Inhibition of the sodium-chloride symporter in the distal tubule
C. Antagonism of aldosterone receptors in the collecting duct
D. Osmotic pressure increase within the proximal convoluted tubule
Answer: A
Explanation: Furosemide acts specifically on the thick ascending limb of the loop of Henle
by blocking the Na-K-2Cl symporter. This results in significant excretion of water, sodium,
potassium, and calcium, making it a potent diuretic for fluid overload. Nurses must monitor
for hypokalemia and ototoxicity as specific adverse effects of this pharmacological action.
5. A patient is started on warfarin therapy for atrial fibrillation. Which laboratory value will
the nurse monitor to evaluate the effectiveness of this medication?
A. aPTT
B. International Normalized Ratio (INR)
C. Platelet count
D. Serum creatinine
Answer: B
Explanation: The INR is the standardized measurement used to monitor the effectiveness
of warfarin therapy, with a typical target range of 2.0 to 3.0 for atrial fibrillation. Unlike
heparin which uses aPTT, warfarin interferes with the synthesis of vitamin K-dependent
clotting factors. Frequent monitoring is essential to ensure the patient remains within the
narrow therapeutic window to prevent strokes or bleeding.
6. Which teaching point is most important for a patient newly prescribed atorvastatin?
A. Take the medication with grapefruit juice to increase absorption
B. Report any unexplained muscle pain or tenderness immediately
C. Stop taking the medication if you experience a mild headache
D. Avoid all forms of exercise to prevent muscle strain
, Answer: B
Explanation: Muscle pain or weakness in a patient taking a statin may indicate
rhabdomyolysis, a serious condition involving muscle breakdown that can lead to renal
failure. Patients are instructed to report these symptoms so that creatine kinase levels can
be evaluated and the drug potentially discontinued. This monitoring is a critical safety
component of HMG-CoA reductase inhibitor therapy.
7. A patient with Type 1 diabetes is prescribed insulin glargine. What is a unique
characteristic of this specific insulin?
A. It should be administered 15 minutes before meals
B. It must be mixed with NPH insulin to be effective
C. It is the only insulin that can be given intravenously
D. It has no peak action and provides a steady basal rate
Answer: D
Explanation: Insulin glargine is a long-acting basal insulin designed to provide a
continuous level of insulin for 24 hours without a pronounced peak. This helps maintain
stable blood glucose levels overnight and between meals, reducing the risk of
hypoglycemia. It is important to note that glargine cannot be mixed in the same syringe
with any other insulin.
8. The nurse is preparing to administer spironolactone. Which electrolyte abnormality is a
contraindication for this medication?
A. Hypokalemia
B. Hyponatremia
C. Hypocalcemia
D. Hyperkalemia
Answer: D
Explanation: Spironolactone is a potassium-sparing diuretic that acts by antagonizing
aldosterone in the distal tubules. Because it promotes potassium retention, giving it to a
patient who already has high serum potassium (hyperkalemia) can lead to life-threatening
cardiac arrhythmias. The nurse must check the most recent metabolic panel before
administration to ensure patient safety.
9. Which medication is considered the first-line treatment for an acute asthma attack?
A. Salmeterol
B. Montelukast
C. Fluticasone
