NURS 305 Final Exam V3 | NURS 305 Pharmacology | Actual Q&A with
Rationale (NURS305 Final Exam) | Liberty University
1. A patient is prescribed warfarin (Coumadin) for chronic atrial fibrillation. Which laboratory
value must the nurse monitor to evaluate the therapeutic effect of this medication?
A. Activated Partial Thromboplastin Time (aPTT)
B. International Normalized Ratio (INR)
C. Platelet count
D. Serum potassium level
Answer: B
Explanation: The International Normalized Ratio (INR) is the gold standard for monitoring
warfarin therapy because it provides a standardized measurement across different
laboratories. A therapeutic range is typically between 2.0 and 3.0 for most indications,
though it may be higher for mechanical heart valves. Nurses must monitor this value
closely to balance the risk of thrombosis with the risk of spontaneous hemorrhage.
2. A patient diagnosed with heart failure is receiving digoxin. Which electrolyte abnormality
most significantly increases the risk for digoxin toxicity?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypomagnesemia
Answer: B
Explanation: Hypokalemia increases the risk of digoxin toxicity because potassium and
digoxin compete for binding sites on the sodium-potassium ATPase pump. When
potassium levels are low, digoxin binds more effectively, leading to excessive inhibition of
the pump and toxic levels in the blood. Nurses must educate patients on consuming
potassium-rich foods and monitor lab values frequently during therapy.
3. A nurse is preparing to administer epinephrine to a patient experiencing anaphylaxis.
Which physiological response is expected following administration?
A. Bradycardia and bronchoconstriction
B. Peripheral vasodilation and sedation
C. Decreased cardiac output and miosis
D. Increased blood pressure and bronchodilation
,Answer: D
Explanation: Epinephrine acts as a non-selective adrenergic agonist, stimulating alpha-1,
beta-1, and beta-2 receptors. This results in vasoconstriction to raise blood pressure,
increased heart rate, and relaxation of bronchial smooth muscle to restore airway patency.
It is considered the first-line emergency treatment for severe allergic reactions and must be
administered intramuscularly for the fastest onset.
4. A patient taking lisinopril (Zestril) reports a persistent, dry, nonproductive cough. What is
the pharmacological basis for this adverse effect?
A. Direct irritation of the pharyngeal mucosa by the drug molecule
B. Bronchospasm caused by beta-adrenergic blockade
C. Alveolar edema due to increased pulmonary capillary pressure
D. Accumulation of bradykinin in the lungs
Answer: D
Explanation: ACE inhibitors prevent the conversion of angiotensin I to angiotensin II, but
they also inhibit the enzyme kininase, which normally breaks down bradykinin. The
resulting accumulation of bradykinin in the respiratory tract triggers the inflammatory
response that manifests as a dry cough. This side effect is a common reason for patients to
switch from an ACE inhibitor to an Angiotensin II Receptor Blocker (ARB).
5. A nurse is teaching a patient about lithium carbonate for bipolar disorder. Which dietary
instruction is critical for preventing lithium toxicity?
A. Restrict dietary potassium intake
B. Avoid foods high in tyramine
C. Maintain a consistent intake of dietary sodium
D. Limit fluid intake to less than 1 liter per day
Answer: C
Explanation: Lithium is a salt, and the kidneys handle it in a manner similar to sodium. If
sodium levels drop due to low intake or excessive sweating, the kidneys will reabsorb
lithium in place of sodium, leading to toxic accumulations. Patients should be instructed to
maintain steady sodium and fluid intake to keep serum lithium levels within the narrow
therapeutic window of 0.6 to 1.2 mEq/L.
6. A patient is brought to the emergency department with suspected opioid overdose. Which
medication should the nurse anticipate administering immediately?
A. Acetylcysteine
B. Flumazenil
, C. Naloxone
D. Physostigmine
Answer: C
Explanation: Naloxone is an opioid antagonist that competitively binds to mu-opioid
receptors, effectively reversing respiratory depression and sedation. Because its half-life is
often shorter than the opioid it is reversing, repeated doses may be necessary to prevent
the return of respiratory failure. Nurses must monitor the patient’s respiratory rate and
level of consciousness continuously after administration.
7. A nurse is reviewing the medical record of a patient with a new prescription for
propranolol. Which condition in the patient’s history would require the nurse to clarify the
order with the provider?
A. Hypertension
B. Asthma
C. Glaucoma
D. Tachycardia
Answer: B
Explanation: Propranolol is a non-selective beta-blocker that antagonizes both beta-1
(heart) and beta-2 (lung) receptors. Blocking beta-2 receptors can cause
bronchoconstriction, which is life-threatening for patients with asthma or chronic
obstructive pulmonary disease (COPD). For these patients, cardioselective beta-blockers
like metoprolol are generally preferred to minimize respiratory complications.
8. A patient has taken an intentional overdose of acetaminophen (Tylenol). Which medication
serves as the specific antidote for this toxicity?
A. Protamine sulfate
B. Acetylcysteine
C. Vitamin K
D. Calcium gluconate
Answer: B
Explanation: Acetylcysteine acts by restoring hepatic concentrations of glutathione, which
is necessary to neutralize the toxic metabolite of acetaminophen known as NAPQI. If
administered within 8 to 10 hours of ingestion, it is highly effective at preventing severe
liver necrosis. The nurse should be aware that the oral form of this medication has a very
unpleasant odor and may cause vomiting.
Rationale (NURS305 Final Exam) | Liberty University
1. A patient is prescribed warfarin (Coumadin) for chronic atrial fibrillation. Which laboratory
value must the nurse monitor to evaluate the therapeutic effect of this medication?
A. Activated Partial Thromboplastin Time (aPTT)
B. International Normalized Ratio (INR)
C. Platelet count
D. Serum potassium level
Answer: B
Explanation: The International Normalized Ratio (INR) is the gold standard for monitoring
warfarin therapy because it provides a standardized measurement across different
laboratories. A therapeutic range is typically between 2.0 and 3.0 for most indications,
though it may be higher for mechanical heart valves. Nurses must monitor this value
closely to balance the risk of thrombosis with the risk of spontaneous hemorrhage.
2. A patient diagnosed with heart failure is receiving digoxin. Which electrolyte abnormality
most significantly increases the risk for digoxin toxicity?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypomagnesemia
Answer: B
Explanation: Hypokalemia increases the risk of digoxin toxicity because potassium and
digoxin compete for binding sites on the sodium-potassium ATPase pump. When
potassium levels are low, digoxin binds more effectively, leading to excessive inhibition of
the pump and toxic levels in the blood. Nurses must educate patients on consuming
potassium-rich foods and monitor lab values frequently during therapy.
3. A nurse is preparing to administer epinephrine to a patient experiencing anaphylaxis.
Which physiological response is expected following administration?
A. Bradycardia and bronchoconstriction
B. Peripheral vasodilation and sedation
C. Decreased cardiac output and miosis
D. Increased blood pressure and bronchodilation
,Answer: D
Explanation: Epinephrine acts as a non-selective adrenergic agonist, stimulating alpha-1,
beta-1, and beta-2 receptors. This results in vasoconstriction to raise blood pressure,
increased heart rate, and relaxation of bronchial smooth muscle to restore airway patency.
It is considered the first-line emergency treatment for severe allergic reactions and must be
administered intramuscularly for the fastest onset.
4. A patient taking lisinopril (Zestril) reports a persistent, dry, nonproductive cough. What is
the pharmacological basis for this adverse effect?
A. Direct irritation of the pharyngeal mucosa by the drug molecule
B. Bronchospasm caused by beta-adrenergic blockade
C. Alveolar edema due to increased pulmonary capillary pressure
D. Accumulation of bradykinin in the lungs
Answer: D
Explanation: ACE inhibitors prevent the conversion of angiotensin I to angiotensin II, but
they also inhibit the enzyme kininase, which normally breaks down bradykinin. The
resulting accumulation of bradykinin in the respiratory tract triggers the inflammatory
response that manifests as a dry cough. This side effect is a common reason for patients to
switch from an ACE inhibitor to an Angiotensin II Receptor Blocker (ARB).
5. A nurse is teaching a patient about lithium carbonate for bipolar disorder. Which dietary
instruction is critical for preventing lithium toxicity?
A. Restrict dietary potassium intake
B. Avoid foods high in tyramine
C. Maintain a consistent intake of dietary sodium
D. Limit fluid intake to less than 1 liter per day
Answer: C
Explanation: Lithium is a salt, and the kidneys handle it in a manner similar to sodium. If
sodium levels drop due to low intake or excessive sweating, the kidneys will reabsorb
lithium in place of sodium, leading to toxic accumulations. Patients should be instructed to
maintain steady sodium and fluid intake to keep serum lithium levels within the narrow
therapeutic window of 0.6 to 1.2 mEq/L.
6. A patient is brought to the emergency department with suspected opioid overdose. Which
medication should the nurse anticipate administering immediately?
A. Acetylcysteine
B. Flumazenil
, C. Naloxone
D. Physostigmine
Answer: C
Explanation: Naloxone is an opioid antagonist that competitively binds to mu-opioid
receptors, effectively reversing respiratory depression and sedation. Because its half-life is
often shorter than the opioid it is reversing, repeated doses may be necessary to prevent
the return of respiratory failure. Nurses must monitor the patient’s respiratory rate and
level of consciousness continuously after administration.
7. A nurse is reviewing the medical record of a patient with a new prescription for
propranolol. Which condition in the patient’s history would require the nurse to clarify the
order with the provider?
A. Hypertension
B. Asthma
C. Glaucoma
D. Tachycardia
Answer: B
Explanation: Propranolol is a non-selective beta-blocker that antagonizes both beta-1
(heart) and beta-2 (lung) receptors. Blocking beta-2 receptors can cause
bronchoconstriction, which is life-threatening for patients with asthma or chronic
obstructive pulmonary disease (COPD). For these patients, cardioselective beta-blockers
like metoprolol are generally preferred to minimize respiratory complications.
8. A patient has taken an intentional overdose of acetaminophen (Tylenol). Which medication
serves as the specific antidote for this toxicity?
A. Protamine sulfate
B. Acetylcysteine
C. Vitamin K
D. Calcium gluconate
Answer: B
Explanation: Acetylcysteine acts by restoring hepatic concentrations of glutathione, which
is necessary to neutralize the toxic metabolite of acetaminophen known as NAPQI. If
administered within 8 to 10 hours of ingestion, it is highly effective at preventing severe
liver necrosis. The nurse should be aware that the oral form of this medication has a very
unpleasant odor and may cause vomiting.
