NR293 Final Exam Actual Exam Style V2 |
NR 293 Pharmacology for Nursing Practice
| Chamberlain
1. A patient is prescribed an oral medication that has a high first-pass effect. Which statement
by the nurse best explains this concept to the student nurse?
A. The drug is metabolized by the liver before it reaches the systemic circulation.
B. The medication is absorbed faster in the stomach than in the small intestine.
C. The medication bypasses the liver and enters the bloodstream directly.
D. The drug binds strongly to albumin and is distributed slowly to the tissues.
Answer: A
Rationale: The first-pass effect refers to the metabolism of a drug by the liver after it is
absorbed from the gastrointestinal tract. This process occurs before the drug can reach the
rest of the body through systemic circulation. As a result, the concentration of the drug is
significantly reduced, often requiring higher oral doses compared to intravenous doses.
2. A nurse is preparing to administer digoxin to a patient with heart failure. Which
assessment finding would require the nurse to hold the medication?
A. Apical pulse of 52 beats per minute
B. Serum potassium level of 4.8 mEq/L
C. Blood pressure of 110/70 mmHg
,D. Respiratory rate of 18 breaths per minute
Answer: A
Rationale: Digoxin is a cardiac glycoside that slows the heart rate and increases the force
of contraction. Before administration, the nurse must assess the apical pulse for one full
minute to ensure it is at least 60 beats per minute. If the heart rate is below 60, the
medication should be held and the provider notified to prevent further bradycardia.
3. A patient newly diagnosed with hypertension is prescribed Lisinopril. Which side effect
should the nurse instruct the patient to report immediately?
A. A persistent, dry, hacking cough
B. Occasional mild headaches in the morning
C. Increased urinary frequency during the day
D. Swelling of the tongue or lips
Answer: D
Rationale: While a dry cough is a common side effect of ACE inhibitors like Lisinopril,
swelling of the lips or tongue indicates angioedema. Angioedema is a potentially life-
threatening adverse reaction that can obstruct the airway. The patient must be taught to
seek emergency medical attention immediately if these symptoms occur.
4. A nurse is caring for a patient receiving Warfarin for deep vein thrombosis. Which lab value
should the nurse monitor to evaluate the effectiveness of the therapy?
A. Activated partial thromboplastin time (aPTT)
, B. International Normalized Ratio (INR)
C. Platelet count
D. Hemoglobin and Hematocrit
Answer: B
Rationale: The INR is the standard laboratory test used to monitor the effectiveness of
Warfarin therapy. For most patients, a therapeutic INR range is between 2.0 and 3.0. This
ensures the blood is sufficiently thinned to prevent clots while minimizing the risk of
excessive bleeding.
5. A patient with Type 1 Diabetes is prescribed Insulin Lispro (Humalog). When should the
nurse instruct the patient to administer this medication?
A. At bedtime with a protein-rich snack
B. Within 15 minutes of starting a meal
C. 30 to 45 minutes before eating a meal
D. Once daily in the morning regardless of food
Answer: B
Rationale: Insulin Lispro is a rapid-acting insulin with a very quick onset of action, usually
within 15 minutes. It should be administered right before or immediately after eating to
cover post-meal glucose spikes. Administering it too early without food intake could lead to
severe hypoglycemia.
NR 293 Pharmacology for Nursing Practice
| Chamberlain
1. A patient is prescribed an oral medication that has a high first-pass effect. Which statement
by the nurse best explains this concept to the student nurse?
A. The drug is metabolized by the liver before it reaches the systemic circulation.
B. The medication is absorbed faster in the stomach than in the small intestine.
C. The medication bypasses the liver and enters the bloodstream directly.
D. The drug binds strongly to albumin and is distributed slowly to the tissues.
Answer: A
Rationale: The first-pass effect refers to the metabolism of a drug by the liver after it is
absorbed from the gastrointestinal tract. This process occurs before the drug can reach the
rest of the body through systemic circulation. As a result, the concentration of the drug is
significantly reduced, often requiring higher oral doses compared to intravenous doses.
2. A nurse is preparing to administer digoxin to a patient with heart failure. Which
assessment finding would require the nurse to hold the medication?
A. Apical pulse of 52 beats per minute
B. Serum potassium level of 4.8 mEq/L
C. Blood pressure of 110/70 mmHg
,D. Respiratory rate of 18 breaths per minute
Answer: A
Rationale: Digoxin is a cardiac glycoside that slows the heart rate and increases the force
of contraction. Before administration, the nurse must assess the apical pulse for one full
minute to ensure it is at least 60 beats per minute. If the heart rate is below 60, the
medication should be held and the provider notified to prevent further bradycardia.
3. A patient newly diagnosed with hypertension is prescribed Lisinopril. Which side effect
should the nurse instruct the patient to report immediately?
A. A persistent, dry, hacking cough
B. Occasional mild headaches in the morning
C. Increased urinary frequency during the day
D. Swelling of the tongue or lips
Answer: D
Rationale: While a dry cough is a common side effect of ACE inhibitors like Lisinopril,
swelling of the lips or tongue indicates angioedema. Angioedema is a potentially life-
threatening adverse reaction that can obstruct the airway. The patient must be taught to
seek emergency medical attention immediately if these symptoms occur.
4. A nurse is caring for a patient receiving Warfarin for deep vein thrombosis. Which lab value
should the nurse monitor to evaluate the effectiveness of the therapy?
A. Activated partial thromboplastin time (aPTT)
, B. International Normalized Ratio (INR)
C. Platelet count
D. Hemoglobin and Hematocrit
Answer: B
Rationale: The INR is the standard laboratory test used to monitor the effectiveness of
Warfarin therapy. For most patients, a therapeutic INR range is between 2.0 and 3.0. This
ensures the blood is sufficiently thinned to prevent clots while minimizing the risk of
excessive bleeding.
5. A patient with Type 1 Diabetes is prescribed Insulin Lispro (Humalog). When should the
nurse instruct the patient to administer this medication?
A. At bedtime with a protein-rich snack
B. Within 15 minutes of starting a meal
C. 30 to 45 minutes before eating a meal
D. Once daily in the morning regardless of food
Answer: B
Rationale: Insulin Lispro is a rapid-acting insulin with a very quick onset of action, usually
within 15 minutes. It should be administered right before or immediately after eating to
cover post-meal glucose spikes. Administering it too early without food intake could lead to
severe hypoglycemia.
