,NU 160 Exam 1 | Comprehensive Questions &
Verified Answers | 2026 Edition | Galen College
1. Which of the following best describes the mechanism of action of a proton pump inhibitor such as
omeprazole?
A) Neutralization of gastric acid
B) Blockade of histamine H2 receptors
C) Irreversible inhibition of H+/K+-ATPase in parietal cells
D) Formation of a protective barrier over the gastric mucosa
Correct Answer: Irreversible inhibition of H+/K+-ATPase in parietal cells
Rationale: Omeprazole and other PPIs covalently bind to the proton pump, the final step in gastric acid
secretion, and irreversibly inhibit it. This produces a profound and long-lasting reduction in acid. H2
blockers are reversible, antacids neutralize acid, and sucralfate forms a barrier.
2. The nurse is teaching a patient about the action of warfarin. Warfarin exerts its anticoagulant effect
by inhibiting
A) thrombin
B) vitamin K epoxide reductase
C) factor Xa
D) platelet aggregation
Correct Answer: Vitamin K epoxide reductase
Rationale: Warfarin blocks the enzyme vitamin K epoxide reductase, preventing the recycling of vitamin
K and thereby reducing the synthesis of functional clotting factors II, VII, IX, and X. It does not directly
inhibit thrombin, factor Xa, or platelets.
3. A patient is started on lisinopril for hypertension. The nurse should monitor for which common
adverse effect?
,A) Hypokalemia
B) Persistent dry cough
C) Tachycardia
D) Diarrhea
Correct Answer: Persistent dry cough
Rationale: ACE inhibitors like lisinopril can cause a persistent, nonproductive cough due to accumulation
of bradykinin. Hyperkalemia, not hypokalemia, may occur. Tachycardia and diarrhea are not typical side
effects.
4. The nurse is administering regular insulin intravenously. Which electrolyte must be monitored most
closely?
A) Sodium
B) Calcium
C) Potassium
D) Magnesium
Correct Answer: Potassium
Rationale: Insulin drives potassium from the extracellular fluid into cells, potentially causing
life-threatening hypokalemia. Potassium levels must be monitored frequently during IV insulin infusions,
with replacement as needed.
5. A patient is prescribed metformin for type 2 diabetes. The nurse should recognize that metformin is
contraindicated in patients with
A) obesity
B) hypertension
C) renal impairment with creatinine clearance below 30 mL/min
D) hyperlipidemia
, Correct Answer: Renal impairment with creatinine clearance below 30 mL/min
Rationale: Metformin carries a risk of lactic acidosis, particularly in patients with significant renal
impairment. It is contraindicated when eGFR is below 30 mL/min/1.73 m². Obesity, hypertension, and
hyperlipidemia are not contraindications but are often coexisting conditions.
6. Which of the following is the antidote for an overdose of acetaminophen?
A) Naloxone
B) Flumazenil
C) Acetylcysteine
D) Protamine sulfate
Correct Answer: Acetylcysteine
Rationale: Acetylcysteine replenishes hepatic glutathione stores, preventing hepatotoxicity from the
toxic metabolite of acetaminophen. It is most effective when given within 8–10 hours of ingestion.
Naloxone is for opioids; flumazenil for benzodiazepines; protamine for heparin.
7. The nurse is monitoring a patient receiving gentamicin. Which adverse effect is of greatest concern?
A) Hepatotoxicity
B) Nephrotoxicity and ototoxicity
C) Cardiotoxicity
D) Pulmonary toxicity
Correct Answer: Nephrotoxicity and ototoxicity
Rationale: Aminoglycosides like gentamicin are known for causing acute kidney injury and irreversible
hearing or balance loss. Peak and trough levels are monitored to minimize these risks. Liver, cardiac, and
pulmonary toxicities are not characteristic of gentamicin.
8. A patient is prescribed albuterol for asthma. This medication works by
Verified Answers | 2026 Edition | Galen College
1. Which of the following best describes the mechanism of action of a proton pump inhibitor such as
omeprazole?
A) Neutralization of gastric acid
B) Blockade of histamine H2 receptors
C) Irreversible inhibition of H+/K+-ATPase in parietal cells
D) Formation of a protective barrier over the gastric mucosa
Correct Answer: Irreversible inhibition of H+/K+-ATPase in parietal cells
Rationale: Omeprazole and other PPIs covalently bind to the proton pump, the final step in gastric acid
secretion, and irreversibly inhibit it. This produces a profound and long-lasting reduction in acid. H2
blockers are reversible, antacids neutralize acid, and sucralfate forms a barrier.
2. The nurse is teaching a patient about the action of warfarin. Warfarin exerts its anticoagulant effect
by inhibiting
A) thrombin
B) vitamin K epoxide reductase
C) factor Xa
D) platelet aggregation
Correct Answer: Vitamin K epoxide reductase
Rationale: Warfarin blocks the enzyme vitamin K epoxide reductase, preventing the recycling of vitamin
K and thereby reducing the synthesis of functional clotting factors II, VII, IX, and X. It does not directly
inhibit thrombin, factor Xa, or platelets.
3. A patient is started on lisinopril for hypertension. The nurse should monitor for which common
adverse effect?
,A) Hypokalemia
B) Persistent dry cough
C) Tachycardia
D) Diarrhea
Correct Answer: Persistent dry cough
Rationale: ACE inhibitors like lisinopril can cause a persistent, nonproductive cough due to accumulation
of bradykinin. Hyperkalemia, not hypokalemia, may occur. Tachycardia and diarrhea are not typical side
effects.
4. The nurse is administering regular insulin intravenously. Which electrolyte must be monitored most
closely?
A) Sodium
B) Calcium
C) Potassium
D) Magnesium
Correct Answer: Potassium
Rationale: Insulin drives potassium from the extracellular fluid into cells, potentially causing
life-threatening hypokalemia. Potassium levels must be monitored frequently during IV insulin infusions,
with replacement as needed.
5. A patient is prescribed metformin for type 2 diabetes. The nurse should recognize that metformin is
contraindicated in patients with
A) obesity
B) hypertension
C) renal impairment with creatinine clearance below 30 mL/min
D) hyperlipidemia
, Correct Answer: Renal impairment with creatinine clearance below 30 mL/min
Rationale: Metformin carries a risk of lactic acidosis, particularly in patients with significant renal
impairment. It is contraindicated when eGFR is below 30 mL/min/1.73 m². Obesity, hypertension, and
hyperlipidemia are not contraindications but are often coexisting conditions.
6. Which of the following is the antidote for an overdose of acetaminophen?
A) Naloxone
B) Flumazenil
C) Acetylcysteine
D) Protamine sulfate
Correct Answer: Acetylcysteine
Rationale: Acetylcysteine replenishes hepatic glutathione stores, preventing hepatotoxicity from the
toxic metabolite of acetaminophen. It is most effective when given within 8–10 hours of ingestion.
Naloxone is for opioids; flumazenil for benzodiazepines; protamine for heparin.
7. The nurse is monitoring a patient receiving gentamicin. Which adverse effect is of greatest concern?
A) Hepatotoxicity
B) Nephrotoxicity and ototoxicity
C) Cardiotoxicity
D) Pulmonary toxicity
Correct Answer: Nephrotoxicity and ototoxicity
Rationale: Aminoglycosides like gentamicin are known for causing acute kidney injury and irreversible
hearing or balance loss. Peak and trough levels are monitored to minimize these risks. Liver, cardiac, and
pulmonary toxicities are not characteristic of gentamicin.
8. A patient is prescribed albuterol for asthma. This medication works by
