NURS 300 (Pharmacology) Unit Exam 1
Latest 2026/2027 | Newly Released
San Diego State University (SDSU).
50 Questions and Answers With Expert Rationales
Guaranteed Pass | Graded A +
Q1. A patient is prescribed digoxin 0.125 mg daily. The nurse knows that digoxin has a narrow
therapeutic index. Which laboratory value must be monitored regularly to prevent toxicity?
A. Serum creatinine
B. Serum digoxin level
C. Liver function tests
D. Complete blood count
Correct Answer: B
Digoxin has a narrow therapeutic index of 0.5 to 2.0 ng/mL, meaning small changes in plasma
concentration can cause toxicity or therapeutic failure. Regular monitoring of serum digoxin
levels, along with potassium and renal function, is essential for safe administration. Serum
creatinine alone does not reflect digoxin concentration, liver function tests are not primary
monitoring parameters, and complete blood count does not assess cardiac glycoside levels.
Q2. A nurse is teaching a patient about a new prescription for atenolol. Which statement by the
patient indicates a need for further teaching?
A. "I should check my pulse before taking this medication."
B. "I can stop this medication if my blood pressure returns to normal."
C. "I may feel dizzy when I stand up quickly."
D. "I should avoid taking this with decongestants."
Correct Answer: B
Abrupt discontinuation of beta-blockers such as atenolol can cause rebound hypertension,
tachycardia, and myocardial ischemia due to upregulation of beta-adrenergic receptors. Patients
must taper the dose gradually under medical supervision rather than stopping independently.
Checking pulse, anticipating orthostatic hypotension, and avoiding decongestants that cause
vasoconstriction are all appropriate patient education points.
,Q3. A drug that binds to a receptor but does not produce a biological response is classified as:
A. An agonist
B. An antagonist
C. A partial agonist
D. An inverse agonist
Correct Answer: B
An antagonist binds to a receptor without activating it, thereby blocking the action of
endogenous ligands or exogenous agonists. This competitive or noncompetitive blockade
prevents receptor activation and the downstream biological response. Agonists produce full
activation, partial agonists produce submaximal activation, and inverse agonists reduce
constitutive baseline receptor activity.
Q4. A patient with severe liver disease is prescribed lorazepam instead of diazepam for anxiety.
The nurse understands that this decision was made because:
A. Lorazepam is metabolized by glucuronidation, which is preserved in liver disease
B. Lorazepam has a shorter half-life than diazepam
C. Lorazepam is excreted unchanged by the kidneys
D. Lorazepam does not cross the blood-brain barrier
Correct Answer: A
Lorazepam undergoes glucuronidation, a Phase II metabolic pathway that remains relatively
intact even in severe hepatic dysfunction. Diazepam relies heavily on Phase I oxidation via
CYP450 enzymes, which is significantly impaired in liver disease. This pharmacokinetic
difference makes lorazepam safer for patients with hepatic impairment, as it avoids accumulation
and prolonged sedation.
Q5. A patient is taking levodopa for Parkinson's disease and reports darkening of urine and
sweat. The nurse recognizes this as:
A. A sign of rhabdomyolysis requiring immediate intervention
B. A harmless, expected effect of levodopa metabolism
C. An indication of liver failure
D. A symptom of urinary tract infection
Correct Answer: B
, Levodopa is metabolized to melanin-like pigments that can darken urine, sweat, and saliva in
some patients. This is a benign, expected effect that does not indicate organ damage or infection.
However, nurses should distinguish this from pathological causes of dark urine, such as
myoglobinuria from rhabdomyolysis or bilirubinuria from hepatic dysfunction, by assessing
associated symptoms.
Q6. A patient is prescribed omeprazole for gastroesophageal reflux disease. The nurse
understands that omeprazole exerts its therapeutic effect by:
A. Neutralizing gastric acid
B. Blocking histamine H2 receptors
C. Inhibiting the hydrogen-potassium ATPase pump in parietal cells
D. Stimulating prostaglandin synthesis
Correct Answer: C
Omeprazole is a proton pump inhibitor that irreversibly blocks the hydrogen-potassium ATPase
pump in gastric parietal cells, preventing the final step of acid production. This mechanism
provides more potent and longer-lasting acid suppression than H2 blockers or antacids.
Prostaglandin stimulation is the mechanism of misoprostol, which protects gastric mucosa
through a different pathway.
Q7. A patient taking phenelzine eats aged cheese at a restaurant and develops a severe headache,
flushing, and blood pressure of 210/120 mmHg. The nurse recognizes this as:
A. Anaphylaxis
B. A hypertensive crisis from tyramine interaction
C. A migraine triggered by food additives
D. Serotonin syndrome
Correct Answer: B
Phenelzine is a monoamine oxidase inhibitor that prevents the breakdown of tyramine, a
vasoactive amine found in aged cheeses, cured meats, and fermented foods. Tyramine
accumulation causes massive norepinephrine release, producing a potentially fatal hypertensive
crisis. This requires immediate blood pressure management and patient education about strict
dietary restrictions while taking MAOIs.
Q8. A patient is prescribed aspirin 81 mg daily for cardioprotection. The nurse understands that
aspirin's antiplatelet effect is achieved through:
Latest 2026/2027 | Newly Released
San Diego State University (SDSU).
50 Questions and Answers With Expert Rationales
Guaranteed Pass | Graded A +
Q1. A patient is prescribed digoxin 0.125 mg daily. The nurse knows that digoxin has a narrow
therapeutic index. Which laboratory value must be monitored regularly to prevent toxicity?
A. Serum creatinine
B. Serum digoxin level
C. Liver function tests
D. Complete blood count
Correct Answer: B
Digoxin has a narrow therapeutic index of 0.5 to 2.0 ng/mL, meaning small changes in plasma
concentration can cause toxicity or therapeutic failure. Regular monitoring of serum digoxin
levels, along with potassium and renal function, is essential for safe administration. Serum
creatinine alone does not reflect digoxin concentration, liver function tests are not primary
monitoring parameters, and complete blood count does not assess cardiac glycoside levels.
Q2. A nurse is teaching a patient about a new prescription for atenolol. Which statement by the
patient indicates a need for further teaching?
A. "I should check my pulse before taking this medication."
B. "I can stop this medication if my blood pressure returns to normal."
C. "I may feel dizzy when I stand up quickly."
D. "I should avoid taking this with decongestants."
Correct Answer: B
Abrupt discontinuation of beta-blockers such as atenolol can cause rebound hypertension,
tachycardia, and myocardial ischemia due to upregulation of beta-adrenergic receptors. Patients
must taper the dose gradually under medical supervision rather than stopping independently.
Checking pulse, anticipating orthostatic hypotension, and avoiding decongestants that cause
vasoconstriction are all appropriate patient education points.
,Q3. A drug that binds to a receptor but does not produce a biological response is classified as:
A. An agonist
B. An antagonist
C. A partial agonist
D. An inverse agonist
Correct Answer: B
An antagonist binds to a receptor without activating it, thereby blocking the action of
endogenous ligands or exogenous agonists. This competitive or noncompetitive blockade
prevents receptor activation and the downstream biological response. Agonists produce full
activation, partial agonists produce submaximal activation, and inverse agonists reduce
constitutive baseline receptor activity.
Q4. A patient with severe liver disease is prescribed lorazepam instead of diazepam for anxiety.
The nurse understands that this decision was made because:
A. Lorazepam is metabolized by glucuronidation, which is preserved in liver disease
B. Lorazepam has a shorter half-life than diazepam
C. Lorazepam is excreted unchanged by the kidneys
D. Lorazepam does not cross the blood-brain barrier
Correct Answer: A
Lorazepam undergoes glucuronidation, a Phase II metabolic pathway that remains relatively
intact even in severe hepatic dysfunction. Diazepam relies heavily on Phase I oxidation via
CYP450 enzymes, which is significantly impaired in liver disease. This pharmacokinetic
difference makes lorazepam safer for patients with hepatic impairment, as it avoids accumulation
and prolonged sedation.
Q5. A patient is taking levodopa for Parkinson's disease and reports darkening of urine and
sweat. The nurse recognizes this as:
A. A sign of rhabdomyolysis requiring immediate intervention
B. A harmless, expected effect of levodopa metabolism
C. An indication of liver failure
D. A symptom of urinary tract infection
Correct Answer: B
, Levodopa is metabolized to melanin-like pigments that can darken urine, sweat, and saliva in
some patients. This is a benign, expected effect that does not indicate organ damage or infection.
However, nurses should distinguish this from pathological causes of dark urine, such as
myoglobinuria from rhabdomyolysis or bilirubinuria from hepatic dysfunction, by assessing
associated symptoms.
Q6. A patient is prescribed omeprazole for gastroesophageal reflux disease. The nurse
understands that omeprazole exerts its therapeutic effect by:
A. Neutralizing gastric acid
B. Blocking histamine H2 receptors
C. Inhibiting the hydrogen-potassium ATPase pump in parietal cells
D. Stimulating prostaglandin synthesis
Correct Answer: C
Omeprazole is a proton pump inhibitor that irreversibly blocks the hydrogen-potassium ATPase
pump in gastric parietal cells, preventing the final step of acid production. This mechanism
provides more potent and longer-lasting acid suppression than H2 blockers or antacids.
Prostaglandin stimulation is the mechanism of misoprostol, which protects gastric mucosa
through a different pathway.
Q7. A patient taking phenelzine eats aged cheese at a restaurant and develops a severe headache,
flushing, and blood pressure of 210/120 mmHg. The nurse recognizes this as:
A. Anaphylaxis
B. A hypertensive crisis from tyramine interaction
C. A migraine triggered by food additives
D. Serotonin syndrome
Correct Answer: B
Phenelzine is a monoamine oxidase inhibitor that prevents the breakdown of tyramine, a
vasoactive amine found in aged cheeses, cured meats, and fermented foods. Tyramine
accumulation causes massive norepinephrine release, producing a potentially fatal hypertensive
crisis. This requires immediate blood pressure management and patient education about strict
dietary restrictions while taking MAOIs.
Q8. A patient is prescribed aspirin 81 mg daily for cardioprotection. The nurse understands that
aspirin's antiplatelet effect is achieved through:
