NURS 251 Final Exam V1 | NURS 251 Final
Exam – Pharmacology | Portage | Q&A with
Rationale (Portage NURS 251 Final Exam)
1. Which pharmacokinetic process is primarily responsible for the ‘first-pass effect’ in oral
medications?
A. Metabolism in the liver
B. Absorption in the stomach
C. Excretion through the kidneys
D. Distribution to the brain
Answer: A
Rationale: The first-pass effect occurs when a drug is metabolized by the liver before it
reaches the systemic circulation. This process significantly reduces the bioavailability of
many oral medications. Nurses must understand this concept to rationalize why oral doses
are often much higher than intravenous doses for the same drug.
2. A patient is prescribed Albuterol for acute bronchospasm. Which physiological response
should the nurse monitor for as a common side effect?
A. Tachycardia
B. Hypoglycemia
C. Bradycardia
,D. Somnolence
Answer: A
Rationale: Albuterol is a sympathomimetic agent that primarily targets Beta-2 receptors
but can also stimulate Beta-1 receptors in the heart. This stimulation often leads to
increased heart rate and palpitations in patients using rescue inhalers. Education should
include advising the patient that these sensations are expected but should be reported if
they become severe or persistent.
3. What is the primary mechanism of action of ACE inhibitors such as Lisinopril?
A. Blocking calcium influx into cardiac cells
B. Antagonizing Beta-adrenergic receptors
C. Inhibiting the conversion of Angiotensin I to Angiotensin II
D. Directly relaxing vascular smooth muscle
Answer: C
Rationale: ACE inhibitors prevent the conversion of Angiotensin I to the potent
vasoconstrictor Angiotensin II. This inhibition results in vasodilation and decreased
aldosterone secretion, which lowers blood pressure. A key adverse effect for nurses to
monitor is the development of a persistent, non-productive dry cough.
4. When administering Warfarin, which lab value is most critical for determining the
therapeutic dosage?
A. INR (International Normalized Ratio)
, B. Platelet count
C. aPTT (Activated Partial Thromboplastin Time)
D. BUN (Blood Urea Nitrogen)
Answer: A
Rationale: The INR is the standardized measurement used to monitor the effectiveness of
Warfarin therapy. A therapeutic range is typically between 2.0 and 3.0 for most indications
like atrial fibrillation or DVT. Consistently monitoring this value is essential to prevent both
subtherapeutic clotting and supratherapeutic bleeding risks.
5. Which of the following is the specific antidote for a Heparin overdose?
A. Protamine Sulfate
B. Vitamin K
C. Naloxone
D. Glucagon
Answer: A
Rationale: Protamine sulfate is a basic protein that binds with acidic heparin to form a
stable salt, neutralizing its anticoagulant effect. It is administered intravenously when
immediate reversal of heparin is required due to hemorrhage. Nurses must monitor for
bradycardia and hypotension during the rapid administration of this antidote.
Exam – Pharmacology | Portage | Q&A with
Rationale (Portage NURS 251 Final Exam)
1. Which pharmacokinetic process is primarily responsible for the ‘first-pass effect’ in oral
medications?
A. Metabolism in the liver
B. Absorption in the stomach
C. Excretion through the kidneys
D. Distribution to the brain
Answer: A
Rationale: The first-pass effect occurs when a drug is metabolized by the liver before it
reaches the systemic circulation. This process significantly reduces the bioavailability of
many oral medications. Nurses must understand this concept to rationalize why oral doses
are often much higher than intravenous doses for the same drug.
2. A patient is prescribed Albuterol for acute bronchospasm. Which physiological response
should the nurse monitor for as a common side effect?
A. Tachycardia
B. Hypoglycemia
C. Bradycardia
,D. Somnolence
Answer: A
Rationale: Albuterol is a sympathomimetic agent that primarily targets Beta-2 receptors
but can also stimulate Beta-1 receptors in the heart. This stimulation often leads to
increased heart rate and palpitations in patients using rescue inhalers. Education should
include advising the patient that these sensations are expected but should be reported if
they become severe or persistent.
3. What is the primary mechanism of action of ACE inhibitors such as Lisinopril?
A. Blocking calcium influx into cardiac cells
B. Antagonizing Beta-adrenergic receptors
C. Inhibiting the conversion of Angiotensin I to Angiotensin II
D. Directly relaxing vascular smooth muscle
Answer: C
Rationale: ACE inhibitors prevent the conversion of Angiotensin I to the potent
vasoconstrictor Angiotensin II. This inhibition results in vasodilation and decreased
aldosterone secretion, which lowers blood pressure. A key adverse effect for nurses to
monitor is the development of a persistent, non-productive dry cough.
4. When administering Warfarin, which lab value is most critical for determining the
therapeutic dosage?
A. INR (International Normalized Ratio)
, B. Platelet count
C. aPTT (Activated Partial Thromboplastin Time)
D. BUN (Blood Urea Nitrogen)
Answer: A
Rationale: The INR is the standardized measurement used to monitor the effectiveness of
Warfarin therapy. A therapeutic range is typically between 2.0 and 3.0 for most indications
like atrial fibrillation or DVT. Consistently monitoring this value is essential to prevent both
subtherapeutic clotting and supratherapeutic bleeding risks.
5. Which of the following is the specific antidote for a Heparin overdose?
A. Protamine Sulfate
B. Vitamin K
C. Naloxone
D. Glucagon
Answer: A
Rationale: Protamine sulfate is a basic protein that binds with acidic heparin to form a
stable salt, neutralizing its anticoagulant effect. It is administered intravenously when
immediate reversal of heparin is required due to hemorrhage. Nurses must monitor for
bradycardia and hypotension during the rapid administration of this antidote.
