NUR 210 Principles of Pharmacology Exam 2
Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
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SECTION 1: CARDIOVASCULAR & RENAL PHARMACOLOGY Q1 – Q10
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Question 1 of 50
A 78-year-old patient with heart failure is receiving digoxin 0.25 mg daily. During the morning
assessment, the nurse notes a new onset of confusion, nausea, and a heart rate of 52 beats
per minute. The serum digoxin level is reported as 2.8 ng/mL. The nurse should anticipate
which provider order as the priority intervention?
A. Hold the next digoxin dose and notify the provider immediately ✓ CORRECT
B. Administer the scheduled dose with a slow heart rate assessment
C. Give atropine 0.5 mg IV push and prepare for transcutaneous pacing
D. Draw a repeat digoxin level and administer the dose if it is below 2.0 ng/mL
Correct Answer: A
Rationale: A digoxin level of 2.8 ng/mL exceeds the therapeutic range of 0.5 to 2.0 ng/mL and
the bradycardia indicates toxicity, so holding the dose and notifying the provider is the priority
to prevent further cardiac suppression. Administering the scheduled dose would worsen
toxicity, and atropine is not indicated without provider orders for symptomatic bradycardia.
Always correlate digoxin levels with clinical presentation rather than relying on the number
alone.
Question 2 of 50
A 62-year-old patient with hypertension has been taking lisinopril 20 mg daily for three
months. At the follow-up clinic visit, the patient reports a persistent dry cough that started
two weeks after beginning the medication and interferes with sleep. The blood pressure is
128/78 mmHg and the patient denies angioedema or dizziness. The nurse anticipates the
provider will most likely recommend which action?
,A. Add a thiazide diuretic to enhance the antihypertensive effect
B. Discontinue lisinopril and consider an angiotensin receptor blocker ✓ CORRECT
C. Prescribe a cough suppressant with dextromethorphan for nighttime relief
D. Reduce the lisinopril dose to 10 mg daily and monitor for two more weeks
Correct Answer: B
Rationale: A dry, nonproductive cough is a well-known adverse effect of ACE inhibitors
caused by bradykinin accumulation, and switching to an ARB such as losartan typically
resolves the cough while maintaining blood pressure control. Adding a cough suppressant
masks the symptom without addressing the underlying medication cause, and dose reduction
rarely eliminates this class effect. Documenting the cough and communicating it to the
provider allows for timely medication adjustment.
Question 3 of 50
A 55-year-old patient with acute decompensated heart failure is receiving furosemide 40 mg
IV twice daily. On the second day of therapy, the nurse reviews the morning laboratory results
and notes a potassium level of 3.2 mEq/L. The patient reports mild muscle weakness and
has 2+ pitting edema in the lower extremities. Which nursing intervention is the priority
before administering the next scheduled dose?
A. Administer the furosemide and recheck the potassium level in four hours
B. Hold the furosemide and notify the provider of the hypokalemia
C. Administer potassium chloride 20 mEq orally per protocol and monitor the patient ✓
CORRECT
D. Increase the patient's oral fluid intake to enhance potassium reabsorption
Correct Answer: C
Rationale: Furosemide is a loop diuretic that causes significant potassium wasting, and a
level of 3.2 mEq/L represents mild hypokalemia that requires replacement per protocol to
prevent cardiac dysrhythmias while continuing the necessary diuretic therapy. Holding the
furosemide may worsen the patient's fluid overload status, and increasing fluid intake
contradicts the treatment goal for heart failure. Always verify the potassium level is within a
safe range before giving loop diuretics when protocol allows replacement.
Question 4 of 50
A 48-year-old patient admitted for a hypertensive emergency has a blood pressure of 210/120
mmHg. The provider orders nicardipine IV drip at 5 mg per hour with parameters to keep
systolic pressure between 140 and 160 mmHg. Thirty minutes after initiation, the nurse notes
the blood pressure is 158/96 mmHg and the patient reports a headache. Which action should
the nurse take first?
A. Increase the nicardipine infusion rate to achieve a lower pressure faster
, B. Administer acetaminophen 650 mg orally for the headache
C. Place the patient in a supine position with the legs elevated
D. Continue the current infusion rate and reassess the blood pressure in 15 minutes ✓
CORRECT
Correct Answer: D
Rationale: The blood pressure of 158/96 mmHg falls within the prescribed target range of 140
to 160 mmHg systolic, so continuing the current rate and reassessing prevents overshooting
into hypotension during titration. Increasing the rate would risk dropping the pressure too
rapidly and compromising cerebral perfusion, and acetaminophen addresses only the
symptom rather than the therapeutic goal. In hypertensive emergencies, gradual reduction
protects organ perfusion and prevents ischemic complications.
Question 5 of 50
A 70-year-old patient with atrial fibrillation takes warfarin 5 mg daily and presents to the
emergency department with a nosebleed that has persisted for 30 minutes. The INR is 5.2 and
the patient reports eating large amounts of spinach over the past week. The nurse anticipates
which provider order as the priority?
A. Hold warfarin and administer phytonadione vitamin K subcutaneously ✓ CORRECT
B. Continue warfarin and apply bilateral nasal packing immediately
C. Administer fresh frozen plasma and resume the usual warfarin dose tonight
D. Transfuse two units of packed red blood cells and monitor for hematuria
Correct Answer: A
Rationale: An INR of 5.2 with active bleeding indicates supratherapeutic anticoagulation, and
vitamin K is the specific antidote for warfarin that promotes synthesis of functional clotting
factors to reverse the drug's effect. Continuing warfarin would worsen the bleeding, and fresh
frozen plasma is typically reserved for life-threatening bleeding rather than a manageable
nosebleed. The patient's increased intake of vitamin K-rich foods suggests dietary
inconsistency, which reinforces the need for thorough anticoagulation education.
Question 6 of 50
A 54-year-old patient with hyperlipidemia started atorvastatin 40 mg daily four weeks ago.
During a telephone follow-up, the patient reports new onset of bilateral thigh muscle pain and
dark-colored urine. The patient denies fever or recent strenuous exercise. The nurse should
instruct the patient to take which action?
A. Take ibuprofen 400 mg every six hours for the muscle pain
B. Stop the atorvastatin and contact the provider for a creatine kinase level ✓ CORRECT
C. Increase fluid intake to dilute the urine and continue the medication
D. Schedule an appointment in two weeks if the symptoms do not improve
Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR & RENAL PHARMACOLOGY Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 78-year-old patient with heart failure is receiving digoxin 0.25 mg daily. During the morning
assessment, the nurse notes a new onset of confusion, nausea, and a heart rate of 52 beats
per minute. The serum digoxin level is reported as 2.8 ng/mL. The nurse should anticipate
which provider order as the priority intervention?
A. Hold the next digoxin dose and notify the provider immediately ✓ CORRECT
B. Administer the scheduled dose with a slow heart rate assessment
C. Give atropine 0.5 mg IV push and prepare for transcutaneous pacing
D. Draw a repeat digoxin level and administer the dose if it is below 2.0 ng/mL
Correct Answer: A
Rationale: A digoxin level of 2.8 ng/mL exceeds the therapeutic range of 0.5 to 2.0 ng/mL and
the bradycardia indicates toxicity, so holding the dose and notifying the provider is the priority
to prevent further cardiac suppression. Administering the scheduled dose would worsen
toxicity, and atropine is not indicated without provider orders for symptomatic bradycardia.
Always correlate digoxin levels with clinical presentation rather than relying on the number
alone.
Question 2 of 50
A 62-year-old patient with hypertension has been taking lisinopril 20 mg daily for three
months. At the follow-up clinic visit, the patient reports a persistent dry cough that started
two weeks after beginning the medication and interferes with sleep. The blood pressure is
128/78 mmHg and the patient denies angioedema or dizziness. The nurse anticipates the
provider will most likely recommend which action?
,A. Add a thiazide diuretic to enhance the antihypertensive effect
B. Discontinue lisinopril and consider an angiotensin receptor blocker ✓ CORRECT
C. Prescribe a cough suppressant with dextromethorphan for nighttime relief
D. Reduce the lisinopril dose to 10 mg daily and monitor for two more weeks
Correct Answer: B
Rationale: A dry, nonproductive cough is a well-known adverse effect of ACE inhibitors
caused by bradykinin accumulation, and switching to an ARB such as losartan typically
resolves the cough while maintaining blood pressure control. Adding a cough suppressant
masks the symptom without addressing the underlying medication cause, and dose reduction
rarely eliminates this class effect. Documenting the cough and communicating it to the
provider allows for timely medication adjustment.
Question 3 of 50
A 55-year-old patient with acute decompensated heart failure is receiving furosemide 40 mg
IV twice daily. On the second day of therapy, the nurse reviews the morning laboratory results
and notes a potassium level of 3.2 mEq/L. The patient reports mild muscle weakness and
has 2+ pitting edema in the lower extremities. Which nursing intervention is the priority
before administering the next scheduled dose?
A. Administer the furosemide and recheck the potassium level in four hours
B. Hold the furosemide and notify the provider of the hypokalemia
C. Administer potassium chloride 20 mEq orally per protocol and monitor the patient ✓
CORRECT
D. Increase the patient's oral fluid intake to enhance potassium reabsorption
Correct Answer: C
Rationale: Furosemide is a loop diuretic that causes significant potassium wasting, and a
level of 3.2 mEq/L represents mild hypokalemia that requires replacement per protocol to
prevent cardiac dysrhythmias while continuing the necessary diuretic therapy. Holding the
furosemide may worsen the patient's fluid overload status, and increasing fluid intake
contradicts the treatment goal for heart failure. Always verify the potassium level is within a
safe range before giving loop diuretics when protocol allows replacement.
Question 4 of 50
A 48-year-old patient admitted for a hypertensive emergency has a blood pressure of 210/120
mmHg. The provider orders nicardipine IV drip at 5 mg per hour with parameters to keep
systolic pressure between 140 and 160 mmHg. Thirty minutes after initiation, the nurse notes
the blood pressure is 158/96 mmHg and the patient reports a headache. Which action should
the nurse take first?
A. Increase the nicardipine infusion rate to achieve a lower pressure faster
, B. Administer acetaminophen 650 mg orally for the headache
C. Place the patient in a supine position with the legs elevated
D. Continue the current infusion rate and reassess the blood pressure in 15 minutes ✓
CORRECT
Correct Answer: D
Rationale: The blood pressure of 158/96 mmHg falls within the prescribed target range of 140
to 160 mmHg systolic, so continuing the current rate and reassessing prevents overshooting
into hypotension during titration. Increasing the rate would risk dropping the pressure too
rapidly and compromising cerebral perfusion, and acetaminophen addresses only the
symptom rather than the therapeutic goal. In hypertensive emergencies, gradual reduction
protects organ perfusion and prevents ischemic complications.
Question 5 of 50
A 70-year-old patient with atrial fibrillation takes warfarin 5 mg daily and presents to the
emergency department with a nosebleed that has persisted for 30 minutes. The INR is 5.2 and
the patient reports eating large amounts of spinach over the past week. The nurse anticipates
which provider order as the priority?
A. Hold warfarin and administer phytonadione vitamin K subcutaneously ✓ CORRECT
B. Continue warfarin and apply bilateral nasal packing immediately
C. Administer fresh frozen plasma and resume the usual warfarin dose tonight
D. Transfuse two units of packed red blood cells and monitor for hematuria
Correct Answer: A
Rationale: An INR of 5.2 with active bleeding indicates supratherapeutic anticoagulation, and
vitamin K is the specific antidote for warfarin that promotes synthesis of functional clotting
factors to reverse the drug's effect. Continuing warfarin would worsen the bleeding, and fresh
frozen plasma is typically reserved for life-threatening bleeding rather than a manageable
nosebleed. The patient's increased intake of vitamin K-rich foods suggests dietary
inconsistency, which reinforces the need for thorough anticoagulation education.
Question 6 of 50
A 54-year-old patient with hyperlipidemia started atorvastatin 40 mg daily four weeks ago.
During a telephone follow-up, the patient reports new onset of bilateral thigh muscle pain and
dark-colored urine. The patient denies fever or recent strenuous exercise. The nurse should
instruct the patient to take which action?
A. Take ibuprofen 400 mg every six hours for the muscle pain
B. Stop the atorvastatin and contact the provider for a creatine kinase level ✓ CORRECT
C. Increase fluid intake to dilute the urine and continue the medication
D. Schedule an appointment in two weeks if the symptoms do not improve
