NURS 6521N Midterm V1 | NURS 6521N
Advanced Pharmacology | Actual Q&A
with Rationale (NURS6521N Midterm) |
Walden University
1. A 65-year-old patient with heart failure is prescribed digoxin. Which of the following
clinical manifestations should the nurse identify as an early sign of digoxin toxicity?
A. Hyperkalemia and increased urinary output
B. Anorexia, nausea, and vomiting
C. Tachycardia and hypertensive crisis
D. Visual disturbances such as blurred vision and halo effect
Answer: B
Rationale: Gastrointestinal symptoms such as anorexia and nausea are typically the
earliest indicators of digoxin toxicity in the clinical setting. While visual disturbances are a
classic sign, they often occur later in the progression of toxicity than gastrointestinal
distress. The nurse must monitor for these non-specific symptoms to prevent more serious
cardiac arrhythmias associated with high serum levels.
2. A patient is being treated with an ACE inhibitor for hypertension. The patient develops a
persistent, dry cough and asks why this is happening. What is the pharmacological basis for
this side effect?
A. Increased production of angiotensin II in the lungs
,B. Direct irritation of the bronchial mucosa by the drug
C. A localized allergic reaction to the sulfonamide component
D. Accumulation of bradykinin in the respiratory tract
Answer: D
Rationale: ACE inhibitors prevent the breakdown of bradykinin, leading to its
accumulation in the lungs and subsequent irritation of the sensory nerves. This
biochemical mechanism is responsible for the characteristic dry, non-productive cough that
often necessitates a change in therapy. Switching to an Angiotensin Receptor Blocker (ARB)
is the standard intervention because ARBs do not affect bradykinin levels.
3. When administering a drug with a narrow therapeutic index, which action by the nurse is
most appropriate?
A. Monitor for the drug’s effects only once per week
B. Monitor peak and trough serum drug levels closely
C. Administer the drug on an as-needed basis for symptom control
D. Encourage the patient to double the dose if symptoms persist
Answer: B
Rationale: Drugs with a narrow therapeutic index have a small margin of safety between
the effective dose and the toxic dose. Frequent monitoring of serum drug levels is essential
to ensure the patient remains within the therapeutic range and to avoid severe toxicity. The
,nurse must coordinate blood draws precisely with the timing of drug administration to
obtain accurate peak and trough data.
4. An elderly patient is prescribed a lipophilic medication. How does the physiological change
in body composition in older adults affect the distribution of this drug?
A. The drug will be excreted more rapidly via the kidneys
B. The drug will have a decreased effect due to higher muscle mass
C. The drug will have an increased volume of distribution and a longer half-life
D. The drug will achieve higher plasma concentrations more quickly
Answer: C
Rationale: Older adults typically experience an increase in body fat percentage and a
decrease in total body water and lean muscle mass. Lipophilic (fat-soluble) drugs distribute
into adipose tissue, leading to an increased volume of distribution and a prolonged
duration of action. Nurses must be aware that this can lead to drug accumulation and an
increased risk for adverse effects over time.
5. A patient is receiving gentamicin for a severe infection. Which laboratory values must the
nurse prioritize to monitor for potential adverse effects?
A. Hemoglobin and Hematocrit
B. Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT)
C. Prothrombin time and INR
, D. Serum creatinine and blood urea nitrogen (BUN)
Answer: D
Rationale: Gentamicin is an aminoglycoside antibiotic known for its significant
nephrotoxic and ototoxic potential. Monitoring renal function through BUN and creatinine
is critical to detect early signs of kidney injury and adjust the dosage accordingly. The nurse
should also assess the patient for tinnitus or hearing loss, which could indicate
vestibulocochlear nerve damage.
6. A nurse is providing discharge teaching for a patient starting warfarin therapy. Which
dietary instruction is most important for maintaining a stable therapeutic level?
A. Completely eliminate all green leafy vegetables from the diet
B. Maintain a consistent intake of foods rich in vitamin K
C. Increase the intake of foods high in vitamin K to prevent bleeding
D. Drink at least 8 ounces of grapefruit juice daily
Answer: B
Rationale: Warfarin works by inhibiting the synthesis of vitamin K-dependent clotting
factors, so sudden changes in vitamin K intake can drastically alter the INR. Patients do not
need to avoid vitamin K entirely but must ensure their consumption is consistent from day
to day to avoid therapeutic instability. The nurse should educate the patient that a sudden
increase in greens can lower the INR, while a decrease can increase the risk of bleeding.
Advanced Pharmacology | Actual Q&A
with Rationale (NURS6521N Midterm) |
Walden University
1. A 65-year-old patient with heart failure is prescribed digoxin. Which of the following
clinical manifestations should the nurse identify as an early sign of digoxin toxicity?
A. Hyperkalemia and increased urinary output
B. Anorexia, nausea, and vomiting
C. Tachycardia and hypertensive crisis
D. Visual disturbances such as blurred vision and halo effect
Answer: B
Rationale: Gastrointestinal symptoms such as anorexia and nausea are typically the
earliest indicators of digoxin toxicity in the clinical setting. While visual disturbances are a
classic sign, they often occur later in the progression of toxicity than gastrointestinal
distress. The nurse must monitor for these non-specific symptoms to prevent more serious
cardiac arrhythmias associated with high serum levels.
2. A patient is being treated with an ACE inhibitor for hypertension. The patient develops a
persistent, dry cough and asks why this is happening. What is the pharmacological basis for
this side effect?
A. Increased production of angiotensin II in the lungs
,B. Direct irritation of the bronchial mucosa by the drug
C. A localized allergic reaction to the sulfonamide component
D. Accumulation of bradykinin in the respiratory tract
Answer: D
Rationale: ACE inhibitors prevent the breakdown of bradykinin, leading to its
accumulation in the lungs and subsequent irritation of the sensory nerves. This
biochemical mechanism is responsible for the characteristic dry, non-productive cough that
often necessitates a change in therapy. Switching to an Angiotensin Receptor Blocker (ARB)
is the standard intervention because ARBs do not affect bradykinin levels.
3. When administering a drug with a narrow therapeutic index, which action by the nurse is
most appropriate?
A. Monitor for the drug’s effects only once per week
B. Monitor peak and trough serum drug levels closely
C. Administer the drug on an as-needed basis for symptom control
D. Encourage the patient to double the dose if symptoms persist
Answer: B
Rationale: Drugs with a narrow therapeutic index have a small margin of safety between
the effective dose and the toxic dose. Frequent monitoring of serum drug levels is essential
to ensure the patient remains within the therapeutic range and to avoid severe toxicity. The
,nurse must coordinate blood draws precisely with the timing of drug administration to
obtain accurate peak and trough data.
4. An elderly patient is prescribed a lipophilic medication. How does the physiological change
in body composition in older adults affect the distribution of this drug?
A. The drug will be excreted more rapidly via the kidneys
B. The drug will have a decreased effect due to higher muscle mass
C. The drug will have an increased volume of distribution and a longer half-life
D. The drug will achieve higher plasma concentrations more quickly
Answer: C
Rationale: Older adults typically experience an increase in body fat percentage and a
decrease in total body water and lean muscle mass. Lipophilic (fat-soluble) drugs distribute
into adipose tissue, leading to an increased volume of distribution and a prolonged
duration of action. Nurses must be aware that this can lead to drug accumulation and an
increased risk for adverse effects over time.
5. A patient is receiving gentamicin for a severe infection. Which laboratory values must the
nurse prioritize to monitor for potential adverse effects?
A. Hemoglobin and Hematocrit
B. Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT)
C. Prothrombin time and INR
, D. Serum creatinine and blood urea nitrogen (BUN)
Answer: D
Rationale: Gentamicin is an aminoglycoside antibiotic known for its significant
nephrotoxic and ototoxic potential. Monitoring renal function through BUN and creatinine
is critical to detect early signs of kidney injury and adjust the dosage accordingly. The nurse
should also assess the patient for tinnitus or hearing loss, which could indicate
vestibulocochlear nerve damage.
6. A nurse is providing discharge teaching for a patient starting warfarin therapy. Which
dietary instruction is most important for maintaining a stable therapeutic level?
A. Completely eliminate all green leafy vegetables from the diet
B. Maintain a consistent intake of foods rich in vitamin K
C. Increase the intake of foods high in vitamin K to prevent bleeding
D. Drink at least 8 ounces of grapefruit juice daily
Answer: B
Rationale: Warfarin works by inhibiting the synthesis of vitamin K-dependent clotting
factors, so sudden changes in vitamin K intake can drastically alter the INR. Patients do not
need to avoid vitamin K entirely but must ensure their consumption is consistent from day
to day to avoid therapeutic instability. The nurse should educate the patient that a sudden
increase in greens can lower the INR, while a decrease can increase the risk of bleeding.
