NUR 378 FINAL EXAM – PHARMACOLOGY STUDY GUIDE | TESTBANK | PRACTICE
QUESTIONS & ANSWERS | EXAM PREPARATION | ADVANCED REVIEW |
COMPREHENSIVE PRACTICE EXAM | LATEST UPDATE 2026/2027
Examiner:
University School of Nursing (Course: NUR 378 – Pharmacology)
TABLE OF CONTENTS
1. Principles of Pharmacokinetics
2. Principles of Pharmacodynamics
3. Medication Safety and Error Prevention
4. Dosage Calculations and Drug Administration
5. Autonomic Nervous System Pharmacology
6. Cardiovascular Pharmacology
7. Renal and Electrolyte Pharmacology
8. Endocrine Pharmacology
9. Respiratory Pharmacology
10. Gastrointestinal Pharmacology
11. Antimicrobial Pharmacology
12. Pain Management and Anesthetics
13. Central Nervous System Pharmacology
14. Oncology Pharmacology
15. Immunologic and Anti-inflammatory Agents
16. Women's and Men's Health Pharmacology
17. Pediatric and Geriatric Pharmacology
18. Toxicology and Antidotes
19. Clinical Case-Based Pharmacology
20. Professional Nursing Responsibilities in Medication Management
PHARMACOLOGY || PHARMACOKINETICS || PHARMACODYNAMICS || ADVERSE
DRUG REACTIONS || DRUG INTERACTIONS || DOSAGE CALCULATIONS || HIGH-
ALERT MEDICATIONS || ANTIMICROBIALS || CARDIOVASCULAR AGENTS ||
,ENDOCRINE DRUGS || CNS PHARMACOLOGY || ONCOLOGY || TOXICOLOGY ||
EVIDENCE-BASED PRACTICE || CLINICAL DECISION-MAKING || MEDICATION
SAFETY || PATIENT EDUCATION || NURSING RESPONSIBILITIES || COMPLIANCE ||
ADVANCED REVIEW
QUESTION 1.
A 72-year-old patient with chronic kidney disease stage IV is prescribed gentamicin
for a severe gram-negative infection. Which pharmacokinetic principle should most
strongly influence the nurse's monitoring plan?
A. Reduced renal clearance increases the risk of drug accumulation and toxicity.
B. Increased hepatic metabolism shortens the drug's half-life.
C. Enhanced gastrointestinal absorption necessitates lower oral doses.
D. Increased protein binding decreases free drug concentration.
Correct Answer: A. Reduced renal clearance increases the risk of drug
accumulation and toxicity.
Explanation: Aminoglycosides are primarily eliminated through the kidneys.
Impaired renal function significantly prolongs elimination and increases the risk of
nephrotoxicity and ototoxicity, making therapeutic drug monitoring essential. The
remaining options do not accurately describe the primary pharmacokinetic concern
associated with gentamicin in advanced kidney disease.
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QUESTION 2.
A patient receiving intravenous unfractionated heparin develops sudden
hypotension, hematuria, and markedly prolonged activated partial thromboplastin
time (aPTT). Which intervention should the nurse anticipate first?
A. Administer vitamin K intravenously.
B. Administer protamine sulfate.
C. Administer fresh frozen plasma only.
D. Administer idarucizumab.
, Correct Answer: B. Administer protamine sulfate.
Explanation: Protamine sulfate is the specific antidote for unfractionated heparin
and rapidly neutralizes its anticoagulant effects. Vitamin K reverses warfarin,
idarucizumab reverses dabigatran, and plasma alone is not the primary antidote
for heparin toxicity.
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QUESTION 3.
A patient receiving lisinopril develops facial swelling, difficulty swallowing, and
hoarseness shortly after the morning dose. What is the nurse's priority action?
A. Administer the next dose with food.
B. Encourage oral fluids and continue monitoring.
C. Hold the medication and initiate emergency management for angioedema.
D. Reduce the dose and reassess in one hour.
Correct Answer: C. Hold the medication and initiate emergency management
for angioedema.
Explanation: ACE inhibitor-induced angioedema is a potentially life-threatening
emergency because it can rapidly compromise the airway. The medication should
be discontinued immediately while emergency treatment is initiated. Dose
reduction or observation alone is inappropriate.
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QUESTION 4.
A patient with atrial fibrillation taking warfarin begins trimethoprim-
sulfamethoxazole therapy. Which outcome is most likely if no dosage adjustment is
made?
A. Decreased INR due to enzyme induction.
B. Reduced anticoagulant effect from impaired absorption.
, C. Therapeutic INR with no clinically significant interaction.
D. Increased INR and elevated bleeding risk.
Correct Answer: D. Increased INR and elevated bleeding risk.
Explanation: Trimethoprim-sulfamethoxazole inhibits warfarin metabolism,
increasing anticoagulant activity and significantly raising bleeding risk. Careful INR
monitoring and dose adjustment are generally required. The other responses are
inconsistent with this well-recognized interaction.
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QUESTION 5.
A patient with heart failure is receiving furosemide. Which assessment finding most
strongly suggests the development of a clinically significant adverse effect?
A. Progressive muscle weakness with flattened T waves on ECG.
B. Mild increase in urine output.
C. Blood pressure improvement after treatment.
D. Weight loss of 1 kg after diuresis.
Correct Answer: A. Progressive muscle weakness with flattened T waves on
ECG.
Explanation: Loop diuretics commonly cause hypokalemia, which may present with
muscle weakness and characteristic ECG changes. The remaining findings are
expected therapeutic effects rather than complications requiring immediate
intervention.
────────────────────────────────────────
QUESTION 6.
A hospitalized patient receiving vancomycin develops rising serum creatinine despite
therapeutic trough concentrations. Which nursing interpretation is most appropriate?
A. Therapeutic trough levels eliminate nephrotoxicity risk.
B. Renal injury may occur despite therapeutic serum concentrations.
QUESTIONS & ANSWERS | EXAM PREPARATION | ADVANCED REVIEW |
COMPREHENSIVE PRACTICE EXAM | LATEST UPDATE 2026/2027
Examiner:
University School of Nursing (Course: NUR 378 – Pharmacology)
TABLE OF CONTENTS
1. Principles of Pharmacokinetics
2. Principles of Pharmacodynamics
3. Medication Safety and Error Prevention
4. Dosage Calculations and Drug Administration
5. Autonomic Nervous System Pharmacology
6. Cardiovascular Pharmacology
7. Renal and Electrolyte Pharmacology
8. Endocrine Pharmacology
9. Respiratory Pharmacology
10. Gastrointestinal Pharmacology
11. Antimicrobial Pharmacology
12. Pain Management and Anesthetics
13. Central Nervous System Pharmacology
14. Oncology Pharmacology
15. Immunologic and Anti-inflammatory Agents
16. Women's and Men's Health Pharmacology
17. Pediatric and Geriatric Pharmacology
18. Toxicology and Antidotes
19. Clinical Case-Based Pharmacology
20. Professional Nursing Responsibilities in Medication Management
PHARMACOLOGY || PHARMACOKINETICS || PHARMACODYNAMICS || ADVERSE
DRUG REACTIONS || DRUG INTERACTIONS || DOSAGE CALCULATIONS || HIGH-
ALERT MEDICATIONS || ANTIMICROBIALS || CARDIOVASCULAR AGENTS ||
,ENDOCRINE DRUGS || CNS PHARMACOLOGY || ONCOLOGY || TOXICOLOGY ||
EVIDENCE-BASED PRACTICE || CLINICAL DECISION-MAKING || MEDICATION
SAFETY || PATIENT EDUCATION || NURSING RESPONSIBILITIES || COMPLIANCE ||
ADVANCED REVIEW
QUESTION 1.
A 72-year-old patient with chronic kidney disease stage IV is prescribed gentamicin
for a severe gram-negative infection. Which pharmacokinetic principle should most
strongly influence the nurse's monitoring plan?
A. Reduced renal clearance increases the risk of drug accumulation and toxicity.
B. Increased hepatic metabolism shortens the drug's half-life.
C. Enhanced gastrointestinal absorption necessitates lower oral doses.
D. Increased protein binding decreases free drug concentration.
Correct Answer: A. Reduced renal clearance increases the risk of drug
accumulation and toxicity.
Explanation: Aminoglycosides are primarily eliminated through the kidneys.
Impaired renal function significantly prolongs elimination and increases the risk of
nephrotoxicity and ototoxicity, making therapeutic drug monitoring essential. The
remaining options do not accurately describe the primary pharmacokinetic concern
associated with gentamicin in advanced kidney disease.
────────────────────────────────────────
QUESTION 2.
A patient receiving intravenous unfractionated heparin develops sudden
hypotension, hematuria, and markedly prolonged activated partial thromboplastin
time (aPTT). Which intervention should the nurse anticipate first?
A. Administer vitamin K intravenously.
B. Administer protamine sulfate.
C. Administer fresh frozen plasma only.
D. Administer idarucizumab.
, Correct Answer: B. Administer protamine sulfate.
Explanation: Protamine sulfate is the specific antidote for unfractionated heparin
and rapidly neutralizes its anticoagulant effects. Vitamin K reverses warfarin,
idarucizumab reverses dabigatran, and plasma alone is not the primary antidote
for heparin toxicity.
────────────────────────────────────────
QUESTION 3.
A patient receiving lisinopril develops facial swelling, difficulty swallowing, and
hoarseness shortly after the morning dose. What is the nurse's priority action?
A. Administer the next dose with food.
B. Encourage oral fluids and continue monitoring.
C. Hold the medication and initiate emergency management for angioedema.
D. Reduce the dose and reassess in one hour.
Correct Answer: C. Hold the medication and initiate emergency management
for angioedema.
Explanation: ACE inhibitor-induced angioedema is a potentially life-threatening
emergency because it can rapidly compromise the airway. The medication should
be discontinued immediately while emergency treatment is initiated. Dose
reduction or observation alone is inappropriate.
────────────────────────────────────────
QUESTION 4.
A patient with atrial fibrillation taking warfarin begins trimethoprim-
sulfamethoxazole therapy. Which outcome is most likely if no dosage adjustment is
made?
A. Decreased INR due to enzyme induction.
B. Reduced anticoagulant effect from impaired absorption.
, C. Therapeutic INR with no clinically significant interaction.
D. Increased INR and elevated bleeding risk.
Correct Answer: D. Increased INR and elevated bleeding risk.
Explanation: Trimethoprim-sulfamethoxazole inhibits warfarin metabolism,
increasing anticoagulant activity and significantly raising bleeding risk. Careful INR
monitoring and dose adjustment are generally required. The other responses are
inconsistent with this well-recognized interaction.
────────────────────────────────────────
QUESTION 5.
A patient with heart failure is receiving furosemide. Which assessment finding most
strongly suggests the development of a clinically significant adverse effect?
A. Progressive muscle weakness with flattened T waves on ECG.
B. Mild increase in urine output.
C. Blood pressure improvement after treatment.
D. Weight loss of 1 kg after diuresis.
Correct Answer: A. Progressive muscle weakness with flattened T waves on
ECG.
Explanation: Loop diuretics commonly cause hypokalemia, which may present with
muscle weakness and characteristic ECG changes. The remaining findings are
expected therapeutic effects rather than complications requiring immediate
intervention.
────────────────────────────────────────
QUESTION 6.
A hospitalized patient receiving vancomycin develops rising serum creatinine despite
therapeutic trough concentrations. Which nursing interpretation is most appropriate?
A. Therapeutic trough levels eliminate nephrotoxicity risk.
B. Renal injury may occur despite therapeutic serum concentrations.
