NSG 3253 Pharmacotherapeutics II Exam 1, 2
& Final Review | Complete Practice Question
Bank 2026/2027
Question 1
What primary electrolyte imbalance should a nurse monitor for in a
patient prescribed spironolactone, a potassium-sparing diuretic?
• A. Hyperkalemia due to aldosterone receptor antagonism in the
distal nephron
• B. Severe hypokalemia and metabolic alkalosis
• C. Rapid hyponatremia and hypercalcemia
• D. Profound hypomagnesemia and hyperphosphatemia
Correct Answer: A. Hyperkalemia due to aldosterone receptor
antagonism in the distal nephron
Detailed Rationale: Spironolactone blocks aldosterone receptors in the
late distal convoluted tubule and collecting ducts, reducing sodium
reabsorption while retaining potassium, which can lead to dangerous
hyperkalemia, especially if combined with ACE inhibitors or potassium
supplements.
Question 2
What critical drug interaction must be assessed before administering
sublingual nitroglycerin to a patient experiencing chest pain?
, • A. Concurrent use of phosphodiesterase-5 (PDE-5) inhibitors (e.g.,
sildenafil) within the past 24 to 48 hours
• B. Recent ingestion of high-fat meals within the last 2 hours
• C. Concurrent use of over-the-counter NSAIDs like ibuprofen
• D. Recent administration of low-dose daily aspirin
Correct Answer: A. Concurrent use of phosphodiesterase-5 (PDE-5)
inhibitors (e.g., sildenafil) within the past 24 to 48 hours
Detailed Rationale: Both nitrates and PDE-5 inhibitors increase cyclic
GMP, leading to profound, life-threatening systemic hypotension and
cardiovascular collapse when combined.
Question 3
What electrolyte abnormality is frequently caused by loop diuretics like
furosemide, requiring careful clinical monitoring?
• A. Hypokalemia, hypomagnesemia, and hyponatremia
• B. Hyperkalemia and hypercalcemia
• C. Hypernatremia and metabolic acidosis
• D. Hyperphosphatemia and hypouricemia
Correct Answer: A. Hypokalemia, hypomagnesemia, and hyponatremia
Detailed Rationale: Loop diuretics inhibit the Na+/K+/2Cl-
cotransporter in the thick ascending limb of the loop of Henle, causing
substantial renal excretion of sodium, potassium, chloride, calcium, and
magnesium.
Question 4
,What physiological mechanism explains why non-selective beta-
blockers must be used with extreme caution in patients with asthma?
• A. Blockade of bronchial beta-2 receptors leads to acute
bronchoconstriction and airway resistance
• B. Stimulation of alpha-1 receptors triggers massive pulmonary
vasoconstriction
• C. Inhibition of muscarinic receptors causes excessive mucus
production
• D. Rapid depression of the medullary respiratory center
Correct Answer: A. Blockade of bronchial beta-2 receptors leads to
acute bronchoconstriction and airway resistance
Detailed Rationale: Non-selective beta-blockers block both beta-1
(heart) and beta-2 (lungs) receptors. Blocking beta-2 receptors prevents
bronchodilation, potentially triggering severe asthma exacerbations or
bronchospasm.
Question 5
What life-threatening adverse effect can occur if insulin lispro is
administered without ensuring the patient eats a meal immediately?
• A. Severe acute hypoglycemia due to its rapid onset and peak
action within 30 to 90 minutes
• B. Rapid onset diabetic ketoacidosis with high blood glucose
• C. Immediate cardiovascular collapse and pulmonary edema
• D. Severe metabolic alkalosis and muscle tetany
, Correct Answer: A. Severe acute hypoglycemia due to its rapid onset
and peak action within 30 to 90 minutes
Detailed Rationale: Insulin lispro is a rapid-acting analog with an onset
of 15 minutes and peak around 30-90 minutes. Administering it without
food causes a sharp drop in blood glucose, leading to dangerous
hypoglycemia.
Question 6
What safety precaution is critical when initiating thyroid hormone
replacement therapy (levothyroxine) in an elderly patient with known
coronary artery disease?
• A. Start with a low initial dose and titrate slowly to avoid
precipitating myocardial ischemia or angina
• B. Double the standard maintenance dose to ensure rapid
metabolic normalization
• C. Administer the medication exclusively at bedtime with a high-
protein snack
• D. Combine it immediately with a high-dose stimulant to boost
energy levels
Correct Answer: A. Start with a low initial dose and titrate slowly to
avoid precipitating myocardial ischemia or angina
Detailed Rationale: Levothyroxine increases cellular metabolism and
myocardial oxygen demand. In patients with coronary artery disease, a
sudden increase in metabolic rate can trigger angina, myocardial
infarction, or tachyarrhythmias, necessitating a low and slow titration.
Question 7
& Final Review | Complete Practice Question
Bank 2026/2027
Question 1
What primary electrolyte imbalance should a nurse monitor for in a
patient prescribed spironolactone, a potassium-sparing diuretic?
• A. Hyperkalemia due to aldosterone receptor antagonism in the
distal nephron
• B. Severe hypokalemia and metabolic alkalosis
• C. Rapid hyponatremia and hypercalcemia
• D. Profound hypomagnesemia and hyperphosphatemia
Correct Answer: A. Hyperkalemia due to aldosterone receptor
antagonism in the distal nephron
Detailed Rationale: Spironolactone blocks aldosterone receptors in the
late distal convoluted tubule and collecting ducts, reducing sodium
reabsorption while retaining potassium, which can lead to dangerous
hyperkalemia, especially if combined with ACE inhibitors or potassium
supplements.
Question 2
What critical drug interaction must be assessed before administering
sublingual nitroglycerin to a patient experiencing chest pain?
, • A. Concurrent use of phosphodiesterase-5 (PDE-5) inhibitors (e.g.,
sildenafil) within the past 24 to 48 hours
• B. Recent ingestion of high-fat meals within the last 2 hours
• C. Concurrent use of over-the-counter NSAIDs like ibuprofen
• D. Recent administration of low-dose daily aspirin
Correct Answer: A. Concurrent use of phosphodiesterase-5 (PDE-5)
inhibitors (e.g., sildenafil) within the past 24 to 48 hours
Detailed Rationale: Both nitrates and PDE-5 inhibitors increase cyclic
GMP, leading to profound, life-threatening systemic hypotension and
cardiovascular collapse when combined.
Question 3
What electrolyte abnormality is frequently caused by loop diuretics like
furosemide, requiring careful clinical monitoring?
• A. Hypokalemia, hypomagnesemia, and hyponatremia
• B. Hyperkalemia and hypercalcemia
• C. Hypernatremia and metabolic acidosis
• D. Hyperphosphatemia and hypouricemia
Correct Answer: A. Hypokalemia, hypomagnesemia, and hyponatremia
Detailed Rationale: Loop diuretics inhibit the Na+/K+/2Cl-
cotransporter in the thick ascending limb of the loop of Henle, causing
substantial renal excretion of sodium, potassium, chloride, calcium, and
magnesium.
Question 4
,What physiological mechanism explains why non-selective beta-
blockers must be used with extreme caution in patients with asthma?
• A. Blockade of bronchial beta-2 receptors leads to acute
bronchoconstriction and airway resistance
• B. Stimulation of alpha-1 receptors triggers massive pulmonary
vasoconstriction
• C. Inhibition of muscarinic receptors causes excessive mucus
production
• D. Rapid depression of the medullary respiratory center
Correct Answer: A. Blockade of bronchial beta-2 receptors leads to
acute bronchoconstriction and airway resistance
Detailed Rationale: Non-selective beta-blockers block both beta-1
(heart) and beta-2 (lungs) receptors. Blocking beta-2 receptors prevents
bronchodilation, potentially triggering severe asthma exacerbations or
bronchospasm.
Question 5
What life-threatening adverse effect can occur if insulin lispro is
administered without ensuring the patient eats a meal immediately?
• A. Severe acute hypoglycemia due to its rapid onset and peak
action within 30 to 90 minutes
• B. Rapid onset diabetic ketoacidosis with high blood glucose
• C. Immediate cardiovascular collapse and pulmonary edema
• D. Severe metabolic alkalosis and muscle tetany
, Correct Answer: A. Severe acute hypoglycemia due to its rapid onset
and peak action within 30 to 90 minutes
Detailed Rationale: Insulin lispro is a rapid-acting analog with an onset
of 15 minutes and peak around 30-90 minutes. Administering it without
food causes a sharp drop in blood glucose, leading to dangerous
hypoglycemia.
Question 6
What safety precaution is critical when initiating thyroid hormone
replacement therapy (levothyroxine) in an elderly patient with known
coronary artery disease?
• A. Start with a low initial dose and titrate slowly to avoid
precipitating myocardial ischemia or angina
• B. Double the standard maintenance dose to ensure rapid
metabolic normalization
• C. Administer the medication exclusively at bedtime with a high-
protein snack
• D. Combine it immediately with a high-dose stimulant to boost
energy levels
Correct Answer: A. Start with a low initial dose and titrate slowly to
avoid precipitating myocardial ischemia or angina
Detailed Rationale: Levothyroxine increases cellular metabolism and
myocardial oxygen demand. In patients with coronary artery disease, a
sudden increase in metabolic rate can trigger angina, myocardial
infarction, or tachyarrhythmias, necessitating a low and slow titration.
Question 7
