NSG 3253 Pharmacology II Final Exam Study Guide |
High-Yield Questions, Answers & Rationales
Question 1
What classic visual disturbance is a hallmark symptom of digitalis
(digoxin) toxicity?
• A. Seeing yellowish-green halos or blurred vision around lights
• B. Complete and sudden bilateral blindness within minutes
• C. Persistent double vision and nystagmus looking left
• D. Total loss of color vision affecting only red and green
Correct Answer: A. Seeing yellowish-green halos or blurred vision
around lights
Detailed Rationale: Digoxin toxicity frequently manifests with
neurological and visual disturbances, classically including xanthopsia
(yellow-green vision), photophobia, and blurred or halo vision,
alongside gastrointestinal distress and cardiac arrhythmias.
Question 2
What specific pharmacological reversal agent is administered
immediately to neutralize a severe overdose of unfractionated heparin?
• A. Protamine sulfate
• B. Vitamin K phytadione
, • C. Fresh frozen plasma alone
• D. Andexanet alfa
Correct Answer: A. Protamine sulfate
Detailed Rationale: Protamine sulfate is a positively charged basic
protein that binds chemically to acidic heparin molecules, forming an
inactive complex and rapidly neutralizing its anticoagulant effect.
Question 3
What life-threatening adverse reaction can occur early in treatment
with angiotensin-converting enzyme (ACE) inhibitors, requiring
immediate discontinuation and emergency management?
• A. Angioedema involving swelling of the lips, tongue, and glottis
• B. Severe sudden bone marrow aplasia and profound
agranulocytosis
• C. Rapid permanent destruction of the aortic heart valve
• D. Acute metabolic alkalosis and severe tetany
Correct Answer: A. Angioedema involving swelling of the lips, tongue,
and glottis
Detailed Rationale: ACE inhibitors can cause angioedema due to the
accumulation of bradykinin. Even though it is relatively rare, it can cause
fatal airway obstruction and requires immediate cessation of the drug
and emergency intervention.
Question 4
,What severe cardiovascular complication can occur if a beta-adrenergic
blocking agent (such as metoprolol) is discontinued abruptly rather than
tapered?
• A. Rebound hypertension, severe tachycardia, and exacerbation of
ischemic myocardial events
• B. Sudden profound hypotension and circulatory collapse
• C. Complete heart block and lifelong bradycardia
• D. Rapid onset congestive heart failure with pulmonary edema
Correct Answer: A. Rebound hypertension, severe tachycardia, and
exacerbation of ischemic myocardial events
Detailed Rationale: Chronic beta-blocker therapy causes upregulation
of beta-receptors. Abrupt cessation exposes the heart to high
circulating catecholamines, precipitating rebound hypertension, severe
tachycardia, and potential myocardial infarction.
Question 5
What prominent black box warning is associated with glucagon-like
peptide-1 (GLP-1) receptor agonists such as liraglutide?
• A. Risk of thyroid C-cell tumors (medullary thyroid carcinoma)
based on rodent studies
• B. Severe irreversible aplastic anemia and pancytopenia
• C. Permanent retinal detachment and acute glaucoma
• D. Rapid calcification of coronary arteries
Correct Answer: A. Risk of thyroid C-cell tumors (medullary thyroid
carcinoma) based on rodent studies
, Detailed Rationale: GLP-1 receptor agonists carry a black box warning
for thyroid C-cell tumors observed in animal testing. They are
contraindicated in patients with a personal or family history of
medullary thyroid carcinoma or MEN 2.
Question 6
Which antithyroid medication is preferred during the first trimester of
pregnancy due to a lower risk of specific fetal teratogenic
malformations associated with the alternative drug?
• A. Propylthiouracil (PTU)
• B. Methimazole
• C. Radioactive iodine (I-131)
• D. Potassium iodide supersaturated solution
Correct Answer: A. Propylthiouracil (PTU)
Detailed Rationale: Methimazole is associated with aplasia cutis and
choanal atresia in developing fetuses during the first trimester.
Therefore, PTU is preferred during early pregnancy, though it carries a
risk of hepatotoxicity.
Question 7
What hallmark clinical manifestations should the nurse monitor for in a
patient receiving long-term, high-dose systemic corticosteroid therapy?
• A. Cushingoid appearance (moon face, buffalo hump, central
obesity), hyperglycemia, and increased susceptibility to infection
• B. Severe hypoglycemia, profound weight loss, and
hyperpigmentation of the skin
High-Yield Questions, Answers & Rationales
Question 1
What classic visual disturbance is a hallmark symptom of digitalis
(digoxin) toxicity?
• A. Seeing yellowish-green halos or blurred vision around lights
• B. Complete and sudden bilateral blindness within minutes
• C. Persistent double vision and nystagmus looking left
• D. Total loss of color vision affecting only red and green
Correct Answer: A. Seeing yellowish-green halos or blurred vision
around lights
Detailed Rationale: Digoxin toxicity frequently manifests with
neurological and visual disturbances, classically including xanthopsia
(yellow-green vision), photophobia, and blurred or halo vision,
alongside gastrointestinal distress and cardiac arrhythmias.
Question 2
What specific pharmacological reversal agent is administered
immediately to neutralize a severe overdose of unfractionated heparin?
• A. Protamine sulfate
• B. Vitamin K phytadione
, • C. Fresh frozen plasma alone
• D. Andexanet alfa
Correct Answer: A. Protamine sulfate
Detailed Rationale: Protamine sulfate is a positively charged basic
protein that binds chemically to acidic heparin molecules, forming an
inactive complex and rapidly neutralizing its anticoagulant effect.
Question 3
What life-threatening adverse reaction can occur early in treatment
with angiotensin-converting enzyme (ACE) inhibitors, requiring
immediate discontinuation and emergency management?
• A. Angioedema involving swelling of the lips, tongue, and glottis
• B. Severe sudden bone marrow aplasia and profound
agranulocytosis
• C. Rapid permanent destruction of the aortic heart valve
• D. Acute metabolic alkalosis and severe tetany
Correct Answer: A. Angioedema involving swelling of the lips, tongue,
and glottis
Detailed Rationale: ACE inhibitors can cause angioedema due to the
accumulation of bradykinin. Even though it is relatively rare, it can cause
fatal airway obstruction and requires immediate cessation of the drug
and emergency intervention.
Question 4
,What severe cardiovascular complication can occur if a beta-adrenergic
blocking agent (such as metoprolol) is discontinued abruptly rather than
tapered?
• A. Rebound hypertension, severe tachycardia, and exacerbation of
ischemic myocardial events
• B. Sudden profound hypotension and circulatory collapse
• C. Complete heart block and lifelong bradycardia
• D. Rapid onset congestive heart failure with pulmonary edema
Correct Answer: A. Rebound hypertension, severe tachycardia, and
exacerbation of ischemic myocardial events
Detailed Rationale: Chronic beta-blocker therapy causes upregulation
of beta-receptors. Abrupt cessation exposes the heart to high
circulating catecholamines, precipitating rebound hypertension, severe
tachycardia, and potential myocardial infarction.
Question 5
What prominent black box warning is associated with glucagon-like
peptide-1 (GLP-1) receptor agonists such as liraglutide?
• A. Risk of thyroid C-cell tumors (medullary thyroid carcinoma)
based on rodent studies
• B. Severe irreversible aplastic anemia and pancytopenia
• C. Permanent retinal detachment and acute glaucoma
• D. Rapid calcification of coronary arteries
Correct Answer: A. Risk of thyroid C-cell tumors (medullary thyroid
carcinoma) based on rodent studies
, Detailed Rationale: GLP-1 receptor agonists carry a black box warning
for thyroid C-cell tumors observed in animal testing. They are
contraindicated in patients with a personal or family history of
medullary thyroid carcinoma or MEN 2.
Question 6
Which antithyroid medication is preferred during the first trimester of
pregnancy due to a lower risk of specific fetal teratogenic
malformations associated with the alternative drug?
• A. Propylthiouracil (PTU)
• B. Methimazole
• C. Radioactive iodine (I-131)
• D. Potassium iodide supersaturated solution
Correct Answer: A. Propylthiouracil (PTU)
Detailed Rationale: Methimazole is associated with aplasia cutis and
choanal atresia in developing fetuses during the first trimester.
Therefore, PTU is preferred during early pregnancy, though it carries a
risk of hepatotoxicity.
Question 7
What hallmark clinical manifestations should the nurse monitor for in a
patient receiving long-term, high-dose systemic corticosteroid therapy?
• A. Cushingoid appearance (moon face, buffalo hump, central
obesity), hyperglycemia, and increased susceptibility to infection
• B. Severe hypoglycemia, profound weight loss, and
hyperpigmentation of the skin
