, NUR 2474 Pharmacology for Professional
Nursing Midterm Exam Review Questions
and Answers with Rationale 2026/2027
Question 1
A client with a history of hypertension is prescribed nifedipine
(Procardia) alongside metoprolol (Lopressor). What is the
primary rationale for adding metoprolol to this medication
protocol?
A. To prevent reflex tachycardia induced by nifedipine
B. To eliminate the risk of peripheral edema
C. To potentiate the hypokalemic effects of loop diuretics
D. To replace the antihypertensive action completely
Correct Answer: A
Rationale: Dihydropyridine calcium channel blockers like
nifedipine can cause reflex tachycardia due to vasodilation and
subsequent baroreceptor activation. A beta-blocker like
metoprolol is frequently added to suppress this reflex heart rate
increase.
Question 2
A client is admitted with lower abdominal pain, nausea, a
distended and firm abdomen, absent bowel sounds, and no
bowel movement for three days. Which action should the nurse
anticipate?
A. Administering a bulk-forming laxative immediately
, B. Holding any laxative orders and notifying the provider
due to suspected bowel obstruction
C. Encouraging high-fiber food intake and oral fluids
D. Administering strong stimulant laxatives orally
Correct Answer: B
Rationale: A rigid, distended abdomen with absent bowel
sounds and a multi-day absence of stool strongly suggests a
bowel obstruction or acute abdomen. Laxatives (especially bulk-
forming or stimulants) are strictly contraindicated when an
obstruction is suspected because increased peristalsis can lead to
bowel perforation.
Question 3
A client is receiving an intravenous infusion of heparin
postoperatively to prevent deep vein thrombosis (DVT). The
nurse notes an aPTT value greater than 90 seconds, along with
lumbar pain and hypotension. Which medication order should
the nurse expect from the healthcare provider?
A. Vitamin K
B. Protamine sulfate
C. Flumazenil
D. Naloxone
Correct Answer: B
Rationale: Protamine sulfate is the specific antidote for heparin
overdose. An aPTT significantly above the therapeutic range
coupled with signs of bleeding or internal hemorrhage (like
, lumbar pain and low blood pressure) requires immediate
cessation of heparin and administration of its reversal agent.
Question 4
A client with a history of chronic asthma who uses an inhaled
glucocorticoid calls the clinic to report white patches in the
mouth and mild throat hoarseness. What is the nurse's best
response?
A. "Stop taking the inhaler immediately and come to the
emergency department."
B. "This is an expected systemic side effect; you can
double your dose to compensate."
C. "Are you rinsing your mouth and gargling with water
after each use of the inhaler?"
D. "You should swallow the excess medication remaining
in your mouth to prevent thrush."
Correct Answer: C
Rationale: Inhaled glucocorticoids can cause oropharyngeal
candidiasis (thrush) and dysphonia. Rinsing the mouth with
water and spitting it out (without swallowing) after every
administration significantly reduces local deposition and fungal
growth.
Question 5
A client is prescribed spironolactone (Aldactone) for heart
failure. Assessment reveals bilateral 2+ pitting edema, bibasilar
crackles, and a serum potassium level of 6.0 mEq/L. Which
action should the nurse take?
Nursing Midterm Exam Review Questions
and Answers with Rationale 2026/2027
Question 1
A client with a history of hypertension is prescribed nifedipine
(Procardia) alongside metoprolol (Lopressor). What is the
primary rationale for adding metoprolol to this medication
protocol?
A. To prevent reflex tachycardia induced by nifedipine
B. To eliminate the risk of peripheral edema
C. To potentiate the hypokalemic effects of loop diuretics
D. To replace the antihypertensive action completely
Correct Answer: A
Rationale: Dihydropyridine calcium channel blockers like
nifedipine can cause reflex tachycardia due to vasodilation and
subsequent baroreceptor activation. A beta-blocker like
metoprolol is frequently added to suppress this reflex heart rate
increase.
Question 2
A client is admitted with lower abdominal pain, nausea, a
distended and firm abdomen, absent bowel sounds, and no
bowel movement for three days. Which action should the nurse
anticipate?
A. Administering a bulk-forming laxative immediately
, B. Holding any laxative orders and notifying the provider
due to suspected bowel obstruction
C. Encouraging high-fiber food intake and oral fluids
D. Administering strong stimulant laxatives orally
Correct Answer: B
Rationale: A rigid, distended abdomen with absent bowel
sounds and a multi-day absence of stool strongly suggests a
bowel obstruction or acute abdomen. Laxatives (especially bulk-
forming or stimulants) are strictly contraindicated when an
obstruction is suspected because increased peristalsis can lead to
bowel perforation.
Question 3
A client is receiving an intravenous infusion of heparin
postoperatively to prevent deep vein thrombosis (DVT). The
nurse notes an aPTT value greater than 90 seconds, along with
lumbar pain and hypotension. Which medication order should
the nurse expect from the healthcare provider?
A. Vitamin K
B. Protamine sulfate
C. Flumazenil
D. Naloxone
Correct Answer: B
Rationale: Protamine sulfate is the specific antidote for heparin
overdose. An aPTT significantly above the therapeutic range
coupled with signs of bleeding or internal hemorrhage (like
, lumbar pain and low blood pressure) requires immediate
cessation of heparin and administration of its reversal agent.
Question 4
A client with a history of chronic asthma who uses an inhaled
glucocorticoid calls the clinic to report white patches in the
mouth and mild throat hoarseness. What is the nurse's best
response?
A. "Stop taking the inhaler immediately and come to the
emergency department."
B. "This is an expected systemic side effect; you can
double your dose to compensate."
C. "Are you rinsing your mouth and gargling with water
after each use of the inhaler?"
D. "You should swallow the excess medication remaining
in your mouth to prevent thrush."
Correct Answer: C
Rationale: Inhaled glucocorticoids can cause oropharyngeal
candidiasis (thrush) and dysphonia. Rinsing the mouth with
water and spitting it out (without swallowing) after every
administration significantly reduces local deposition and fungal
growth.
Question 5
A client is prescribed spironolactone (Aldactone) for heart
failure. Assessment reveals bilateral 2+ pitting edema, bibasilar
crackles, and a serum potassium level of 6.0 mEq/L. Which
action should the nurse take?
