NUR 6011 Exam 1 WPU Advanced Pharmacology –
(2026/2027) Actual Questions, Verified Answers with
Rationales | Guarantee Pass
SECTION 1: CARDIOVASCULAR & RENAL PHARMACOLOGY
Digoxin & Cardiac Glycosides
Question 1
KL is a 57-year-old male seen in the ED with nausea/vomiting for 2 days. Labs: K+
5.6 mEq/L, SrCr 1.9, BUN 23. ECG shows second-degree AV block. Digoxin level is
4.1 ng/mL taken ~3 hours post-dose. Based on this, which is most accurate?
• A. The digoxin level was taken too soon; wait at least 6-8 hours post-dose
for an accurate level.
• B. Lab error is suspected; redraw the level immediately.
• C. The patient is exhibiting signs of digoxin toxicity.
• D. The digoxin level is within normal limits.
Answer: C. The patient is exhibiting signs of digoxin toxicity.
Rationale: Classic signs of digoxin toxicity include gastrointestinal symptoms
(nausea/vomiting), hyperkalemia (K+ >5.0 mEq/L) from severe Na+/K+-ATPase
inhibition, and cardiac conduction disturbances (second-degree AV block). A
digoxin level of 4.1 ng/mL is significantly above the therapeutic range (0.8-2.0
ng/mL) .
Question 2
A 4-year-old boy with cardiac disease receiving furosemide is started on digoxin.
Which comment is true?
• A. Digoxin is not used in children.
• B. Diuretic therapy increases digoxin elimination.
• C. Hypokalemia from the diuretic increases the digoxin level.
, • D. Hypokalemia from the diuretic increases the risk of digoxin toxicity
without affecting the digoxin level.
Answer: D. Hypokalemia from the diuretic increases the risk of digoxin toxicity
without affecting the digoxin level.
Rationale: Loop diuretics like furosemide cause potassium loss (hypokalemia),
which sensitizes the myocardium to digoxin, increasing the risk of toxicity at
unchanged serum concentrations. Digoxin is commonly used in pediatrics but
requires careful potassium monitoring .
Question 3
Which of the following may occur with the therapeutic use of digoxin?
• A. AV block
• B. Purple toe syndrome
• C. Decreased potassium levels
• D. Increased lithium levels
Answer: A. AV block.
Rationale: Digoxin slows AV nodal conduction and can cause varying degrees of
AV block even at therapeutic levels. Purple toe syndrome is associated with
warfarin, not digoxin. Lithium levels are affected by renal function and diuretics .
Question 4
OI is started on digoxin for CHF. Which statement is true?
• A. Digoxin immune Fab should be given to anyone with a digoxin level > 3.3
ng/mL
• B. Digoxin's efficacy in CHF is due mainly to decreased AV nodal conduction
• C. If the digoxin level rises from 5 ng/mL to 15 ng/mL after Fab, the Fab was
ineffective
, • D. A potassium level of 5.5 mEq/L in the face of digoxin toxicity is an
indicator of poor outcome
Answer: D. A potassium level of 5.5 mEq/L in the face of digoxin toxicity is an
indicator of poor outcome.
Rationale: Hyperkalemia during acute digoxin overdose reflects severe Na+/K+-
ATPase inhibition and is associated with increased mortality. Digoxin immune Fab
is reserved for serious toxicity; assay levels rise after Fab because the antibody-
bound drug is still measured .
Question 5
First-line treatment for acute digoxin toxicity with malignant arrhythmia is:
• A. Lidocaine
• B. Amiodarone
• C. Digoxin immune Fab (Digibind)
• D. Magnesium sulfate
Answer: C. Digoxin immune Fab (Digibind).
Rationale: Digoxin immune Fab binds digoxin, rendering it inactive. It is the
specific antidote for life-threatening digoxin toxicity .
Question 6
A patient on digoxin has potassium 5.5 mEq/L, AV block, and nausea. What is
most accurate?
• A. The digoxin level was taken too soon
• B. GI complaints are likely from uremia
• C. This is digoxin toxicity
• D. Patient needs lipid rescue
Answer: C. This is digoxin toxicity.
, Rationale: Classic triad: GI symptoms (nausea), hyperkalemia, and
bradyarrhythmia (AV block) indicates digoxin toxicity until proven otherwise .
Question 7
Which medication increases digoxin levels?
• A. Amlodipine
• B. Lisinopril
• C. Amiodarone
• D. Metformin
Answer: C. Amiodarone.
Rationale: Amiodarone increases digoxin levels by displacing digoxin from tissue-
binding sites and decreasing renal clearance. Dose reduction of digoxin is
recommended when amiodarone is initiated .
Question 8
Hypokalemia increases the risk of digoxin toxicity because:
• A. It increases digoxin serum levels
• B. It decreases digoxin renal clearance
• C. It increases digoxin binding to Na-K-ATPase
• D. It increases protein binding of digoxin
Answer: C. It increases digoxin binding to Na-K-ATPase.
Rationale: Hypokalemia increases digoxin binding to Na-K-ATPase, increasing
toxicity risk. The serum digoxin level may remain unchanged while the
pharmacodynamic effect is enhanced .
Beta-Blockers & Heart Rate
(2026/2027) Actual Questions, Verified Answers with
Rationales | Guarantee Pass
SECTION 1: CARDIOVASCULAR & RENAL PHARMACOLOGY
Digoxin & Cardiac Glycosides
Question 1
KL is a 57-year-old male seen in the ED with nausea/vomiting for 2 days. Labs: K+
5.6 mEq/L, SrCr 1.9, BUN 23. ECG shows second-degree AV block. Digoxin level is
4.1 ng/mL taken ~3 hours post-dose. Based on this, which is most accurate?
• A. The digoxin level was taken too soon; wait at least 6-8 hours post-dose
for an accurate level.
• B. Lab error is suspected; redraw the level immediately.
• C. The patient is exhibiting signs of digoxin toxicity.
• D. The digoxin level is within normal limits.
Answer: C. The patient is exhibiting signs of digoxin toxicity.
Rationale: Classic signs of digoxin toxicity include gastrointestinal symptoms
(nausea/vomiting), hyperkalemia (K+ >5.0 mEq/L) from severe Na+/K+-ATPase
inhibition, and cardiac conduction disturbances (second-degree AV block). A
digoxin level of 4.1 ng/mL is significantly above the therapeutic range (0.8-2.0
ng/mL) .
Question 2
A 4-year-old boy with cardiac disease receiving furosemide is started on digoxin.
Which comment is true?
• A. Digoxin is not used in children.
• B. Diuretic therapy increases digoxin elimination.
• C. Hypokalemia from the diuretic increases the digoxin level.
, • D. Hypokalemia from the diuretic increases the risk of digoxin toxicity
without affecting the digoxin level.
Answer: D. Hypokalemia from the diuretic increases the risk of digoxin toxicity
without affecting the digoxin level.
Rationale: Loop diuretics like furosemide cause potassium loss (hypokalemia),
which sensitizes the myocardium to digoxin, increasing the risk of toxicity at
unchanged serum concentrations. Digoxin is commonly used in pediatrics but
requires careful potassium monitoring .
Question 3
Which of the following may occur with the therapeutic use of digoxin?
• A. AV block
• B. Purple toe syndrome
• C. Decreased potassium levels
• D. Increased lithium levels
Answer: A. AV block.
Rationale: Digoxin slows AV nodal conduction and can cause varying degrees of
AV block even at therapeutic levels. Purple toe syndrome is associated with
warfarin, not digoxin. Lithium levels are affected by renal function and diuretics .
Question 4
OI is started on digoxin for CHF. Which statement is true?
• A. Digoxin immune Fab should be given to anyone with a digoxin level > 3.3
ng/mL
• B. Digoxin's efficacy in CHF is due mainly to decreased AV nodal conduction
• C. If the digoxin level rises from 5 ng/mL to 15 ng/mL after Fab, the Fab was
ineffective
, • D. A potassium level of 5.5 mEq/L in the face of digoxin toxicity is an
indicator of poor outcome
Answer: D. A potassium level of 5.5 mEq/L in the face of digoxin toxicity is an
indicator of poor outcome.
Rationale: Hyperkalemia during acute digoxin overdose reflects severe Na+/K+-
ATPase inhibition and is associated with increased mortality. Digoxin immune Fab
is reserved for serious toxicity; assay levels rise after Fab because the antibody-
bound drug is still measured .
Question 5
First-line treatment for acute digoxin toxicity with malignant arrhythmia is:
• A. Lidocaine
• B. Amiodarone
• C. Digoxin immune Fab (Digibind)
• D. Magnesium sulfate
Answer: C. Digoxin immune Fab (Digibind).
Rationale: Digoxin immune Fab binds digoxin, rendering it inactive. It is the
specific antidote for life-threatening digoxin toxicity .
Question 6
A patient on digoxin has potassium 5.5 mEq/L, AV block, and nausea. What is
most accurate?
• A. The digoxin level was taken too soon
• B. GI complaints are likely from uremia
• C. This is digoxin toxicity
• D. Patient needs lipid rescue
Answer: C. This is digoxin toxicity.
, Rationale: Classic triad: GI symptoms (nausea), hyperkalemia, and
bradyarrhythmia (AV block) indicates digoxin toxicity until proven otherwise .
Question 7
Which medication increases digoxin levels?
• A. Amlodipine
• B. Lisinopril
• C. Amiodarone
• D. Metformin
Answer: C. Amiodarone.
Rationale: Amiodarone increases digoxin levels by displacing digoxin from tissue-
binding sites and decreasing renal clearance. Dose reduction of digoxin is
recommended when amiodarone is initiated .
Question 8
Hypokalemia increases the risk of digoxin toxicity because:
• A. It increases digoxin serum levels
• B. It decreases digoxin renal clearance
• C. It increases digoxin binding to Na-K-ATPase
• D. It increases protein binding of digoxin
Answer: C. It increases digoxin binding to Na-K-ATPase.
Rationale: Hypokalemia increases digoxin binding to Na-K-ATPase, increasing
toxicity risk. The serum digoxin level may remain unchanged while the
pharmacodynamic effect is enhanced .
Beta-Blockers & Heart Rate
