NUR 210 Principles Of Pharmacology Exam 2 | Questions
And Answers 100% Correct Answers With Explained
Rationale | 2026/2027 Updates
Question 1.
A patient with hypertension is prescribed hydrochlorothiazide. The nurse knows that
the primary mechanism by which thiazide diuretics lower blood pressure is:
A. Direct vasodilation of arterioles.
B. Inhibition of sodium and chloride reabsorption in the distal convoluted tubule, reducing
plasma volume and peripheral vascular resistance.
C. Blockade of beta-1 adrenergic receptors in the heart.
D. Inhibition of angiotensin II formation.
Correct Answer: B
Rationale: Thiazide diuretics (hydrochlorothiazide, chlorthalidone) act on the distal
convoluted tubule to inhibit the sodium-chloride cotransporter, increasing excretion of
sodium, chloride, and water. Initially, blood pressure drops due to reduced plasma volume.
With chronic use, peripheral vascular resistance decreases through mechanisms that are
not fully understood but may involve vascular smooth muscle relaxation. Thiazides are
first-line therapy for uncomplicated hypertension. Side effects include: hypokalemia,
hyponatremia, hyperglycemia, hyperuricemia, and photosensitivity.
Question 2.
A patient with heart failure is prescribed spironolactone. The nurse should monitor
for which adverse effect, which is the primary reason this drug is used in heart
failure?
A. Hypokalemia.
B. Hyperkalemia and its anti-aldosterone effects that reduce myocardial fibrosis.
C. Severe hypotension.
D. Tachycardia.
Correct Answer: B
,Rationale: Spironolactone is a potassium-sparing diuretic and aldosterone antagonist. It
blocks aldosterone receptors in the distal nephron and collecting duct, promoting sodium
and water excretion while retaining potassium. In heart failure, spironolactone (and
eplerenone) reduces mortality by blocking aldosterone's deleterious effects on the heart,
including myocardial fibrosis, hypertrophy, and endothelial dysfunction. The nurse must
monitor serum potassium closely, as hyperkalemia is a significant risk, especially when
combined with ACE inhibitors, ARBs, or potassium supplements.
Question 3.
A patient with atrial fibrillation is switched from warfarin to apixaban. The nurse
should teach the patient that a major advantage of apixaban over warfarin is that
apixaban:
A. Has a specific antidote that can be given orally.
B. Does not require routine INR monitoring and has fewer drug-food interactions.
C. Can be safely used in patients with mechanical heart valves.
D. Is significantly less expensive than warfarin.
Correct Answer: B
Rationale: Apixaban is a direct oral anticoagulant (DOAC) that inhibits factor Xa. Compared
to warfarin, DOACs have several advantages: no routine coagulation monitoring (no INR
checks), rapid onset of action, fixed dosing, fewer drug-food interactions (no dietary vitamin
K restrictions), and lower risk of intracranial hemorrhage. Andexanet alfa is the IV reversal
agent for apixaban and rivaroxaban. DOACs are NOT approved for patients with mechanical
heart valves or moderate-severe mitral stenosis (warfarin remains standard). Cost varies
but DOACs are generally more expensive than generic warfarin.
Question 4.
A patient is prescribed clopidogrel after placement of a drug-eluting stent. The nurse
knows that clopidogrel is classified as a(n):
A. Anticoagulant.
B. Antiplatelet agent.
C. Fibrinolytic.
D. Direct thrombin inhibitor.
, Correct Answer: B
Rationale: Clopidogrel is an antiplatelet agent (thienopyridine/P2Y12 inhibitor). It
irreversibly inhibits the P2Y12 ADP receptor on platelets, preventing platelet activation and
aggregation. It is used with aspirin (dual antiplatelet therapy, DAPT) after coronary stent
placement, for acute coronary syndrome, and for secondary stroke prevention. Other P2Y12
inhibitors include: prasugrel, ticagrelor, and cangrelor. The nurse should monitor for
bleeding, bruising, and teach the patient to report black stools or unusual bleeding. DAPT is
typically continued for 12 months after drug-eluting stent placement.
Question 5.
A patient with hyperlipidemia is prescribed rosuvastatin. The nurse should teach the
patient to report which symptom immediately, as it may indicate a rare but serious
adverse effect?
A. Mild headache.
B. Unexplained muscle pain, tenderness, or weakness, especially with dark urine.
C. Mild nausea after taking the medication.
D. Drowsiness.
Correct Answer: B
Rationale: Statins (HMG-CoA reductase inhibitors) can cause myopathy, which ranges from
mild muscle aches to severe rhabdomyolysis (muscle breakdown releasing myoglobin into
the urine, causing dark/cola-colored urine and acute kidney injury). The risk is increased
with higher doses, advanced age, renal impairment, hypothyroidism, and concurrent use of
CYP3A4 inhibitors (clarithromycin, azole antifungals, grapefruit juice) or gemfibrozil. The
patient should report unexplained muscle pain, tenderness, weakness, or dark urine
immediately. The nurse should also monitor liver function tests, as statins can cause
hepatotoxicity.
Question 6.
A patient with ventricular tachycardia is prescribed lidocaine IV. The nurse knows
that lidocaine is classified as a:
A. Class IA antiarrhythmic (sodium channel blocker with intermediate effect on
repolarization).
And Answers 100% Correct Answers With Explained
Rationale | 2026/2027 Updates
Question 1.
A patient with hypertension is prescribed hydrochlorothiazide. The nurse knows that
the primary mechanism by which thiazide diuretics lower blood pressure is:
A. Direct vasodilation of arterioles.
B. Inhibition of sodium and chloride reabsorption in the distal convoluted tubule, reducing
plasma volume and peripheral vascular resistance.
C. Blockade of beta-1 adrenergic receptors in the heart.
D. Inhibition of angiotensin II formation.
Correct Answer: B
Rationale: Thiazide diuretics (hydrochlorothiazide, chlorthalidone) act on the distal
convoluted tubule to inhibit the sodium-chloride cotransporter, increasing excretion of
sodium, chloride, and water. Initially, blood pressure drops due to reduced plasma volume.
With chronic use, peripheral vascular resistance decreases through mechanisms that are
not fully understood but may involve vascular smooth muscle relaxation. Thiazides are
first-line therapy for uncomplicated hypertension. Side effects include: hypokalemia,
hyponatremia, hyperglycemia, hyperuricemia, and photosensitivity.
Question 2.
A patient with heart failure is prescribed spironolactone. The nurse should monitor
for which adverse effect, which is the primary reason this drug is used in heart
failure?
A. Hypokalemia.
B. Hyperkalemia and its anti-aldosterone effects that reduce myocardial fibrosis.
C. Severe hypotension.
D. Tachycardia.
Correct Answer: B
,Rationale: Spironolactone is a potassium-sparing diuretic and aldosterone antagonist. It
blocks aldosterone receptors in the distal nephron and collecting duct, promoting sodium
and water excretion while retaining potassium. In heart failure, spironolactone (and
eplerenone) reduces mortality by blocking aldosterone's deleterious effects on the heart,
including myocardial fibrosis, hypertrophy, and endothelial dysfunction. The nurse must
monitor serum potassium closely, as hyperkalemia is a significant risk, especially when
combined with ACE inhibitors, ARBs, or potassium supplements.
Question 3.
A patient with atrial fibrillation is switched from warfarin to apixaban. The nurse
should teach the patient that a major advantage of apixaban over warfarin is that
apixaban:
A. Has a specific antidote that can be given orally.
B. Does not require routine INR monitoring and has fewer drug-food interactions.
C. Can be safely used in patients with mechanical heart valves.
D. Is significantly less expensive than warfarin.
Correct Answer: B
Rationale: Apixaban is a direct oral anticoagulant (DOAC) that inhibits factor Xa. Compared
to warfarin, DOACs have several advantages: no routine coagulation monitoring (no INR
checks), rapid onset of action, fixed dosing, fewer drug-food interactions (no dietary vitamin
K restrictions), and lower risk of intracranial hemorrhage. Andexanet alfa is the IV reversal
agent for apixaban and rivaroxaban. DOACs are NOT approved for patients with mechanical
heart valves or moderate-severe mitral stenosis (warfarin remains standard). Cost varies
but DOACs are generally more expensive than generic warfarin.
Question 4.
A patient is prescribed clopidogrel after placement of a drug-eluting stent. The nurse
knows that clopidogrel is classified as a(n):
A. Anticoagulant.
B. Antiplatelet agent.
C. Fibrinolytic.
D. Direct thrombin inhibitor.
, Correct Answer: B
Rationale: Clopidogrel is an antiplatelet agent (thienopyridine/P2Y12 inhibitor). It
irreversibly inhibits the P2Y12 ADP receptor on platelets, preventing platelet activation and
aggregation. It is used with aspirin (dual antiplatelet therapy, DAPT) after coronary stent
placement, for acute coronary syndrome, and for secondary stroke prevention. Other P2Y12
inhibitors include: prasugrel, ticagrelor, and cangrelor. The nurse should monitor for
bleeding, bruising, and teach the patient to report black stools or unusual bleeding. DAPT is
typically continued for 12 months after drug-eluting stent placement.
Question 5.
A patient with hyperlipidemia is prescribed rosuvastatin. The nurse should teach the
patient to report which symptom immediately, as it may indicate a rare but serious
adverse effect?
A. Mild headache.
B. Unexplained muscle pain, tenderness, or weakness, especially with dark urine.
C. Mild nausea after taking the medication.
D. Drowsiness.
Correct Answer: B
Rationale: Statins (HMG-CoA reductase inhibitors) can cause myopathy, which ranges from
mild muscle aches to severe rhabdomyolysis (muscle breakdown releasing myoglobin into
the urine, causing dark/cola-colored urine and acute kidney injury). The risk is increased
with higher doses, advanced age, renal impairment, hypothyroidism, and concurrent use of
CYP3A4 inhibitors (clarithromycin, azole antifungals, grapefruit juice) or gemfibrozil. The
patient should report unexplained muscle pain, tenderness, weakness, or dark urine
immediately. The nurse should also monitor liver function tests, as statins can cause
hepatotoxicity.
Question 6.
A patient with ventricular tachycardia is prescribed lidocaine IV. The nurse knows
that lidocaine is classified as a:
A. Class IA antiarrhythmic (sodium channel blocker with intermediate effect on
repolarization).
