NUR 210 Principles Of Pharmacology Exam 3 | 50
Questions With Rationales | 2026/2027 Updates
Question 1.
A patient with hypertension is prescribed lisinopril. The nurse understands that the
primary mechanism of action of ACE inhibitors is:
• A. Inhibition of angiotensin-converting enzyme, reducing angiotensin II
production and decreasing aldosterone secretion
• B. Blockade of angiotensin II receptors in vascular smooth muscle
• C. Inhibition of renin release from the juxtaglomerular cells
• D. Direct relaxation of vascular smooth muscle through calcium channel blockade
Correct Answer: A
Rationale: ACE inhibitors (e.g., lisinopril, enalapril) block the conversion of angiotensin I to
angiotensin II. This reduces vasoconstriction, decreases aldosterone secretion (reducing
sodium and water retention), and prevents the breakdown of bradykinin. Common side
effects include a dry cough (due to bradykinin accumulation), hyperkalemia, and
angioedema.
Question 2.
A patient taking warfarin is started on a course of ciprofloxacin for a urinary tract
infection. The nurse should monitor for which potential interaction?
• A. Increased warfarin effect and elevated INR due to displacement from protein
binding and inhibition of hepatic metabolism
• B. Decreased warfarin absorption due to chelation in the gastrointestinal tract
• C. Increased risk of hypoglycemia due to enhanced insulin secretion
• D. Reduced effectiveness of ciprofloxacin due to antagonism at receptor sites
Correct Answer: A
Rationale: Fluoroquinolones (ciprofloxacin) can increase warfarin's anticoagulant effect by
displacing it from protein binding sites and inhibiting hepatic metabolism. This increases
the risk of bleeding. The nurse should monitor INR more frequently and observe for signs of
bleeding (bruising, hematuria, melena). Many antibiotics alter gut flora that produce
vitamin K, further potentiating warfarin's effect.
Question 3.
,A patient with type 1 diabetes is prescribed regular insulin and NPH insulin to be
mixed in the same syringe. The nurse should instruct the patient to:
• A. Draw up regular (clear) insulin first, then NPH (cloudy) insulin
• B. Draw up NPH (cloudy) insulin first, then regular (clear) insulin
• C. Mix the insulins in the vial before drawing up the dose
• D. Use separate syringes for each insulin to prevent incompatibility
Correct Answer: A
Rationale: When mixing regular (short-acting, clear) and NPH (intermediate-acting,
cloudy) insulin in the same syringe, always draw up the clear insulin first. This prevents
contaminating the regular insulin vial with NPH insulin, which could alter the onset and
duration of action of subsequent doses. The mnemonic is 'clear before cloudy.' Roll the NPH
vial gently to resuspend particles; do not shake vigorously.
Question 4.
A patient with asthma is prescribed albuterol via metered-dose inhaler (MDI). The
nurse should teach the patient that albuterol is classified as a:
• A. Short-acting beta-2 adrenergic agonist (SABA) used for acute bronchospasm
relief
• B. Long-acting beta-2 adrenergic agonist (LABA) used for maintenance therapy
• C. Inhaled corticosteroid that reduces airway inflammation
• D. Leukotriene receptor antagonist that prevents bronchoconstriction
Correct Answer: A
Rationale: Albuterol is a short-acting beta-2 adrenergic agonist (SABA) that rapidly relaxes
bronchial smooth muscle, providing quick relief of acute bronchospasm. It is a rescue
medication, not a controller. Side effects include tachycardia, tremors, and hypokalemia.
Patients should be taught proper MDI technique (slow deep inhalation, 5-10 second breath
hold) and to use a spacer for improved drug delivery.
Question 5.
A patient with atrial fibrillation is prescribed digoxin. The nurse should monitor for
early signs of digoxin toxicity, which include:
• A. Nausea, vomiting, anorexia, and visual disturbances (yellow-green halos)
• B. Severe hypotension, bradycardia, and syncope
• C. Hyperglycemia, polyuria, and polydipsia
,• D. Tinnitus, hearing loss, and gastrointestinal bleeding
Correct Answer: A
Rationale: Early signs of digoxin toxicity include gastrointestinal symptoms (nausea,
vomiting, anorexia) and neurologic symptoms (visual disturbances such as yellow-green
halos, confusion, headache). Cardiac manifestations include various arrhythmias
(premature ventricular contractions, atrioventricular blocks). Risk factors for toxicity
include hypokalemia, hypomagnesemia, hypercalcemia, renal impairment, and advanced
age. The therapeutic range for digoxin is narrow (0.5-0.9 ng/mL for heart failure; 0.5-2.0
ng/mL for AFib).
Question 6.
A patient with a severe bacterial infection is prescribed gentamicin. The nurse should
monitor for which adverse effect that is characteristic of aminoglycosides?
• A. Nephrotoxicity and ototoxicity
• B. Hepatotoxicity and bone marrow suppression
• C. Pulmonary fibrosis and pneumonitis
• D. Cardiotoxicity and QT prolongation
Correct Answer: A
Rationale: Aminoglycosides (gentamicin, tobramycin, amikacin) are associated with dose-
dependent nephrotoxicity (acute tubular necrosis) and ototoxicity (irreversible vestibular
and cochlear damage). Monitoring of serum peak and trough levels is essential to maintain
therapeutic concentrations while minimizing toxicity. Risk factors include prolonged
therapy, dehydration, concurrent nephrotoxic drugs (vancomycin, amphotericin B), and
pre-existing renal impairment.
Question 7.
A patient with depression is prescribed fluoxetine, a selective serotonin reuptake
inhibitor (SSRI). The nurse should educate the patient about which important
precaution?
• A. Avoid concurrent use of MAO inhibitors due to risk of serotonin syndrome
• B. Take the medication on an empty stomach to enhance absorption
• C. Discontinue the medication immediately if mild nausea occurs
• D. Combine with St. John's wort for enhanced antidepressant effect
Correct Answer: A
, Rationale: SSRIs should never be combined with MAO inhibitors due to the risk of
serotonin syndrome, a potentially fatal condition characterized by mental status changes,
autonomic instability (hyperthermia, tachycardia, hypertension), and neuromuscular
abnormalities (clonus, hyperreflexia, rigidity). A 14-day washout period is required when
switching between these drug classes. SSRIs can also interact with tramadol, triptans, and
St. John's wort.
Question 8.
A patient with peptic ulcer disease is prescribed sucralfate. The nurse should instruct
the patient to take this medication:
• A. On an empty stomach, 1 hour before meals and at bedtime
• B. With meals to enhance absorption and reduce gastric irritation
• C. At the same time as antacids for synergistic effect
• D. Crushed and mixed with food to improve palatability
Correct Answer: A
Rationale: Sucralfate is a mucosal protective agent that forms a protective barrier over
ulcerated tissue in acidic conditions. It must be taken on an empty stomach (1 hour before
meals and at bedtime) to allow it to adhere to the ulcer site. Antacids should be taken 30
minutes before or after sucralfate, as they can interfere with its activation. Sucralfate can
bind other medications (fluoroquinolones, phenytoin, warfarin), so these should be taken 2
hours apart.
Question 9.
A patient with hyperlipidemia is prescribed atorvastatin. The nurse should instruct
the patient to report which adverse effect immediately?
• A. Unexplained muscle pain, weakness, or dark urine suggestive of
rhabdomyolysis
• B. Mild headache that resolves with acetaminophen
• C. Occasional constipation managed with dietary fiber
• D. Mild ankle edema after prolonged standing
Correct Answer: A
Rationale: Statins (HMG-CoA reductase inhibitors) can cause myopathy and, rarely,
rhabdomyolysis—severe muscle breakdown that can lead to acute kidney injury. Patients
should report unexplained muscle pain, tenderness, weakness, or dark-colored urine
immediately. Risk factors include high-dose statin therapy, advanced age, renal impairment,
Questions With Rationales | 2026/2027 Updates
Question 1.
A patient with hypertension is prescribed lisinopril. The nurse understands that the
primary mechanism of action of ACE inhibitors is:
• A. Inhibition of angiotensin-converting enzyme, reducing angiotensin II
production and decreasing aldosterone secretion
• B. Blockade of angiotensin II receptors in vascular smooth muscle
• C. Inhibition of renin release from the juxtaglomerular cells
• D. Direct relaxation of vascular smooth muscle through calcium channel blockade
Correct Answer: A
Rationale: ACE inhibitors (e.g., lisinopril, enalapril) block the conversion of angiotensin I to
angiotensin II. This reduces vasoconstriction, decreases aldosterone secretion (reducing
sodium and water retention), and prevents the breakdown of bradykinin. Common side
effects include a dry cough (due to bradykinin accumulation), hyperkalemia, and
angioedema.
Question 2.
A patient taking warfarin is started on a course of ciprofloxacin for a urinary tract
infection. The nurse should monitor for which potential interaction?
• A. Increased warfarin effect and elevated INR due to displacement from protein
binding and inhibition of hepatic metabolism
• B. Decreased warfarin absorption due to chelation in the gastrointestinal tract
• C. Increased risk of hypoglycemia due to enhanced insulin secretion
• D. Reduced effectiveness of ciprofloxacin due to antagonism at receptor sites
Correct Answer: A
Rationale: Fluoroquinolones (ciprofloxacin) can increase warfarin's anticoagulant effect by
displacing it from protein binding sites and inhibiting hepatic metabolism. This increases
the risk of bleeding. The nurse should monitor INR more frequently and observe for signs of
bleeding (bruising, hematuria, melena). Many antibiotics alter gut flora that produce
vitamin K, further potentiating warfarin's effect.
Question 3.
,A patient with type 1 diabetes is prescribed regular insulin and NPH insulin to be
mixed in the same syringe. The nurse should instruct the patient to:
• A. Draw up regular (clear) insulin first, then NPH (cloudy) insulin
• B. Draw up NPH (cloudy) insulin first, then regular (clear) insulin
• C. Mix the insulins in the vial before drawing up the dose
• D. Use separate syringes for each insulin to prevent incompatibility
Correct Answer: A
Rationale: When mixing regular (short-acting, clear) and NPH (intermediate-acting,
cloudy) insulin in the same syringe, always draw up the clear insulin first. This prevents
contaminating the regular insulin vial with NPH insulin, which could alter the onset and
duration of action of subsequent doses. The mnemonic is 'clear before cloudy.' Roll the NPH
vial gently to resuspend particles; do not shake vigorously.
Question 4.
A patient with asthma is prescribed albuterol via metered-dose inhaler (MDI). The
nurse should teach the patient that albuterol is classified as a:
• A. Short-acting beta-2 adrenergic agonist (SABA) used for acute bronchospasm
relief
• B. Long-acting beta-2 adrenergic agonist (LABA) used for maintenance therapy
• C. Inhaled corticosteroid that reduces airway inflammation
• D. Leukotriene receptor antagonist that prevents bronchoconstriction
Correct Answer: A
Rationale: Albuterol is a short-acting beta-2 adrenergic agonist (SABA) that rapidly relaxes
bronchial smooth muscle, providing quick relief of acute bronchospasm. It is a rescue
medication, not a controller. Side effects include tachycardia, tremors, and hypokalemia.
Patients should be taught proper MDI technique (slow deep inhalation, 5-10 second breath
hold) and to use a spacer for improved drug delivery.
Question 5.
A patient with atrial fibrillation is prescribed digoxin. The nurse should monitor for
early signs of digoxin toxicity, which include:
• A. Nausea, vomiting, anorexia, and visual disturbances (yellow-green halos)
• B. Severe hypotension, bradycardia, and syncope
• C. Hyperglycemia, polyuria, and polydipsia
,• D. Tinnitus, hearing loss, and gastrointestinal bleeding
Correct Answer: A
Rationale: Early signs of digoxin toxicity include gastrointestinal symptoms (nausea,
vomiting, anorexia) and neurologic symptoms (visual disturbances such as yellow-green
halos, confusion, headache). Cardiac manifestations include various arrhythmias
(premature ventricular contractions, atrioventricular blocks). Risk factors for toxicity
include hypokalemia, hypomagnesemia, hypercalcemia, renal impairment, and advanced
age. The therapeutic range for digoxin is narrow (0.5-0.9 ng/mL for heart failure; 0.5-2.0
ng/mL for AFib).
Question 6.
A patient with a severe bacterial infection is prescribed gentamicin. The nurse should
monitor for which adverse effect that is characteristic of aminoglycosides?
• A. Nephrotoxicity and ototoxicity
• B. Hepatotoxicity and bone marrow suppression
• C. Pulmonary fibrosis and pneumonitis
• D. Cardiotoxicity and QT prolongation
Correct Answer: A
Rationale: Aminoglycosides (gentamicin, tobramycin, amikacin) are associated with dose-
dependent nephrotoxicity (acute tubular necrosis) and ototoxicity (irreversible vestibular
and cochlear damage). Monitoring of serum peak and trough levels is essential to maintain
therapeutic concentrations while minimizing toxicity. Risk factors include prolonged
therapy, dehydration, concurrent nephrotoxic drugs (vancomycin, amphotericin B), and
pre-existing renal impairment.
Question 7.
A patient with depression is prescribed fluoxetine, a selective serotonin reuptake
inhibitor (SSRI). The nurse should educate the patient about which important
precaution?
• A. Avoid concurrent use of MAO inhibitors due to risk of serotonin syndrome
• B. Take the medication on an empty stomach to enhance absorption
• C. Discontinue the medication immediately if mild nausea occurs
• D. Combine with St. John's wort for enhanced antidepressant effect
Correct Answer: A
, Rationale: SSRIs should never be combined with MAO inhibitors due to the risk of
serotonin syndrome, a potentially fatal condition characterized by mental status changes,
autonomic instability (hyperthermia, tachycardia, hypertension), and neuromuscular
abnormalities (clonus, hyperreflexia, rigidity). A 14-day washout period is required when
switching between these drug classes. SSRIs can also interact with tramadol, triptans, and
St. John's wort.
Question 8.
A patient with peptic ulcer disease is prescribed sucralfate. The nurse should instruct
the patient to take this medication:
• A. On an empty stomach, 1 hour before meals and at bedtime
• B. With meals to enhance absorption and reduce gastric irritation
• C. At the same time as antacids for synergistic effect
• D. Crushed and mixed with food to improve palatability
Correct Answer: A
Rationale: Sucralfate is a mucosal protective agent that forms a protective barrier over
ulcerated tissue in acidic conditions. It must be taken on an empty stomach (1 hour before
meals and at bedtime) to allow it to adhere to the ulcer site. Antacids should be taken 30
minutes before or after sucralfate, as they can interfere with its activation. Sucralfate can
bind other medications (fluoroquinolones, phenytoin, warfarin), so these should be taken 2
hours apart.
Question 9.
A patient with hyperlipidemia is prescribed atorvastatin. The nurse should instruct
the patient to report which adverse effect immediately?
• A. Unexplained muscle pain, weakness, or dark urine suggestive of
rhabdomyolysis
• B. Mild headache that resolves with acetaminophen
• C. Occasional constipation managed with dietary fiber
• D. Mild ankle edema after prolonged standing
Correct Answer: A
Rationale: Statins (HMG-CoA reductase inhibitors) can cause myopathy and, rarely,
rhabdomyolysis—severe muscle breakdown that can lead to acute kidney injury. Patients
should report unexplained muscle pain, tenderness, weakness, or dark-colored urine
immediately. Risk factors include high-dose statin therapy, advanced age, renal impairment,
