NR 293 Pharmacology Exam 4 | 75 Questions And Answers
With Detailed Rationale | 2026/2027 Updates
Question 1.
A patient with septic shock is prescribed norepinephrine. The nurse understands that norepinephrine
is the first-line vasopressor in septic shock because it:
A. Causes significant tachycardia, increasing cardiac output
B. Is a potent alpha-1 agonist with moderate beta-1 activity, increasing vascular tone and blood pressure
withless arrhythmogenic potential than dopamine
C. Is the cheapest vasopressor available
D. Has no effect on renal perfusion
Correct Answer: B
Rationale:
Norepinephrine is the first-line vasopressor for septic shock per Surviving Sepsis guidelines. It is a potent alpha-1 agonist
(vasoconstriction) with moderate beta-1 activity (modest inotropy), effectively increasing MAP with less tachycardia and
arrhythmia risk than dopamine. A is incorrect because it causes less tachycardia than dopamine. C is incorrect because
cost is not the clinical reason. D is incorrect because it does affect renal perfusion through increased
MAP.
Question 2.
A patient with anaphylactic shock is receiving epinephrine. The nurse understands that epinephrine is
the drug of choice because it:
A. Only blocks histamine receptors
B. Activates alpha-1 receptors (vasoconstriction), beta-1 receptors (inotropy/chronotropy), and beta-2
receptors (bronchodilation), addressing all pathophysiologic aspects of anaphylaxis
C. Is an antihistamine with no cardiovascular effects
D. Only dilates coronary arteries
Correct Answer: B
Rationale:
Epinephrine is the drug of choice for anaphylaxis because it addresses all aspects: alpha-1 for vasoconstriction and blood
pressure support, beta-1 for cardiac output, and beta-2 for bronchodilation and mast cell stabilization. A is incorrect
because it does not block histamine receptors. C is incorrect because it is not an antihistamine. D is incorrect because its
effects are much broader.
Question 3.
A patient with cardiogenic shock is receiving dobutamine. The nurse notes the patient develops
ventricular tachycardia. The nurse understands that this adverse effect occurs because dobutamine:
A. Is a pure alpha-agonist
B. Is a beta-1 agonist that increases myocardial oxygen demand and can precipitate arrhythmias
C. Blocks potassium channels
Page 1
,D. Causes severe bradycardia
Correct Answer: B
Rationale:
Dobutamine is a beta-1 agonist that increases contractility, heart rate, and myocardial oxygen demand. In patients with
underlying ischemia or arrhythmia potential, it can precipitate ventricular arrhythmias. A is incorrect because it is not an
alpha-agonist. C is incorrect because it does not block potassium channels. D is incorrect because it causes tachycardia,
not bradycardia.
Question 4.
A patient with bradycardia and hypotension unresponsive to atropine is receiving epinephrine
infusion. The nurse understands that epinephrine is preferred over dopamine in this situation
because:
A. Epinephrine is cheaper
B. Epinephrine has more potent beta-1 and alpha-1 effects, providing both chronotropy and vasoconstriction
C. Dopamine causes more bronchodilation
D. Epinephrine has no cardiac effects
Correct Answer: B
Rationale:
In bradycardic arrest or symptomatic bradycardia unresponsive to atropine, epinephrine provides potent beta-1 stimulation
(increased heart rate and contractility) and alpha-1 stimulation (vasoconstriction), supporting both cardiac output and blood
pressure. A is incorrect because cost is not the factor. C is incorrect because epinephrine causes more bronchodilation,
not dopamine. D is incorrect because epinephrine has significant cardiac effects.
Question 5.
A patient with pulmonary embolism and hemodynamic instability is receiving systemic thrombolytics.
The nurse understands that the absolute contraindication to thrombolytics in this patient would be:
A. A blood pressure of 150/90 mmHg
B. Active internal bleeding or hemorrhagic stroke within 3 months
C. A history of peptic ulcer disease 10 years ago
D. Age over 75
Correct Answer: B
Rationale:
Absolute contraindications to thrombolytics include active internal bleeding, history of hemorrhagic stroke, ischemic stroke
within 3 months, suspected aortic dissection, and intracranial neoplasm. A is incorrect because hypertension alone is not
an absolute contraindication. C is incorrect because remote PUD is not a contraindication. D is incorrect because
advanced age is a relative, not absolute, contraindication.
Question 6.
A patient with atrial fibrillation is being considered for electrical cardioversion. The nurse knows that if
the atrial fibrillation duration is unknown or exceeds 48 hours, the patient must:
A. Undergo cardioversion immediately without anticoagulation
Page 2
, B. Receive therapeutic anticoagulation for at least 3 weeks before and 4 weeks after cardioversion, orundergo
transesophageal echocardiography to exclude left atrial thrombus
C. Take aspirin only
D. Receive heparin for 24 hours only
Correct Answer: B
Rationale:
For AF >48 hours or unknown duration, therapeutic anticoagulation (warfarin with INR 2-3, or DOAC) is required for 3
weeks before and 4 weeks after cardioversion to prevent thromboembolism. Alternatively, TEE can exclude LA thrombus,
allowing immediate cardioversion if negative, followed by 4 weeks of anticoagulation. A is incorrect because this risks
stroke. C is incorrect because aspirin is insufficient. D is incorrect because 24 hours is inadequate.
Question 7.
A patient with ventricular tachycardia is receiving amiodarone IV. The nurse should administer the
medication through:
A. A peripheral IV at maximum infusion rate
B. A central venous catheter or a large peripheral vein with an in-line filter, due to risk of phlebitis
andhypotension with rapid infusion
C. An arterial line
D. Subcutaneously
Correct Answer: B
Rationale:
IV amiodarone can cause significant hypotension and phlebitis. It should be administered through a central line when
possible, or a large peripheral vein with careful monitoring. In-line filters are recommended. A is incorrect because rapid
peripheral infusion increases phlebitis risk. C is incorrect because arterial administration is never used. D is incorrect
because it is not given subcutaneously.
Question 8.
A patient with ST-elevation myocardial infarction (STEMI) is receiving tenecteplase. The nurse
understands that tenecteplase is a fibrin-specific thrombolytic that is administered as a:
A. Continuous infusion over 90 minutes
B. Single IV bolus weight-based dose
C. Subcutaneous injection
D. Intramuscular injection
Correct Answer: B
Rationale:
Tenecteplase is a third-generation fibrin-specific thrombolytic given as a single IV bolus over 5 seconds based on patient
weight (30-50 mg). This simplifies administration compared to alteplase, which requires a 90-minute infusion. A is incorrect
because that describes alteplase. C and D are incorrect because thrombolytics are given IV.
Question 9.
A patient with a non-ST elevation myocardial infarction (NSTEMI) is prescribed eptifibatide. The nurse
understands that eptifibatide is a:
Page 3
With Detailed Rationale | 2026/2027 Updates
Question 1.
A patient with septic shock is prescribed norepinephrine. The nurse understands that norepinephrine
is the first-line vasopressor in septic shock because it:
A. Causes significant tachycardia, increasing cardiac output
B. Is a potent alpha-1 agonist with moderate beta-1 activity, increasing vascular tone and blood pressure
withless arrhythmogenic potential than dopamine
C. Is the cheapest vasopressor available
D. Has no effect on renal perfusion
Correct Answer: B
Rationale:
Norepinephrine is the first-line vasopressor for septic shock per Surviving Sepsis guidelines. It is a potent alpha-1 agonist
(vasoconstriction) with moderate beta-1 activity (modest inotropy), effectively increasing MAP with less tachycardia and
arrhythmia risk than dopamine. A is incorrect because it causes less tachycardia than dopamine. C is incorrect because
cost is not the clinical reason. D is incorrect because it does affect renal perfusion through increased
MAP.
Question 2.
A patient with anaphylactic shock is receiving epinephrine. The nurse understands that epinephrine is
the drug of choice because it:
A. Only blocks histamine receptors
B. Activates alpha-1 receptors (vasoconstriction), beta-1 receptors (inotropy/chronotropy), and beta-2
receptors (bronchodilation), addressing all pathophysiologic aspects of anaphylaxis
C. Is an antihistamine with no cardiovascular effects
D. Only dilates coronary arteries
Correct Answer: B
Rationale:
Epinephrine is the drug of choice for anaphylaxis because it addresses all aspects: alpha-1 for vasoconstriction and blood
pressure support, beta-1 for cardiac output, and beta-2 for bronchodilation and mast cell stabilization. A is incorrect
because it does not block histamine receptors. C is incorrect because it is not an antihistamine. D is incorrect because its
effects are much broader.
Question 3.
A patient with cardiogenic shock is receiving dobutamine. The nurse notes the patient develops
ventricular tachycardia. The nurse understands that this adverse effect occurs because dobutamine:
A. Is a pure alpha-agonist
B. Is a beta-1 agonist that increases myocardial oxygen demand and can precipitate arrhythmias
C. Blocks potassium channels
Page 1
,D. Causes severe bradycardia
Correct Answer: B
Rationale:
Dobutamine is a beta-1 agonist that increases contractility, heart rate, and myocardial oxygen demand. In patients with
underlying ischemia or arrhythmia potential, it can precipitate ventricular arrhythmias. A is incorrect because it is not an
alpha-agonist. C is incorrect because it does not block potassium channels. D is incorrect because it causes tachycardia,
not bradycardia.
Question 4.
A patient with bradycardia and hypotension unresponsive to atropine is receiving epinephrine
infusion. The nurse understands that epinephrine is preferred over dopamine in this situation
because:
A. Epinephrine is cheaper
B. Epinephrine has more potent beta-1 and alpha-1 effects, providing both chronotropy and vasoconstriction
C. Dopamine causes more bronchodilation
D. Epinephrine has no cardiac effects
Correct Answer: B
Rationale:
In bradycardic arrest or symptomatic bradycardia unresponsive to atropine, epinephrine provides potent beta-1 stimulation
(increased heart rate and contractility) and alpha-1 stimulation (vasoconstriction), supporting both cardiac output and blood
pressure. A is incorrect because cost is not the factor. C is incorrect because epinephrine causes more bronchodilation,
not dopamine. D is incorrect because epinephrine has significant cardiac effects.
Question 5.
A patient with pulmonary embolism and hemodynamic instability is receiving systemic thrombolytics.
The nurse understands that the absolute contraindication to thrombolytics in this patient would be:
A. A blood pressure of 150/90 mmHg
B. Active internal bleeding or hemorrhagic stroke within 3 months
C. A history of peptic ulcer disease 10 years ago
D. Age over 75
Correct Answer: B
Rationale:
Absolute contraindications to thrombolytics include active internal bleeding, history of hemorrhagic stroke, ischemic stroke
within 3 months, suspected aortic dissection, and intracranial neoplasm. A is incorrect because hypertension alone is not
an absolute contraindication. C is incorrect because remote PUD is not a contraindication. D is incorrect because
advanced age is a relative, not absolute, contraindication.
Question 6.
A patient with atrial fibrillation is being considered for electrical cardioversion. The nurse knows that if
the atrial fibrillation duration is unknown or exceeds 48 hours, the patient must:
A. Undergo cardioversion immediately without anticoagulation
Page 2
, B. Receive therapeutic anticoagulation for at least 3 weeks before and 4 weeks after cardioversion, orundergo
transesophageal echocardiography to exclude left atrial thrombus
C. Take aspirin only
D. Receive heparin for 24 hours only
Correct Answer: B
Rationale:
For AF >48 hours or unknown duration, therapeutic anticoagulation (warfarin with INR 2-3, or DOAC) is required for 3
weeks before and 4 weeks after cardioversion to prevent thromboembolism. Alternatively, TEE can exclude LA thrombus,
allowing immediate cardioversion if negative, followed by 4 weeks of anticoagulation. A is incorrect because this risks
stroke. C is incorrect because aspirin is insufficient. D is incorrect because 24 hours is inadequate.
Question 7.
A patient with ventricular tachycardia is receiving amiodarone IV. The nurse should administer the
medication through:
A. A peripheral IV at maximum infusion rate
B. A central venous catheter or a large peripheral vein with an in-line filter, due to risk of phlebitis
andhypotension with rapid infusion
C. An arterial line
D. Subcutaneously
Correct Answer: B
Rationale:
IV amiodarone can cause significant hypotension and phlebitis. It should be administered through a central line when
possible, or a large peripheral vein with careful monitoring. In-line filters are recommended. A is incorrect because rapid
peripheral infusion increases phlebitis risk. C is incorrect because arterial administration is never used. D is incorrect
because it is not given subcutaneously.
Question 8.
A patient with ST-elevation myocardial infarction (STEMI) is receiving tenecteplase. The nurse
understands that tenecteplase is a fibrin-specific thrombolytic that is administered as a:
A. Continuous infusion over 90 minutes
B. Single IV bolus weight-based dose
C. Subcutaneous injection
D. Intramuscular injection
Correct Answer: B
Rationale:
Tenecteplase is a third-generation fibrin-specific thrombolytic given as a single IV bolus over 5 seconds based on patient
weight (30-50 mg). This simplifies administration compared to alteplase, which requires a 90-minute infusion. A is incorrect
because that describes alteplase. C and D are incorrect because thrombolytics are given IV.
Question 9.
A patient with a non-ST elevation myocardial infarction (NSTEMI) is prescribed eptifibatide. The nurse
understands that eptifibatide is a:
Page 3
