NUR 210 Final Exam V2 | NUR 210 Pharmacology | Actual Q&A with
Rationale (NUR 210 Final Exam) | Galen
1. A patient is prescribed an oral medication that has a high first-pass effect. Which route of
administration would bypass this effect and provide the highest bioavailability?
A. Oral capsule
B. Nasogastric tube
C. Rectal suppository
D. Sublingual tablet
Answer: D
Rationale: The first-pass effect occurs when a drug is metabolized in the liver before
reaching systemic circulation, significantly reducing its concentration. Sublingual
administration allows the drug to be absorbed directly into the capillary bed under the
tongue, which bypasses the portal vein and liver. This route results in faster absorption and
higher bioavailability compared to the oral or rectal routes.
2. A nurse is assessing a patient taking digoxin (Lanoxin) for heart failure. Which clinical
finding is the most indicative of early digoxin toxicity?
A. Blood pressure of 150/90 mmHg
B. Heart rate of 110 beats per minute
C. Anorexia, nausea, and vomiting
D. Increased urinary output
Answer: C
Rationale: Early signs of digoxin toxicity often involve the gastrointestinal system,
specifically anorexia, nausea, and vomiting. As toxicity progresses, patients may experience
visual disturbances such as blurred vision or yellow-green halos around lights. The nurse
should always assess the apical pulse for one full minute and monitor serum potassium
levels, as hypokalemia increases the risk of toxicity.
3. Which instruction is most important for a patient newly prescribed albuterol (Proventil)
and beclomethasone (Qvar) inhalers?
A. Use the albuterol inhaler first, wait 5 minutes, then use the beclomethasone inhaler.
B. Use the beclomethasone inhaler first, then use the albuterol inhaler immediately.
C. Only use the albuterol inhaler if the beclomethasone does not provide relief.
D. Mix both medications in a nebulizer to ensure they are inhaled together.
,Answer: A
Rationale: Albuterol is a short-acting beta-2 agonist (SABA) that acts as a bronchodilator,
whereas beclomethasone is a corticosteroid used for long-term inflammation control.
Using the bronchodilator first opens the airways, allowing the steroid medication to
penetrate deeper into the lung tissue for better efficacy. Patients must be taught to wait
approximately 5 minutes between the two different inhalers and to rinse their mouth after
the steroid to prevent oral candidiasis.
4. A patient with Type 1 Diabetes Mellitus is administered 5 units of Lispro (Humalog) insulin
at 0800. At what time should the nurse be most concerned about a hypoglycemic reaction?
A. 0815
B. 1200
C. 1500
D. 0900
Answer: D
Rationale: Lispro (Humalog) is a rapid-acting insulin with an onset of 15 minutes and a
peak action time of 1 to 2 hours. A peak occurs when the insulin is at its maximum strength
in the body, which is the time of highest risk for hypoglycemia. Since the insulin was given
at 0800, the peak would occur between 0900 and 1000, necessitating close monitoring of
the patient’s blood glucose.
5. Which laboratory value is used to monitor the therapeutic effectiveness of Heparin
therapy?
A. Activated Partial Thromboplastin Time (aPTT)
B. International Normalized Ratio (INR)
C. Prothrombin Time (PT)
D. Platelet Count
Answer: A
Rationale: The aPTT is the standard laboratory test used to monitor the effectiveness of
unfractionated heparin and to adjust the dosage accordingly. The goal for therapeutic
heparinization is typically 1.5 to 2.5 times the normal control value. While platelet counts
are monitored to detect heparin-induced thrombocytopenia (HIT), they do not measure the
anticoagulant effect itself.
6. A patient receiving intravenous Vancomycin begins to develop flushing of the neck and
face with a rapid heart rate. Which action should the nurse take first?
A. Administer intramuscular epinephrine immediately.
B. Notify the physician that the patient is having an anaphylactic reaction.
, C. Slow the rate of the Vancomycin infusion.
D. Discontinue the infusion and document the drug allergy.
Answer: C
Rationale: The symptoms described (flushing and tachycardia) are characteristic of ‘Red
Man Syndrome,’ which is a rate-dependent infusion reaction rather than a true allergic
reaction. Slowing the infusion rate usually resolves these symptoms and prevents further
discomfort for the patient. If the symptoms are severe or do not resolve, the nurse should
notify the provider, but the immediate priority is to address the rate of administration.
7. What is the therapeutic serum range for a patient receiving Lithium carbonate for bipolar
disorder?
A. 0.1 to 0.5 mEq/L
B. 1.5 to 2.5 mEq/L
C. 2.0 to 3.5 mEq/L
D. 0.6 to 1.2 mEq/L
Answer: D
Rationale: Lithium has a very narrow therapeutic index, with the target range usually
being 0.6 to 1.2 mEq/L for maintenance therapy. Levels above 1.5 mEq/L are considered
toxic and can lead to symptoms such as tremors, confusion, and seizures. Patients must be
educated on maintaining consistent salt and fluid intake, as dehydration or low sodium
levels can cause lithium levels to rise dangerously.
8. Which medication is the drug of choice for treating a patient experiencing a symptomatic
sinus bradycardia?
A. Epinephrine
B. Amiodarone
C. Dopamine
D. Atropine
Answer: D
Rationale: Atropine is an anticholinergic medication that increases the heart rate by
blocking the vagus nerve’s inhibitory effects on the sinoatrial node. It is the first-line
treatment for symptomatic bradycardia according to ACLS guidelines. If atropine is
ineffective, other treatments such as transcutaneous pacing or dopamine/epinephrine
infusions may be considered.
Rationale (NUR 210 Final Exam) | Galen
1. A patient is prescribed an oral medication that has a high first-pass effect. Which route of
administration would bypass this effect and provide the highest bioavailability?
A. Oral capsule
B. Nasogastric tube
C. Rectal suppository
D. Sublingual tablet
Answer: D
Rationale: The first-pass effect occurs when a drug is metabolized in the liver before
reaching systemic circulation, significantly reducing its concentration. Sublingual
administration allows the drug to be absorbed directly into the capillary bed under the
tongue, which bypasses the portal vein and liver. This route results in faster absorption and
higher bioavailability compared to the oral or rectal routes.
2. A nurse is assessing a patient taking digoxin (Lanoxin) for heart failure. Which clinical
finding is the most indicative of early digoxin toxicity?
A. Blood pressure of 150/90 mmHg
B. Heart rate of 110 beats per minute
C. Anorexia, nausea, and vomiting
D. Increased urinary output
Answer: C
Rationale: Early signs of digoxin toxicity often involve the gastrointestinal system,
specifically anorexia, nausea, and vomiting. As toxicity progresses, patients may experience
visual disturbances such as blurred vision or yellow-green halos around lights. The nurse
should always assess the apical pulse for one full minute and monitor serum potassium
levels, as hypokalemia increases the risk of toxicity.
3. Which instruction is most important for a patient newly prescribed albuterol (Proventil)
and beclomethasone (Qvar) inhalers?
A. Use the albuterol inhaler first, wait 5 minutes, then use the beclomethasone inhaler.
B. Use the beclomethasone inhaler first, then use the albuterol inhaler immediately.
C. Only use the albuterol inhaler if the beclomethasone does not provide relief.
D. Mix both medications in a nebulizer to ensure they are inhaled together.
,Answer: A
Rationale: Albuterol is a short-acting beta-2 agonist (SABA) that acts as a bronchodilator,
whereas beclomethasone is a corticosteroid used for long-term inflammation control.
Using the bronchodilator first opens the airways, allowing the steroid medication to
penetrate deeper into the lung tissue for better efficacy. Patients must be taught to wait
approximately 5 minutes between the two different inhalers and to rinse their mouth after
the steroid to prevent oral candidiasis.
4. A patient with Type 1 Diabetes Mellitus is administered 5 units of Lispro (Humalog) insulin
at 0800. At what time should the nurse be most concerned about a hypoglycemic reaction?
A. 0815
B. 1200
C. 1500
D. 0900
Answer: D
Rationale: Lispro (Humalog) is a rapid-acting insulin with an onset of 15 minutes and a
peak action time of 1 to 2 hours. A peak occurs when the insulin is at its maximum strength
in the body, which is the time of highest risk for hypoglycemia. Since the insulin was given
at 0800, the peak would occur between 0900 and 1000, necessitating close monitoring of
the patient’s blood glucose.
5. Which laboratory value is used to monitor the therapeutic effectiveness of Heparin
therapy?
A. Activated Partial Thromboplastin Time (aPTT)
B. International Normalized Ratio (INR)
C. Prothrombin Time (PT)
D. Platelet Count
Answer: A
Rationale: The aPTT is the standard laboratory test used to monitor the effectiveness of
unfractionated heparin and to adjust the dosage accordingly. The goal for therapeutic
heparinization is typically 1.5 to 2.5 times the normal control value. While platelet counts
are monitored to detect heparin-induced thrombocytopenia (HIT), they do not measure the
anticoagulant effect itself.
6. A patient receiving intravenous Vancomycin begins to develop flushing of the neck and
face with a rapid heart rate. Which action should the nurse take first?
A. Administer intramuscular epinephrine immediately.
B. Notify the physician that the patient is having an anaphylactic reaction.
, C. Slow the rate of the Vancomycin infusion.
D. Discontinue the infusion and document the drug allergy.
Answer: C
Rationale: The symptoms described (flushing and tachycardia) are characteristic of ‘Red
Man Syndrome,’ which is a rate-dependent infusion reaction rather than a true allergic
reaction. Slowing the infusion rate usually resolves these symptoms and prevents further
discomfort for the patient. If the symptoms are severe or do not resolve, the nurse should
notify the provider, but the immediate priority is to address the rate of administration.
7. What is the therapeutic serum range for a patient receiving Lithium carbonate for bipolar
disorder?
A. 0.1 to 0.5 mEq/L
B. 1.5 to 2.5 mEq/L
C. 2.0 to 3.5 mEq/L
D. 0.6 to 1.2 mEq/L
Answer: D
Rationale: Lithium has a very narrow therapeutic index, with the target range usually
being 0.6 to 1.2 mEq/L for maintenance therapy. Levels above 1.5 mEq/L are considered
toxic and can lead to symptoms such as tremors, confusion, and seizures. Patients must be
educated on maintaining consistent salt and fluid intake, as dehydration or low sodium
levels can cause lithium levels to rise dangerously.
8. Which medication is the drug of choice for treating a patient experiencing a symptomatic
sinus bradycardia?
A. Epinephrine
B. Amiodarone
C. Dopamine
D. Atropine
Answer: D
Rationale: Atropine is an anticholinergic medication that increases the heart rate by
blocking the vagus nerve’s inhibitory effects on the sinoatrial node. It is the first-line
treatment for symptomatic bradycardia according to ACLS guidelines. If atropine is
ineffective, other treatments such as transcutaneous pacing or dopamine/epinephrine
infusions may be considered.
