NUR 210 Final Exam V1 | NUR 210 Pharmacology | Actual Q&A with
Rationale (NUR 210 Final Exam) | Galen
1. A patient is prescribed a medication that has a high ‘first-pass effect.’ Which route of
administration should the nurse expect to be avoided if a rapid systemic effect is desired?
A. Intravenous
B. Transdermal
C. Sublingual
D. Oral
Answer: D
Rationale: The first-pass effect refers to the metabolism of a drug by the liver before it
reaches the systemic circulation, which occurs primarily with oral administration. Drugs
given intravenously or sublingually bypass this initial hepatic metabolism. Therefore, the
oral route results in a lower concentration of the active drug reaching the bloodstream
compared to other routes.
2. A patient taking Digoxin for heart failure reports seeing yellow-green halos around lights.
What is the nurse’s priority action?
A. Administer the next scheduled dose
B. Assess for other signs of toxicity and notify the provider
C. Document the finding as a common side effect
D. Increase the patient’s intake of potassium-rich foods
Answer: B
Rationale: Visual disturbances, such as yellow or green halos, are classic signs of digoxin
toxicity. Digoxin has a narrow therapeutic range, usually between 0.5 and 2.0 ng/mL. The
nurse must hold the dose and notify the healthcare provider immediately to prevent life-
threatening arrhythmias.
3. Which laboratory value is most critical for the nurse to monitor in a patient receiving
Warfarin therapy?
A. Prothrombin time (PT) and International Normalized Ratio (INR)
B. Platelet count
C. Activated partial thromboplastin time (aPTT)
D. Hemoglobin and Hematocrit
,Answer: A
Rationale: Warfarin therapy is monitored using the PT/INR to ensure the dosage is within
the therapeutic range, typically 2.0 to 3.0 for most indications. The aPTT is used specifically
to monitor heparin therapy, not warfarin. Monitoring these levels is essential to prevent
both subtherapeutic dosing and excessive bleeding risks.
4. A nurse is caring for a patient with a history of asthma who is now prescribed Propranolol
for hypertension. Why should the nurse question this order?
A. Propranolol causes severe hypertension in asthmatics
B. Propranolol increases the heart rate too rapidly for asthmatics
C. Propranolol will decrease the effectiveness of rescue inhalers
D. Propranolol is a non-selective beta-blocker that can cause bronchoconstriction
Answer: D
Rationale: Propranolol is a non-selective beta-adrenergic antagonist that blocks both
beta1 and beta2 receptors. Blocking beta2 receptors in the lungs can lead to
bronchospasm, which is dangerous for patients with asthma or COPD. Selective beta-1
blockers, such as metoprolol, are preferred for patients with respiratory issues.
5. A patient with Type 1 diabetes is prescribed Lispro (Humalog) insulin. When should the
nurse instruct the patient to eat after administration?
A. Immediately before bedtime
B. 30 to 60 minutes after
C. 2 hours after administration
D. Within 15 minutes
Answer: D
Rationale: Lispro is a rapid-acting insulin with an onset of approximately 15 minutes. To
prevent hypoglycemia, the patient must have a meal ready and consume it shortly after
administration. Waiting too long to eat can result in a dangerous drop in blood glucose
levels as the insulin peaks.
6. A patient taking Lisinopril for hypertension develops a persistent, dry, non-productive
cough. What is the most likely cause of this symptom?
A. Development of heart failure
B. Allergic reaction to the medication filler
C. Viral upper respiratory infection
D. Accumulation of bradykinin due to ACE inhibition
, Answer: D
Rationale: ACE inhibitors like Lisinopril prevent the breakdown of bradykinin in the lungs,
leading to a persistent dry cough in about 10-20% of patients. This side effect is not
dangerous but is often intolerable, leading to a switch to an Angiotensin II Receptor Blocker
(ARB). The cough typically resolves within a few days to weeks after discontinuing the
drug.
7. What is the primary mechanism of action of Nitroglycerin in the treatment of angina?
A. Increasing heart rate to improve output
B. Vasodilation of veins and coronary arteries to decrease preload and increase oxygen
supply
C. Increasing the force of myocardial contraction
D. Blocking calcium channels in the smooth muscle
Answer: B
Rationale: Nitroglycerin acts directly on vascular smooth muscle to cause vasodilation,
primarily in the venous system, which reduces preload. It also dilates coronary arteries,
improving oxygen delivery to the myocardium. These actions combined reduce the cardiac
workload and relieve anginal pain.
8. A patient is receiving Furosemide (Lasix) 40 mg IV daily. Which electrolyte imbalance is the
patient at highest risk for?
A. Hyperkalemia
B. Hypercalcemia
C. Hypokalemia
D. Hyponatremia only
Answer: C
Rationale: Furosemide is a loop diuretic that inhibits the reabsorption of sodium and
chloride in the loop of Henle, leading to increased excretion of water and potassium.
Hypokalemia is a significant risk and can lead to cardiac arrhythmias. Nurses must monitor
serum potassium levels and encourage intake of potassium-rich foods or supplements.
9. A nurse is preparing to administer Morphine sulfate to a patient. Which assessment finding
would cause the nurse to hold the medication?
A. Respiratory rate 9 breaths per minute
B. Blood pressure 110/70 mmHg
C. Heart rate 72 beats per minute
Rationale (NUR 210 Final Exam) | Galen
1. A patient is prescribed a medication that has a high ‘first-pass effect.’ Which route of
administration should the nurse expect to be avoided if a rapid systemic effect is desired?
A. Intravenous
B. Transdermal
C. Sublingual
D. Oral
Answer: D
Rationale: The first-pass effect refers to the metabolism of a drug by the liver before it
reaches the systemic circulation, which occurs primarily with oral administration. Drugs
given intravenously or sublingually bypass this initial hepatic metabolism. Therefore, the
oral route results in a lower concentration of the active drug reaching the bloodstream
compared to other routes.
2. A patient taking Digoxin for heart failure reports seeing yellow-green halos around lights.
What is the nurse’s priority action?
A. Administer the next scheduled dose
B. Assess for other signs of toxicity and notify the provider
C. Document the finding as a common side effect
D. Increase the patient’s intake of potassium-rich foods
Answer: B
Rationale: Visual disturbances, such as yellow or green halos, are classic signs of digoxin
toxicity. Digoxin has a narrow therapeutic range, usually between 0.5 and 2.0 ng/mL. The
nurse must hold the dose and notify the healthcare provider immediately to prevent life-
threatening arrhythmias.
3. Which laboratory value is most critical for the nurse to monitor in a patient receiving
Warfarin therapy?
A. Prothrombin time (PT) and International Normalized Ratio (INR)
B. Platelet count
C. Activated partial thromboplastin time (aPTT)
D. Hemoglobin and Hematocrit
,Answer: A
Rationale: Warfarin therapy is monitored using the PT/INR to ensure the dosage is within
the therapeutic range, typically 2.0 to 3.0 for most indications. The aPTT is used specifically
to monitor heparin therapy, not warfarin. Monitoring these levels is essential to prevent
both subtherapeutic dosing and excessive bleeding risks.
4. A nurse is caring for a patient with a history of asthma who is now prescribed Propranolol
for hypertension. Why should the nurse question this order?
A. Propranolol causes severe hypertension in asthmatics
B. Propranolol increases the heart rate too rapidly for asthmatics
C. Propranolol will decrease the effectiveness of rescue inhalers
D. Propranolol is a non-selective beta-blocker that can cause bronchoconstriction
Answer: D
Rationale: Propranolol is a non-selective beta-adrenergic antagonist that blocks both
beta1 and beta2 receptors. Blocking beta2 receptors in the lungs can lead to
bronchospasm, which is dangerous for patients with asthma or COPD. Selective beta-1
blockers, such as metoprolol, are preferred for patients with respiratory issues.
5. A patient with Type 1 diabetes is prescribed Lispro (Humalog) insulin. When should the
nurse instruct the patient to eat after administration?
A. Immediately before bedtime
B. 30 to 60 minutes after
C. 2 hours after administration
D. Within 15 minutes
Answer: D
Rationale: Lispro is a rapid-acting insulin with an onset of approximately 15 minutes. To
prevent hypoglycemia, the patient must have a meal ready and consume it shortly after
administration. Waiting too long to eat can result in a dangerous drop in blood glucose
levels as the insulin peaks.
6. A patient taking Lisinopril for hypertension develops a persistent, dry, non-productive
cough. What is the most likely cause of this symptom?
A. Development of heart failure
B. Allergic reaction to the medication filler
C. Viral upper respiratory infection
D. Accumulation of bradykinin due to ACE inhibition
, Answer: D
Rationale: ACE inhibitors like Lisinopril prevent the breakdown of bradykinin in the lungs,
leading to a persistent dry cough in about 10-20% of patients. This side effect is not
dangerous but is often intolerable, leading to a switch to an Angiotensin II Receptor Blocker
(ARB). The cough typically resolves within a few days to weeks after discontinuing the
drug.
7. What is the primary mechanism of action of Nitroglycerin in the treatment of angina?
A. Increasing heart rate to improve output
B. Vasodilation of veins and coronary arteries to decrease preload and increase oxygen
supply
C. Increasing the force of myocardial contraction
D. Blocking calcium channels in the smooth muscle
Answer: B
Rationale: Nitroglycerin acts directly on vascular smooth muscle to cause vasodilation,
primarily in the venous system, which reduces preload. It also dilates coronary arteries,
improving oxygen delivery to the myocardium. These actions combined reduce the cardiac
workload and relieve anginal pain.
8. A patient is receiving Furosemide (Lasix) 40 mg IV daily. Which electrolyte imbalance is the
patient at highest risk for?
A. Hyperkalemia
B. Hypercalcemia
C. Hypokalemia
D. Hyponatremia only
Answer: C
Rationale: Furosemide is a loop diuretic that inhibits the reabsorption of sodium and
chloride in the loop of Henle, leading to increased excretion of water and potassium.
Hypokalemia is a significant risk and can lead to cardiac arrhythmias. Nurses must monitor
serum potassium levels and encourage intake of potassium-rich foods or supplements.
9. A nurse is preparing to administer Morphine sulfate to a patient. Which assessment finding
would cause the nurse to hold the medication?
A. Respiratory rate 9 breaths per minute
B. Blood pressure 110/70 mmHg
C. Heart rate 72 beats per minute
