NUR 2407 / NUR 2474 Pharmacology Exam 2 Rasmussen
College Academic Year 2026/2027 Examination 2
Comprehensive Examination 50 Verified Questions and
Correct Answer Rationales
About This Exam Bank
This comprehensive 143-question exam bank is designed to prepare candidates for NUR 2407 / NUR 2474
Pharmacology Exam 2 Rasmussen College Academic Year 2026/2027 Examination 2 Comprehensive Examination
50 Verified Questions and Correct Answer Rationales. Every question is aligned with the latest official content
outline and includes a detailed, evidence-based rationale, an explanation of why each remaining option is incorrect,
and a supporting reference.
Keywords
NUR 2407 / NUR 2474 Pharmacology Exam 2 Rasmussen College Academic Year 2026/2027 Examination 2
Comprehensive Examination 50 Verified Questions and Correct Answer Rationales, exam bank, practice questions,
verified answers, detailed rationales, test prep, study guide, review questions, certification exam, latest update, NUR
2407 / NUR 2474 Pharmacology Exam 2 Rasmussen College Academic Year 2026/2027 Examination 2
Comprehensive Examination 50 Verified Questions and Correct Answer Rationales, exam bank, practice questions,
verified answers, detailed rationales
PART 1: APPLY PHARMACOKINETIC AND PHARMACODYNAMIC PRINCIPLES TO
PREDICT DRUG RESPONSE AND ADVERSE EFFECTS
1. A client receiving warfarin for atrial fibrillation is prescribed trimethoprim-sulfamethoxazole for a urinary tract
infection. Which laboratory value should the nurse monitor most closely within 3 to 5 days?
A) Serum potassium
B) INR
C) Serum creatinine
D) Hemoglobin
' Correct Answer: B
Rationale: Trimethoprim-sulfamethoxazole inhibits CYP2C9, reducing warfarin metabolism and markedly
increasing INR and bleeding risk. Serum potassium may rise with TMP-SMX but is not the primary warfarin safety
parameter. Creatinine and hemoglobin are secondary concerns, not the direct measure of warfarin effect.
2. Which statement best explains why a client with a history of narrow-angle glaucoma must avoid oxybutynin for
urge incontinence?
A) Oxybutynin directly increases intraocular aqueous production.
B) Oxybutynin's anticholinergic mydriasis can precipitate acute angle closure.
C) Oxybutynin stimulates alpha-1 receptors in the ciliary muscle.
D) Oxybutynin reduces tear production, causing corneal abrasion.
' Correct Answer: B
Rationale: Oxybutynin blocks muscarinic receptors, producing mydriasis and cycloplegia that can obstruct aqueous
outflow and trigger acute angle-closure glaucoma. It does not increase aqueous production or act on alpha-1
receptors. Decreased tearing is a nuisance effect, not the contraindication rationale.
Page 1
,3. A client with major depressive disorder has taken sertraline for 5 weeks with minimal improvement. Which action
by the provider is most appropriate?
A) Add a monoamine oxidase inhibitor (MAOI) now.
B) Increase the sertraline dose or consider augmentation after assessing adherence and comorbidities.
C) Discontinue sertraline abruptly and start a tricyclic.
D) Add St. John's wort to enhance serotonergic effect.
' Correct Answer: B
Rationale: SSRIs require 4-8 weeks for full effect; partial response at 5 weeks warrants adherence assessment, dose
optimization, or augmentation-not immediate class switching. MAOI addition risks serotonin syndrome and requires
a washout. Abrupt SSRI discontinuation causes withdrawal, and St. John's wort increases serotonin toxicity risk.
4. A client is prescribed insulin glargine at bedtime and insulin lispro before meals. Which statement indicates
correct understanding of the pharmacodynamics?
A) "Glargine peaks in 2 hours, so I should eat immediately after my bedtime dose."
B) "Lispro has a delayed onset, so I should inject it 30 minutes before eating."
C) "Glargine provides basal coverage with minimal peak, while lispro covers mealtime glucose spikes."
D) "I can mix glargine and lispro in the same syringe to reduce injections."
' Correct Answer: C
Rationale: Glargine is a long-acting basal insulin with a relatively peakless profile, while lispro is a rapid-acting
analog that covers postprandial excursions. Glargine does not peak at 2 hours, lispro onset is 15 minutes (not 30-60),
and glargine must never be mixed with other insulins.
5. A client with heart failure is started on sacubitril/valsartan. Which concurrent medication requires the nurse to
hold and clarify the order?
A) Metoprolol succinate
B) Spironolactone
C) Lisinopril
D) Furosemide
' Correct Answer: C
Rationale: Sacubitril/valsartan contains an ARB (valsartan); concurrent ACE inhibitor (lisinopril) markedly
increases angioedema risk and is contraindicated. A 36-hour washout is required when switching. Beta-blockers,
aldosterone antagonists, and loop diuretics are standard guideline-directed heart failure therapies and may be
continued.
6. A client receiving vancomycin IV develops flushing of the face, neck, and upper torso with pruritus during the
infusion. Which action should the nurse take first?
A) Stop the infusion and prepare to administer diphenhydramine and epinephrine.
B) Slow the infusion rate and notify the provider; this is likely vancomycin infusion reaction.
C) Document the finding as an expected adverse effect and continue the current rate.
D) Obtain a serum vancomycin trough immediately and hold the next dose.
' Correct Answer: B
Rationale: Vancomycin infusion reaction (formerly 'red man syndrome') is a histamine-mediated rate-related
reaction, not true anaphylaxis; slowing the infusion and premedicating with antihistamines is standard. Stopping and
giving epinephrine is reserved for anaphylaxis. Continuing at the same rate is unsafe, and trough levels do not
address the acute reaction.
7. Which mechanism best explains why levothyroxine should be administered on an empty stomach, 30 to 60
minutes before breakfast?
Page 2
, A) Food increases renal clearance of levothyroxine.
B) Food and calcium or iron bind levothyroxine, reducing its absorption.
C) Food induces hepatic enzymes that metabolize levothyroxine.
D) Food enhances conversion of T4 to T3, causing toxicity.
' Correct Answer: B
Rationale: Levothyroxine absorption is reduced by food, calcium, iron, and proton pump inhibitors due to
chelation and altered gastric pH; consistent empty-stomach dosing ensures stable bioavailability. Food does not
increase renal clearance or induce metabolism of levothyroxine, and conversion to T3 is not enhanced by food.
8. A client on lithium carbonate for bipolar disorder presents with coarse hand tremor, vomiting, and confusion.
Which finding is most consistent with lithium toxicity?
A) Serum lithium level of 0.6 mEq/L
B) Serum lithium level of 1.8 mEq/L with decreased creatinine clearance
C) Serum lithium level of 0.9 mEq/L with increased thirst
D) Serum lithium level of 1.2 mEq/L with fine hand tremor
' Correct Answer: B
Rationale: Therapeutic lithium range is 0.6-1.2 mEq/L; levels >1.5 mEq/L with symptoms and reduced renal
clearance indicate toxicity. Fine tremor and thirst are common therapeutic side effects. A level of 0.6 is
subtherapeutic, and 1.2 with fine tremor is within high therapeutic range.
9. A client is prescribed both a beta-2 agonist (albuterol) and an inhaled glucocorticoid (fluticasone) for asthma.
Which instruction is most important for the nurse to include?
A) Use the glucocorticoid inhaler first, then wait 5 minutes before the beta-2 agonist.
B) Use the beta-2 agonist first, wait 5 minutes, then use the glucocorticoid inhaler and rinse the mouth.
C) Use both inhalers simultaneously to improve lung deposition.
D) Use the glucocorticoid inhaler only when symptoms occur.
' Correct Answer: B
Rationale: Beta-2 agonists cause bronchodilation, enhancing deposition of the inhaled glucocorticoid; rinsing after
the steroid prevents oral candidiasis and dysphonia. Reversing the order reduces steroid delivery. Simultaneous use
is ineffective, and glucocorticoids are controllers, not rescue medications.
10. A patient with chronic kidney disease (eGFR 22 mL/min/1.73 m²) is prescribed apixaban for nonvalvular atrial
fibrillation. Which dosing rationale is most accurate?
A) Standard dose 5 mg BID is appropriate because apixaban is not renally cleared.
B) Dose reduction to 2.5 mg BID requires at least two of: age 80, weight 60 kg, or serum creatinine 1.5 mg/dL.
C) Apixaban is contraindicated when eGFR <30 mL/min/1.73 m² and should be replaced with warfarin.
D) Dose should be reduced to 2.5 mg daily based solely on the eGFR value.
' Correct Answer: B
Rationale: Apixaban dose reduction to 2.5 mg BID in atrial fibrillation requires at least two of three criteria: age
80 years, weight 60 kg, or SCr 1.5 mg/dL; eGFR alone does not trigger reduction. Apixaban is partially renally
cleared but is not contraindicated at eGFR <30, and 2.5 mg daily is not a standard AF regimen. Standard 5 mg BID
is incorrect when two reduction criteria are present.
11. Which statement best explains why levothyroxine must be administered on an empty stomach, 30-60 minutes
before breakfast?
A) Food increases gastric pH, which inactivates levothyroxine's phenolic ring.
B) Food binds levothyroxine in the gut and reduces its bioavailability by up to 40%.
C) Food induces hepatic CYP enzymes that accelerate levothyroxine metabolism.
Page 3
, D) Food enhances levothyroxine absorption by delaying gastric emptying.
' Correct Answer: B
Rationale: Food, especially fiber, soy, and calcium, binds levothyroxine in the GI tract and can reduce absorption
by up to 40%, so it must be taken on an empty stomach. Levothyroxine is not primarily inactivated by gastric pH or
hepatic enzyme induction, and food does not enhance its absorption.
12. A patient on chronic high-dose prednisone is being tapered. Which finding most specifically indicates adrenal
insufficiency rather than a recurrence of the underlying disease?
A) Increased joint pain and stiffness in previously affected joints
B) Hyperglycemia and glycosuria after meals
C) Hyponatremia, hyperkalemia, and postural hypotension
D) Increased erythrocyte sedimentation rate and C-reactive protein
' Correct Answer: C
Rationale: Adrenal insufficiency from HPA-axis suppression produces mineralocorticoid deficiency signs:
hyponatremia, hyperkalemia, and orthostasis. Joint pain, elevated inflammatory markers, and hyperglycemia are
more consistent with disease flare or steroid effect, not cortisol deficiency.
13. A patient is prescribed both warfarin and amiodarone. Which monitoring plan is most appropriate?
A) Monitor INR weekly for 2 weeks, then every 4 weeks once stable.
B) Monitor INR every 1-2 weeks for several weeks because amiodarone's effect on warfarin persists for months.
C) Monitor INR daily for 3 days, then discontinue monitoring.
D) Monitor INR only if the patient reports bleeding.
' Correct Answer: B
Rationale: Amiodarone inhibits CYP2C9 and CYP3A4, increasing warfarin effect; because amiodarone has an
extremely long half-life (weeks to months), INR must be monitored every 1-2 weeks for several weeks and the
warfarin dose often reduced. Weekly then monthly monitoring is insufficient given the prolonged interaction, and
daily monitoring for only 3 days misses delayed effects.
14. A patient on lithium carbonate reports new-onset coarse tremor, vomiting, and ataxia. The serum lithium level is
2.1 mEq/L. Which intervention is the priority?
A) Administer the next scheduled lithium dose and encourage oral fluids.
B) Hold lithium, ensure IV hydration, and prepare for hemodialysis if symptoms persist.
C) Administer activated charcoal to bind the lithium.
D) Administer sodium polystyrene sulfonate to enhance lithium excretion.
' Correct Answer: B
Rationale: Lithium toxicity at 2.1 mEq/L with neurologic and GI symptoms requires holding the drug, IV
hydration with normal saline to enhance renal excretion, and hemodialysis if severe. Activated charcoal does not
bind lithium, sodium polystyrene sulfonate exchanges potassium not lithium, and continuing lithium would worsen
toxicity.
15. Which mechanism best explains why ondansetron is less effective for chemotherapy-induced delayed nausea
than for acute nausea?
A) Delayed nausea is mediated primarily by substance P/NK1 receptors rather than serotonin 5-HT3 receptors.
B) Ondansetron has a short half-life that does not cover the delayed phase.
C) Delayed nausea is caused by dopamine D2 stimulation in the chemoreceptor trigger zone.
D) Ondansetron is inactivated by hepatic enzymes induced by chemotherapy agents.
' Correct Answer: A
Page 4
College Academic Year 2026/2027 Examination 2
Comprehensive Examination 50 Verified Questions and
Correct Answer Rationales
About This Exam Bank
This comprehensive 143-question exam bank is designed to prepare candidates for NUR 2407 / NUR 2474
Pharmacology Exam 2 Rasmussen College Academic Year 2026/2027 Examination 2 Comprehensive Examination
50 Verified Questions and Correct Answer Rationales. Every question is aligned with the latest official content
outline and includes a detailed, evidence-based rationale, an explanation of why each remaining option is incorrect,
and a supporting reference.
Keywords
NUR 2407 / NUR 2474 Pharmacology Exam 2 Rasmussen College Academic Year 2026/2027 Examination 2
Comprehensive Examination 50 Verified Questions and Correct Answer Rationales, exam bank, practice questions,
verified answers, detailed rationales, test prep, study guide, review questions, certification exam, latest update, NUR
2407 / NUR 2474 Pharmacology Exam 2 Rasmussen College Academic Year 2026/2027 Examination 2
Comprehensive Examination 50 Verified Questions and Correct Answer Rationales, exam bank, practice questions,
verified answers, detailed rationales
PART 1: APPLY PHARMACOKINETIC AND PHARMACODYNAMIC PRINCIPLES TO
PREDICT DRUG RESPONSE AND ADVERSE EFFECTS
1. A client receiving warfarin for atrial fibrillation is prescribed trimethoprim-sulfamethoxazole for a urinary tract
infection. Which laboratory value should the nurse monitor most closely within 3 to 5 days?
A) Serum potassium
B) INR
C) Serum creatinine
D) Hemoglobin
' Correct Answer: B
Rationale: Trimethoprim-sulfamethoxazole inhibits CYP2C9, reducing warfarin metabolism and markedly
increasing INR and bleeding risk. Serum potassium may rise with TMP-SMX but is not the primary warfarin safety
parameter. Creatinine and hemoglobin are secondary concerns, not the direct measure of warfarin effect.
2. Which statement best explains why a client with a history of narrow-angle glaucoma must avoid oxybutynin for
urge incontinence?
A) Oxybutynin directly increases intraocular aqueous production.
B) Oxybutynin's anticholinergic mydriasis can precipitate acute angle closure.
C) Oxybutynin stimulates alpha-1 receptors in the ciliary muscle.
D) Oxybutynin reduces tear production, causing corneal abrasion.
' Correct Answer: B
Rationale: Oxybutynin blocks muscarinic receptors, producing mydriasis and cycloplegia that can obstruct aqueous
outflow and trigger acute angle-closure glaucoma. It does not increase aqueous production or act on alpha-1
receptors. Decreased tearing is a nuisance effect, not the contraindication rationale.
Page 1
,3. A client with major depressive disorder has taken sertraline for 5 weeks with minimal improvement. Which action
by the provider is most appropriate?
A) Add a monoamine oxidase inhibitor (MAOI) now.
B) Increase the sertraline dose or consider augmentation after assessing adherence and comorbidities.
C) Discontinue sertraline abruptly and start a tricyclic.
D) Add St. John's wort to enhance serotonergic effect.
' Correct Answer: B
Rationale: SSRIs require 4-8 weeks for full effect; partial response at 5 weeks warrants adherence assessment, dose
optimization, or augmentation-not immediate class switching. MAOI addition risks serotonin syndrome and requires
a washout. Abrupt SSRI discontinuation causes withdrawal, and St. John's wort increases serotonin toxicity risk.
4. A client is prescribed insulin glargine at bedtime and insulin lispro before meals. Which statement indicates
correct understanding of the pharmacodynamics?
A) "Glargine peaks in 2 hours, so I should eat immediately after my bedtime dose."
B) "Lispro has a delayed onset, so I should inject it 30 minutes before eating."
C) "Glargine provides basal coverage with minimal peak, while lispro covers mealtime glucose spikes."
D) "I can mix glargine and lispro in the same syringe to reduce injections."
' Correct Answer: C
Rationale: Glargine is a long-acting basal insulin with a relatively peakless profile, while lispro is a rapid-acting
analog that covers postprandial excursions. Glargine does not peak at 2 hours, lispro onset is 15 minutes (not 30-60),
and glargine must never be mixed with other insulins.
5. A client with heart failure is started on sacubitril/valsartan. Which concurrent medication requires the nurse to
hold and clarify the order?
A) Metoprolol succinate
B) Spironolactone
C) Lisinopril
D) Furosemide
' Correct Answer: C
Rationale: Sacubitril/valsartan contains an ARB (valsartan); concurrent ACE inhibitor (lisinopril) markedly
increases angioedema risk and is contraindicated. A 36-hour washout is required when switching. Beta-blockers,
aldosterone antagonists, and loop diuretics are standard guideline-directed heart failure therapies and may be
continued.
6. A client receiving vancomycin IV develops flushing of the face, neck, and upper torso with pruritus during the
infusion. Which action should the nurse take first?
A) Stop the infusion and prepare to administer diphenhydramine and epinephrine.
B) Slow the infusion rate and notify the provider; this is likely vancomycin infusion reaction.
C) Document the finding as an expected adverse effect and continue the current rate.
D) Obtain a serum vancomycin trough immediately and hold the next dose.
' Correct Answer: B
Rationale: Vancomycin infusion reaction (formerly 'red man syndrome') is a histamine-mediated rate-related
reaction, not true anaphylaxis; slowing the infusion and premedicating with antihistamines is standard. Stopping and
giving epinephrine is reserved for anaphylaxis. Continuing at the same rate is unsafe, and trough levels do not
address the acute reaction.
7. Which mechanism best explains why levothyroxine should be administered on an empty stomach, 30 to 60
minutes before breakfast?
Page 2
, A) Food increases renal clearance of levothyroxine.
B) Food and calcium or iron bind levothyroxine, reducing its absorption.
C) Food induces hepatic enzymes that metabolize levothyroxine.
D) Food enhances conversion of T4 to T3, causing toxicity.
' Correct Answer: B
Rationale: Levothyroxine absorption is reduced by food, calcium, iron, and proton pump inhibitors due to
chelation and altered gastric pH; consistent empty-stomach dosing ensures stable bioavailability. Food does not
increase renal clearance or induce metabolism of levothyroxine, and conversion to T3 is not enhanced by food.
8. A client on lithium carbonate for bipolar disorder presents with coarse hand tremor, vomiting, and confusion.
Which finding is most consistent with lithium toxicity?
A) Serum lithium level of 0.6 mEq/L
B) Serum lithium level of 1.8 mEq/L with decreased creatinine clearance
C) Serum lithium level of 0.9 mEq/L with increased thirst
D) Serum lithium level of 1.2 mEq/L with fine hand tremor
' Correct Answer: B
Rationale: Therapeutic lithium range is 0.6-1.2 mEq/L; levels >1.5 mEq/L with symptoms and reduced renal
clearance indicate toxicity. Fine tremor and thirst are common therapeutic side effects. A level of 0.6 is
subtherapeutic, and 1.2 with fine tremor is within high therapeutic range.
9. A client is prescribed both a beta-2 agonist (albuterol) and an inhaled glucocorticoid (fluticasone) for asthma.
Which instruction is most important for the nurse to include?
A) Use the glucocorticoid inhaler first, then wait 5 minutes before the beta-2 agonist.
B) Use the beta-2 agonist first, wait 5 minutes, then use the glucocorticoid inhaler and rinse the mouth.
C) Use both inhalers simultaneously to improve lung deposition.
D) Use the glucocorticoid inhaler only when symptoms occur.
' Correct Answer: B
Rationale: Beta-2 agonists cause bronchodilation, enhancing deposition of the inhaled glucocorticoid; rinsing after
the steroid prevents oral candidiasis and dysphonia. Reversing the order reduces steroid delivery. Simultaneous use
is ineffective, and glucocorticoids are controllers, not rescue medications.
10. A patient with chronic kidney disease (eGFR 22 mL/min/1.73 m²) is prescribed apixaban for nonvalvular atrial
fibrillation. Which dosing rationale is most accurate?
A) Standard dose 5 mg BID is appropriate because apixaban is not renally cleared.
B) Dose reduction to 2.5 mg BID requires at least two of: age 80, weight 60 kg, or serum creatinine 1.5 mg/dL.
C) Apixaban is contraindicated when eGFR <30 mL/min/1.73 m² and should be replaced with warfarin.
D) Dose should be reduced to 2.5 mg daily based solely on the eGFR value.
' Correct Answer: B
Rationale: Apixaban dose reduction to 2.5 mg BID in atrial fibrillation requires at least two of three criteria: age
80 years, weight 60 kg, or SCr 1.5 mg/dL; eGFR alone does not trigger reduction. Apixaban is partially renally
cleared but is not contraindicated at eGFR <30, and 2.5 mg daily is not a standard AF regimen. Standard 5 mg BID
is incorrect when two reduction criteria are present.
11. Which statement best explains why levothyroxine must be administered on an empty stomach, 30-60 minutes
before breakfast?
A) Food increases gastric pH, which inactivates levothyroxine's phenolic ring.
B) Food binds levothyroxine in the gut and reduces its bioavailability by up to 40%.
C) Food induces hepatic CYP enzymes that accelerate levothyroxine metabolism.
Page 3
, D) Food enhances levothyroxine absorption by delaying gastric emptying.
' Correct Answer: B
Rationale: Food, especially fiber, soy, and calcium, binds levothyroxine in the GI tract and can reduce absorption
by up to 40%, so it must be taken on an empty stomach. Levothyroxine is not primarily inactivated by gastric pH or
hepatic enzyme induction, and food does not enhance its absorption.
12. A patient on chronic high-dose prednisone is being tapered. Which finding most specifically indicates adrenal
insufficiency rather than a recurrence of the underlying disease?
A) Increased joint pain and stiffness in previously affected joints
B) Hyperglycemia and glycosuria after meals
C) Hyponatremia, hyperkalemia, and postural hypotension
D) Increased erythrocyte sedimentation rate and C-reactive protein
' Correct Answer: C
Rationale: Adrenal insufficiency from HPA-axis suppression produces mineralocorticoid deficiency signs:
hyponatremia, hyperkalemia, and orthostasis. Joint pain, elevated inflammatory markers, and hyperglycemia are
more consistent with disease flare or steroid effect, not cortisol deficiency.
13. A patient is prescribed both warfarin and amiodarone. Which monitoring plan is most appropriate?
A) Monitor INR weekly for 2 weeks, then every 4 weeks once stable.
B) Monitor INR every 1-2 weeks for several weeks because amiodarone's effect on warfarin persists for months.
C) Monitor INR daily for 3 days, then discontinue monitoring.
D) Monitor INR only if the patient reports bleeding.
' Correct Answer: B
Rationale: Amiodarone inhibits CYP2C9 and CYP3A4, increasing warfarin effect; because amiodarone has an
extremely long half-life (weeks to months), INR must be monitored every 1-2 weeks for several weeks and the
warfarin dose often reduced. Weekly then monthly monitoring is insufficient given the prolonged interaction, and
daily monitoring for only 3 days misses delayed effects.
14. A patient on lithium carbonate reports new-onset coarse tremor, vomiting, and ataxia. The serum lithium level is
2.1 mEq/L. Which intervention is the priority?
A) Administer the next scheduled lithium dose and encourage oral fluids.
B) Hold lithium, ensure IV hydration, and prepare for hemodialysis if symptoms persist.
C) Administer activated charcoal to bind the lithium.
D) Administer sodium polystyrene sulfonate to enhance lithium excretion.
' Correct Answer: B
Rationale: Lithium toxicity at 2.1 mEq/L with neurologic and GI symptoms requires holding the drug, IV
hydration with normal saline to enhance renal excretion, and hemodialysis if severe. Activated charcoal does not
bind lithium, sodium polystyrene sulfonate exchanges potassium not lithium, and continuing lithium would worsen
toxicity.
15. Which mechanism best explains why ondansetron is less effective for chemotherapy-induced delayed nausea
than for acute nausea?
A) Delayed nausea is mediated primarily by substance P/NK1 receptors rather than serotonin 5-HT3 receptors.
B) Ondansetron has a short half-life that does not cover the delayed phase.
C) Delayed nausea is caused by dopamine D2 stimulation in the chemoreceptor trigger zone.
D) Ondansetron is inactivated by hepatic enzymes induced by chemotherapy agents.
' Correct Answer: A
Page 4
