Arizona College of Nursing NUR 354
Pharmacology II Exam 1 Comprehensive
Questions & Answers | Updated
Question 1
What is necessary to convert angiotensin 1 into angiotensin 2?
Correct Answer
angiotensin conversing enzyme
Question 2
what are the side effects of angiotensin receptor blockers?
Correct Answer
hypotension
no cough
rarer angioedema
Question 3
What are the side effects of direct vasodilators?
Correct Answer
- reflex tachycardia (prevented by concurrent use of BB)
- rebound hypertension (due to reflex tachycardia
- sodium and water retention
- activation of RAAS which may cause HTN (admin diuretic to counteract)
- excessive diuresis resulting in hypotension and circulatory collapse
Page 1 of 79
,Question 4
What are the steps of angina protocol?
Correct Answer
stop activity
sit/lie down
immediately use NTG or spray
wait 5 mins
if pain persists, call 911 and take 2nd nitro dose
wait 5 minutes
if pain persists take 3rd nitro dose
Question 1: Which class of antihypertensive medications is primarily contraindicated
in patients with a history of bilateral renal artery stenosis due to the risk of
precipitating acute renal failure?
A. Thiazide diuretics
B. Angiotensin-converting enzyme (ACE) inhibitors
C. Dihydropyridine calcium channel blockers
D. Beta-adrenergic blockers
CORRECT ANSWER: B. Angiotensin-converting enzyme (ACE) inhibitors
Rationale: ACE inhibitors reduce the formation of angiotensin II, leading to dilation
of the efferent arterioles of the glomerulus. In bilateral renal artery stenosis, this loss
of vasoconstriction drops glomerular filtration pressure drastically, precipitating
acute renal failure.
Question 2: A patient receiving intravenous heparin therapy has an activated partial
thromboplastin time (aPTT) that is significantly above the therapeutic range and is
exhibiting signs of minor bleeding. Which medication should the nurse anticipate
administering as the specific antidote?
A. Vitamin K
B. Protamine sulfate
C. Aminocaproic acid
D. Fresh frozen plasma
CORRECT ANSWER: B. Protamine sulfate
Page 2 of 79
,Rationale: Protamine sulfate binds ionically to heparin to form a stable salt complex,
rapidly neutralizing its anticoagulant effect and reversing heparin-induced bleeding.
Question 3: When administering digoxin to a patient with heart failure, which clinical
finding should the nurse prioritize reporting to the healthcare provider immediately
before giving the dose?
A. Blood pressure of 132/84 mmHg
B. Serum potassium level of 3.2 mEq/L
C. Heart rate of 74 beats per minute
D. Mild baseline fatigue
CORRECT ANSWER: B. Serum potassium level of 3.2 mEq/L
Rationale: Hypokalemia increases myocardial sensitivity to digoxin, drastically
elevating the risk of life-threatening digitalis toxicity and cardiac arrhythmias. The
nurse must withhold the dose and report the low potassium.
Question 4: Which mechanism of action best describes how loop diuretics, such as
furosemide, achieve their potent diuresis effect?
A. Inhibition of sodium and chloride reabsorption in the distal convoluted tubule
B. Competitive blockade of aldosterone receptors in the collecting duct
C. Inhibition of the sodium-potassium-2 chloride (Na+-K+-2Cl-) cotransporter in
the thick ascending limb of the loop of Henle
D. Osmotic attraction of water into the renal lumen via inert sugar molecules
CORRECT ANSWER: C. Inhibition of the sodium-potassium-2 chloride (Na+-K+-2Cl-)
cotransporter in the thick ascending limb of the loop of Henle
Rationale: Loop diuretics work by blocking the Na+-K+-2Cl- cotransporter in the
ascending loop of Henle, preventing the reabsorption of massive amounts of
sodium and water, resulting in profound diuresis.
Question 5: A patient is prescribed a non-selective beta-blocker for hypertension.
Which pre-existing respiratory condition requires the nurse to question this
prescription?
A. Mild seasonal allergic rhinitis
B. Chronic obstructive pulmonary disease (COPD) with bronchospasm
C. Resolved childhood asthma
Page 3 of 79
, D. Obstructive sleep apnea
CORRECT ANSWER: B. Chronic obstructive pulmonary disease (COPD) with
bronchospasm
Rationale: Non-selective beta-blockers block both beta-1 (cardiac) and beta-2
(bronchial) receptors. Blocking beta-2 receptors in the lungs can precipitate severe,
life-threatening bronchospasm in patients with asthma or COPD.
Question 6: Which pharmacological property distinguishes low-molecular-weight
heparins (LMWHs), such as enoxaparin, from unfractionated heparin?
A. LMWHs require continuous intravenous infusion monitoring via aPTT.
B. LMWHs have a higher affinity for inhibiting factor Xa than thrombin and have
more predictable pharmacokinetics.
C. LMWHs are administered exclusively via oral route.
D. LMWHs cannot be used in outpatient settings.
CORRECT ANSWER: B. LMWHs have a higher affinity for inhibiting factor Xa than
thrombin and have more predictable pharmacokinetics.
Rationale: Enoxaparin and other LMWHs preferentially inhibit factor Xa over
thrombin, provide a longer half-life, and exhibit predictable dose-response
characteristics, eliminating the need for routine aPTT monitoring.
Question 7: A patient taking spironolactone for heart failure is instructed to avoid salt
substitutes. What is the primary rationale for this dietary instruction?
A. Salt substitutes contain high amounts of sodium, which counteract
spironolactone.
B. Salt substitutes frequently replace sodium with potassium chloride, risking severe
hyperkalemia.
C. Salt substitutes interact chemically to cause severe gastrointestinal ulceration.
D. Salt substitutes deactivate the diuretic properties of potassium-sparing agents.
CORRECT ANSWER: B. Salt substitutes frequently replace sodium with potassium
chloride, risking severe hyperkalemia.
Rationale: Spironolactone is a potassium-sparing diuretic that blocks aldosterone.
Using potassium-based salt substitutes alongside this medication significantly
increases the risk of dangerous hyperkalemia.
Page 4 of 79
Pharmacology II Exam 1 Comprehensive
Questions & Answers | Updated
Question 1
What is necessary to convert angiotensin 1 into angiotensin 2?
Correct Answer
angiotensin conversing enzyme
Question 2
what are the side effects of angiotensin receptor blockers?
Correct Answer
hypotension
no cough
rarer angioedema
Question 3
What are the side effects of direct vasodilators?
Correct Answer
- reflex tachycardia (prevented by concurrent use of BB)
- rebound hypertension (due to reflex tachycardia
- sodium and water retention
- activation of RAAS which may cause HTN (admin diuretic to counteract)
- excessive diuresis resulting in hypotension and circulatory collapse
Page 1 of 79
,Question 4
What are the steps of angina protocol?
Correct Answer
stop activity
sit/lie down
immediately use NTG or spray
wait 5 mins
if pain persists, call 911 and take 2nd nitro dose
wait 5 minutes
if pain persists take 3rd nitro dose
Question 1: Which class of antihypertensive medications is primarily contraindicated
in patients with a history of bilateral renal artery stenosis due to the risk of
precipitating acute renal failure?
A. Thiazide diuretics
B. Angiotensin-converting enzyme (ACE) inhibitors
C. Dihydropyridine calcium channel blockers
D. Beta-adrenergic blockers
CORRECT ANSWER: B. Angiotensin-converting enzyme (ACE) inhibitors
Rationale: ACE inhibitors reduce the formation of angiotensin II, leading to dilation
of the efferent arterioles of the glomerulus. In bilateral renal artery stenosis, this loss
of vasoconstriction drops glomerular filtration pressure drastically, precipitating
acute renal failure.
Question 2: A patient receiving intravenous heparin therapy has an activated partial
thromboplastin time (aPTT) that is significantly above the therapeutic range and is
exhibiting signs of minor bleeding. Which medication should the nurse anticipate
administering as the specific antidote?
A. Vitamin K
B. Protamine sulfate
C. Aminocaproic acid
D. Fresh frozen plasma
CORRECT ANSWER: B. Protamine sulfate
Page 2 of 79
,Rationale: Protamine sulfate binds ionically to heparin to form a stable salt complex,
rapidly neutralizing its anticoagulant effect and reversing heparin-induced bleeding.
Question 3: When administering digoxin to a patient with heart failure, which clinical
finding should the nurse prioritize reporting to the healthcare provider immediately
before giving the dose?
A. Blood pressure of 132/84 mmHg
B. Serum potassium level of 3.2 mEq/L
C. Heart rate of 74 beats per minute
D. Mild baseline fatigue
CORRECT ANSWER: B. Serum potassium level of 3.2 mEq/L
Rationale: Hypokalemia increases myocardial sensitivity to digoxin, drastically
elevating the risk of life-threatening digitalis toxicity and cardiac arrhythmias. The
nurse must withhold the dose and report the low potassium.
Question 4: Which mechanism of action best describes how loop diuretics, such as
furosemide, achieve their potent diuresis effect?
A. Inhibition of sodium and chloride reabsorption in the distal convoluted tubule
B. Competitive blockade of aldosterone receptors in the collecting duct
C. Inhibition of the sodium-potassium-2 chloride (Na+-K+-2Cl-) cotransporter in
the thick ascending limb of the loop of Henle
D. Osmotic attraction of water into the renal lumen via inert sugar molecules
CORRECT ANSWER: C. Inhibition of the sodium-potassium-2 chloride (Na+-K+-2Cl-)
cotransporter in the thick ascending limb of the loop of Henle
Rationale: Loop diuretics work by blocking the Na+-K+-2Cl- cotransporter in the
ascending loop of Henle, preventing the reabsorption of massive amounts of
sodium and water, resulting in profound diuresis.
Question 5: A patient is prescribed a non-selective beta-blocker for hypertension.
Which pre-existing respiratory condition requires the nurse to question this
prescription?
A. Mild seasonal allergic rhinitis
B. Chronic obstructive pulmonary disease (COPD) with bronchospasm
C. Resolved childhood asthma
Page 3 of 79
, D. Obstructive sleep apnea
CORRECT ANSWER: B. Chronic obstructive pulmonary disease (COPD) with
bronchospasm
Rationale: Non-selective beta-blockers block both beta-1 (cardiac) and beta-2
(bronchial) receptors. Blocking beta-2 receptors in the lungs can precipitate severe,
life-threatening bronchospasm in patients with asthma or COPD.
Question 6: Which pharmacological property distinguishes low-molecular-weight
heparins (LMWHs), such as enoxaparin, from unfractionated heparin?
A. LMWHs require continuous intravenous infusion monitoring via aPTT.
B. LMWHs have a higher affinity for inhibiting factor Xa than thrombin and have
more predictable pharmacokinetics.
C. LMWHs are administered exclusively via oral route.
D. LMWHs cannot be used in outpatient settings.
CORRECT ANSWER: B. LMWHs have a higher affinity for inhibiting factor Xa than
thrombin and have more predictable pharmacokinetics.
Rationale: Enoxaparin and other LMWHs preferentially inhibit factor Xa over
thrombin, provide a longer half-life, and exhibit predictable dose-response
characteristics, eliminating the need for routine aPTT monitoring.
Question 7: A patient taking spironolactone for heart failure is instructed to avoid salt
substitutes. What is the primary rationale for this dietary instruction?
A. Salt substitutes contain high amounts of sodium, which counteract
spironolactone.
B. Salt substitutes frequently replace sodium with potassium chloride, risking severe
hyperkalemia.
C. Salt substitutes interact chemically to cause severe gastrointestinal ulceration.
D. Salt substitutes deactivate the diuretic properties of potassium-sparing agents.
CORRECT ANSWER: B. Salt substitutes frequently replace sodium with potassium
chloride, risking severe hyperkalemia.
Rationale: Spironolactone is a potassium-sparing diuretic that blocks aldosterone.
Using potassium-based salt substitutes alongside this medication significantly
increases the risk of dangerous hyperkalemia.
Page 4 of 79
