NUR 354 Pharmacology II Exam 3 Comprehensive Review
Questions and Correct Answers plus Rationales | Already
Graded A+ | New 2026-2027 Update
1. Which of the following best describes the primary purpose of beta-
adrenergic blockers in the management of heart failure?
A) To increase cardiac contractility
B) To block the harmful effects of the sympathetic nervous system on the
heart
C) To reduce preload by dilating veins
D) To inhibit the sodium-potassium pump
Correct Answer: To block the harmful effects of the sympathetic nervous system
on the heart
Rationale: Beta-blockers such as carvedilol and metoprolol are a cornerstone of
heart failure therapy. They work by blocking the sympathetic nervous system's
harmful effects on the heart, which reduces heart rate, decreases myocardial
oxygen demand, and improves cardiac remodeling over time. They must be
started at low doses and titrated slowly to avoid decompensation.
2. What is the primary function of milrinone in the treatment of heart failure?
A) To increase cardiac contractility and promote vasodilation
B) To reduce heart rate and blood pressure
C) To inhibit the reabsorption of sodium in the distal tubule
D) To block the effects of aldosterone
Correct Answer: To increase cardiac contractility and promote vasodilation
Rationale: Milrinone is a phosphodiesterase-3 inhibitor that increases intracellular
cAMP, leading to increased cardiac contractility (positive inotropy) and
vasodilation. It is used for short-term management of acute decompensated heart
failure. It can cause hypotension and dysrhythmias and is not a first-line chronic
therapy.
, 3. Which laboratory value should be monitored closely before administering
digoxin to a patient with heart failure?
A) Serum potassium
B) Serum sodium
C) Serum calcium
D) Serum magnesium
Correct Answer: Serum potassium
Rationale: Hypokalemia increases the risk of digoxin toxicity because digoxin and
potassium compete for the same binding sites on the sodium-potassium ATPase
pump. Low potassium levels enhance the effects of digoxin, increasing the risk of
dysrhythmias. Normal potassium levels are essential for safe digoxin
administration.
4. What is the primary mechanism of action of loop diuretics in heart failure
management?
A) Inhibiting sodium and chloride reabsorption in the loop of Henle
B) Blocking aldosterone receptors in the distal tubule
C) Dilating peripheral blood vessels
D) Increasing cardiac contractility
Correct Answer: Inhibiting sodium and chloride reabsorption in the loop of Henle
Rationale: Loop diuretics such as furosemide inhibit the sodium-potassium-
chloride cotransporter in the ascending loop of Henle, producing potent diuresis.
They reduce preload and relieve symptoms of fluid overload. Monitoring
potassium levels is essential because these agents cause significant potassium
loss.
5. According to the exam blueprint, which medication is listed as a topic for
heart failure management?
A) Lisinopril
B) Atorvastatin
C) Clopidogrel
D) Adenosine
Correct Answer: Lisinopril
,Rationale: The NUR 354 Exam 3 blueprint specifically lists lisinopril under drugs
for heart failure. Lisinopril is an ACE inhibitor that reduces afterload and preload
by inhibiting the conversion of angiotensin I to angiotensin II, and it is a standard
therapy for heart failure with reduced ejection fraction.
6. A nurse is reviewing the medication list for a patient with heart failure and a
history of asthma. Which medication requires clarification with the
provider?
A) Carvedilol
B) Furosemide
C) Lisinopril
D) Digoxin
Correct Answer: Carvedilol
Rationale: Carvedilol is a non-selective beta-blocker that can cause
bronchoconstriction and is contraindicated in patients with asthma or severe
COPD. The nurse should clarify this order because it could precipitate an asthma
exacerbation. Cardioselective beta-blockers may be safer alternatives in some
patients.
7. What is the primary purpose of administering hydralazine in a patient with
heart failure?
A) To reduce afterload by directly dilating arterioles
B) To reduce preload by dilating veins
C) To increase heart rate and contractility
D) To inhibit the renin-angiotensin-aldosterone system
Correct Answer: To reduce afterload by directly dilating arterioles
Rationale: Hydralazine is a direct arterial vasodilator that reduces afterload in
heart failure. It is often combined with isosorbide dinitrate, particularly in African
American patients, to improve outcomes. It does not primarily affect preload or
directly increase contractility.
8. Which finding is most consistent with digoxin toxicity?
A) Visual disturbances such as halos around dark objects
B) Hypertension and tachycardia
, C) Hyperkalemia and polyuria
D) Hyperglycemia and weight gain
Correct Answer: Visual disturbances such as halos around dark objects
Rationale: Early signs of digoxin toxicity include visual disturbances such as halos,
blurred vision, or yellow-green tinting, along with nausea, vomiting, and
dysrhythmias. Hypokalemia increases the risk of toxicity. Serum digoxin levels
should be monitored closely.
9. What is the primary mechanism of action of statins in managing lipid
disorders?
A) Inhibiting HMG-CoA reductase, the rate-limiting enzyme in cholesterol
synthesis
B) Binding bile acids in the intestine to increase their excretion
C) Inhibiting cholesterol absorption in the small intestine
D) Activating lipoprotein lipase to break down triglycerides
Correct Answer: Inhibiting HMG-CoA reductase, the rate-limiting enzyme in
cholesterol synthesis
Rationale: Statins such as atorvastatin inhibit HMG-CoA reductase, the rate-
limiting enzyme in hepatic cholesterol synthesis. This leads to a reduction in LDL
cholesterol and a modest increase in HDL cholesterol. They are first-line therapy
for hyperlipidemia and cardiovascular risk reduction.
10.Which adverse effect is most commonly associated with statin therapy?
A) Rhabdomyolysis and hepatotoxicity
B) Hypertension and tachycardia
C) Hyperkalemia and renal failure
D) Photosensitivity and rash
Correct Answer: Rhabdomyolysis and hepatotoxicity
Rationale: The most serious adverse effects of statins are rhabdomyolysis (muscle
breakdown) and hepatotoxicity. Patients should report muscle pain, weakness, or
tea-colored urine immediately. Liver function tests should be monitored
periodically. The risk increases with high doses and certain drug interactions.
Questions and Correct Answers plus Rationales | Already
Graded A+ | New 2026-2027 Update
1. Which of the following best describes the primary purpose of beta-
adrenergic blockers in the management of heart failure?
A) To increase cardiac contractility
B) To block the harmful effects of the sympathetic nervous system on the
heart
C) To reduce preload by dilating veins
D) To inhibit the sodium-potassium pump
Correct Answer: To block the harmful effects of the sympathetic nervous system
on the heart
Rationale: Beta-blockers such as carvedilol and metoprolol are a cornerstone of
heart failure therapy. They work by blocking the sympathetic nervous system's
harmful effects on the heart, which reduces heart rate, decreases myocardial
oxygen demand, and improves cardiac remodeling over time. They must be
started at low doses and titrated slowly to avoid decompensation.
2. What is the primary function of milrinone in the treatment of heart failure?
A) To increase cardiac contractility and promote vasodilation
B) To reduce heart rate and blood pressure
C) To inhibit the reabsorption of sodium in the distal tubule
D) To block the effects of aldosterone
Correct Answer: To increase cardiac contractility and promote vasodilation
Rationale: Milrinone is a phosphodiesterase-3 inhibitor that increases intracellular
cAMP, leading to increased cardiac contractility (positive inotropy) and
vasodilation. It is used for short-term management of acute decompensated heart
failure. It can cause hypotension and dysrhythmias and is not a first-line chronic
therapy.
, 3. Which laboratory value should be monitored closely before administering
digoxin to a patient with heart failure?
A) Serum potassium
B) Serum sodium
C) Serum calcium
D) Serum magnesium
Correct Answer: Serum potassium
Rationale: Hypokalemia increases the risk of digoxin toxicity because digoxin and
potassium compete for the same binding sites on the sodium-potassium ATPase
pump. Low potassium levels enhance the effects of digoxin, increasing the risk of
dysrhythmias. Normal potassium levels are essential for safe digoxin
administration.
4. What is the primary mechanism of action of loop diuretics in heart failure
management?
A) Inhibiting sodium and chloride reabsorption in the loop of Henle
B) Blocking aldosterone receptors in the distal tubule
C) Dilating peripheral blood vessels
D) Increasing cardiac contractility
Correct Answer: Inhibiting sodium and chloride reabsorption in the loop of Henle
Rationale: Loop diuretics such as furosemide inhibit the sodium-potassium-
chloride cotransporter in the ascending loop of Henle, producing potent diuresis.
They reduce preload and relieve symptoms of fluid overload. Monitoring
potassium levels is essential because these agents cause significant potassium
loss.
5. According to the exam blueprint, which medication is listed as a topic for
heart failure management?
A) Lisinopril
B) Atorvastatin
C) Clopidogrel
D) Adenosine
Correct Answer: Lisinopril
,Rationale: The NUR 354 Exam 3 blueprint specifically lists lisinopril under drugs
for heart failure. Lisinopril is an ACE inhibitor that reduces afterload and preload
by inhibiting the conversion of angiotensin I to angiotensin II, and it is a standard
therapy for heart failure with reduced ejection fraction.
6. A nurse is reviewing the medication list for a patient with heart failure and a
history of asthma. Which medication requires clarification with the
provider?
A) Carvedilol
B) Furosemide
C) Lisinopril
D) Digoxin
Correct Answer: Carvedilol
Rationale: Carvedilol is a non-selective beta-blocker that can cause
bronchoconstriction and is contraindicated in patients with asthma or severe
COPD. The nurse should clarify this order because it could precipitate an asthma
exacerbation. Cardioselective beta-blockers may be safer alternatives in some
patients.
7. What is the primary purpose of administering hydralazine in a patient with
heart failure?
A) To reduce afterload by directly dilating arterioles
B) To reduce preload by dilating veins
C) To increase heart rate and contractility
D) To inhibit the renin-angiotensin-aldosterone system
Correct Answer: To reduce afterload by directly dilating arterioles
Rationale: Hydralazine is a direct arterial vasodilator that reduces afterload in
heart failure. It is often combined with isosorbide dinitrate, particularly in African
American patients, to improve outcomes. It does not primarily affect preload or
directly increase contractility.
8. Which finding is most consistent with digoxin toxicity?
A) Visual disturbances such as halos around dark objects
B) Hypertension and tachycardia
, C) Hyperkalemia and polyuria
D) Hyperglycemia and weight gain
Correct Answer: Visual disturbances such as halos around dark objects
Rationale: Early signs of digoxin toxicity include visual disturbances such as halos,
blurred vision, or yellow-green tinting, along with nausea, vomiting, and
dysrhythmias. Hypokalemia increases the risk of toxicity. Serum digoxin levels
should be monitored closely.
9. What is the primary mechanism of action of statins in managing lipid
disorders?
A) Inhibiting HMG-CoA reductase, the rate-limiting enzyme in cholesterol
synthesis
B) Binding bile acids in the intestine to increase their excretion
C) Inhibiting cholesterol absorption in the small intestine
D) Activating lipoprotein lipase to break down triglycerides
Correct Answer: Inhibiting HMG-CoA reductase, the rate-limiting enzyme in
cholesterol synthesis
Rationale: Statins such as atorvastatin inhibit HMG-CoA reductase, the rate-
limiting enzyme in hepatic cholesterol synthesis. This leads to a reduction in LDL
cholesterol and a modest increase in HDL cholesterol. They are first-line therapy
for hyperlipidemia and cardiovascular risk reduction.
10.Which adverse effect is most commonly associated with statin therapy?
A) Rhabdomyolysis and hepatotoxicity
B) Hypertension and tachycardia
C) Hyperkalemia and renal failure
D) Photosensitivity and rash
Correct Answer: Rhabdomyolysis and hepatotoxicity
Rationale: The most serious adverse effects of statins are rhabdomyolysis (muscle
breakdown) and hepatotoxicity. Patients should report muscle pain, weakness, or
tea-colored urine immediately. Liver function tests should be monitored
periodically. The risk increases with high doses and certain drug interactions.
