NUR 354 Pharmacology II - Exam 3
Comprehensive Review | Full Questions and
Answers with Rationales | 2026/2027
Updated | 100% Correct.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
148 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam assesses advanced pharmacologic principles across cardiovascular, endocrine, antimicrobial,
neurologic, and hematologic drug classes. It emphasizes clinical application, patient safety, monitoring
parameters, and evidence-based prescribing per current US guidelines. Questions integrate drug mechanism,
adverse effects, interactions, and nursing management.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 78%.
HIGHP - Page 1 of 47
,1. A patient with heart failure is prescribed sacubitril/valsartan. Which instruction is
essential for the nurse to include in patient teaching?
[ ] A. Avoid potassium-rich foods to prevent hyperkalemia.
[ ] B. Take the medication with a potassium supplement to prevent hypokalemia.
[ ] C. Report any swelling of the face, lips, or tongue immediately.
[ ] D. Discontinue the drug if a dry cough develops.
CORRECT: C. Report any swelling of the face, lips, or tongue immediately.
Sacubitril/valsartan can cause angioedema, especially in patients with a history of ACE inhibitor-induced
angioedema. Patients must report facial swelling immediately. Potassium supplements are not routinely
recommended and may cause hyperkalemia; dry cough is more common with ACE inhibitors, not this
combination.
2. Which laboratory value should the nurse monitor most closely in a patient receiving
spironolactone for resistant hypertension?
[ ] A. Serum sodium
[ ] B. Serum potassium
[ ] C. Serum calcium
[ ] D. Serum magnesium
CORRECT: B. Serum potassium
Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia, particularly in patients with renal
impairment or those taking ACE inhibitors/ARBs. Monitoring serum potassium is critical to prevent cardiac
dysrhythmias. Sodium, calcium, and magnesium are less directly affected.
3. A patient with type 2 diabetes is prescribed empagliflozin. Which teaching point is most
important regarding this medication?
[ ] A. It may cause weight gain and fluid retention.
[ ] B. It increases the risk of genital mycotic infections and urinary tract infections.
[ ] C. It should be taken on an empty stomach to enhance absorption.
[ ] D. It often causes hypoglycemia when used as monotherapy.
CORRECT: B. It increases the risk of genital mycotic infections and urinary tract infections.
SGLT2 inhibitors like empagliflozin promote glucosuria, which increases the risk of genital mycotic infections
and UTIs. They are associated with weight loss, not gain, and carry a low risk of hypoglycemia when used
alone. Food does not significantly affect absorption.
4. Which antibiotic requires therapeutic drug monitoring to prevent ototoxicity and
nephrotoxicity?
[ ] A. Azithromycin
HIGHP - Page 2 of 47
, [ ] B. Ceftriaxone
[ ] C. Gentamicin
[ ] D. Doxycycline
CORRECT: C. Gentamicin
Gentamicin, an aminoglycoside, is associated with dose-dependent ototoxicity and nephrotoxicity,
necessitating peak and trough level monitoring. Azithromycin, ceftriaxone, and doxycycline do not require
routine therapeutic drug monitoring for these toxicities.
5. A patient on warfarin has an INR of 6.5 and is not bleeding. Which intervention is most
appropriate?
[ ] A. Administer vitamin K 10 mg IV push.
[ ] B. Withhold warfarin and administer oral vitamin K 2.5 mg.
[ ] C. Continue warfarin and recheck INR in 24 hours.
[ ] D. Administer fresh frozen plasma immediately.
CORRECT: B. Withhold warfarin and administer oral vitamin K 2.5 mg.
For an INR >5 without bleeding, guidelines recommend withholding warfarin and giving low-dose oral vitamin
K (2.5 mg). IV vitamin K is reserved for severe bleeding, and FFP is not indicated without active hemorrhage.
Continuing warfarin would increase bleeding risk.
6. Which medication is a first-line treatment for absence seizures?
[ ] A. Carbamazepine
[ ] B. Ethosuximide
[ ] C. Phenytoin
[ ] D. Gabapentin
CORRECT: B. Ethosuximide
Ethosuximide is a first-line agent for absence seizures, effectively reducing T-type calcium currents in
thalamic neurons. Carbamazepine and phenytoin can exacerbate absence seizures. Gabapentin is not
effective for absence seizures.
7. A patient taking levothyroxine reports palpitations and insomnia. Which assessment
finding is most concerning?
[ ] A. Heart rate 112 beats/min
[ ] B. Blood pressure 118/76 mm Hg
[ ] C. Weight gain of 1 kg
[ ] D. Serum TSH 1.8 mIU/L
HIGHP - Page 3 of 47
, CORRECT: A. Heart rate 112 beats/min
Palpitations and insomnia suggest excessive thyroid hormone replacement. A heart rate of 112 indicates
tachycardia, a sign of thyrotoxicosis, which requires dose reduction. The other findings are not immediately
concerning; weight gain and normal TSH do not indicate over-replacement.
8. Which adverse effect is most characteristic of long-term corticosteroid therapy?
[ ] A. Hypoglycemia
[ ] B. Osteoporosis
[ ] C. Weight loss
[ ] D. Hypotension
CORRECT: B. Osteoporosis
Long-term corticosteroids reduce bone formation and increase resorption, leading to osteoporosis. They
cause hyperglycemia, weight gain, and hypertension, not hypoglycemia, weight loss, or hypotension.
9. A patient with asthma is prescribed montelukast. Which instruction should the nurse
provide?
[ ] A. Take the medication at the onset of an acute asthma attack.
[ ] B. It is a rescue inhaler for immediate symptom relief.
[ ] C. It is taken daily for prophylaxis and not for acute attacks.
[ ] D. It may cause bradycardia and should be held if heart rate is below 60.
CORRECT: C. It is taken daily for prophylaxis and not for acute attacks.
Montelukast is a leukotriene receptor antagonist used for chronic prophylaxis of asthma, not for acute
attacks. It does not provide immediate bronchodilation and is not a rescue inhaler. It is not associated with
bradycardia.
10. A patient is prescribed digoxin. Which finding indicates possible digoxin toxicity?
[ ] A. Serum potassium 4.0 mEq/L
[ ] B. Heart rate 58 beats/min
[ ] C. Visual disturbances such as yellow halos
[ ] D. Blood pressure 130/80 mm Hg
CORRECT: C. Visual disturbances such as yellow halos
Visual disturbances (yellow halos, blurred vision) are classic signs of digoxin toxicity. Bradycardia can be a
normal effect, but heart rate <60 may also indicate toxicity; however, visual changes are more specific.
Potassium and blood pressure are not direct indicators.
HIGHP - Page 4 of 47
Comprehensive Review | Full Questions and
Answers with Rationales | 2026/2027
Updated | 100% Correct.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
148 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam assesses advanced pharmacologic principles across cardiovascular, endocrine, antimicrobial,
neurologic, and hematologic drug classes. It emphasizes clinical application, patient safety, monitoring
parameters, and evidence-based prescribing per current US guidelines. Questions integrate drug mechanism,
adverse effects, interactions, and nursing management.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 78%.
HIGHP - Page 1 of 47
,1. A patient with heart failure is prescribed sacubitril/valsartan. Which instruction is
essential for the nurse to include in patient teaching?
[ ] A. Avoid potassium-rich foods to prevent hyperkalemia.
[ ] B. Take the medication with a potassium supplement to prevent hypokalemia.
[ ] C. Report any swelling of the face, lips, or tongue immediately.
[ ] D. Discontinue the drug if a dry cough develops.
CORRECT: C. Report any swelling of the face, lips, or tongue immediately.
Sacubitril/valsartan can cause angioedema, especially in patients with a history of ACE inhibitor-induced
angioedema. Patients must report facial swelling immediately. Potassium supplements are not routinely
recommended and may cause hyperkalemia; dry cough is more common with ACE inhibitors, not this
combination.
2. Which laboratory value should the nurse monitor most closely in a patient receiving
spironolactone for resistant hypertension?
[ ] A. Serum sodium
[ ] B. Serum potassium
[ ] C. Serum calcium
[ ] D. Serum magnesium
CORRECT: B. Serum potassium
Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia, particularly in patients with renal
impairment or those taking ACE inhibitors/ARBs. Monitoring serum potassium is critical to prevent cardiac
dysrhythmias. Sodium, calcium, and magnesium are less directly affected.
3. A patient with type 2 diabetes is prescribed empagliflozin. Which teaching point is most
important regarding this medication?
[ ] A. It may cause weight gain and fluid retention.
[ ] B. It increases the risk of genital mycotic infections and urinary tract infections.
[ ] C. It should be taken on an empty stomach to enhance absorption.
[ ] D. It often causes hypoglycemia when used as monotherapy.
CORRECT: B. It increases the risk of genital mycotic infections and urinary tract infections.
SGLT2 inhibitors like empagliflozin promote glucosuria, which increases the risk of genital mycotic infections
and UTIs. They are associated with weight loss, not gain, and carry a low risk of hypoglycemia when used
alone. Food does not significantly affect absorption.
4. Which antibiotic requires therapeutic drug monitoring to prevent ototoxicity and
nephrotoxicity?
[ ] A. Azithromycin
HIGHP - Page 2 of 47
, [ ] B. Ceftriaxone
[ ] C. Gentamicin
[ ] D. Doxycycline
CORRECT: C. Gentamicin
Gentamicin, an aminoglycoside, is associated with dose-dependent ototoxicity and nephrotoxicity,
necessitating peak and trough level monitoring. Azithromycin, ceftriaxone, and doxycycline do not require
routine therapeutic drug monitoring for these toxicities.
5. A patient on warfarin has an INR of 6.5 and is not bleeding. Which intervention is most
appropriate?
[ ] A. Administer vitamin K 10 mg IV push.
[ ] B. Withhold warfarin and administer oral vitamin K 2.5 mg.
[ ] C. Continue warfarin and recheck INR in 24 hours.
[ ] D. Administer fresh frozen plasma immediately.
CORRECT: B. Withhold warfarin and administer oral vitamin K 2.5 mg.
For an INR >5 without bleeding, guidelines recommend withholding warfarin and giving low-dose oral vitamin
K (2.5 mg). IV vitamin K is reserved for severe bleeding, and FFP is not indicated without active hemorrhage.
Continuing warfarin would increase bleeding risk.
6. Which medication is a first-line treatment for absence seizures?
[ ] A. Carbamazepine
[ ] B. Ethosuximide
[ ] C. Phenytoin
[ ] D. Gabapentin
CORRECT: B. Ethosuximide
Ethosuximide is a first-line agent for absence seizures, effectively reducing T-type calcium currents in
thalamic neurons. Carbamazepine and phenytoin can exacerbate absence seizures. Gabapentin is not
effective for absence seizures.
7. A patient taking levothyroxine reports palpitations and insomnia. Which assessment
finding is most concerning?
[ ] A. Heart rate 112 beats/min
[ ] B. Blood pressure 118/76 mm Hg
[ ] C. Weight gain of 1 kg
[ ] D. Serum TSH 1.8 mIU/L
HIGHP - Page 3 of 47
, CORRECT: A. Heart rate 112 beats/min
Palpitations and insomnia suggest excessive thyroid hormone replacement. A heart rate of 112 indicates
tachycardia, a sign of thyrotoxicosis, which requires dose reduction. The other findings are not immediately
concerning; weight gain and normal TSH do not indicate over-replacement.
8. Which adverse effect is most characteristic of long-term corticosteroid therapy?
[ ] A. Hypoglycemia
[ ] B. Osteoporosis
[ ] C. Weight loss
[ ] D. Hypotension
CORRECT: B. Osteoporosis
Long-term corticosteroids reduce bone formation and increase resorption, leading to osteoporosis. They
cause hyperglycemia, weight gain, and hypertension, not hypoglycemia, weight loss, or hypotension.
9. A patient with asthma is prescribed montelukast. Which instruction should the nurse
provide?
[ ] A. Take the medication at the onset of an acute asthma attack.
[ ] B. It is a rescue inhaler for immediate symptom relief.
[ ] C. It is taken daily for prophylaxis and not for acute attacks.
[ ] D. It may cause bradycardia and should be held if heart rate is below 60.
CORRECT: C. It is taken daily for prophylaxis and not for acute attacks.
Montelukast is a leukotriene receptor antagonist used for chronic prophylaxis of asthma, not for acute
attacks. It does not provide immediate bronchodilation and is not a rescue inhaler. It is not associated with
bradycardia.
10. A patient is prescribed digoxin. Which finding indicates possible digoxin toxicity?
[ ] A. Serum potassium 4.0 mEq/L
[ ] B. Heart rate 58 beats/min
[ ] C. Visual disturbances such as yellow halos
[ ] D. Blood pressure 130/80 mm Hg
CORRECT: C. Visual disturbances such as yellow halos
Visual disturbances (yellow halos, blurred vision) are classic signs of digoxin toxicity. Bradycardia can be a
normal effect, but heart rate <60 may also indicate toxicity; however, visual changes are more specific.
Potassium and blood pressure are not direct indicators.
HIGHP - Page 4 of 47
