NUR 2474 EXAM 2 — PHARMACOLOGY FOR PROFESSIONAL Rasmussen
NURSING University | 130 Questions | Verified Answers & Rationales
NUR 2474 EXAM 2
PHARMACOLOGY FOR PROFESSIONAL NURSING — 130 EXAM-STYLE
QUESTIONS
Verified Answers & Detailed Rationales • All Core Domains Covered • Nursing Clinical Judgment
Rasmussen University • Pharmacology for Professional Nursing • Latest 2026/2027
Cognitive Distribution Question Style Total Questions Sections
Recall 30% / Application 50% / Analysis
80% 20%
Scenario-Based / 20% Direct Recall & Calculation
130 Multiple-Choice (A–D) 9 Core Pharmacology Domains
This comprehensive 130-question exam has been developed to mirror the content, cognitive complexity, and clinical
reasoning demands of NUR 2474 Pharmacology for Professional Nursing Exam 2 at Rasmussen University. Each item has
been constructed using pharmacology-level nursing clinical judgment, with distractors designed to reflect the most
common nursing pharmacology pitfalls: confusing ACE inhibitor with ARB adverse effects, misidentifying anticoagulant
monitoring parameters, incorrect insulin titration, confusing beta blocker adverse effects, improper corticosteroid tapering,
and misunderstanding diuretic electrolyte effects. Rationales integrate mechanism of action, monitoring parameters,
adverse effects, patient safety considerations, and calculation demonstrations where applicable. Aligned with 2026 ADA
Standards of Care, JNC/AHA hypertension guidelines, and ISMP high-alert medication standards.
EXAM INSTRUCTIONS: Select the ONE best answer for each question. Rationales appear immediately below each item
with pharmacological reasoning and monitoring parameters.
SECTION 1: Cardiovascular Pharmacology I (Antihypertensives, Diuretics, Beta
Blockers, & Calcium Channel Blockers) — Questions Q1–Q18
Q1: A 58-year-old patient with hypertension and a history of gout is prescribed
hydrochlorothiazide (HCTZ) 25 mg daily. Which adverse effect should the nurse monitor for that
would be MOST concerning given the patient's comorbidity?
A. Hypokalemia only
B. Hyperuricemia precipitating acute gout attack [CORRECT]
C. Hyponatremia only
D. Hypercalcemia only
Correct Answer: B
Rationale: Thiazide diuretics (HCTZ, chlorthalidone, indapamide) inhibit the Na/Cl cotransporter in the distal
tubule, increasing uric acid reabsorption and causing hyperuricemia—a known trigger for acute gout attacks. In a
patient with gout history, thiazides should be avoided or used with allopurinol prophylaxis. The nurse should also
monitor for hypokalemia, hyponatremia, hypomagnesemia, and hypercalcemia, but gout exacerbation is the most
immediate concern. Preferred antihypertensives in gout: losartan (mild uricosuric effect), CCBs.
Latest 2026/2027 | Pharmacology for Professional Nursing Page 1
,NUR 2474 EXAM 2 — PHARMACOLOGY FOR PROFESSIONAL Rasmussen
NURSING University | 130 Questions | Verified Answers & Rationales
Q2: A patient is receiving IV furosemide for acute decompensated heart failure. Which electrolyte
imbalance is the nurse's PRIORITY to monitor given the mechanism of action in the thick
ascending limb of the loop of Henle?
A. Hyperkalemia, hypercalcemia, hypernatremia
B. Hypokalemia, hypocalcemia, hypomagnesemia, hyponatremia [CORRECT]
C. Hyperkalemia only
D. Hypercalcemia, hyperphosphatemia
Correct Answer: B
Rationale: Loop diuretics (furosemide, torsemide, bumetanide) inhibit the Na/K/2Cl cotransporter in the thick
ascending limb, causing excretion of potassium, magnesium, calcium, and sodium. Hypokalemia is most dangerous
(increases digoxin toxicity, arrhythmia risk). Monitor BMP, magnesium, calcium. Unlike thiazides (which cause
hypercalcemia), loops cause hypocalcemia. Ototoxicity is also a risk with high-dose IV furosemide, especially in
renal impairment or with aminoglycosides.
Q3: A patient with asthma and hypertension requires a beta blocker. Which beta blocker is the
BEST choice due to beta-1 selectivity, minimizing bronchospasm risk?
A. Propranolol (Inderal)
B. Metoprolol (Lopressor) [CORRECT]
C. Nadolol (Corgard)
D. Carvedilol (Coreg)
Correct Answer: B
Rationale: Metoprolol is beta-1 selective (cardioselective) at low doses, sparing beta-2 receptors in bronchial smooth
muscle. Propranolol, nadolol, and timolol are non-selective (block beta-1 and beta-2) and contraindicated in asthma.
Carvedilol blocks beta-1, beta-2, AND alpha-1, also contraindicated in asthma. Even beta-1 selective agents lose
selectivity at higher doses and should be used cautiously in asthma/COPD with close monitoring. Atenolol,
bisoprolol, and nebivolol are other cardioselective options.
Q4: A patient has been taking metoprolol 50 mg BID for hypertension for 6 months and abruptly
stops the medication. Which adverse effect should the nurse anticipate?
A. Severe hypotension and bradycardia
B. Rebound tachycardia, hypertension, and possible myocardial ischemia due to upregulation
of beta receptors [CORRECT]
C. Acute bronchospasm
D. Hyperkalemia
Correct Answer: B
Rationale: Chronic beta blockade causes upregulation (increased density) of beta receptors. Abrupt discontinuation
leaves upregulated receptors exposed to unopposed catecholamine stimulation, producing rebound tachycardia,
hypertension, angina, MI, and arrhythmias (beta-blocker withdrawal syndrome). Always taper beta blockers over 1–2
weeks. Counsel patients NEVER to abruptly stop. Higher risk in patients with CAD or HF. The same principle applies
to clonidine (severe rebound HTN) and SSRIs (discontinuation syndrome).
Latest 2026/2027 | Pharmacology for Professional Nursing Page 2
,NUR 2474 EXAM 2 — PHARMACOLOGY FOR PROFESSIONAL Rasmussen
NURSING University | 130 Questions | Verified Answers & Rationales
Q5: A patient is started on amlodipine 5 mg daily for hypertension. Two weeks later, the patient
reports ankle swelling. Which mechanism BEST explains this adverse effect?
A. Sodium and water retention from renal effects
B. Precapillary arteriolar vasodilation without matching venodilation, causing increased
capillary pressure and peripheral edema [CORRECT]
C. Heart failure exacerbation
D. Allergic reaction
Correct Answer: B
Rationale: Dihydropyridine CCBs (amlodipine, nifedipine, felodipine) cause selective arteriolar vasodilation
(precapillary) without proportional venodilation, increasing capillary hydrostatic pressure and causing
dose-dependent peripheral edema (5–20%). This is not fluid overload—diuretics are NOT effective and may worsen
it. Management: dose reduction, switch to non-DHP (verapamil/diltiazem, less edema), add ACEI/ARB (counteract
arteriolar dilation), or switch agents. Counsel patient this is not heart failure.
Q6: Which assessment finding would require the nurse to HOLD a scheduled dose of metoprolol
and notify the provider?
A. Heart rate 88 bpm and BP 130/85
B. Heart rate 52 bpm and BP 98/60 with dizziness [CORRECT]
C. Respiratory rate 16
D. Temperature 99.0°F
Correct Answer: B
Rationale: Beta blockers should be held for bradycardia (HR <60 in adults) and hypotension (systolic <100 or
symptomatic), as both indicate excessive beta blockade. Metoprolol causes negative chronotropy (decreased HR) and
negative inotropy (decreased contractility). HR 52 with dizziness and BP 98/60 suggests over-blockade. Notify
provider for dose adjustment. Also hold for 2nd/3rd degree AV block, decompensated HF, and severe bronchospasm.
Normal HR 88 with BP 130/85 would be administered as scheduled.
Q7: A patient with heart failure with reduced ejection fraction (HFrEF, EF 30%) requires a beta
blocker. Which beta blocker has proven mortality benefit in HFrEF and is appropriate for this
patient?
A. Atenolol (Tenormin)
B. Metoprolol succinate (Toprol XL) or carvedilol (Coreg) [CORRECT]
C. Metoprolol tartrate (Lopressor) immediate-release
D. Propranolol (Inderal)
Correct Answer: B
Rationale: Three beta blockers have mortality benefit in HFrEF: metoprolol succinate ER (MERIT-HF trial),
carvedilol (COPERNICUS, also alpha-1 antagonist), and bisoprolol (CIBIS-II). Metoprolol tartrate IR has NOT
shown mortality benefit and is NOT used for HFrEF. Start low (metoprolol succinate 12.5–25 mg daily; carvedilol
3.125 mg BID), titrate slowly to target dose over weeks. Monitor for HF exacerbation during initiation. Avoid in
decompensated HF; stabilize first then initiate.
Latest 2026/2027 | Pharmacology for Professional Nursing Page 3
, NUR 2474 EXAM 2 — PHARMACOLOGY FOR PROFESSIONAL Rasmussen
NURSING University | 130 Questions | Verified Answers & Rationales
Q8: A 70-year-old patient with hypertension, type 2 diabetes, and CKD stage 3 (eGFR 40) is
prescribed an antihypertensive. Which medication class is MOST appropriate given the
renal-protective benefits in diabetic nephropathy?
A. Thiazide diuretic
B. ACE inhibitor (e.g., lisinopril) or ARB (e.g., losartan) [CORRECT]
C. Calcium channel blocker
D. Beta blocker
Correct Answer: B
Rationale: ACE inhibitors (lisinopril, enalapril) and ARBs (losartan, valsartan) reduce proteinuria and slow CKD
progression in diabetic nephropathy by decreasing intraglomerular pressure (efferent arteriole vasodilation). They
are first-line for HTN with diabetes + albuminuria per ADA/JNC guidelines. Monitor K (hyperkalemia risk), Cr (rise
up to 30% acceptable; greater warrants evaluation), and BP. Avoid combined ACEI+ARB. Avoid in bilateral renal
artery stenosis. Pregnancy category D (contraindicated).
Q9: A patient on verapamil for atrial fibrillation develops constipation. Which mechanism explains
this adverse effect, and what is the BEST nursing intervention?
A. Beta-2 blockade causing bronchospasm; switch to amlodipine
B. Calcium channel blockade in intestinal smooth muscle decreasing motility; increase fluids,
fiber, activity, and consider stool softener [CORRECT]
C. Alpha-1 blockade causing vasodilation; increase sodium intake
D. Direct GI toxicity independent of calcium channels
Correct Answer: B
Rationale: Non-dihydropyridine CCBs (verapamil, diltiazem) block L-type calcium channels in intestinal smooth
muscle, causing decreased motility and constipation (verapamil > diltiazem). Management: increase fluids, dietary
fiber, activity, and stool softeners. Verapamil also causes bradycardia, AV block, and negative inotropy (avoid in
HFrEF). Dihydropyridines (amlodipine) cause peripheral edema and reflex tachycardia, NOT constipation. Counsel
patients on prevention strategies.
Q10: A patient receiving IV labetalol for hypertensive emergency asks how the medication works.
Which is the nurse's BEST response?
A. "It blocks alpha-1 receptors only, causing vasodilation."
B. "It blocks both non-selective beta receptors AND alpha-1 receptors, producing vasodilation
(alpha) and reduced heart rate/contractility (beta)." [CORRECT]
C. "It blocks beta-1 receptors only, slowing the heart rate."
D. "It is a direct vasodilator that does not affect receptors."
Correct Answer: B
Rationale: Labetalol is a combined non-selective beta and alpha-1 antagonist (ratio ~7:1 oral, 3:1 IV). Alpha-1
blockade causes vasodilation (lowering BP); beta blockade prevents reflex tachycardia. Used IV for hypertensive
emergency (especially pregnancy/preeclampsia, aortic dissection). Side effects: orthostatic hypotension, bradycardia,
AV block, bronchospasm (avoid in asthma), hepatotoxicity (rare), fatigue. Carvedilol is similar oral combination
used for HFrEF. Monitor BP continuously during IV administration.
Latest 2026/2027 | Pharmacology for Professional Nursing Page 4
NURSING University | 130 Questions | Verified Answers & Rationales
NUR 2474 EXAM 2
PHARMACOLOGY FOR PROFESSIONAL NURSING — 130 EXAM-STYLE
QUESTIONS
Verified Answers & Detailed Rationales • All Core Domains Covered • Nursing Clinical Judgment
Rasmussen University • Pharmacology for Professional Nursing • Latest 2026/2027
Cognitive Distribution Question Style Total Questions Sections
Recall 30% / Application 50% / Analysis
80% 20%
Scenario-Based / 20% Direct Recall & Calculation
130 Multiple-Choice (A–D) 9 Core Pharmacology Domains
This comprehensive 130-question exam has been developed to mirror the content, cognitive complexity, and clinical
reasoning demands of NUR 2474 Pharmacology for Professional Nursing Exam 2 at Rasmussen University. Each item has
been constructed using pharmacology-level nursing clinical judgment, with distractors designed to reflect the most
common nursing pharmacology pitfalls: confusing ACE inhibitor with ARB adverse effects, misidentifying anticoagulant
monitoring parameters, incorrect insulin titration, confusing beta blocker adverse effects, improper corticosteroid tapering,
and misunderstanding diuretic electrolyte effects. Rationales integrate mechanism of action, monitoring parameters,
adverse effects, patient safety considerations, and calculation demonstrations where applicable. Aligned with 2026 ADA
Standards of Care, JNC/AHA hypertension guidelines, and ISMP high-alert medication standards.
EXAM INSTRUCTIONS: Select the ONE best answer for each question. Rationales appear immediately below each item
with pharmacological reasoning and monitoring parameters.
SECTION 1: Cardiovascular Pharmacology I (Antihypertensives, Diuretics, Beta
Blockers, & Calcium Channel Blockers) — Questions Q1–Q18
Q1: A 58-year-old patient with hypertension and a history of gout is prescribed
hydrochlorothiazide (HCTZ) 25 mg daily. Which adverse effect should the nurse monitor for that
would be MOST concerning given the patient's comorbidity?
A. Hypokalemia only
B. Hyperuricemia precipitating acute gout attack [CORRECT]
C. Hyponatremia only
D. Hypercalcemia only
Correct Answer: B
Rationale: Thiazide diuretics (HCTZ, chlorthalidone, indapamide) inhibit the Na/Cl cotransporter in the distal
tubule, increasing uric acid reabsorption and causing hyperuricemia—a known trigger for acute gout attacks. In a
patient with gout history, thiazides should be avoided or used with allopurinol prophylaxis. The nurse should also
monitor for hypokalemia, hyponatremia, hypomagnesemia, and hypercalcemia, but gout exacerbation is the most
immediate concern. Preferred antihypertensives in gout: losartan (mild uricosuric effect), CCBs.
Latest 2026/2027 | Pharmacology for Professional Nursing Page 1
,NUR 2474 EXAM 2 — PHARMACOLOGY FOR PROFESSIONAL Rasmussen
NURSING University | 130 Questions | Verified Answers & Rationales
Q2: A patient is receiving IV furosemide for acute decompensated heart failure. Which electrolyte
imbalance is the nurse's PRIORITY to monitor given the mechanism of action in the thick
ascending limb of the loop of Henle?
A. Hyperkalemia, hypercalcemia, hypernatremia
B. Hypokalemia, hypocalcemia, hypomagnesemia, hyponatremia [CORRECT]
C. Hyperkalemia only
D. Hypercalcemia, hyperphosphatemia
Correct Answer: B
Rationale: Loop diuretics (furosemide, torsemide, bumetanide) inhibit the Na/K/2Cl cotransporter in the thick
ascending limb, causing excretion of potassium, magnesium, calcium, and sodium. Hypokalemia is most dangerous
(increases digoxin toxicity, arrhythmia risk). Monitor BMP, magnesium, calcium. Unlike thiazides (which cause
hypercalcemia), loops cause hypocalcemia. Ototoxicity is also a risk with high-dose IV furosemide, especially in
renal impairment or with aminoglycosides.
Q3: A patient with asthma and hypertension requires a beta blocker. Which beta blocker is the
BEST choice due to beta-1 selectivity, minimizing bronchospasm risk?
A. Propranolol (Inderal)
B. Metoprolol (Lopressor) [CORRECT]
C. Nadolol (Corgard)
D. Carvedilol (Coreg)
Correct Answer: B
Rationale: Metoprolol is beta-1 selective (cardioselective) at low doses, sparing beta-2 receptors in bronchial smooth
muscle. Propranolol, nadolol, and timolol are non-selective (block beta-1 and beta-2) and contraindicated in asthma.
Carvedilol blocks beta-1, beta-2, AND alpha-1, also contraindicated in asthma. Even beta-1 selective agents lose
selectivity at higher doses and should be used cautiously in asthma/COPD with close monitoring. Atenolol,
bisoprolol, and nebivolol are other cardioselective options.
Q4: A patient has been taking metoprolol 50 mg BID for hypertension for 6 months and abruptly
stops the medication. Which adverse effect should the nurse anticipate?
A. Severe hypotension and bradycardia
B. Rebound tachycardia, hypertension, and possible myocardial ischemia due to upregulation
of beta receptors [CORRECT]
C. Acute bronchospasm
D. Hyperkalemia
Correct Answer: B
Rationale: Chronic beta blockade causes upregulation (increased density) of beta receptors. Abrupt discontinuation
leaves upregulated receptors exposed to unopposed catecholamine stimulation, producing rebound tachycardia,
hypertension, angina, MI, and arrhythmias (beta-blocker withdrawal syndrome). Always taper beta blockers over 1–2
weeks. Counsel patients NEVER to abruptly stop. Higher risk in patients with CAD or HF. The same principle applies
to clonidine (severe rebound HTN) and SSRIs (discontinuation syndrome).
Latest 2026/2027 | Pharmacology for Professional Nursing Page 2
,NUR 2474 EXAM 2 — PHARMACOLOGY FOR PROFESSIONAL Rasmussen
NURSING University | 130 Questions | Verified Answers & Rationales
Q5: A patient is started on amlodipine 5 mg daily for hypertension. Two weeks later, the patient
reports ankle swelling. Which mechanism BEST explains this adverse effect?
A. Sodium and water retention from renal effects
B. Precapillary arteriolar vasodilation without matching venodilation, causing increased
capillary pressure and peripheral edema [CORRECT]
C. Heart failure exacerbation
D. Allergic reaction
Correct Answer: B
Rationale: Dihydropyridine CCBs (amlodipine, nifedipine, felodipine) cause selective arteriolar vasodilation
(precapillary) without proportional venodilation, increasing capillary hydrostatic pressure and causing
dose-dependent peripheral edema (5–20%). This is not fluid overload—diuretics are NOT effective and may worsen
it. Management: dose reduction, switch to non-DHP (verapamil/diltiazem, less edema), add ACEI/ARB (counteract
arteriolar dilation), or switch agents. Counsel patient this is not heart failure.
Q6: Which assessment finding would require the nurse to HOLD a scheduled dose of metoprolol
and notify the provider?
A. Heart rate 88 bpm and BP 130/85
B. Heart rate 52 bpm and BP 98/60 with dizziness [CORRECT]
C. Respiratory rate 16
D. Temperature 99.0°F
Correct Answer: B
Rationale: Beta blockers should be held for bradycardia (HR <60 in adults) and hypotension (systolic <100 or
symptomatic), as both indicate excessive beta blockade. Metoprolol causes negative chronotropy (decreased HR) and
negative inotropy (decreased contractility). HR 52 with dizziness and BP 98/60 suggests over-blockade. Notify
provider for dose adjustment. Also hold for 2nd/3rd degree AV block, decompensated HF, and severe bronchospasm.
Normal HR 88 with BP 130/85 would be administered as scheduled.
Q7: A patient with heart failure with reduced ejection fraction (HFrEF, EF 30%) requires a beta
blocker. Which beta blocker has proven mortality benefit in HFrEF and is appropriate for this
patient?
A. Atenolol (Tenormin)
B. Metoprolol succinate (Toprol XL) or carvedilol (Coreg) [CORRECT]
C. Metoprolol tartrate (Lopressor) immediate-release
D. Propranolol (Inderal)
Correct Answer: B
Rationale: Three beta blockers have mortality benefit in HFrEF: metoprolol succinate ER (MERIT-HF trial),
carvedilol (COPERNICUS, also alpha-1 antagonist), and bisoprolol (CIBIS-II). Metoprolol tartrate IR has NOT
shown mortality benefit and is NOT used for HFrEF. Start low (metoprolol succinate 12.5–25 mg daily; carvedilol
3.125 mg BID), titrate slowly to target dose over weeks. Monitor for HF exacerbation during initiation. Avoid in
decompensated HF; stabilize first then initiate.
Latest 2026/2027 | Pharmacology for Professional Nursing Page 3
, NUR 2474 EXAM 2 — PHARMACOLOGY FOR PROFESSIONAL Rasmussen
NURSING University | 130 Questions | Verified Answers & Rationales
Q8: A 70-year-old patient with hypertension, type 2 diabetes, and CKD stage 3 (eGFR 40) is
prescribed an antihypertensive. Which medication class is MOST appropriate given the
renal-protective benefits in diabetic nephropathy?
A. Thiazide diuretic
B. ACE inhibitor (e.g., lisinopril) or ARB (e.g., losartan) [CORRECT]
C. Calcium channel blocker
D. Beta blocker
Correct Answer: B
Rationale: ACE inhibitors (lisinopril, enalapril) and ARBs (losartan, valsartan) reduce proteinuria and slow CKD
progression in diabetic nephropathy by decreasing intraglomerular pressure (efferent arteriole vasodilation). They
are first-line for HTN with diabetes + albuminuria per ADA/JNC guidelines. Monitor K (hyperkalemia risk), Cr (rise
up to 30% acceptable; greater warrants evaluation), and BP. Avoid combined ACEI+ARB. Avoid in bilateral renal
artery stenosis. Pregnancy category D (contraindicated).
Q9: A patient on verapamil for atrial fibrillation develops constipation. Which mechanism explains
this adverse effect, and what is the BEST nursing intervention?
A. Beta-2 blockade causing bronchospasm; switch to amlodipine
B. Calcium channel blockade in intestinal smooth muscle decreasing motility; increase fluids,
fiber, activity, and consider stool softener [CORRECT]
C. Alpha-1 blockade causing vasodilation; increase sodium intake
D. Direct GI toxicity independent of calcium channels
Correct Answer: B
Rationale: Non-dihydropyridine CCBs (verapamil, diltiazem) block L-type calcium channels in intestinal smooth
muscle, causing decreased motility and constipation (verapamil > diltiazem). Management: increase fluids, dietary
fiber, activity, and stool softeners. Verapamil also causes bradycardia, AV block, and negative inotropy (avoid in
HFrEF). Dihydropyridines (amlodipine) cause peripheral edema and reflex tachycardia, NOT constipation. Counsel
patients on prevention strategies.
Q10: A patient receiving IV labetalol for hypertensive emergency asks how the medication works.
Which is the nurse's BEST response?
A. "It blocks alpha-1 receptors only, causing vasodilation."
B. "It blocks both non-selective beta receptors AND alpha-1 receptors, producing vasodilation
(alpha) and reduced heart rate/contractility (beta)." [CORRECT]
C. "It blocks beta-1 receptors only, slowing the heart rate."
D. "It is a direct vasodilator that does not affect receptors."
Correct Answer: B
Rationale: Labetalol is a combined non-selective beta and alpha-1 antagonist (ratio ~7:1 oral, 3:1 IV). Alpha-1
blockade causes vasodilation (lowering BP); beta blockade prevents reflex tachycardia. Used IV for hypertensive
emergency (especially pregnancy/preeclampsia, aortic dissection). Side effects: orthostatic hypotension, bradycardia,
AV block, bronchospasm (avoid in asthma), hepatotoxicity (rare), fatigue. Carvedilol is similar oral combination
used for HFrEF. Monitor BP continuously during IV administration.
Latest 2026/2027 | Pharmacology for Professional Nursing Page 4
