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MSN 621 Final Exam 2025/2026 – Full
Actual Exam with Verified Answers |
Latest Updated Version | Graded A+
Advanced Pharmacology (25 Questions)
1. A patient with hypertension is prescribed lisinopril. Which adverse effect should the
nurse monitor?
A) Hyperkalemia
B) Hypoglycemia
C) Tachycardia
D) Hypocalcemia
Answer: A. Hyperkalemia
Rationale: Lisinopril, an ACE inhibitor, can cause hyperkalemia due to reduced
aldosterone secretion, which impairs potassium excretion.
2. A patient receiving warfarin reports bleeding gums. What is the nurse’s priority action?
A) Administer protamine sulfate
B) Notify the provider
C) Encourage vitamin K intake
D) Monitor blood pressure
Rationale: Bleeding gums suggest warfarin-induced coagulopathy, requiring immediate
provider notification to adjust therapy or administer reversal agents.
3. Which medication is contraindicated in a patient with a sulfa allergy?
A) Metformin
B) Sulfamethoxazole
C) Lisinopril
D) Atorvastatin
Rationale: Sulfamethoxazole is a sulfonamide antibiotic, contraindicated in patients with
sulfa allergies due to risk of hypersensitivity reactions.
4. A patient with type 2 diabetes is prescribed metformin. When should it be administered?
A) At bedtime
B) With meals
C) 30 minutes before meals
D) Every 12 hours
Rationale: Metformin is taken with meals to reduce gastrointestinal side effects and
optimize absorption.
5. A patient receiving digoxin reports nausea and visual halos. What should the nurse assess
first?
A) Blood pressure
B) Serum digoxin level
, 2
C) Blood glucose
D) Respiratory rate
Rationale: Nausea and visual halos are signs of digoxin toxicity, requiring immediate
assessment of serum digoxin levels.
6. Which laboratory value should the nurse monitor in a patient receiving vancomycin?
A) Blood glucose
B) Serum creatinine
C) INR
D) Platelet count
Rationale: Vancomycin is nephrotoxic, necessitating monitoring of serum creatinine to
assess renal function.
7. A patient is prescribed levothyroxine. Which finding indicates therapeutic effectiveness?
A) Increased fatigue
B) Weight loss
C) Bradycardia
D) Cold intolerance
Rationale: Levothyroxine corrects hypothyroidism, evidenced by weight loss and
improved energy levels.
8. A patient with asthma is prescribed albuterol. Which instruction should the nurse
provide?
A) Use daily to prevent symptoms
B) Use as needed for wheezing
C) Take with meals
D) Avoid with oxygen therapy
Rationale: Albuterol, a rescue inhaler, is used as needed for acute asthma symptoms like
wheezing.
9. A patient receiving chemotherapy reports nausea. Which medication is most appropriate?
A) Lorazepam
B) Ondansetron
C) Morphine
D) Furosemide
Rationale: Ondansetron, a 5-HT3 receptor antagonist, is effective for chemotherapy-
induced nausea.
10. A patient is prescribed heparin. Which laboratory value should the nurse monitor?
A) INR
B) aPTT
C) Blood glucose
D) Serum potassium
Rationale: Heparin requires aPTT monitoring (therapeutic range 1.5–2.5 times control)
to assess anticoagulation efficacy.
11. A patient with heart failure is prescribed furosemide. Which electrolyte imbalance is a
risk?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
, 3
D) Hypermagnesemia
Rationale: Furosemide, a loop diuretic, causes potassium loss, risking hypokalemia.
12. A patient receiving morphine reports constipation. What should the nurse recommend?
A) Restrict fluids
B) Take a stool softener
C) Avoid fiber
D) Reduce activity
Rationale: Opioids like morphine cause constipation, managed with stool softeners to
promote bowel movement.
13. Which medication requires monitoring for hepatotoxicity?
A) Lisinopril
B) Acetaminophen
C) Metformin
D) Albuterol
Rationale: Acetaminophen can cause hepatotoxicity, especially at high doses, requiring
liver function monitoring.
14. A patient is prescribed clopidogrel. What should the nurse teach the patient to avoid?
A) Caffeine
B) Aspirin
C) Dairy
D) Sugar
Rationale: Aspirin increases bleeding risk when combined with clopidogrel, an
antiplatelet.
15. A patient with epilepsy is prescribed phenytoin. Which finding indicates toxicity?
A) Heart rate 80/min
B) Nystagmus
C) Blood pressure 120/80 mmHg
D) Increased appetite
Rationale: Nystagmus is a hallmark of phenytoin toxicity, requiring immediate
intervention.
16. A patient is prescribed spironolactone. Which electrolyte should the nurse monitor?
A) Sodium
B) Potassium
C) Calcium
D) Magnesium
Rationale: Spironolactone, a potassium-sparing diuretic, risks hyperkalemia, requiring
potassium monitoring.
17. A patient receiving IV gentamicin reports tinnitus. What is the nurse’s priority action?
A) Continue the infusion
B) Notify the provider
C) Encourage fluids
D) Monitor vital signs
Rationale: Tinnitus suggests gentamicin ototoxicity, requiring provider evaluation and
possible discontinuation.
18. A patient is prescribed prednisone. Which side effect should the nurse monitor?
A) Hypoglycemia
MSN 621 Final Exam 2025/2026 – Full
Actual Exam with Verified Answers |
Latest Updated Version | Graded A+
Advanced Pharmacology (25 Questions)
1. A patient with hypertension is prescribed lisinopril. Which adverse effect should the
nurse monitor?
A) Hyperkalemia
B) Hypoglycemia
C) Tachycardia
D) Hypocalcemia
Answer: A. Hyperkalemia
Rationale: Lisinopril, an ACE inhibitor, can cause hyperkalemia due to reduced
aldosterone secretion, which impairs potassium excretion.
2. A patient receiving warfarin reports bleeding gums. What is the nurse’s priority action?
A) Administer protamine sulfate
B) Notify the provider
C) Encourage vitamin K intake
D) Monitor blood pressure
Rationale: Bleeding gums suggest warfarin-induced coagulopathy, requiring immediate
provider notification to adjust therapy or administer reversal agents.
3. Which medication is contraindicated in a patient with a sulfa allergy?
A) Metformin
B) Sulfamethoxazole
C) Lisinopril
D) Atorvastatin
Rationale: Sulfamethoxazole is a sulfonamide antibiotic, contraindicated in patients with
sulfa allergies due to risk of hypersensitivity reactions.
4. A patient with type 2 diabetes is prescribed metformin. When should it be administered?
A) At bedtime
B) With meals
C) 30 minutes before meals
D) Every 12 hours
Rationale: Metformin is taken with meals to reduce gastrointestinal side effects and
optimize absorption.
5. A patient receiving digoxin reports nausea and visual halos. What should the nurse assess
first?
A) Blood pressure
B) Serum digoxin level
, 2
C) Blood glucose
D) Respiratory rate
Rationale: Nausea and visual halos are signs of digoxin toxicity, requiring immediate
assessment of serum digoxin levels.
6. Which laboratory value should the nurse monitor in a patient receiving vancomycin?
A) Blood glucose
B) Serum creatinine
C) INR
D) Platelet count
Rationale: Vancomycin is nephrotoxic, necessitating monitoring of serum creatinine to
assess renal function.
7. A patient is prescribed levothyroxine. Which finding indicates therapeutic effectiveness?
A) Increased fatigue
B) Weight loss
C) Bradycardia
D) Cold intolerance
Rationale: Levothyroxine corrects hypothyroidism, evidenced by weight loss and
improved energy levels.
8. A patient with asthma is prescribed albuterol. Which instruction should the nurse
provide?
A) Use daily to prevent symptoms
B) Use as needed for wheezing
C) Take with meals
D) Avoid with oxygen therapy
Rationale: Albuterol, a rescue inhaler, is used as needed for acute asthma symptoms like
wheezing.
9. A patient receiving chemotherapy reports nausea. Which medication is most appropriate?
A) Lorazepam
B) Ondansetron
C) Morphine
D) Furosemide
Rationale: Ondansetron, a 5-HT3 receptor antagonist, is effective for chemotherapy-
induced nausea.
10. A patient is prescribed heparin. Which laboratory value should the nurse monitor?
A) INR
B) aPTT
C) Blood glucose
D) Serum potassium
Rationale: Heparin requires aPTT monitoring (therapeutic range 1.5–2.5 times control)
to assess anticoagulation efficacy.
11. A patient with heart failure is prescribed furosemide. Which electrolyte imbalance is a
risk?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
, 3
D) Hypermagnesemia
Rationale: Furosemide, a loop diuretic, causes potassium loss, risking hypokalemia.
12. A patient receiving morphine reports constipation. What should the nurse recommend?
A) Restrict fluids
B) Take a stool softener
C) Avoid fiber
D) Reduce activity
Rationale: Opioids like morphine cause constipation, managed with stool softeners to
promote bowel movement.
13. Which medication requires monitoring for hepatotoxicity?
A) Lisinopril
B) Acetaminophen
C) Metformin
D) Albuterol
Rationale: Acetaminophen can cause hepatotoxicity, especially at high doses, requiring
liver function monitoring.
14. A patient is prescribed clopidogrel. What should the nurse teach the patient to avoid?
A) Caffeine
B) Aspirin
C) Dairy
D) Sugar
Rationale: Aspirin increases bleeding risk when combined with clopidogrel, an
antiplatelet.
15. A patient with epilepsy is prescribed phenytoin. Which finding indicates toxicity?
A) Heart rate 80/min
B) Nystagmus
C) Blood pressure 120/80 mmHg
D) Increased appetite
Rationale: Nystagmus is a hallmark of phenytoin toxicity, requiring immediate
intervention.
16. A patient is prescribed spironolactone. Which electrolyte should the nurse monitor?
A) Sodium
B) Potassium
C) Calcium
D) Magnesium
Rationale: Spironolactone, a potassium-sparing diuretic, risks hyperkalemia, requiring
potassium monitoring.
17. A patient receiving IV gentamicin reports tinnitus. What is the nurse’s priority action?
A) Continue the infusion
B) Notify the provider
C) Encourage fluids
D) Monitor vital signs
Rationale: Tinnitus suggests gentamicin ototoxicity, requiring provider evaluation and
possible discontinuation.
18. A patient is prescribed prednisone. Which side effect should the nurse monitor?
A) Hypoglycemia
