UR 210/ NUR210 Exam 2 –
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Principles of Pharmacology Review
ACTUAL EXAM 2026/2027 |
Principles of Pharmacology Review
| Verified Q&A | Pass Guaranteed -
A+ Graded
=======================================================================
=
========
PART A – MULTIPLE CHOICE (Q1–60)
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========
* *Q1 (Anticoagulants – warfarin reversal):**
A patient on warfarin (Coumadin) presents with an INR of 6.5 and active bleeding. Which
intervention is most appropriate?
A. Administer protamine sulfate
B. Administer vitamin K (phytonadione) 5–10 mg IV
C. Administer andexanet alfa
D. Administer fresh frozen plasma (FFP) only
* *[CORRECT]** B
*Rationale: The American College of Chest Physicians (CHEST) guidelines recommend vitamin
K (phytonadione) 5–10 mg IV for warfarin-associated major bleeding with INR >4.5. Protamine
sulfate (A) reverses heparin, not warfarin. Andexanet alfa (C) is indicated for
apixaban/rivaroxaban reversal, not warfarin. FFP alone (D) is insufficient because it does not
correct the underlying vitamin K-dependent factor deficiency.*
* *Q2 (ACE inhibitors – adverse effects):**
A 62-year-old patient prescribed lisinopril (Prinivil) for hypertension returns complaining of a
persistent dry cough. Which mechanism explains this adverse effect?
A. Increased bradykinin levels
B. Decreased angiotensin II production
C. Increased prostaglandin synthesis
,D. Decreased aldosterone secretion
* *[CORRECT]** A
*Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II and also inhibit
the degradation of bradykinin, leading to accumulation and a dry, nonproductive cough in
5–20% of patients. Decreased angiotensin II (B) is the desired therapeutic effect. Prostaglandin
synthesis (C) is not the primary mechanism. Decreased aldosterone (D) causes hyperkalemia,
not cough.*
* *Q3 (Beta-blockers – contraindications):**
Which condition is an absolute contraindication to the administration of metoprolol (Lopressor)?
A. Type 2 diabetes mellitus
B. Heart rate of 58 beats/minute
C. Severe bradycardia (HR <45 bpm)
D. Mild asthma
* *[CORRECT]** C
*Rationale: Severe bradycardia (HR <45 bpm) is an absolute contraindication to beta-blocker
therapy because beta-blockers further decrease heart rate via beta-1 receptor blockade. Type 2
diabetes (A) is a relative contraindication due to masking of hypoglycemia symptoms, not
absolute. HR 58 bpm (B) warrants monitoring but is not an absolute contraindication. Mild
asthma (D) is a relative contraindication due to nonselective beta-blocker risk.*
* *Q4 (Calcium channel blockers – adverse effects):**
A patient taking amlodipine (Norvasc) reports bilateral ankle edema. The nurse understands this
is caused by:
A. Sodium and water retention
B. Arteriolar vasodilation without venous vasodilation
C. Direct cardiac suppression
D. Increased capillary permeability
* *[CORRECT]** B
*Rationale: Dihydropyridine calcium channel blockers (amlodipine) cause preferential arteriolar
vasodilation without compensatory venous vasodilation, leading to increased hydrostatic
pressure in capillary beds and peripheral edema. Sodium retention (A) is more characteristic of
dihydropyridine use in combination with heart failure. Direct cardiac suppression (C) occurs with
nondihydropyridines (verapamil, diltiazem). Capillary permeability (D) is not the mechanism.*
* *Q5 (Diuretics – loop diuretics adverse effects):**
A patient receiving furosemide (Lasix) IV develops tinnitus and hearing loss. The nurse
recognizes this as:
A. An expected adverse effect requiring dose reduction
B. A sign of ototoxicity requiring immediate discontinuation
C. A hypersensitivity reaction
, D. An indication of therapeutic effectiveness
* *[CORRECT]** B
*Rationale: Loop diuretics (furosemide, bumetanide, torsemide) cause ototoxicity via damage to
the stria vascularis and hair cells of the cochlea, particularly with rapid IV administration or in
renal impairment. This is an indication for immediate discontinuation and audiology evaluation.
Dose reduction (A) is insufficient. Hypersensitivity (C) presents with rash or anaphylaxis.
Tinnitus is never a therapeutic indicator (D). Clinical pearl: Administer furosemide IV over 1–2
minutes to minimize ototoxicity risk.*
* *Q6 (Antidysrhythmics – amiodarone):**
A patient on long-term amiodarone (Cordarone) therapy requires monitoring for which
potentially life-threatening adverse effect?
A. Acute liver failure
B. Pulmonary fibrosis
C. Aplastic anemia
D. Hemorrhagic cystitis
* *[CORRECT]** B
*Rationale: Amiodarone (Class III antidysrhythmic) accumulates in lung tissue and can cause
potentially fatal pulmonary fibrosis, pneumonitis, or organizing pneumonia. Baseline and
periodic chest X-rays and pulmonary function tests are required. While hepatotoxicity occurs,
acute liver failure (A) is rare. Aplastic anemia (C) is associated with carbamazepine and
chloramphenicol. Hemorrhagic cystitis (D) is associated with cyclophosphamide.*
* *Q7 (Antidysrhythmics – adenosine):**
When administering adenosine (Adenocard) for supraventricular tachycardia (SVT), the nurse
should expect:
A. A gradual decrease in heart rate over 5 minutes
B. Brief asystole followed by normal sinus rhythm
C. Sustained hypotension for 30 minutes
D. Immediate ventricular fibrillation
* *[CORRECT]** B
*Rationale: Adenosine causes transient AV nodal blockade via activation of A1 receptors,
producing brief asystole (6–12 seconds) followed by restoration of normal sinus rhythm in 90%
of SVT cases. Rapid IV push followed by a 20 mL saline flush is required. Gradual decrease (A)
describes beta-blockers. Sustained hypotension (C) is not characteristic. Ventricular fibrillation
(D) is a rare complication, not an expected outcome.*
* *Q8 (Anticoagulants – heparin monitoring):**
A patient receiving unfractionated heparin has an aPTT of 98 seconds (therapeutic range 60–80
seconds). What is the nurse's priority action?
A. Continue the current infusion rate
N
Principles of Pharmacology Review
ACTUAL EXAM 2026/2027 |
Principles of Pharmacology Review
| Verified Q&A | Pass Guaranteed -
A+ Graded
=======================================================================
=
========
PART A – MULTIPLE CHOICE (Q1–60)
========================================================================
========
* *Q1 (Anticoagulants – warfarin reversal):**
A patient on warfarin (Coumadin) presents with an INR of 6.5 and active bleeding. Which
intervention is most appropriate?
A. Administer protamine sulfate
B. Administer vitamin K (phytonadione) 5–10 mg IV
C. Administer andexanet alfa
D. Administer fresh frozen plasma (FFP) only
* *[CORRECT]** B
*Rationale: The American College of Chest Physicians (CHEST) guidelines recommend vitamin
K (phytonadione) 5–10 mg IV for warfarin-associated major bleeding with INR >4.5. Protamine
sulfate (A) reverses heparin, not warfarin. Andexanet alfa (C) is indicated for
apixaban/rivaroxaban reversal, not warfarin. FFP alone (D) is insufficient because it does not
correct the underlying vitamin K-dependent factor deficiency.*
* *Q2 (ACE inhibitors – adverse effects):**
A 62-year-old patient prescribed lisinopril (Prinivil) for hypertension returns complaining of a
persistent dry cough. Which mechanism explains this adverse effect?
A. Increased bradykinin levels
B. Decreased angiotensin II production
C. Increased prostaglandin synthesis
,D. Decreased aldosterone secretion
* *[CORRECT]** A
*Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II and also inhibit
the degradation of bradykinin, leading to accumulation and a dry, nonproductive cough in
5–20% of patients. Decreased angiotensin II (B) is the desired therapeutic effect. Prostaglandin
synthesis (C) is not the primary mechanism. Decreased aldosterone (D) causes hyperkalemia,
not cough.*
* *Q3 (Beta-blockers – contraindications):**
Which condition is an absolute contraindication to the administration of metoprolol (Lopressor)?
A. Type 2 diabetes mellitus
B. Heart rate of 58 beats/minute
C. Severe bradycardia (HR <45 bpm)
D. Mild asthma
* *[CORRECT]** C
*Rationale: Severe bradycardia (HR <45 bpm) is an absolute contraindication to beta-blocker
therapy because beta-blockers further decrease heart rate via beta-1 receptor blockade. Type 2
diabetes (A) is a relative contraindication due to masking of hypoglycemia symptoms, not
absolute. HR 58 bpm (B) warrants monitoring but is not an absolute contraindication. Mild
asthma (D) is a relative contraindication due to nonselective beta-blocker risk.*
* *Q4 (Calcium channel blockers – adverse effects):**
A patient taking amlodipine (Norvasc) reports bilateral ankle edema. The nurse understands this
is caused by:
A. Sodium and water retention
B. Arteriolar vasodilation without venous vasodilation
C. Direct cardiac suppression
D. Increased capillary permeability
* *[CORRECT]** B
*Rationale: Dihydropyridine calcium channel blockers (amlodipine) cause preferential arteriolar
vasodilation without compensatory venous vasodilation, leading to increased hydrostatic
pressure in capillary beds and peripheral edema. Sodium retention (A) is more characteristic of
dihydropyridine use in combination with heart failure. Direct cardiac suppression (C) occurs with
nondihydropyridines (verapamil, diltiazem). Capillary permeability (D) is not the mechanism.*
* *Q5 (Diuretics – loop diuretics adverse effects):**
A patient receiving furosemide (Lasix) IV develops tinnitus and hearing loss. The nurse
recognizes this as:
A. An expected adverse effect requiring dose reduction
B. A sign of ototoxicity requiring immediate discontinuation
C. A hypersensitivity reaction
, D. An indication of therapeutic effectiveness
* *[CORRECT]** B
*Rationale: Loop diuretics (furosemide, bumetanide, torsemide) cause ototoxicity via damage to
the stria vascularis and hair cells of the cochlea, particularly with rapid IV administration or in
renal impairment. This is an indication for immediate discontinuation and audiology evaluation.
Dose reduction (A) is insufficient. Hypersensitivity (C) presents with rash or anaphylaxis.
Tinnitus is never a therapeutic indicator (D). Clinical pearl: Administer furosemide IV over 1–2
minutes to minimize ototoxicity risk.*
* *Q6 (Antidysrhythmics – amiodarone):**
A patient on long-term amiodarone (Cordarone) therapy requires monitoring for which
potentially life-threatening adverse effect?
A. Acute liver failure
B. Pulmonary fibrosis
C. Aplastic anemia
D. Hemorrhagic cystitis
* *[CORRECT]** B
*Rationale: Amiodarone (Class III antidysrhythmic) accumulates in lung tissue and can cause
potentially fatal pulmonary fibrosis, pneumonitis, or organizing pneumonia. Baseline and
periodic chest X-rays and pulmonary function tests are required. While hepatotoxicity occurs,
acute liver failure (A) is rare. Aplastic anemia (C) is associated with carbamazepine and
chloramphenicol. Hemorrhagic cystitis (D) is associated with cyclophosphamide.*
* *Q7 (Antidysrhythmics – adenosine):**
When administering adenosine (Adenocard) for supraventricular tachycardia (SVT), the nurse
should expect:
A. A gradual decrease in heart rate over 5 minutes
B. Brief asystole followed by normal sinus rhythm
C. Sustained hypotension for 30 minutes
D. Immediate ventricular fibrillation
* *[CORRECT]** B
*Rationale: Adenosine causes transient AV nodal blockade via activation of A1 receptors,
producing brief asystole (6–12 seconds) followed by restoration of normal sinus rhythm in 90%
of SVT cases. Rapid IV push followed by a 20 mL saline flush is required. Gradual decrease (A)
describes beta-blockers. Sustained hypotension (C) is not characteristic. Ventricular fibrillation
(D) is a rare complication, not an expected outcome.*
* *Q8 (Anticoagulants – heparin monitoring):**
A patient receiving unfractionated heparin has an aPTT of 98 seconds (therapeutic range 60–80
seconds). What is the nurse's priority action?
A. Continue the current infusion rate
