NUR 2474 Pharmacology Final Exam
Questions And Well Graded Solutions
With Rationales Updated 2026-2027-
Rasmussen University
Ace your nursing pharmacology final with this verified NUR 2474 study bundle! Contains
comprehensive multiple-choice questions, accurate answers, and detailed clinical rationales
mapped directly to the latest exam blueprints. Deeply covers high-alert medications, critical
lab thresholds, insulin protocols, anti-infectives, and dosage calculations. Perfect for students
at Rasmussen, Walden, and top nursing schools to master prioritization questions and pass
the final exam on the first attempt.
Endocrine & Diabetes Management
1. A nurse prepares to administer rapid-acting insulin lispro to a patient. When should
the nurse ensure the patient's meal tray is available?
A) Within 45 to 60 minutes after administration
B) Within 15 minutes of administration
C) Exactly 2 hours after administration
D) Directly before the patient goes to sleep
Rationale: Rapid-acting insulin has an onset of 15 minutes. The meal tray must be
present immediately to prevent rapid, severe hypoglycemia.
2. A patient is prescribed long-acting insulin glargine and short-acting regular insulin at
bedtime. Which action must the nurse take?
A) Draw up the regular insulin first, then the glargine in the same syringe.
B) Draw up the glargine first, then the regular insulin in the same syringe.
C) Prepare and administer them in two completely separate syringes.
D) Mix them together and administer the solution via a slow intravenous push.
Rationale: Insulin glargine has an acidic pH and will precipitate if mixed with any
other insulin. It must always be given as a separate subcutaneous injection.
3. A patient with diabetes is prescribed a beta-blocker for hypertension. Which
symptom of hypoglycemia should the nurse teach the patient to monitor for closely?
A) Tachycardia
B) Palpitations
C) Diaphoresis
D) Nervousness
Rationale: Beta-blockers mask the autonomic symptoms of hypoglycemia such as
tachycardia and tremors. Sweating (diaphoresis) is mediated by cholinergic
pathways and is not blocked.
4. A patient is starting levothyroxine for hypothyroidism. Which instruction should the
nurse include in the discharge teaching?
A) Take this medication first thing in the morning on an empty stomach.
B) Take the medication with a glass of milk or calcium supplement.
C) Double the dose if you experience extreme fatigue or weight gain.
D) Take the medication right before bedtime with a full meal.
Rationale: Levothyroxine absorption is increased on an empty stomach. Calcium and
1|Page
, food significantly impair its absorption, so it must be taken 30–60 minutes before
breakfast.
5. A nurse evaluates a patient taking levothyroxine. Which finding indicates the dose
may be too high?
A) Bradycardia and weight gain
B) Somnolence and dry skin
C) Insomnia and tremors
D) Hypotension and hypothermia
Rationale: Insomnia, tremors, tachycardia, and heat intolerance are signs of
hyperthyroidism, indicating the levothyroxine dosage is excessive.
6. A patient is prescribed metformin for type 2 diabetes. Which diagnostic test is a
priority before the patient undergoes a scheduled CT scan with contrast dye?
A) Serum potassium level
B) Glycated hemoglobin (A1C)
C) Serum creatinine and BUN
D) Liver function tests (LFTs)
Rationale: Contrast dye combined with metformin severely increases the risk of
acute renal failure and lactic acidosis. Renal function must be checked, and
metformin held for 48 hours after contrast.
7. A patient with type 1 diabetes is found unresponsive with a blood glucose level of 42
mg/dL. The patient does not have intravenous access. Which medication should the
nurse administer?
A) Subcutaneous or intramuscular glucagon
B) Intravenous 50% dextrose injection
C) Subcutaneous regular insulin
D) Oral orange juice with packets of sugar
Rationale: Glucagon is the first-line emergency treatment for severe hypoglycemia in
an unconscious patient who lacks immediate IV access.
8. A patient is prescribed propylthiouracil (PTU) for hyperthyroidism. Which laboratory
value is most critical for the nurse to monitor?
A) Serum calcium
B) Complete blood count (CBC) with differential
C) Serum sodium
D) Blood urea nitrogen
Rationale: PTU can cause agranulocytosis, a severe drop in white blood cells that
puts the patient at extreme risk for life-threatening infections.
9. A patient is taking regular insulin at 0730. At what time should the nurse monitor
most closely for systemic signs of hypoglycemia?
A) 0800
B) 1000
C) 1300
D) 1600
Rationale: Regular insulin peaks approximately 2 to 4 hours after subcutaneous
injection, which is when the risk of hypoglycemia is at its highest.
10. A patient is prescribed radioactive iodine (I-131) for Graves' disease. Which
precaution should the nurse teach the patient?
A) Avoid eating any seafood or iodized salt.
B) Discontinue the drug if a metallic taste develops.
C) Avoid close contact with pregnant women or children for several days.
D) Monitor for a sudden surge of physical energy and tachycardia.
2|Page
, Rationale: Radioactive iodine emits radiation. Patients must avoid close physical
proximity to children and pregnant women to prevent secondary radiation exposure.
Cardiovascular Medications
11. A nurse is preparing to administer digoxin to a patient. The patient’s apical heart rate
is 54 beats per minute. Which action should the nurse take?
A) Administer the medication and recheck the pulse in 1 hour.
B) Hold the medication and notify the healthcare provider.
C) Administer half of the prescribed digitalis dose.
D) Administer the drug along with an intravenous fluid bolus.
Rationale: Digoxin slows conduction through the AV node. It must be held if the
apical pulse is below 60 bpm in an adult to avoid dangerous bradyarrhythmias.
12. A patient reports seeing yellow-green halos around lights and experiencing severe
nausea. The nurse suspects toxicity from which medication?
A) Furosemide
B) Digoxin
C) Lisinopril
D) Metoprolol
Rationale: Visual disturbances (yellow-green halos) and gastrointestinal distress
(nausea/vomiting) are classic early signs of digitalis toxicity.
13. A patient is receiving a slow continuous infusion of diltiazem. Which safety
parameter must the nurse continuously assess?
A) Electrocardiogram (ECG) and blood pressure
B) Deep tendon reflexes and pupillary response
C) Urine specific gravity and urine output
D) Platelet count and prothrombin time
Rationale: Diltiazem is a calcium channel blocker that slows the heart rate and drops
blood pressure. Continuous ECG and blood pressure monitoring are vital to catch
bradycardia or severe hypotension.
14. A patient is prescribed lisinopril. Which adverse effect should the nurse instruct the
patient to report immediately?
A) Increased urinary frequency
B) Macular rash on the lower extremities
C) Swelling of the tongue, lips, or throat
D) Mild muscle aches after exercising
Rationale: Angioedema (swelling of the face, lips, tongue, or airway) is a life-
threatening adverse effect of ACE inhibitors that requires immediate emergency
intervention.
15. A patient taking an ACE inhibitor develops a persistent, dry, hacking cough. Which
medication class does the nurse expect the provider to switch the patient to?
A) Beta-blockers
B) Calcium channel blockers
C) Angiotensin II receptor blockers (ARBs)
D) Loop diuretics
Rationale: ACE inhibitor cough is caused by an accumulation of bradykinin. ARBs do
3|Page
, not affect bradykinin and provide similar cardiovascular benefits without the dry
cough.
16. A patient is prescribed spironolactone daily. Which dietary instruction is essential for
the nurse to provide?
A) Increase your intake of bananas and spinach.
B) Avoid the use of potassium-based salt substitutes.
C) Drink at least 4 liters of water every single day.
D) Consume extra dairy products to prevent hypocalcemia.
Rationale: Spironolactone is a potassium-sparing diuretic. Using salt substitutes
(which contain potassium chloride) can lead to severe, life-threatening hyperkalemia.
17. A nurse administers intravenous furosemide to a patient with acute pulmonary
edema. Which laboratory value should the nurse monitor closely?
A) Serum potassium
B) Serum sodium
C) Ionized calcium
D) Serum magnesium
Rationale: Loop diuretics like furosemide cause profound excretion of potassium,
putting the patient at risk for hypokalemia and dangerous cardiac arrhythmias.
18. A patient is prescribed sublingual nitroglycerin for stable angina. What should the
nurse teach the patient to do first when chest pain occurs?
A) Call emergency services immediately.
B) Swallow one tablet with a full glass of water.
C) Stop all activity and sit or lie down.
D) Take a deep breath and walk slowly around the room.
Rationale: Nitroglycerin causes rapid vasodilation and orthostatic hypotension. The
patient must sit or lie down immediately to prevent falls or syncope.
19. A patient has taken three sublingual nitroglycerin tablets 5 minutes apart for chest
pain. The pain has not changed. What is the priority action?
A) Call emergency services immediately.
B) Take a fourth tablet and wait an additional 5 minutes.
C) Drive to the nearest outpatient urgent care clinic.
D) Lie down flat on the floor and elevate both legs.
Rationale: If chest pain is unrelieved or worsens 5 minutes after the first dose (or
after 3 doses depending on the protocol), it may indicate a myocardial infarction,
requiring immediate emergency care.
20. A patient is prescribed metoprolol for hypertension. Which co-existing medical
condition should prompt the nurse to clarify this prescription?
A) Chronic open-angle glaucoma
B) Severe asthma or COPD
C) Rheumatoid arthritis
D) Chronic iron-deficiency anemia
Rationale: Non-selective beta-blockers (and even high doses of cardio-selective
ones like metoprolol) can cause bronchoconstriction, which can trigger a fatal
asthma attack.
Pain Management & Opioids
4|Page
Questions And Well Graded Solutions
With Rationales Updated 2026-2027-
Rasmussen University
Ace your nursing pharmacology final with this verified NUR 2474 study bundle! Contains
comprehensive multiple-choice questions, accurate answers, and detailed clinical rationales
mapped directly to the latest exam blueprints. Deeply covers high-alert medications, critical
lab thresholds, insulin protocols, anti-infectives, and dosage calculations. Perfect for students
at Rasmussen, Walden, and top nursing schools to master prioritization questions and pass
the final exam on the first attempt.
Endocrine & Diabetes Management
1. A nurse prepares to administer rapid-acting insulin lispro to a patient. When should
the nurse ensure the patient's meal tray is available?
A) Within 45 to 60 minutes after administration
B) Within 15 minutes of administration
C) Exactly 2 hours after administration
D) Directly before the patient goes to sleep
Rationale: Rapid-acting insulin has an onset of 15 minutes. The meal tray must be
present immediately to prevent rapid, severe hypoglycemia.
2. A patient is prescribed long-acting insulin glargine and short-acting regular insulin at
bedtime. Which action must the nurse take?
A) Draw up the regular insulin first, then the glargine in the same syringe.
B) Draw up the glargine first, then the regular insulin in the same syringe.
C) Prepare and administer them in two completely separate syringes.
D) Mix them together and administer the solution via a slow intravenous push.
Rationale: Insulin glargine has an acidic pH and will precipitate if mixed with any
other insulin. It must always be given as a separate subcutaneous injection.
3. A patient with diabetes is prescribed a beta-blocker for hypertension. Which
symptom of hypoglycemia should the nurse teach the patient to monitor for closely?
A) Tachycardia
B) Palpitations
C) Diaphoresis
D) Nervousness
Rationale: Beta-blockers mask the autonomic symptoms of hypoglycemia such as
tachycardia and tremors. Sweating (diaphoresis) is mediated by cholinergic
pathways and is not blocked.
4. A patient is starting levothyroxine for hypothyroidism. Which instruction should the
nurse include in the discharge teaching?
A) Take this medication first thing in the morning on an empty stomach.
B) Take the medication with a glass of milk or calcium supplement.
C) Double the dose if you experience extreme fatigue or weight gain.
D) Take the medication right before bedtime with a full meal.
Rationale: Levothyroxine absorption is increased on an empty stomach. Calcium and
1|Page
, food significantly impair its absorption, so it must be taken 30–60 minutes before
breakfast.
5. A nurse evaluates a patient taking levothyroxine. Which finding indicates the dose
may be too high?
A) Bradycardia and weight gain
B) Somnolence and dry skin
C) Insomnia and tremors
D) Hypotension and hypothermia
Rationale: Insomnia, tremors, tachycardia, and heat intolerance are signs of
hyperthyroidism, indicating the levothyroxine dosage is excessive.
6. A patient is prescribed metformin for type 2 diabetes. Which diagnostic test is a
priority before the patient undergoes a scheduled CT scan with contrast dye?
A) Serum potassium level
B) Glycated hemoglobin (A1C)
C) Serum creatinine and BUN
D) Liver function tests (LFTs)
Rationale: Contrast dye combined with metformin severely increases the risk of
acute renal failure and lactic acidosis. Renal function must be checked, and
metformin held for 48 hours after contrast.
7. A patient with type 1 diabetes is found unresponsive with a blood glucose level of 42
mg/dL. The patient does not have intravenous access. Which medication should the
nurse administer?
A) Subcutaneous or intramuscular glucagon
B) Intravenous 50% dextrose injection
C) Subcutaneous regular insulin
D) Oral orange juice with packets of sugar
Rationale: Glucagon is the first-line emergency treatment for severe hypoglycemia in
an unconscious patient who lacks immediate IV access.
8. A patient is prescribed propylthiouracil (PTU) for hyperthyroidism. Which laboratory
value is most critical for the nurse to monitor?
A) Serum calcium
B) Complete blood count (CBC) with differential
C) Serum sodium
D) Blood urea nitrogen
Rationale: PTU can cause agranulocytosis, a severe drop in white blood cells that
puts the patient at extreme risk for life-threatening infections.
9. A patient is taking regular insulin at 0730. At what time should the nurse monitor
most closely for systemic signs of hypoglycemia?
A) 0800
B) 1000
C) 1300
D) 1600
Rationale: Regular insulin peaks approximately 2 to 4 hours after subcutaneous
injection, which is when the risk of hypoglycemia is at its highest.
10. A patient is prescribed radioactive iodine (I-131) for Graves' disease. Which
precaution should the nurse teach the patient?
A) Avoid eating any seafood or iodized salt.
B) Discontinue the drug if a metallic taste develops.
C) Avoid close contact with pregnant women or children for several days.
D) Monitor for a sudden surge of physical energy and tachycardia.
2|Page
, Rationale: Radioactive iodine emits radiation. Patients must avoid close physical
proximity to children and pregnant women to prevent secondary radiation exposure.
Cardiovascular Medications
11. A nurse is preparing to administer digoxin to a patient. The patient’s apical heart rate
is 54 beats per minute. Which action should the nurse take?
A) Administer the medication and recheck the pulse in 1 hour.
B) Hold the medication and notify the healthcare provider.
C) Administer half of the prescribed digitalis dose.
D) Administer the drug along with an intravenous fluid bolus.
Rationale: Digoxin slows conduction through the AV node. It must be held if the
apical pulse is below 60 bpm in an adult to avoid dangerous bradyarrhythmias.
12. A patient reports seeing yellow-green halos around lights and experiencing severe
nausea. The nurse suspects toxicity from which medication?
A) Furosemide
B) Digoxin
C) Lisinopril
D) Metoprolol
Rationale: Visual disturbances (yellow-green halos) and gastrointestinal distress
(nausea/vomiting) are classic early signs of digitalis toxicity.
13. A patient is receiving a slow continuous infusion of diltiazem. Which safety
parameter must the nurse continuously assess?
A) Electrocardiogram (ECG) and blood pressure
B) Deep tendon reflexes and pupillary response
C) Urine specific gravity and urine output
D) Platelet count and prothrombin time
Rationale: Diltiazem is a calcium channel blocker that slows the heart rate and drops
blood pressure. Continuous ECG and blood pressure monitoring are vital to catch
bradycardia or severe hypotension.
14. A patient is prescribed lisinopril. Which adverse effect should the nurse instruct the
patient to report immediately?
A) Increased urinary frequency
B) Macular rash on the lower extremities
C) Swelling of the tongue, lips, or throat
D) Mild muscle aches after exercising
Rationale: Angioedema (swelling of the face, lips, tongue, or airway) is a life-
threatening adverse effect of ACE inhibitors that requires immediate emergency
intervention.
15. A patient taking an ACE inhibitor develops a persistent, dry, hacking cough. Which
medication class does the nurse expect the provider to switch the patient to?
A) Beta-blockers
B) Calcium channel blockers
C) Angiotensin II receptor blockers (ARBs)
D) Loop diuretics
Rationale: ACE inhibitor cough is caused by an accumulation of bradykinin. ARBs do
3|Page
, not affect bradykinin and provide similar cardiovascular benefits without the dry
cough.
16. A patient is prescribed spironolactone daily. Which dietary instruction is essential for
the nurse to provide?
A) Increase your intake of bananas and spinach.
B) Avoid the use of potassium-based salt substitutes.
C) Drink at least 4 liters of water every single day.
D) Consume extra dairy products to prevent hypocalcemia.
Rationale: Spironolactone is a potassium-sparing diuretic. Using salt substitutes
(which contain potassium chloride) can lead to severe, life-threatening hyperkalemia.
17. A nurse administers intravenous furosemide to a patient with acute pulmonary
edema. Which laboratory value should the nurse monitor closely?
A) Serum potassium
B) Serum sodium
C) Ionized calcium
D) Serum magnesium
Rationale: Loop diuretics like furosemide cause profound excretion of potassium,
putting the patient at risk for hypokalemia and dangerous cardiac arrhythmias.
18. A patient is prescribed sublingual nitroglycerin for stable angina. What should the
nurse teach the patient to do first when chest pain occurs?
A) Call emergency services immediately.
B) Swallow one tablet with a full glass of water.
C) Stop all activity and sit or lie down.
D) Take a deep breath and walk slowly around the room.
Rationale: Nitroglycerin causes rapid vasodilation and orthostatic hypotension. The
patient must sit or lie down immediately to prevent falls or syncope.
19. A patient has taken three sublingual nitroglycerin tablets 5 minutes apart for chest
pain. The pain has not changed. What is the priority action?
A) Call emergency services immediately.
B) Take a fourth tablet and wait an additional 5 minutes.
C) Drive to the nearest outpatient urgent care clinic.
D) Lie down flat on the floor and elevate both legs.
Rationale: If chest pain is unrelieved or worsens 5 minutes after the first dose (or
after 3 doses depending on the protocol), it may indicate a myocardial infarction,
requiring immediate emergency care.
20. A patient is prescribed metoprolol for hypertension. Which co-existing medical
condition should prompt the nurse to clarify this prescription?
A) Chronic open-angle glaucoma
B) Severe asthma or COPD
C) Rheumatoid arthritis
D) Chronic iron-deficiency anemia
Rationale: Non-selective beta-blockers (and even high doses of cardio-selective
ones like metoprolol) can cause bronchoconstriction, which can trigger a fatal
asthma attack.
Pain Management & Opioids
4|Page
