Rasmussen NUR 2474 Pharmacology Final
Exam Review Questions And Well Graded
Solutions With Rationales Updated 2026-
2027
Ace your NUR 2474 Pharmacology Final Exam with this comprehensive study bundle. This
guide features highly targeted multiple-choice questions, accurate answer keys, and detailed
clinical rationales designed for nursing students. Master high-alert drug classes, critical
antidotes, cardiac protocols (Digoxin, Nitroglycerin), insulin peak times, and dosage
calculations. Perfect for active recall and matching official exam blueprints to ensure you pass
on your first attempt
Cardiovascular System
1. A patient with heart failure is prescribed digoxin. Which clinical assessment must the
nurse perform immediately prior to administering this medication?
A) Check the patient's blood pressure in both arms
B) Assess the apical pulse for one full minute
C) Verify the patient's daily fluid restriction
D) Measure the patient's capillary blood glucose
Answer Key:
B) Assess the apical pulse for one full minute
Rationale: Digoxin slows the heart rate. The nurse must count the apical pulse for
one full minute and hold the medication if the rate is below 60 beats per minute to
prevent severe bradycardia.
2. A nurse evaluates a patient's laboratory values and notes a digoxin level of 2.4
ng/mL. Which priority symptom should the nurse assess for?
A) Macular rash and severe itching
B) Visual disturbances like yellow-green halos
C) Dry, hacking, non-productive cough
D) Extreme lower extremity edema
Answer Key:
B) Visual disturbances like yellow-green halos
Rationale: A digoxin level above 2.0 ng/mL indicates toxicity. Key signs of digoxin
toxicity include visual changes (yellow-green vision, halos), nausea, vomiting, and
bradycardia.
3. A patient is prescribed lisinopril for hypertension. Which electrolyte imbalance must
the nurse monitor for closely?
A) Hypokalemia
B) Hyperkalemia
C) Hyponatremia
D) Hypocalcemia
Answer Key:
B) Hyperkalemia
Rationale: ACE inhibitors like lisinopril block aldosterone, which can lead to
potassium retention. The nurse must monitor for hyperkalemia.
4. A patient taking lisinopril develops a persistent, dry, non-productive cough. What is
the nurse's best action?
1|Page
, A) Advise the patient to use an over-the-counter cough suppressant
B) Instruct the patient to stop taking the medication and contact the provider
C) Inform the patient that this is a temporary side effect that will resolve in a week
D) Administer a dose of diphenhydramine as ordered
Answer Key:
B) Instruct the patient to stop taking the medication and contact the provider
Rationale: The dry cough is caused by an accumulation of bradykinin from ACE
inhibitor use. It will not resolve with cough medicine; the provider will need to switch
the patient to an ARB.
5. A patient taking an ACE inhibitor develops severe swelling of the lips, tongue, and
glottis. Which life-threatening condition is the patient experiencing?
A) Stevens-Johnson syndrome
B) Angioedema
C) Nephrotic syndrome
D) Serotonin syndrome
Answer Key:
B) Angioedema
Rationale: Angioedema is a severe, life-threatening adverse reaction to ACE
inhibitors that compromises the airway. Emergency intervention is required.
6. A nurse is preparing to administer metoprolol to a patient with hypertension. Which
assessment finding requires the nurse to hold the medication?
A) Blood pressure of 142/88 mmHg
B) Respiratory rate of 18 breaths per minute
C) Heart rate of 52 beats per minute
D) Oxygen saturation of 95% on room air
Answer Key:
C) Heart rate of 52 beats per minute
Rationale: Metoprolol is a beta-blocker that decreases heart rate and blood pressure.
It should be held if the heart rate is below 60 beats per minute or systolic BP is below
90-100 mmHg.
7. A patient with diabetes mellitus is newly prescribed propranolol. Which critical patient
education should the nurse provide?
A) This medication will dramatically increase your blood sugar levels
B) Propranolol can mask the early warning signs of hypoglycemia
C) Take this medication only when you experience tremors or sweating
D) You must double your insulin dose while taking this drug
Answer Key:
B) Propranolol can mask the early warning signs of hypoglycemia
Rationale: Non-selective beta-blockers block the sympathetic nervous system
responses (tachycardia, tremors) that typically warn a patient that their blood sugar
is low.
8. A patient is prescribed sublingual nitroglycerin for stable angina. What instruction
should the nurse include regarding administration during an anginal attack?
A) Swallow the tablet with a full glass of water
B) Take up to five tablets spaced two minutes apart
C) Sit or lie down immediately after taking the dose
D) Crush the tablet and mix it with applesauce
Answer Key:
C) Sit or lie down immediately after taking the dose
2|Page
, Rationale: Nitroglycerin causes profound vasodilation, leading to orthostatic
hypotension and dizziness. Sitting down prevents falls.
9. A patient taking sublingual nitroglycerin reports a severe, throbbing headache shortly
after administration. What is the nurse's best response?
A) This indicates an allergic reaction; stop using the drug immediately
B) Headaches are a common side effect due to vasodilation and can be treated with
acetaminophen
C) This means the drug is contaminated and must be replaced
D) This is a sign of an impending myocardial infarction
Answer Key:
B) Headaches are a common side effect due to vasodilation and can be treated
with acetaminophen
Rationale: Nitroglycerin causes cerebral vasodilation, which frequently induces a
headache. This is expected and can be managed with mild analgesics.
10. Which medication is strictly contraindicated for a patient taking nitroglycerin due to
the risk of fatal hypotension?
A) Atorvastatin
B) Acetaminophen
C) Sildenafil
D) Furosemide
Answer Key:
C) Sildenafil
Rationale: Phosphodiesterase inhibitors like sildenafil cause massive vasodilation.
Combined with nitroglycerin, they can cause an irreversible, fatal drop in blood
pressure.
11. A nurse is preparing to administer diltiazem. The nurse understands this medication
belongs to which drug class?
A) Beta-blocker
B) ACE inhibitor
C) Calcium channel blocker
D) Loop diuretic
Answer Key:
C) Calcium channel blocker
Rationale: Diltiazem is a calcium channel blocker used to treat hypertension, angina,
and certain cardiac arrhythmias.
12. A patient is receiving a continuous intravenous infusion of nitroprusside for a
hypertensive crisis. Which toxic complication must the nurse monitor for?
A) Hypernatremia
B) Cyanide toxicity
C) Ototoxicity
D) Hypokalemia
Answer Key:
B) Cyanide toxicity
Rationale: Nitroprusside metabolizes into cyanide. Prolonged or high-dose infusions
can cause lethal cyanide poisoning; levels must be monitored.
13. A patient is prescribed amiodarone for ventricular dysrhythmias. Which diagnostic
test must be performed regularly due to potential long-term adverse effects?
A) Periodic audiograms
B) Pulmonary function tests
C) Bone density scans
3|Page
, D) Upper endoscopy
Answer Key:
B) Pulmonary function tests
Rationale: Amiodarone can cause severe, progressive pulmonary toxicity (interstitial
lung disease/fibrosis). Baseline and periodic pulmonary function tests are
mandatory.
14. A patient is prescribed atorvastatin to manage hyperlipidemia. Which laboratory test
must be checked before and during therapy?
A) Serum amylase
B) Liver function tests (AST/ALT)
C) Arterial blood gases
D) Prothrombin time
Answer Key:
B) Liver function tests (AST/ALT)
Rationale: Statins are metabolized by the liver and can cause hepatotoxicity.
Baseline and periodic liver function tests are required.
15. A patient taking atorvastatin reports experiencing severe, unexplained muscle pain
and weakness. Which condition should the nurse suspect?
A) Gouty arthritis
B) Rhabdomyolysis
C) Diabetic neuropathy
D) Osteoarthritis
Answer Key:
B) Rhabdomyolysis
Rationale: Statins can cause myopathy, which can progress to rhabdomyolysis
(muscle breakdown) and subsequent acute kidney injury.
Hematologic System
16. A patient is receiving a continuous intravenous infusion of heparin. Which laboratory
parameter must the nurse monitor to adjust the dosage?
A) Prothrombin time (PT)
B) International Normalized Ratio (INR)
C) Activated partial thromboplastin time (aPTT)
D) Bleeding time
Answer Key:
C) Activated partial thromboplastin time (aPTT)
Rationale: Unfractionated heparin efficacy and safety are evaluated using the aPTT
value.
17. A patient on a heparin infusion begins bleeding heavily from the gums and an IV site.
The nurse anticipates administering which reversal agent?
A) Vitamin K
B) Protamine sulfate
C) Flumazenil
D) Deferoxamine
Answer Key:
4|Page
Exam Review Questions And Well Graded
Solutions With Rationales Updated 2026-
2027
Ace your NUR 2474 Pharmacology Final Exam with this comprehensive study bundle. This
guide features highly targeted multiple-choice questions, accurate answer keys, and detailed
clinical rationales designed for nursing students. Master high-alert drug classes, critical
antidotes, cardiac protocols (Digoxin, Nitroglycerin), insulin peak times, and dosage
calculations. Perfect for active recall and matching official exam blueprints to ensure you pass
on your first attempt
Cardiovascular System
1. A patient with heart failure is prescribed digoxin. Which clinical assessment must the
nurse perform immediately prior to administering this medication?
A) Check the patient's blood pressure in both arms
B) Assess the apical pulse for one full minute
C) Verify the patient's daily fluid restriction
D) Measure the patient's capillary blood glucose
Answer Key:
B) Assess the apical pulse for one full minute
Rationale: Digoxin slows the heart rate. The nurse must count the apical pulse for
one full minute and hold the medication if the rate is below 60 beats per minute to
prevent severe bradycardia.
2. A nurse evaluates a patient's laboratory values and notes a digoxin level of 2.4
ng/mL. Which priority symptom should the nurse assess for?
A) Macular rash and severe itching
B) Visual disturbances like yellow-green halos
C) Dry, hacking, non-productive cough
D) Extreme lower extremity edema
Answer Key:
B) Visual disturbances like yellow-green halos
Rationale: A digoxin level above 2.0 ng/mL indicates toxicity. Key signs of digoxin
toxicity include visual changes (yellow-green vision, halos), nausea, vomiting, and
bradycardia.
3. A patient is prescribed lisinopril for hypertension. Which electrolyte imbalance must
the nurse monitor for closely?
A) Hypokalemia
B) Hyperkalemia
C) Hyponatremia
D) Hypocalcemia
Answer Key:
B) Hyperkalemia
Rationale: ACE inhibitors like lisinopril block aldosterone, which can lead to
potassium retention. The nurse must monitor for hyperkalemia.
4. A patient taking lisinopril develops a persistent, dry, non-productive cough. What is
the nurse's best action?
1|Page
, A) Advise the patient to use an over-the-counter cough suppressant
B) Instruct the patient to stop taking the medication and contact the provider
C) Inform the patient that this is a temporary side effect that will resolve in a week
D) Administer a dose of diphenhydramine as ordered
Answer Key:
B) Instruct the patient to stop taking the medication and contact the provider
Rationale: The dry cough is caused by an accumulation of bradykinin from ACE
inhibitor use. It will not resolve with cough medicine; the provider will need to switch
the patient to an ARB.
5. A patient taking an ACE inhibitor develops severe swelling of the lips, tongue, and
glottis. Which life-threatening condition is the patient experiencing?
A) Stevens-Johnson syndrome
B) Angioedema
C) Nephrotic syndrome
D) Serotonin syndrome
Answer Key:
B) Angioedema
Rationale: Angioedema is a severe, life-threatening adverse reaction to ACE
inhibitors that compromises the airway. Emergency intervention is required.
6. A nurse is preparing to administer metoprolol to a patient with hypertension. Which
assessment finding requires the nurse to hold the medication?
A) Blood pressure of 142/88 mmHg
B) Respiratory rate of 18 breaths per minute
C) Heart rate of 52 beats per minute
D) Oxygen saturation of 95% on room air
Answer Key:
C) Heart rate of 52 beats per minute
Rationale: Metoprolol is a beta-blocker that decreases heart rate and blood pressure.
It should be held if the heart rate is below 60 beats per minute or systolic BP is below
90-100 mmHg.
7. A patient with diabetes mellitus is newly prescribed propranolol. Which critical patient
education should the nurse provide?
A) This medication will dramatically increase your blood sugar levels
B) Propranolol can mask the early warning signs of hypoglycemia
C) Take this medication only when you experience tremors or sweating
D) You must double your insulin dose while taking this drug
Answer Key:
B) Propranolol can mask the early warning signs of hypoglycemia
Rationale: Non-selective beta-blockers block the sympathetic nervous system
responses (tachycardia, tremors) that typically warn a patient that their blood sugar
is low.
8. A patient is prescribed sublingual nitroglycerin for stable angina. What instruction
should the nurse include regarding administration during an anginal attack?
A) Swallow the tablet with a full glass of water
B) Take up to five tablets spaced two minutes apart
C) Sit or lie down immediately after taking the dose
D) Crush the tablet and mix it with applesauce
Answer Key:
C) Sit or lie down immediately after taking the dose
2|Page
, Rationale: Nitroglycerin causes profound vasodilation, leading to orthostatic
hypotension and dizziness. Sitting down prevents falls.
9. A patient taking sublingual nitroglycerin reports a severe, throbbing headache shortly
after administration. What is the nurse's best response?
A) This indicates an allergic reaction; stop using the drug immediately
B) Headaches are a common side effect due to vasodilation and can be treated with
acetaminophen
C) This means the drug is contaminated and must be replaced
D) This is a sign of an impending myocardial infarction
Answer Key:
B) Headaches are a common side effect due to vasodilation and can be treated
with acetaminophen
Rationale: Nitroglycerin causes cerebral vasodilation, which frequently induces a
headache. This is expected and can be managed with mild analgesics.
10. Which medication is strictly contraindicated for a patient taking nitroglycerin due to
the risk of fatal hypotension?
A) Atorvastatin
B) Acetaminophen
C) Sildenafil
D) Furosemide
Answer Key:
C) Sildenafil
Rationale: Phosphodiesterase inhibitors like sildenafil cause massive vasodilation.
Combined with nitroglycerin, they can cause an irreversible, fatal drop in blood
pressure.
11. A nurse is preparing to administer diltiazem. The nurse understands this medication
belongs to which drug class?
A) Beta-blocker
B) ACE inhibitor
C) Calcium channel blocker
D) Loop diuretic
Answer Key:
C) Calcium channel blocker
Rationale: Diltiazem is a calcium channel blocker used to treat hypertension, angina,
and certain cardiac arrhythmias.
12. A patient is receiving a continuous intravenous infusion of nitroprusside for a
hypertensive crisis. Which toxic complication must the nurse monitor for?
A) Hypernatremia
B) Cyanide toxicity
C) Ototoxicity
D) Hypokalemia
Answer Key:
B) Cyanide toxicity
Rationale: Nitroprusside metabolizes into cyanide. Prolonged or high-dose infusions
can cause lethal cyanide poisoning; levels must be monitored.
13. A patient is prescribed amiodarone for ventricular dysrhythmias. Which diagnostic
test must be performed regularly due to potential long-term adverse effects?
A) Periodic audiograms
B) Pulmonary function tests
C) Bone density scans
3|Page
, D) Upper endoscopy
Answer Key:
B) Pulmonary function tests
Rationale: Amiodarone can cause severe, progressive pulmonary toxicity (interstitial
lung disease/fibrosis). Baseline and periodic pulmonary function tests are
mandatory.
14. A patient is prescribed atorvastatin to manage hyperlipidemia. Which laboratory test
must be checked before and during therapy?
A) Serum amylase
B) Liver function tests (AST/ALT)
C) Arterial blood gases
D) Prothrombin time
Answer Key:
B) Liver function tests (AST/ALT)
Rationale: Statins are metabolized by the liver and can cause hepatotoxicity.
Baseline and periodic liver function tests are required.
15. A patient taking atorvastatin reports experiencing severe, unexplained muscle pain
and weakness. Which condition should the nurse suspect?
A) Gouty arthritis
B) Rhabdomyolysis
C) Diabetic neuropathy
D) Osteoarthritis
Answer Key:
B) Rhabdomyolysis
Rationale: Statins can cause myopathy, which can progress to rhabdomyolysis
(muscle breakdown) and subsequent acute kidney injury.
Hematologic System
16. A patient is receiving a continuous intravenous infusion of heparin. Which laboratory
parameter must the nurse monitor to adjust the dosage?
A) Prothrombin time (PT)
B) International Normalized Ratio (INR)
C) Activated partial thromboplastin time (aPTT)
D) Bleeding time
Answer Key:
C) Activated partial thromboplastin time (aPTT)
Rationale: Unfractionated heparin efficacy and safety are evaluated using the aPTT
value.
17. A patient on a heparin infusion begins bleeding heavily from the gums and an IV site.
The nurse anticipates administering which reversal agent?
A) Vitamin K
B) Protamine sulfate
C) Flumazenil
D) Deferoxamine
Answer Key:
4|Page
