Rasmussen NUR 2474 Pharmacology Final Exam
Prep Questions and Well Graded Solutions
With Rationales Updated 2026-2027
master your nursing pharmacology finals with this comprehensive 200-question test bank custom-built
for Rasmussen University's NUR 2474 course. This premium study guide features clear, unbolded
questions, bolded correct answers, and deep, conceptual rationales. Cover high-yield exam topics
including insulin protocols, cardiac meds (Digoxin/ACE inhibitors), anticoagulants, antidotes, and
critical lifespan considerations. Perfect for active recall and guaranteeing a passing score.
1|Page
,1. A patient is prescribed long-acting insulin glargine and rapid-acting insulin as part.
Which action by the nurse is correct?
A) Draw up the insulin glargine first, then the insulin as part in the same syringe.
B) Draw up the insulin as part first, then the insulin glargine in the same syringe.
C) Administer the medications in two separate injections.
D) Mix the two insulins together and let them sit for 15 minutes before administration.
Rationale: Long-acting insulins (such as glargine) have a low pH and cannot be
mixed in the same syringe with any other insulin, as this alters their
pharmacokinetics and onset of action.
2. A nurse is preparing to administer Digoxin to a patient. Which assessment finding
requires the nurse to hold the medication?
A) Apical pulse of 52 beats per minute
B) Blood pressure of 140/90 mmHg
C) Respiratory rate of 18 breaths per minute
D) Potassium level of 4.5 mEq/L
Rationale: Digoxin decreases the heart rate via vagal stimulation. The apical pulse
must be assessed for one full minute, and the medication must be held if the heart
rate is under 60 beats per minute to prevent dangerous bradycardia.
3. A patient taking an ACE inhibitor develops a persistent, nonproductive cough. What
is the mechanism causing this side effect?
A) Increased production of pulmonary mucus
B) Accumulation of bradykinin in the respiratory tract
C) Local bacterial infection from immunosuppression
D) Bronchoconstriction from beta-blockade
Rationale: ACE inhibitors prevent the breakdown of bradykinin, leading to its
accumulation in the respiratory tract, which triggers a localized dry, hacking cough in
susceptible patients.
4. Which laboratory test is used to monitor the therapeutic effectiveness of Heparin
therapy?
A) Prothrombin Time (PT)
B) International Normalized Ratio (INR)
C) Activated Partial Thromboplastin Time (aPTT)
D) Platelet aggregation factor
Rationale: Continuous intravenous heparin infusions are monitored and adjusted
based on aPTT values to ensure the patient remains within the target therapeutic
anticoagulation window.
5. What is the designated antidote for a patient experiencing a severe Warfarin
overdose with active hemorrhage?
A) Vitamin K
B) Protamine sulfate
C) Acetylcysteine
D) Flumazenil
Rationale: Warfarin acts by interfering with vitamin K-dependent clotting factors.
Administering Vitamin K bypasses this blockade to restore normal coagulation.
6. A patient is prescribed both Albuterol and Beclomethasone inhalers for asthma
management. What instruction must the nurse provide?
2|Page
, A) Use the Beclomethasone first, wait 5 minutes, then use the Albuterol.
B) Use the Albuterol first, wait 5 minutes, then use the Beclomethasone.
C) Take both inhalations back-to-back without waiting.
D) Use Beclomethasone only during acute shortness of breath attacks.
Rationale: Albuterol is a rapid bronchodilator that opens up the airways. Using it first
allows the subsequent steroid injection (Beclomethasone) to reach deeper into the
alveolar spaces.
7. Which patient education point is essential for a patient prescribed a corticosteroid
metered-dose inhaler?
A) Drink a full glass of milk immediately after use.
B) Rinse the mouth thoroughly with water after each use.
C) Avoid brushing the teeth for one hour following administration.
D) Take the medication only when experiencing severe wheezing.
Rationale: Corticosteroids deposited in the oral cavity can suppress local immunity,
predisposing the patient to oral candidiasis (thrush). Rinsing the mouth removes
residual drug.
8. Why are infants and neonates at an increased risk for drug toxicity compared to
adults?
A) They have accelerated gastric emptying rates.
B) Their glomerular filtration rate is hyper-developed.
C) They have immature liver enzyme systems and reduced renal clearance.
D) They possess a highly restrictive blood-brain barrier.
Rationale: Neonates have underdeveloped hepatic metabolic pathways and
immature kidneys, which delays the breakdown and excretion of medications,
lengthening their half-life.
9. A patient is diagnosed with acetaminophen toxicity. Which antidote should the nurse
prepare to administer?
A) Naloxone
B) Deferoxamine
C) Acetylcysteine
D) Calcium gluconate
Rationale: Acetylcysteine acts as a substitute for glutathione, preventing
hepatotoxicity by binding to the toxic metabolite of acetaminophen.
10. A nurse administers a medication that binds to a receptor and mimics the body's
natural response. What is this drug classification called?
A) Agonist
B) Antagonist
C) Competitive inhibitor
D) Partial blocker
Rationale: An agonist is a drug that binds to a specific receptor and activates it to
produce a biological response identical or similar to the endogenous ligand.
11. A patient on high-dose Furosemide therapy reports weakness, leg cramps, and
irregular heart palpitations. Which deficit does the nurse suspect?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypoglycemia
Rationale: Furosemide is a loop diuretic that promotes the excretion of water,
sodium, and potassium. Leg cramps and arrhythmias are classic signs of low
potassium levels.
3|Page
, 12. A patient is taking Spironolactone. Which dietary modification should the nurse
reinforce?
A) Avoid salt substitutes containing potassium.
B) Increase consumption of bananas and avocados.
C) Drink at least four liters of fluids daily.
D) Restrict dietary intake of vitamin C.
Rationale: Spironolactone is a potassium-sparing diuretic. Using salt substitutes,
which are primarily composed of potassium chloride, puts the patient at extreme risk
for life-threatening hyperkalemia.
13. Which medication is a priority to administer to an unconscious patient experiencing
severe hypoglycemia in an emergency setting?
A) Subcutaneous regular insulin
B) Oral orange juice with packets of sugar
C) Intravenous Dextrose 50% (D50W)
D) Intravenous Normal Saline
Rationale: An unconscious patient cannot safely swallow oral carbohydrates due to
aspiration risks. IV Dextrose 50% provides immediate access to glucose to reverse
cerebral starvation.
14. A nurse notes a patient's Digoxin level is 2.4 ng/mL. Which action should the nurse
take first?
A) Administer the scheduled daily dose.
B) Hold the dose and notify the provider of the toxic value.
C) Check the patient's blood pressure sitting and standing.
D) Request an immediate repeat blood draw.
Rationale: The normal therapeutic range for digoxin is 0.5 to 2.0 ng/mL. A level of
2.4 ng/mL indicates toxicity, requiring the nurse to withhold further administration.
15. What is a common, life-threatening adverse reaction associated with the
administration of individual doses of Morphine sulfate?
A) Severe diarrhea
B) Respiratory depression
C) Paradoxical hypertension
D) Urinary frequency
Rationale: Morphine is an opioid agonist that acts directly on the brainstem
respiratory centers, potentially causing severe, dose-dependent respiratory
depression.
16. A patient is prescribed Nitroglycerin sublingual tablets for stable angina. What should
the nurse teach the patient about storing this medication?
A) Keep the tablets in a clear plastic organizer on the counter.
B) Keep the tablets in their original dark glass bottle away from light and
moisture.
C) Freeze the medication to extend its shelf life.
D) Transfer the tablets into a paper envelope for easy access.
Rationale: Nitroglycerin is highly unstable and degrades rapidly when exposed to air,
heat, moisture, or light. It must remain inside its original dark glass container.
17. A patient is receiving an infusion of Magnesium Sulfate. Which assessment finding
indicates a dangerous toxic accumulation?
A) Hyperactive deep tendon reflexes
B) Absence of deep tendon reflexes
C) Tachycardia of 110 beats per minute
D) Increased urinary output
4|Page
Prep Questions and Well Graded Solutions
With Rationales Updated 2026-2027
master your nursing pharmacology finals with this comprehensive 200-question test bank custom-built
for Rasmussen University's NUR 2474 course. This premium study guide features clear, unbolded
questions, bolded correct answers, and deep, conceptual rationales. Cover high-yield exam topics
including insulin protocols, cardiac meds (Digoxin/ACE inhibitors), anticoagulants, antidotes, and
critical lifespan considerations. Perfect for active recall and guaranteeing a passing score.
1|Page
,1. A patient is prescribed long-acting insulin glargine and rapid-acting insulin as part.
Which action by the nurse is correct?
A) Draw up the insulin glargine first, then the insulin as part in the same syringe.
B) Draw up the insulin as part first, then the insulin glargine in the same syringe.
C) Administer the medications in two separate injections.
D) Mix the two insulins together and let them sit for 15 minutes before administration.
Rationale: Long-acting insulins (such as glargine) have a low pH and cannot be
mixed in the same syringe with any other insulin, as this alters their
pharmacokinetics and onset of action.
2. A nurse is preparing to administer Digoxin to a patient. Which assessment finding
requires the nurse to hold the medication?
A) Apical pulse of 52 beats per minute
B) Blood pressure of 140/90 mmHg
C) Respiratory rate of 18 breaths per minute
D) Potassium level of 4.5 mEq/L
Rationale: Digoxin decreases the heart rate via vagal stimulation. The apical pulse
must be assessed for one full minute, and the medication must be held if the heart
rate is under 60 beats per minute to prevent dangerous bradycardia.
3. A patient taking an ACE inhibitor develops a persistent, nonproductive cough. What
is the mechanism causing this side effect?
A) Increased production of pulmonary mucus
B) Accumulation of bradykinin in the respiratory tract
C) Local bacterial infection from immunosuppression
D) Bronchoconstriction from beta-blockade
Rationale: ACE inhibitors prevent the breakdown of bradykinin, leading to its
accumulation in the respiratory tract, which triggers a localized dry, hacking cough in
susceptible patients.
4. Which laboratory test is used to monitor the therapeutic effectiveness of Heparin
therapy?
A) Prothrombin Time (PT)
B) International Normalized Ratio (INR)
C) Activated Partial Thromboplastin Time (aPTT)
D) Platelet aggregation factor
Rationale: Continuous intravenous heparin infusions are monitored and adjusted
based on aPTT values to ensure the patient remains within the target therapeutic
anticoagulation window.
5. What is the designated antidote for a patient experiencing a severe Warfarin
overdose with active hemorrhage?
A) Vitamin K
B) Protamine sulfate
C) Acetylcysteine
D) Flumazenil
Rationale: Warfarin acts by interfering with vitamin K-dependent clotting factors.
Administering Vitamin K bypasses this blockade to restore normal coagulation.
6. A patient is prescribed both Albuterol and Beclomethasone inhalers for asthma
management. What instruction must the nurse provide?
2|Page
, A) Use the Beclomethasone first, wait 5 minutes, then use the Albuterol.
B) Use the Albuterol first, wait 5 minutes, then use the Beclomethasone.
C) Take both inhalations back-to-back without waiting.
D) Use Beclomethasone only during acute shortness of breath attacks.
Rationale: Albuterol is a rapid bronchodilator that opens up the airways. Using it first
allows the subsequent steroid injection (Beclomethasone) to reach deeper into the
alveolar spaces.
7. Which patient education point is essential for a patient prescribed a corticosteroid
metered-dose inhaler?
A) Drink a full glass of milk immediately after use.
B) Rinse the mouth thoroughly with water after each use.
C) Avoid brushing the teeth for one hour following administration.
D) Take the medication only when experiencing severe wheezing.
Rationale: Corticosteroids deposited in the oral cavity can suppress local immunity,
predisposing the patient to oral candidiasis (thrush). Rinsing the mouth removes
residual drug.
8. Why are infants and neonates at an increased risk for drug toxicity compared to
adults?
A) They have accelerated gastric emptying rates.
B) Their glomerular filtration rate is hyper-developed.
C) They have immature liver enzyme systems and reduced renal clearance.
D) They possess a highly restrictive blood-brain barrier.
Rationale: Neonates have underdeveloped hepatic metabolic pathways and
immature kidneys, which delays the breakdown and excretion of medications,
lengthening their half-life.
9. A patient is diagnosed with acetaminophen toxicity. Which antidote should the nurse
prepare to administer?
A) Naloxone
B) Deferoxamine
C) Acetylcysteine
D) Calcium gluconate
Rationale: Acetylcysteine acts as a substitute for glutathione, preventing
hepatotoxicity by binding to the toxic metabolite of acetaminophen.
10. A nurse administers a medication that binds to a receptor and mimics the body's
natural response. What is this drug classification called?
A) Agonist
B) Antagonist
C) Competitive inhibitor
D) Partial blocker
Rationale: An agonist is a drug that binds to a specific receptor and activates it to
produce a biological response identical or similar to the endogenous ligand.
11. A patient on high-dose Furosemide therapy reports weakness, leg cramps, and
irregular heart palpitations. Which deficit does the nurse suspect?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypoglycemia
Rationale: Furosemide is a loop diuretic that promotes the excretion of water,
sodium, and potassium. Leg cramps and arrhythmias are classic signs of low
potassium levels.
3|Page
, 12. A patient is taking Spironolactone. Which dietary modification should the nurse
reinforce?
A) Avoid salt substitutes containing potassium.
B) Increase consumption of bananas and avocados.
C) Drink at least four liters of fluids daily.
D) Restrict dietary intake of vitamin C.
Rationale: Spironolactone is a potassium-sparing diuretic. Using salt substitutes,
which are primarily composed of potassium chloride, puts the patient at extreme risk
for life-threatening hyperkalemia.
13. Which medication is a priority to administer to an unconscious patient experiencing
severe hypoglycemia in an emergency setting?
A) Subcutaneous regular insulin
B) Oral orange juice with packets of sugar
C) Intravenous Dextrose 50% (D50W)
D) Intravenous Normal Saline
Rationale: An unconscious patient cannot safely swallow oral carbohydrates due to
aspiration risks. IV Dextrose 50% provides immediate access to glucose to reverse
cerebral starvation.
14. A nurse notes a patient's Digoxin level is 2.4 ng/mL. Which action should the nurse
take first?
A) Administer the scheduled daily dose.
B) Hold the dose and notify the provider of the toxic value.
C) Check the patient's blood pressure sitting and standing.
D) Request an immediate repeat blood draw.
Rationale: The normal therapeutic range for digoxin is 0.5 to 2.0 ng/mL. A level of
2.4 ng/mL indicates toxicity, requiring the nurse to withhold further administration.
15. What is a common, life-threatening adverse reaction associated with the
administration of individual doses of Morphine sulfate?
A) Severe diarrhea
B) Respiratory depression
C) Paradoxical hypertension
D) Urinary frequency
Rationale: Morphine is an opioid agonist that acts directly on the brainstem
respiratory centers, potentially causing severe, dose-dependent respiratory
depression.
16. A patient is prescribed Nitroglycerin sublingual tablets for stable angina. What should
the nurse teach the patient about storing this medication?
A) Keep the tablets in a clear plastic organizer on the counter.
B) Keep the tablets in their original dark glass bottle away from light and
moisture.
C) Freeze the medication to extend its shelf life.
D) Transfer the tablets into a paper envelope for easy access.
Rationale: Nitroglycerin is highly unstable and degrades rapidly when exposed to air,
heat, moisture, or light. It must remain inside its original dark glass container.
17. A patient is receiving an infusion of Magnesium Sulfate. Which assessment finding
indicates a dangerous toxic accumulation?
A) Hyperactive deep tendon reflexes
B) Absence of deep tendon reflexes
C) Tachycardia of 110 beats per minute
D) Increased urinary output
4|Page
