PHARMACOLOGY FINAL EXAM – QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED ANSWERS PLUS RATIONALES |
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1. A 68-year-old male with a history of heart failure and hypertension presents to the clinic
complaining of a persistent, dry, hacking cough. He was recently started on a new
medication for blood pressure control. Which of the following drugs is the most likely cause
of his symptoms?
A. Amlodipine
B. Lisinopril
C. Metoprolol
D. Hydrochlorothiazide
ANSWER: B. Lisinopril
ACE inhibitors like lisinopril prevent the breakdown of bradykinin, leading to its
accumulation in the respiratory tract, which commonly triggers a persistent dry cough as a
side effect. Amlodipine is a calcium channel blocker associated with peripheral edema rather
than cough, metoprolol is a beta-blocker that can cause bronchospasm but not typically a
chronic dry cough, and hydrochlorothiazide is a thiazide diuretic associated with electrolyte
imbalances rather than cough.
2. A patient is prescribed warfarin for the prevention of stroke secondary to atrial
fibrillation. The nurse is providing dietary education. Which of the following foods should
the patient be advised to maintain in consistent amounts rather than avoiding entirely?
A. Grapefruit and grapefruit juice
B. Leafy green vegetables such as spinach and kale
C. Aged cheeses and cured meats
D. Starchy root vegetables such as potatoes and yams
ANSWER: B. Leafy green vegetables such as spinach and kale
Leafy green vegetables are rich in vitamin K, which is the direct antagonist to warfarin.
Rather than eliminating them, patients must keep their intake consistent to maintain stable
international normalized ratio (INR) levels. Grapefruit juice interacts with cytochrome P450
,enzymes affecting other medications like statins, aged cheeses interact with monoamine
oxidase inhibitors, and root vegetables do not significantly interfere with warfarin therapy.
3. An emergency department nurse is preparing to administer naloxone to a patient
presenting with suspected opioid overdose. Which of the following clinical findings best
indicates the need for this intervention?
A. Hypertension and tachycardia
B. Respiratory depression and pinpoint pupils
C. Hyperactive bowel sounds and tremors
D. Sweating, lacrimation, and rhinorrhea
ANSWER: B. Respiratory depression and pinpoint pupils
The classic triad of opioid overdose includes central nervous system depression, pinpoint
pupils (miosis), and profound respiratory depression, which is the life-threatening symptom
requiring immediate reversal with naloxone. Hypertension and tachycardia suggest
withdrawal or stimulant use, hyperactive bowel sounds and tremors point toward other
toxicities, and sweating, lacrimation, and rhinorrhea are signs of acute opioid withdrawal
rather than overdose.
4. A 54-year-old female with type 2 diabetes mellitus is prescribed metformin. Before
initiating therapy, the clinician orders laboratory work to evaluate which of the following
baseline parameters?
A. Serum creatinine and estimated glomerular filtration rate
B. Complete blood count and platelet aggregation
C. Thyroid-stimulating hormone and free T4
D. Serum potassium and electrocardiogram
ANSWER: A. Serum creatinine and estimated glomerular filtration rate
Metformin is primarily excreted unchanged by the kidneys. Impaired renal function
significantly increases the risk of metformin-associated lactic acidosis, making baseline
evaluation of renal function via serum creatinine and eGFR mandatory. Complete blood
counts, thyroid panels, and potassium levels are not the primary baseline requirements
specifically dictated for safe metformin initiation, though long-term use warrants periodic
vitamin B12 monitoring.
,5. A patient with severe rheumatoid arthritis is prescribed methotrexate. Which of the
following concurrent supplementations is routinely prescribed to reduce the incidence of
adverse hematologic and gastrointestinal toxicities?
A. Calcium carbonate
B. Folic acid
C. Iron sulfate
D. Ascorbic acid
ANSWER: B. Folic acid
Methotrexate is a dihydrofolate reductase inhibitor that blocks folic acid metabolism, causing
toxicities such as stomatitis, bone marrow suppression, and GI distress. Co-administration of
folic acid helps mitigate these adverse effects without reducing the drug's therapeutic efficacy.
Calcium, iron, and ascorbic acid do not serve this specific cellular rescue function for
methotrexate toxicity.
6. A critical care patient is receiving an infusion of regular insulin via an intravenous
protocol. Which of the following electrolyte imbalances must be monitored closely during
this therapy?
A. Hypercalcemia
B. Hypokalemia
C. Hypernatremia
D. Hypomagnesemia
ANSWER: B. Hypokalemia
Insulin drives potassium from the extracellular fluid into the intracellular space by
stimulating the sodium-potassium ATPase pump, which can rapidly precipitate dangerous
hypokalemia. Calcium, sodium, and magnesium are influenced by other metabolic processes,
but potassium shifts are the most immediate and clinically significant electrolyte hazard
during intravenous insulin therapy.
7. A 72-year-old male is prescribed tamsulosin for symptomatic benign prostatic
hyperplasia. When counseling this patient regarding first-dose phenomena, the clinician
should emphasize which of the following instructions?
A. Take the medication on an empty stomach with a full glass of cold water.
, B. Rise slowly from a sitting or lying position to prevent dizziness.
C. Avoid all dairy products for two hours before and after administration.
D. Monitor daily blood glucose levels for signs of hyperglycemia.
ANSWER: B. Rise slowly from a sitting or lying position to prevent dizziness.
Tamsulosin is an alpha-1 adrenergic antagonist that relaxes smooth muscle in the prostate
and bladder neck, but it also causes vascular smooth muscle relaxation, leading to orthostatic
hypotension, particularly after the first dose. Taking it with food actually improves absorption
for certain formulations, dairy restrictions do not apply, and it does not directly cause
hyperglycemia.
8. A patient is prescribed levothyroxine for primary hypothyroidism. The nurse should
provide which of the following instructions regarding the optimal timing of
administration?
A. Take the medication at bedtime with a high-fat snack to improve absorption.
B. Take the medication in the morning on an empty stomach with a full glass of water.
C. Take the medication 30 minutes after a heavy breakfast containing dairy.
D. Take the medication twice daily with meals to maintain steady plasma levels.
ANSWER: B. Take the medication in the morning on an empty stomach with a full glass of
water.
Levothyroxine absorption is significantly impaired by food, calcium, iron, and various
minerals in the gastrointestinal tract. Consequently, it must be taken on an empty stomach,
typically 30 to 60 minutes before breakfast with water. Bedtime dosing can cause insomnia,
and splitting doses is clinically incorrect since it has a long half-life and is administered once
daily.
9. An outpatient is prescribed albuterol metered-dose inhaler for exercise-induced
bronchospasm. The patient demonstrates proper technique when stating that the
medication should be used in which of the following manners?
A. Daily at bedtime as a long-term controller of airway remodeling
B. Fifteen to thirty minutes before engaging in anticipated physical activity
C. Continuously throughout the day regardless of symptom presence
D. Only after experiencing a severe asthma attack that fails to resolve spontaneously
VERIFIED AND WELL DETAILED ANSWERS PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE | EXAM PREP |
STUDY GUIDE | PRACTICE TEST| DOWNLOAD INSTANT PDF
1. A 68-year-old male with a history of heart failure and hypertension presents to the clinic
complaining of a persistent, dry, hacking cough. He was recently started on a new
medication for blood pressure control. Which of the following drugs is the most likely cause
of his symptoms?
A. Amlodipine
B. Lisinopril
C. Metoprolol
D. Hydrochlorothiazide
ANSWER: B. Lisinopril
ACE inhibitors like lisinopril prevent the breakdown of bradykinin, leading to its
accumulation in the respiratory tract, which commonly triggers a persistent dry cough as a
side effect. Amlodipine is a calcium channel blocker associated with peripheral edema rather
than cough, metoprolol is a beta-blocker that can cause bronchospasm but not typically a
chronic dry cough, and hydrochlorothiazide is a thiazide diuretic associated with electrolyte
imbalances rather than cough.
2. A patient is prescribed warfarin for the prevention of stroke secondary to atrial
fibrillation. The nurse is providing dietary education. Which of the following foods should
the patient be advised to maintain in consistent amounts rather than avoiding entirely?
A. Grapefruit and grapefruit juice
B. Leafy green vegetables such as spinach and kale
C. Aged cheeses and cured meats
D. Starchy root vegetables such as potatoes and yams
ANSWER: B. Leafy green vegetables such as spinach and kale
Leafy green vegetables are rich in vitamin K, which is the direct antagonist to warfarin.
Rather than eliminating them, patients must keep their intake consistent to maintain stable
international normalized ratio (INR) levels. Grapefruit juice interacts with cytochrome P450
,enzymes affecting other medications like statins, aged cheeses interact with monoamine
oxidase inhibitors, and root vegetables do not significantly interfere with warfarin therapy.
3. An emergency department nurse is preparing to administer naloxone to a patient
presenting with suspected opioid overdose. Which of the following clinical findings best
indicates the need for this intervention?
A. Hypertension and tachycardia
B. Respiratory depression and pinpoint pupils
C. Hyperactive bowel sounds and tremors
D. Sweating, lacrimation, and rhinorrhea
ANSWER: B. Respiratory depression and pinpoint pupils
The classic triad of opioid overdose includes central nervous system depression, pinpoint
pupils (miosis), and profound respiratory depression, which is the life-threatening symptom
requiring immediate reversal with naloxone. Hypertension and tachycardia suggest
withdrawal or stimulant use, hyperactive bowel sounds and tremors point toward other
toxicities, and sweating, lacrimation, and rhinorrhea are signs of acute opioid withdrawal
rather than overdose.
4. A 54-year-old female with type 2 diabetes mellitus is prescribed metformin. Before
initiating therapy, the clinician orders laboratory work to evaluate which of the following
baseline parameters?
A. Serum creatinine and estimated glomerular filtration rate
B. Complete blood count and platelet aggregation
C. Thyroid-stimulating hormone and free T4
D. Serum potassium and electrocardiogram
ANSWER: A. Serum creatinine and estimated glomerular filtration rate
Metformin is primarily excreted unchanged by the kidneys. Impaired renal function
significantly increases the risk of metformin-associated lactic acidosis, making baseline
evaluation of renal function via serum creatinine and eGFR mandatory. Complete blood
counts, thyroid panels, and potassium levels are not the primary baseline requirements
specifically dictated for safe metformin initiation, though long-term use warrants periodic
vitamin B12 monitoring.
,5. A patient with severe rheumatoid arthritis is prescribed methotrexate. Which of the
following concurrent supplementations is routinely prescribed to reduce the incidence of
adverse hematologic and gastrointestinal toxicities?
A. Calcium carbonate
B. Folic acid
C. Iron sulfate
D. Ascorbic acid
ANSWER: B. Folic acid
Methotrexate is a dihydrofolate reductase inhibitor that blocks folic acid metabolism, causing
toxicities such as stomatitis, bone marrow suppression, and GI distress. Co-administration of
folic acid helps mitigate these adverse effects without reducing the drug's therapeutic efficacy.
Calcium, iron, and ascorbic acid do not serve this specific cellular rescue function for
methotrexate toxicity.
6. A critical care patient is receiving an infusion of regular insulin via an intravenous
protocol. Which of the following electrolyte imbalances must be monitored closely during
this therapy?
A. Hypercalcemia
B. Hypokalemia
C. Hypernatremia
D. Hypomagnesemia
ANSWER: B. Hypokalemia
Insulin drives potassium from the extracellular fluid into the intracellular space by
stimulating the sodium-potassium ATPase pump, which can rapidly precipitate dangerous
hypokalemia. Calcium, sodium, and magnesium are influenced by other metabolic processes,
but potassium shifts are the most immediate and clinically significant electrolyte hazard
during intravenous insulin therapy.
7. A 72-year-old male is prescribed tamsulosin for symptomatic benign prostatic
hyperplasia. When counseling this patient regarding first-dose phenomena, the clinician
should emphasize which of the following instructions?
A. Take the medication on an empty stomach with a full glass of cold water.
, B. Rise slowly from a sitting or lying position to prevent dizziness.
C. Avoid all dairy products for two hours before and after administration.
D. Monitor daily blood glucose levels for signs of hyperglycemia.
ANSWER: B. Rise slowly from a sitting or lying position to prevent dizziness.
Tamsulosin is an alpha-1 adrenergic antagonist that relaxes smooth muscle in the prostate
and bladder neck, but it also causes vascular smooth muscle relaxation, leading to orthostatic
hypotension, particularly after the first dose. Taking it with food actually improves absorption
for certain formulations, dairy restrictions do not apply, and it does not directly cause
hyperglycemia.
8. A patient is prescribed levothyroxine for primary hypothyroidism. The nurse should
provide which of the following instructions regarding the optimal timing of
administration?
A. Take the medication at bedtime with a high-fat snack to improve absorption.
B. Take the medication in the morning on an empty stomach with a full glass of water.
C. Take the medication 30 minutes after a heavy breakfast containing dairy.
D. Take the medication twice daily with meals to maintain steady plasma levels.
ANSWER: B. Take the medication in the morning on an empty stomach with a full glass of
water.
Levothyroxine absorption is significantly impaired by food, calcium, iron, and various
minerals in the gastrointestinal tract. Consequently, it must be taken on an empty stomach,
typically 30 to 60 minutes before breakfast with water. Bedtime dosing can cause insomnia,
and splitting doses is clinically incorrect since it has a long half-life and is administered once
daily.
9. An outpatient is prescribed albuterol metered-dose inhaler for exercise-induced
bronchospasm. The patient demonstrates proper technique when stating that the
medication should be used in which of the following manners?
A. Daily at bedtime as a long-term controller of airway remodeling
B. Fifteen to thirty minutes before engaging in anticipated physical activity
C. Continuously throughout the day regardless of symptom presence
D. Only after experiencing a severe asthma attack that fails to resolve spontaneously
