NUR 354 Exam 2 Comprehensive Study
Guide: Cardiac & Nephrology Pharmacology
| 2026/2027 Update Complete.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
148 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam assesses application-level mastery of cardiovascular and renal pharmacotherapy, including
antihypertensives, diuretics, anticoagulants, heart failure agents, antiarrhythmics, and nephroprotective drugs.
Questions emphasize mechanism, monitoring, adverse effects, and clinical decision-making consistent with
current US guidelines.
STUDY GUIDE
Recommended duration: 2.5 hours. Passing target: 75%.
HIGHP - Page 1 of 48
,1. A patient on lisinopril for heart failure develops a persistent dry cough. Which
mechanism best explains this adverse effect?
[ ] A. Bradykinin accumulation due to ACE inhibition
[ ] B. Angiotensin II receptor blockade
[ ] C. Aldosterone excess
[ ] D. Direct beta-2 receptor stimulation
CORRECT: A. Bradykinin accumulation due to ACE inhibition
ACE inhibitors block the breakdown of bradykinin, leading to its accumulation in the respiratory tract and a
dry cough. ARBs do not affect bradykinin and are less likely to cause cough. Aldosterone excess and beta-2
stimulation are unrelated to this effect.
2. Which laboratory value requires immediate follow-up for a patient receiving
spironolactone?
[ ] A. Serum potassium 5.8 mEq/L
[ ] B. Serum sodium 138 mEq/L
[ ] C. Serum creatinine 0.9 mg/dL
[ ] D. Serum magnesium 1.8 mg/dL
CORRECT: A. Serum potassium 5.8 mEq/L
Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia; a potassium of 5.8 mEq/L is
dangerously high and requires immediate intervention. The other values are within normal limits and do not
indicate an urgent issue related to spironolactone.
3. A patient with atrial fibrillation is prescribed apixaban. Which statement indicates
correct understanding of the medication?
[ ] A. I will need routine INR monitoring.
[ ] B. I should avoid NSAIDs to reduce bleeding risk.
[ ] C. I can stop the drug once my rhythm normalizes.
[ ] D. I must take it with food to enhance absorption.
CORRECT: B. I should avoid NSAIDs to reduce bleeding risk.
Apixaban is a direct oral anticoagulant that does not require routine INR monitoring, but NSAIDs increase
bleeding risk and should be avoided. It should not be stopped abruptly without provider guidance, and food
does not significantly affect its absorption.
4. Which assessment finding is most concerning for a patient receiving intravenous
furosemide?
[ ] A. Blood pressure 88/50 mm Hg
[ ] B. Urine output 50 mL/hr
HIGHP - Page 2 of 48
, [ ] C. Serum potassium 3.9 mEq/L
[ ] D. Weight loss of 0.5 kg
CORRECT: A. Blood pressure 88/50 mm Hg
Furosemide can cause profound hypotension due to rapid diuresis; a BP of 88/50 mm Hg indicates
hypoperfusion and requires immediate attention. The other findings are either expected or within normal
limits.
5. A patient on digoxin reports nausea and visual disturbances. Which action should the
nurse take first?
[ ] A. Administer the next dose as scheduled.
[ ] B. Obtain a serum digoxin level.
[ ] C. Encourage increased fluid intake.
[ ] D. Document the findings and reassess in 4 hours.
CORRECT: B. Obtain a serum digoxin level.
Nausea and visual changes are classic signs of digoxin toxicity; obtaining a serum level is the priority to
confirm and guide treatment. Administering more digoxin could worsen toxicity, and delaying assessment is
unsafe.
6. Which patient teaching is essential for a client starting metoprolol succinate?
[ ] A. Monitor heart rate and report rates below 50 bpm.
[ ] B. Increase sodium intake to prevent hypotension.
[ ] C. Expect increased energy levels immediately.
[ ] D. Take the medication only when symptomatic.
CORRECT: A. Monitor heart rate and report rates below 50 bpm.
Metoprolol can cause bradycardia; patients should monitor their pulse and report rates below 50 bpm.
Sodium increase is not indicated, and the drug should be taken consistently, not PRN.
7. A patient with chronic kidney disease is prescribed epoetin alfa. Which parameter
should the nurse monitor most closely?
[ ] A. Hemoglobin and hematocrit
[ ] B. Serum potassium
[ ] C. Liver function tests
[ ] D. Platelet count
CORRECT: A. Hemoglobin and hematocrit
Epoetin alfa stimulates red blood cell production; monitoring hemoglobin and hematocrit ensures therapeutic
response and prevents excessive increases that raise thrombotic risk. Potassium, liver enzymes, and
HIGHP - Page 3 of 48
, platelets are not the primary parameters for this drug.
8. Which statement by a patient taking atorvastatin indicates a need for further teaching?
[ ] A. I will report muscle pain or weakness.
[ ] B. I should take this medication in the evening.
[ ] C. I can stop taking this once my cholesterol is normal.
[ ] D. I will avoid grapefruit juice.
CORRECT: C. I can stop taking this once my cholesterol is normal.
Statins are typically lifelong therapies; stopping when cholesterol normalizes can lead to rebound elevations
and increased cardiovascular risk. The other statements reflect correct understanding of monitoring, timing,
and grapefruit interactions.
9. A patient is receiving heparin infusion. Which laboratory test is used to monitor
therapeutic effect?
[ ] A. aPTT
[ ] B. PT/INR
[ ] C. Bleeding time
[ ] D. Thrombin time
CORRECT: A. aPTT
Unfractionated heparin therapy is monitored using the activated partial thromboplastin time (aPTT), with a
target range typically 1.5-2.5 times control. PT/INR monitors warfarin, while bleeding time and thrombin time
are not standard for heparin monitoring.
10. Which medication should the nurse question before administration to a patient with
acute decompensated heart failure and a potassium level of 5.6 mEq/L?
[ ] A. Spironolactone
[ ] B. Furosemide
[ ] C. Lisinopril
[ ] D. Carvedilol
CORRECT: A. Spironolactone
Spironolactone is a potassium-sparing diuretic that can further elevate potassium; with a level of 5.6 mEq/L, it
is contraindicated. Furosemide would lower potassium, while lisinopril and carvedilol do not directly cause
hyperkalemia to the same extent, though lisinopril can increase potassium.
HIGHP - Page 4 of 48
Guide: Cardiac & Nephrology Pharmacology
| 2026/2027 Update Complete.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
148 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam assesses application-level mastery of cardiovascular and renal pharmacotherapy, including
antihypertensives, diuretics, anticoagulants, heart failure agents, antiarrhythmics, and nephroprotective drugs.
Questions emphasize mechanism, monitoring, adverse effects, and clinical decision-making consistent with
current US guidelines.
STUDY GUIDE
Recommended duration: 2.5 hours. Passing target: 75%.
HIGHP - Page 1 of 48
,1. A patient on lisinopril for heart failure develops a persistent dry cough. Which
mechanism best explains this adverse effect?
[ ] A. Bradykinin accumulation due to ACE inhibition
[ ] B. Angiotensin II receptor blockade
[ ] C. Aldosterone excess
[ ] D. Direct beta-2 receptor stimulation
CORRECT: A. Bradykinin accumulation due to ACE inhibition
ACE inhibitors block the breakdown of bradykinin, leading to its accumulation in the respiratory tract and a
dry cough. ARBs do not affect bradykinin and are less likely to cause cough. Aldosterone excess and beta-2
stimulation are unrelated to this effect.
2. Which laboratory value requires immediate follow-up for a patient receiving
spironolactone?
[ ] A. Serum potassium 5.8 mEq/L
[ ] B. Serum sodium 138 mEq/L
[ ] C. Serum creatinine 0.9 mg/dL
[ ] D. Serum magnesium 1.8 mg/dL
CORRECT: A. Serum potassium 5.8 mEq/L
Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia; a potassium of 5.8 mEq/L is
dangerously high and requires immediate intervention. The other values are within normal limits and do not
indicate an urgent issue related to spironolactone.
3. A patient with atrial fibrillation is prescribed apixaban. Which statement indicates
correct understanding of the medication?
[ ] A. I will need routine INR monitoring.
[ ] B. I should avoid NSAIDs to reduce bleeding risk.
[ ] C. I can stop the drug once my rhythm normalizes.
[ ] D. I must take it with food to enhance absorption.
CORRECT: B. I should avoid NSAIDs to reduce bleeding risk.
Apixaban is a direct oral anticoagulant that does not require routine INR monitoring, but NSAIDs increase
bleeding risk and should be avoided. It should not be stopped abruptly without provider guidance, and food
does not significantly affect its absorption.
4. Which assessment finding is most concerning for a patient receiving intravenous
furosemide?
[ ] A. Blood pressure 88/50 mm Hg
[ ] B. Urine output 50 mL/hr
HIGHP - Page 2 of 48
, [ ] C. Serum potassium 3.9 mEq/L
[ ] D. Weight loss of 0.5 kg
CORRECT: A. Blood pressure 88/50 mm Hg
Furosemide can cause profound hypotension due to rapid diuresis; a BP of 88/50 mm Hg indicates
hypoperfusion and requires immediate attention. The other findings are either expected or within normal
limits.
5. A patient on digoxin reports nausea and visual disturbances. Which action should the
nurse take first?
[ ] A. Administer the next dose as scheduled.
[ ] B. Obtain a serum digoxin level.
[ ] C. Encourage increased fluid intake.
[ ] D. Document the findings and reassess in 4 hours.
CORRECT: B. Obtain a serum digoxin level.
Nausea and visual changes are classic signs of digoxin toxicity; obtaining a serum level is the priority to
confirm and guide treatment. Administering more digoxin could worsen toxicity, and delaying assessment is
unsafe.
6. Which patient teaching is essential for a client starting metoprolol succinate?
[ ] A. Monitor heart rate and report rates below 50 bpm.
[ ] B. Increase sodium intake to prevent hypotension.
[ ] C. Expect increased energy levels immediately.
[ ] D. Take the medication only when symptomatic.
CORRECT: A. Monitor heart rate and report rates below 50 bpm.
Metoprolol can cause bradycardia; patients should monitor their pulse and report rates below 50 bpm.
Sodium increase is not indicated, and the drug should be taken consistently, not PRN.
7. A patient with chronic kidney disease is prescribed epoetin alfa. Which parameter
should the nurse monitor most closely?
[ ] A. Hemoglobin and hematocrit
[ ] B. Serum potassium
[ ] C. Liver function tests
[ ] D. Platelet count
CORRECT: A. Hemoglobin and hematocrit
Epoetin alfa stimulates red blood cell production; monitoring hemoglobin and hematocrit ensures therapeutic
response and prevents excessive increases that raise thrombotic risk. Potassium, liver enzymes, and
HIGHP - Page 3 of 48
, platelets are not the primary parameters for this drug.
8. Which statement by a patient taking atorvastatin indicates a need for further teaching?
[ ] A. I will report muscle pain or weakness.
[ ] B. I should take this medication in the evening.
[ ] C. I can stop taking this once my cholesterol is normal.
[ ] D. I will avoid grapefruit juice.
CORRECT: C. I can stop taking this once my cholesterol is normal.
Statins are typically lifelong therapies; stopping when cholesterol normalizes can lead to rebound elevations
and increased cardiovascular risk. The other statements reflect correct understanding of monitoring, timing,
and grapefruit interactions.
9. A patient is receiving heparin infusion. Which laboratory test is used to monitor
therapeutic effect?
[ ] A. aPTT
[ ] B. PT/INR
[ ] C. Bleeding time
[ ] D. Thrombin time
CORRECT: A. aPTT
Unfractionated heparin therapy is monitored using the activated partial thromboplastin time (aPTT), with a
target range typically 1.5-2.5 times control. PT/INR monitors warfarin, while bleeding time and thrombin time
are not standard for heparin monitoring.
10. Which medication should the nurse question before administration to a patient with
acute decompensated heart failure and a potassium level of 5.6 mEq/L?
[ ] A. Spironolactone
[ ] B. Furosemide
[ ] C. Lisinopril
[ ] D. Carvedilol
CORRECT: A. Spironolactone
Spironolactone is a potassium-sparing diuretic that can further elevate potassium; with a level of 5.6 mEq/L, it
is contraindicated. Furosemide would lower potassium, while lisinopril and carvedilol do not directly cause
hyperkalemia to the same extent, though lisinopril can increase potassium.
HIGHP - Page 4 of 48
