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COLLEGE OF NURSING AND HEALTH SCIENCES

DEPARTENT OF NURSING
UNIVERSITY OF MASSACHUSETTS BOSTON
NU 314 PHARMACOLOGY EXAM #2 – Fall 2010
Review Sheet and Study Guide

CONTENT REVIEW:
Know the following concepts:
medication adherence
HTN definitions and treatment
Treatment and prevention of hypokalemia
Difference between anticoagulation and thrombolysis
Reversal medications and lab tests to monitor anticoagulants warfarin and heparin
Angioedema identification and treatment
The process of how a drug becomes approved for the market in the US
The 1992 FDA regulation to accelerate drug approval
Individualized drug dosing
Stage C heart Failure drug regimens and rationales
Elderly specifics of adverse drug reactions and best treatment for isolated systolic HTN

3. Focus on the following key drugs:

Furosemide (Lasix)-
HCTZ-
the differences between the beta blockers metoprolol (Lopressor) and propanalol (Inderal)
beta 2 blockade causes bronchoconstriction 
not a problem in folks with normal lungs but can be life-threatening in asthma patients 
SOOO 
in general, try to avoid beta blockers in asthma patients; in Lehne they describe this thoroughly under
bronchoconstriction on p. 166
however, if you DO have to use a beta blocker, a second generation selective beta 1 like metoprolol
(lopressor) is the best choice, certainly better than propanolol (inderal) a 1st generation that blocks beta 1
and beta 2 nonselectively 
hope this helps !! Knowing the difference between these 2 drugs is on the test 
lovastatin (Mevacor),
hydralazine (Apresoline),
organic nitrates,
heparin and low molecular weight heparin,
warfarin (coumadin) aspirin (ASA),
amiodarone (Coradone),
verapamil (Calan);
captopril,
donepezil (arricept)
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1. Based upon your knowledge of evidence-based medication adherence, which of the following patients
would you predict would have the best chance of taking their medication as ordered?

A. a 32 y. o Hispanic woman with pyelonephritis on a 10 day course of Levofloxacin

B. an 83 y. o. African American man with HTN on daily HCTZ
C. a 24 year old white male with schizophrenia on daily antipsychotics
D. a 40 year old man with HIV disease on twice daily ART

2. A nurse is teaching a class on Alzheimer’s disease to a group of nurses. One of the nurses asks how a
cholinesterase inhibitor drug works in the Alzheimer’s patient. Cholinesterase inhibitors prevent the
breakdown of acetylcholine by acetylcholinesterase. The nurse’s best response would be

A. “It helps the healthier nerve cells transmit impulses better.”

B. “It promotes excretion of neurotoxins.”
C. “It reverses central nervous system cell degeneration.”
D. “It helps grow new nerve cells to replace damaged ones in the brain.”

3. The nurse educator informs the novice nurse that ____________ promotes urine production by
blocking the reabsorption of sodium and chloride in the early segment of the distal convoluted tubule.

A. furosemide (Lasix)
B. spironolactone (Aldactone)
C. hydrochlorothiazide (HydroDiuril)
D. bumetanide (Bumex)

4. A patient is admitted to the emergency department with a potassium level of 1.6 mEq/L. The nurse
puts the patient on an EKG monitor and should prepare to administer which of the following
medications?

A. D5W with 20 meq KCl at 125 cc/hour.

B. Both po and IV KCl simultaneously
C. IV Potassium Chloride alone at 10 meq/hour.
D. IV glucose and insulin to promote the release of potassium by cells

5. A patient is started on Lovastatin (Mevacor). The nurse should provide the patient with which of the
following instructions?

A. “Take lovastatin without regard to meals.”

B. “Take this medicine before breakfast.”
C. “Take this medicine on an empty stomach.”
D. “Take lovastatin with your evening meal.”

6. A patient comments, “I don’t understand why I have chest pain when I’m exercising. How will
metoprolol (Lopressor) help?” Which of the following comments made by the nurse is correct?
A. “It improves the right ventricular ejection fraction.”
B. “You’ve probably had several minor heart attacks, therefore sublingual nitroglycerin would be more
appropriate.”
C. “It reduces oxygen demand and increases exercise tolerance".
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D. “It improves sympathetic stimulation to the heart.”

7. A patient with refractory hypertension is taking hydralazine (Apresoline). What is the most likely
reason that this patient was also put on a beta blocker?
A. prevent rebound hypertension.
B. prevent reflex tachycardia.
C. reduce afterload to prevent heart failure.
D. prevent a drug-induced lupus erythematosus–type reaction.

8. Which patient would be targeted to add both a long acting oral nitrate (Isosorbide Dinitrate ) and
hydralazine (apresoline) in combination for symptoms emerging despite well-treated advanced Stage C
heart failure?

A. a 65 y.o. African American man with moderate to severe symptoms of LV failure

B. a 24 y.o. Asian American woman with pulmonary HTN and right sided heart failure
C. a 96 y.o. female Holocaust survivor of Ashkenazi descent
D. an 85 y.o. white woman on hemodialysis

9. A patient is being discharged home on the low molecular weight heparin enoxaparin (Lovenox)
injections for treatment of DVT. Which of the following statements made by the patient indicates a need
for further teaching by the nurse?

A. “I will need to go to my doctor’s office each day to have my blood drawn to see whether
enoxaparin is working.”
B. “I will inject the enoxaparin into the fatty tissue of my abdomen.”
C. “I hate needles, but I know enoxaparin doesn’t come in pill form.”
D. “I will call my physician immediately if I experience any uncontrollable bleeding while on
enoxaparin.”

10. A patient is brought to the emergency department for accidental warfarin (Coumadin) overdose. The
nurse determines that the patient has no apparent signs of bleeding. Which action should the nurse take
next?

A. Obtain a stat PTT level.

B. Prepare to calculate a total bleeding time
C. Type and cross match the patient’s blood.
D. Draw a stat blood level for PT and INR.

11. What medication should the nurse anticipate administering to this patient to “reverse” the Warfarin
(coumadin) anticoagulation effects?

A. Vitamin K
B.. protamine sulfate
C. Aminocarpoic acid (Amicar)
D. There is no reversal of Warfarin, the patient needs to be put on bleeding precautions and wait
for the drug levels to drop

12. A patient is receiving amiodarone (Cordarone). What is the rationale for using this drug?
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A. Opens calcium and sodium channels.

B. Slows AV conduction and prolongs AV refractoriness
C. Vasoconstricts peripheral vessels.
D. To prevent toxicity from antidysrhythmic drugs

13. A patient is receiving heparin therapy. The nurse reviews the patient's lab results and notes that the
platelet count has dropped significantly from yesterday’s value of over 200,000 to less than 100,000 mm3
today. The nurse should suspect __________________ and immediately ____________.

A. massive myocardial infarction; administer nitroglycerin and oxygen

B. hemorrhage; administer vitamin K1
C. thrombocytopenia, stop heparin therapy
D. massive pulmonary embolus; institute ventilator support

14. A patient applies a transdermal nitroglycerin patch at 9 AM. What additional instruction should be
provided by the nurse regarding the patch?

A. “Leave the patch in place until the following morning, when a new patch will be applied.”
B. “Apply an additional patch if breakthrough anginal pain occurs.”
C. “Note the location of the patch, so that it can be reapplied in the same location to enhance absorption.”
D. “Remove the patch at 9 PM.”

15. A patient has hypertension, type 2 diabetes, and renal insufficiency. What should the blood pressure
target goal be?

A. less than 140/90 mm Hg.

B. a diastolic pressure less than 100 mm Hg.
C. less than 130/80 mm Hg.
D. a systolic pressure less than 160 mm Hg.

16. Which of the following patients would most likely need intravenous
antibiotic therapy to treat a urinary tract infection?

A. A patient with an uncomplicated urinary tract infection caused by Escherichia coli

B. A patient with pyelonephritis with symptoms of high fever, chills, and severe flank pain
C. A patient with acute cystitis complaining of dysuria, frequency, and urgency
D. A patient with acute bacterial prostatitis with a mild fever, chills, and nocturia

17. Which of the following patients would need treatment with

trimethoprim-sulfamethoxazole (Bactrim) for a period of 6 months?

A. A female patient with acute pyelonephritis

B. A male patient with acute prostatitis
C. A female patient with recurring acute urinary tract infections
D. A male patient with acute cystitis

18. A patient with heart failure is prescribed furosemide (Lasix). The nurse should instruct the patient to
consume:

A. oranges, spinach, and potatoes.

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B. baked fish, chicken, and cauliflower.

C. tomato juice, skim milk, and cottage cheese.
D. oatmeal, cabbage, and bran flakes.

19. A patient is prescribed spironolactone (Aldactone) for treatment of hypertension. Which foods should
the patient be taught to
avoid?

A. Baked fish
B. Low-fat milk
C. Salt substitutes
D. Green beans

20. A patient has a serum potassium level of 3.1 mEq/L. The nurse plans to administer:

A. sustained-release potassium tablets (K-Dur).

B. foods that are deficient in potassium.
C. furosemide (Lasix).
D. sodium polystyrene sulfonate (Kayexalate).

22. A nurse is evaluating the kidney function of an 82-year-old patient before the administration of
medications. Which laboratory result
would provide the best index of renal function?

A. Serum creatinine
B. Blood urea nitrogen
C. Urinalysis
D. Creatinine clearance

23. The most important factor in adverse drug reactions in the elderly population is:

A. treatment with multiple drugs.

B. declining renal function.
C. use of over-the-counter drugs.
D. use of drugs with a high therapeutic index.

24. The nurse is serving as a preceptor for a new nurse on the unit. The preceptor is assessing the new
nurse’s understanding of antidysrhythmic drugs. Which statement made by the new nurse about the use of
antidysrhythmic drugs best demonstrates correct understanding?

a. “It is best to use as low a dose as possible of the drugs to reduce the risk of dysrhythmias.”
b. “To be effective, these drugs must be used in high doses.”
c. “Many patients may have a hypersensitivity to these drugs.”
d. “These drugs can actually worsen existing dysrhythmias or cause new dysrhythmias.”

25. A nurse administers quinidine to a patient with atrial fibrillation. The

nurse will observe the electrocardiogram (ECG) tracing for:

A. prolongation of the QT interval.

B. prolongation of the PR interval.
C. narrowing of the QRS complex.
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D. tall, peaked T waves.

26. A patient is admitted to the cardiac care unit from the emergency department. He is receiving
amiodarone (Cordarone), because his frequent runs of ventricular tachycardia have proved refractory to
other drugs. The rationale for using this very toxic, potentially ventricular antidysrhythmic drug is that it
a. delays action potential.
b. opens calcium and sodium channels.
c. delays repolarization.
d. vasoconstricts peripheral vessels.
see figure 48-2 
potassium channels are blocked
where is this action located on the cardiac action potential ?? 
27. A nurse prepares to administer a scheduled dose of verapamil (Calan) to a patient with atrial flutter.
The nurse records a heart rate of 92/minute and a blood pressure of 110/76 mm Hg. In light of these
findings, the nurse should
a. administer the dose as prescribed.
b. withhold the drug and notify the prescriber
c. recheck the vital signs in 30 minutes and then administer the dose.
d. administer IV calcium gluconate.

28. The patient is prescribed lovastatin (Mevacor). The nurse will teach
the patient to take the medication:

A. at any meal.
B. with the evening meal.
C. one hour before breakfast.
D. two hours after a meal.

29. A patient is receiving an intravenous infusion of heparin to treat a

pulmonary embolism. What laboratory value will the nurse monitor
to evaluate the treatment with this medication?

A. Activated partial thromboplastin time (aPTT)

B. Prothrombin time (PT)
C. Platelets
D. Hemoglobin and hematocrit

30. The standard Mix for Heparin infusion is 25,000 units in 500 mL.
how many units per ml?
a.A. 25
b.b. 50
c.c. 100
d.d. 250

31. To run at 1000 units per hour, what is IV pump set at (cc/hour)
a.10
b.5
c.20
d.15
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32. The PTT Comes back sub therapeutic, and the HO orders an increase in dose to 1200 units/hour and
repeat the PTT in 6 hours.

a.12
b.14
c.22
d.24

33. A patient is being scheduled for surgery. When does the patient need to stop taking their daily dose of
Aspirin? Answer in number of days before the surgery:

˜A. 2
˜B. 3
˜C. 1 week
˜D. 2 weeks
34. A researcher working for a pharmaceutical company is providing orientation to a new research nurse.
The researcher determines that further education is needed when the nurse states that

a. preclinical testing takes place in animals.

b. clinical testing phase 1 involves normal volunteers.
c. clinical testing phase 2 involves normal volunteers.
d. clinical testing phase 3 involves patients.

35. What was the rationale for the 1992 changes in the Food and Drug Administration’s regulations to
permit accelerated approval of drugs for the treatment of life-threatening or severely debilitating disease
(HIV/AIDS)?

˜a. To allow for marketing before completion of phase II of drug trials

˜b. To ensure that the unknown risks associated with early approval are balanced by the need for
effective drugs
˜c. To change the rules because existing FDA regulations were too stringent for potentially effective
drugs
˜d. To accelerate approval of new drugs to give prescribers the option of using them without research
findings

36. A patient is prescribed Toprol XL, a once a day sustaineded release form of metoprolol. Which
statement made by the patient indicates an understanding of medication teaching?

A. “I will stop taking my diuretic.”

B. “I must swallow the pill whole.”
C. “The medication will cause constipation.”
D. “This medication will not treat my heart rhythm problems.”

37. A patient who has been taking captopril for 2 weeks complains of a dry cough. What patient
education should the nurse provide regarding this complaint?
A. The cough will subside within 5 to 7 days.
B. The cough is an adverse effect of the medication and may lead to angioedema.
C. The medicine decreases immune response and predisposes the patient to colds.
D. The cough is a common side effect of the medication.
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38. A patient is to receive a scheduled dose of verapamil. The nurse should hold the medication and
contact the prescriber if:

A. blood pressure is at or above 190/88 mm Hg.

B. cardiac rhythm is in atrial fibrillation.
C. the patient is complaining of chest pain.
D. the patient is in second-degree heart block.

39. A patient is newly diagnosed to start taking Captopril. The nurse should:

A. assess for signs of hyperkalemia.

B. observe for a hypertensive crisis.
C. administer the medications as scheduled.
D. evaluate for first-dose hypotension.

40. A patient who is taking spironolactone (Aldactone) is newly prescribed losartan (Cozaar). The nurse
should:

A. assess for signs of hyperkalemia.

B. observe for a hypertensive crisis.
C. administer the medications as scheduled.
D. evaluate for first-dose hypotension.