If you are revising for your finals, make time and go through this comprehensive final exam pharmacology study guide. It is a great resource for last minute exam preparation.
1. You are caring for a 66-year-old man with a history of a large intracerebral hemorrhage 2 months ago. He is being evaluated for another acute stroke. The CT scan is negative for hemorrhage. The patient is receiving oxygen via nasal cannula at 2 L/min, and an IV has been established. His blood pressure is 180/100 mm Hg. Which drug do you anticipate giving to this patient?
1. C. Nicardipine
Rationale: In acute ischemic stroke with elevated BP (above 185/110 mm Hg), nicardipine is commonly used to carefully lower blood pressure to meet eligibility criteria for thrombolytics if considered. Aspirin is used later after hemorrhage is ruled out and rtPA not given.
A. aspirin
B. glucose (D50) C. nicardipine
D. rtPA:
2. A patient with sinus bradycardia and a heart rate of 42/min has diaphoresis and a blood pressure of 80/60 mm Hg. What is the initial dose of atropine?
A. 0.1 mg
B. 0.5 mg
C. 1 mg
D. 3 mg:
2. B. 0.5 mg
Rationale: Atropine is first-line for symptomatic bradycardia. The initial dose is 0.5 mg IV, repeated every 3-5 minutes to a max of 3 mg.
3. A patient with STEMI has ongoing chest discomfort. Heparin 4000 units IV bolus and a heparin infusion of 1000 unit per hour are being administered.The patient did not take aspirin because he has a history of gastritis, which was treated 5 years ago. What is your next action?
A. give aspirin 160 to 325 mg to chew
B. give clopidogrel 300 mg orally
C. give enteric-coated aspirin 75 mg orally
D. give enteric-coated aspirin 325 mg rectally:
3. A. Give aspirin 160 to 325 mg to chew
Rationale: Despite the gastritis history, aspirin is critical in acute STEMI unless there’s active bleeding. Chewed aspirin provides quicker absorption.
4. A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which drug should be given next?
A. adenosine 6 mg
B. amiodarone 300 mg
C. epinephrine 3 mg
D. lidocaine 0.5 mg/kg:
4. B. Amiodarone 300 mg
Rationale: After epinephrine and defibrillation fail in pulseless VT/VF, amiodarone is the next antiarrhythmic used. First dose is 300 mg IV push.
5. What is the indication for the us of magnesium in cardiac arrest?
A. ventricular tachycardia associated with a normal QT
interval
B. shock-refractory monomorphic ventricular tachycardia
C. pulseless ventricular tachycardia-associated torsades de pointes
D. shock-refractory ventricular fibrillation:
5. C. Pulseless VT associated with torsades de pointes
Rationale: Magnesium sulfate is indicated for torsades de pointes (a specific type of polymorphic VT) and not for regular VT or VF.
6. In which situation does bradycardia require treatment?
A. 12-lead ECG showing a normal sinus rhythm
B. hypotension
C. diastolic blood pressure greater than 90 mm Hg
D. systolic blood pressure greater than 100 mm Hg:
6. B. Hypotension
Rationale: Bradycardia is treated only if symptomatic. Hypotension is a sign of poor perfusion due to bradycardia and warrants intervention.
7. You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previously advised “no shock indicated.” A rhythm check now finds asystole. After resuming high-quality compressions, which action do you take next?
A. call for a pulse check
B. establish IV or IO access
C. insert a laryngeal airway
D. perform endotracheal intubation:
7. B. Establish IV or IO access
Rationale: In asystole, after CPR, establishing access is a priority to administer medications like epinephrine. Pulse checks are done only during rhythm assessments.
8. A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138/min. He is asymptomatic, with a blood pressure of 110/70 mm Hg. He has a history of angina. What action is recommended next?
A. giving adenosine 6 mg IV bolus
B. giving lidocaine 1 to 1.5 mg IV bolus
C. performing synchronized cardioversion
D. seeking expert consultation:
8. D. Seeking expert consultation
Rationale: For wide-complex irregular tachycardias, such as possibly pre-excited atrial fibrillation, consultation is important due to risk with AV nodal blockers.
9. A patient is in refractory ventricular fibrillation. High-quality CPR is in progress. One dose of epinephrine was given after the second shock. An antiarrhythmic drug was given immediately after the third shock. You are the team leader. Which medication do you order next?
A. epinephrine 1 mg
B. epinephrine 3 mg
C. sodium bicarbonate 50 mEq
D. a second dose of the antiarrhythmic drug:
9. A. Epinephrine 1 mg
Rationale: Epinephrine is repeated every 3-5 minutes during cardiac arrest. It should follow the antiarrhythmic and defibrillation.
10. A monitored patient in the ICU developed a sudden onset of narrow-com- plex tachycardia at a rate of 220/min. The patient’s blood pressure is 128/58
mm Hg, the PETCO2 is 38 mm Hg, and the pulse oximetry reading is 98%. There is vascular access in the left arm, and the patient has not been given any vasoactive drugs. A 12-lead ECG confirms a supraventricular tachycardia with no evidence of ischemia or infarction. The heart rate has no responded to vagal maneuvers. What is your next action?
A. administer adenosine 6 mg IV push
B. administer amiodarone 300 mg IV push
C. perform synchronized cardioversion at 50 J
D. perform synchronized cardioversion at 200 J:
10. A. Administer adenosine 6 mg IV push
Rationale: For stable narrow-complex SVT that hasn’t responded to vagal maneuvers, adenosine is first-line for diagnosis and potential conversion.
11. A 62-year-old man suddenly experienced difficulty speaking and left-sided weakness. he meets initial criteria for fibrinolytic therapy, and a CT scan of the brain is ordered. Which best describes the guidelines for antiplatelet and fibrinolytic therapy?
A. give aspirin 160 to 325 mg to be chewed immediately
B. give aspirin 160 mg and clopidogrel 75 mg orally
C. give heparin if the CT scan is negative for hemorrhage
D. hold aspirin for at least 24 hours if rtPA is administered:
11. D. Hold aspirin for 24 hours if rtPA is administered
Rationale: Antiplatelet therapy is held for 24 hours post-rtPA due to bleeding risk. This allows time for initial stabilization and neuroimaging.
12. A 35-year-old woman has palpitations, light-headedness, and a stable tachycardia. The monitor show a regular narrow-complex QRS at a rate of
180/min. Vagal maneuvers have not been effective in terminating the rhythm. An IV has ben established. Which drug should be administered?
A. adenosine 6 mg
B. atropine 0.5 mg
C. epinephrine 2 to 10 mcg/kg per minute
D. lidocaine 1 mg/kg:
12. A. Adenosine 6 mg
Rationale: Adenosine is used for stable, regular, narrow-complex tachycardias not responding to vagal maneuvers. It’s diagnostic and therapeutic.
13. Which intervention is most appropriate for the treatment of a patient in asystole?
A. atropine
B. defibrillation
C. epinephrine
D. transcutaneous pacing:
13. C. Epinephrine
Rationale: For asystole, epinephrine is the drug of choice. Atropine and defibrillation are not indicated.
14. A patient is in cardiac arrest. High-quality chest compressions are being given. The patient is intubated, and an IV has been started. The rhythm is asystole. What is the first drug/dose to administer?
A. atropine 0.5 mg IV / IO B. atropine 1 mg IV / IO
C. dopamine 2 to 20 mcg/kg per minute IV / IO
D. epinephrine 1 mg IV / IO:
14. D. Epinephrine 1 mg IV/IO
Rationale: In cardiac arrest (asystole), epinephrine 1 mg is the first medication administered after CPR is initiated.
15. A patient is in cardiac arrest. Ventricular fibrillation has been refractory to second shock. Which drug should be administered first?
A. atropine 1 mg IV / IO
B. epinephrine 1 mg IV / IO C. lidocaine 1 mg/kg IV / IO
D. sodium bicarbonate 50 mEq IV / IO:
15. B. Epinephrine 1 mg IV/IO
Rationale: In VF/pulseless VT not responding to initial shock, epinephrine is given to increase coronary perfusion pressure.
16. A patient has sinus bradycardia with a heart rate of 36/min. Atropine has been administered to a total dose of 3 mg. A transcutaneous pacemaker has failed to capture. The patient is confused, and her blood pressure is 88/56 mm Hg. Which therapy is now indicated?
A. atropine 1 mg
B. epinephrine 2 to 10 mcg/min
C. adenosine 6 mg
D. normal saline 250 ml to 500 ml bolus:
16. B. Epinephrine 2–10 mcg/min
Rationale: When atropine and pacing fail in bradycardia with poor perfusion, a continuous infusion of epinephrine is the next step.
17. a 57 year-old-woman has palpitations, chest discomfort, and tachycardia. The monitor show a regular wide-complex QRS at a rate of 180/min. she becomes diaphoretic, and her blood pressure is 80/60 mm Hg. Which action do you take next?
A. establish IV access
B. obtain a 12-lead ECG
C. perform electrical cardioversion
D. seek expert consultation:
17. C. Perform electrical cardioversion
Rationale: Unstable wide-complex tachycardia (low BP, diaphoresis) requires immediate synchronized cardioversion.
18. A patient is in cardiac arrest. Ventricular fibrillation has been refractory to an initial shock. If no pathway for medication administration is in place, which method is preferred?
A. central line
B. endotracheal tube
C. external jugular vein
D. IV or IO:
18. D. IV or IO
Rationale: IV or IO access is the preferred method for drug delivery during cardiac arrest, especially when central access is unavailable.
19. A patient with possible STEMI has ongoing chest discomfort. What is a contraindication to nitrate administration?
A. anterior wall myocardial infarction
B. heart rate less than 90/min
C. systolic blood pressure greater that 180 mm Hg
D. use of a phosphodiesterase inhibitor within the previous
24 hours
19. D. Use of a phosphodiesterase inhibitor within 24 hours
Rationale: PDE5 inhibitors (e.g., sildenafil) can cause profound hypotension with nitrates, so they’re contraindicated within 24 hours of nitrate use.
20. A patient is in refractory ventricular fibrillation and has received multiple appropriate defibrillation shocks, epinephrine 1 mg IV twice, and an initial dose of amiodarone 300 mg IV. The patient is intubated. Which best describe the recommended second dose of amiodarone for this patient?
A. 1 mg/kg IV push
B. 1 to 2 mg/min infusion
C. 150 mg IV push
D. 300 mg IV push:
20. C. 150 mg IV push
Rationale: After the initial 300 mg dose of amiodarone, the second dose is 150 mg if VF/pulseless VT persists.
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