Page | 1 NR566 Advanced Pharmacology Final Exam 2025–2026 |
Chamberlain NP | Verified 200 Questions with Rationales
Question 1: Beta-Blockers in Heart Failure
Q: A patient with chronic heart failure is prescribed carvedilol. Which
assessment finding would require immediate intervention?
A. Heart rate of 58 bpm
B. Blood pressure of 92/64 mmHg
C. Blood glucose of 110 mg/dL
D. Bilateral wheezing on auscultation
Correct Answer: D. Bilateral wheezing on auscultation
Rationale:
Carvedilol is a non-selective beta-blocker that can block beta-2 receptors in
the lungs, potentially leading to bronchospasm, especially in patients with
a history of asthma or reactive airway disease. Bilateral wheezing
suggests airway constriction and requires immediate intervention to
, prevent respiratory compromise. A slightly low heart rate and mild
hypotension are expected side effects that may be monitored. The blood
Page | 2 glucose level is within normal range and not concerning in this context.
Question 2: Statins and Myopathy
Q: A 56-year-old female taking atorvastatin complains of muscle pain and
weakness. What is the nurse practitioner's priority action?
A. Recommend increased physical activity
B. Continue therapy and monitor symptoms
C. Order a creatine kinase (CK) level
D. Refer to physical therapy
Correct Answer: C. Order a creatine kinase (CK) level
Rationale:
Statins like atorvastatin can cause myopathy or rhabdomyolysis,
presenting as muscle pain, tenderness, or weakness, particularly in the
thighs or shoulders. Elevated CK levels are a marker of muscle breakdown
and should be assessed promptly to rule out serious adverse effects.
Continuing therapy without investigation could worsen the condition.
Physical activity may exacerbate symptoms. Referral to physical therapy is
premature without ruling out statin-induced muscle damage.
, Question 3: Antibiotics and QT Prolongation
Page | 3
Q: A client is prescribed azithromycin for pneumonia. Which concurrent
medication would cause concern?
A. Lisinopril
B. Albuterol
C. Omeprazole
D. Amiodarone
Correct Answer: D. Amiodarone
Rationale:
Azithromycin and amiodarone both have the potential to prolong the QT
interval, which increases the risk of torsades de pointes, a potentially
fatal ventricular arrhythmia. Co-administration should be avoided unless
absolutely necessary, and if used, the client must be closely monitored with
ECG. Lisinopril and omeprazole do not affect QT significantly. While
albuterol can affect heart rate, it doesn’t pose the same arrhythmogenic risk
as QT prolongation.
Question 4: Warfarin Interactions
, Q: A client taking warfarin is started on trimethoprim-sulfamethoxazole.
What is the most appropriate action?
Page | 4 A. Instruct the patient to take both medications with food
B. Decrease the warfarin dose preemptively
C. Monitor INR more frequently
D. Discontinue warfarin immediately
Correct Answer: C. Monitor INR more frequently
Rationale:
Trimethoprim-sulfamethoxazole inhibits the metabolism of warfarin,
potentially leading to elevated INR levels and increased bleeding risk. It
is not always necessary to discontinue warfarin, but careful monitoring of
INR is essential to adjust the dose if needed. A preemptive dose reduction
is not recommended without data. Taking both with food won’t mitigate the
drug interaction. Regular INR testing ensures therapeutic and safe
anticoagulation.
Question 5: Levothyroxine Teaching
Q: Which instruction is most important when educating a patient about
levothyroxine?
A. Take it with breakfast every morning
Chamberlain NP | Verified 200 Questions with Rationales
Question 1: Beta-Blockers in Heart Failure
Q: A patient with chronic heart failure is prescribed carvedilol. Which
assessment finding would require immediate intervention?
A. Heart rate of 58 bpm
B. Blood pressure of 92/64 mmHg
C. Blood glucose of 110 mg/dL
D. Bilateral wheezing on auscultation
Correct Answer: D. Bilateral wheezing on auscultation
Rationale:
Carvedilol is a non-selective beta-blocker that can block beta-2 receptors in
the lungs, potentially leading to bronchospasm, especially in patients with
a history of asthma or reactive airway disease. Bilateral wheezing
suggests airway constriction and requires immediate intervention to
, prevent respiratory compromise. A slightly low heart rate and mild
hypotension are expected side effects that may be monitored. The blood
Page | 2 glucose level is within normal range and not concerning in this context.
Question 2: Statins and Myopathy
Q: A 56-year-old female taking atorvastatin complains of muscle pain and
weakness. What is the nurse practitioner's priority action?
A. Recommend increased physical activity
B. Continue therapy and monitor symptoms
C. Order a creatine kinase (CK) level
D. Refer to physical therapy
Correct Answer: C. Order a creatine kinase (CK) level
Rationale:
Statins like atorvastatin can cause myopathy or rhabdomyolysis,
presenting as muscle pain, tenderness, or weakness, particularly in the
thighs or shoulders. Elevated CK levels are a marker of muscle breakdown
and should be assessed promptly to rule out serious adverse effects.
Continuing therapy without investigation could worsen the condition.
Physical activity may exacerbate symptoms. Referral to physical therapy is
premature without ruling out statin-induced muscle damage.
, Question 3: Antibiotics and QT Prolongation
Page | 3
Q: A client is prescribed azithromycin for pneumonia. Which concurrent
medication would cause concern?
A. Lisinopril
B. Albuterol
C. Omeprazole
D. Amiodarone
Correct Answer: D. Amiodarone
Rationale:
Azithromycin and amiodarone both have the potential to prolong the QT
interval, which increases the risk of torsades de pointes, a potentially
fatal ventricular arrhythmia. Co-administration should be avoided unless
absolutely necessary, and if used, the client must be closely monitored with
ECG. Lisinopril and omeprazole do not affect QT significantly. While
albuterol can affect heart rate, it doesn’t pose the same arrhythmogenic risk
as QT prolongation.
Question 4: Warfarin Interactions
, Q: A client taking warfarin is started on trimethoprim-sulfamethoxazole.
What is the most appropriate action?
Page | 4 A. Instruct the patient to take both medications with food
B. Decrease the warfarin dose preemptively
C. Monitor INR more frequently
D. Discontinue warfarin immediately
Correct Answer: C. Monitor INR more frequently
Rationale:
Trimethoprim-sulfamethoxazole inhibits the metabolism of warfarin,
potentially leading to elevated INR levels and increased bleeding risk. It
is not always necessary to discontinue warfarin, but careful monitoring of
INR is essential to adjust the dose if needed. A preemptive dose reduction
is not recommended without data. Taking both with food won’t mitigate the
drug interaction. Regular INR testing ensures therapeutic and safe
anticoagulation.
Question 5: Levothyroxine Teaching
Q: Which instruction is most important when educating a patient about
levothyroxine?
A. Take it with breakfast every morning
