1
ADVANCED PHARMACOLOGY NURSING EXAM –
DRUG CLASSES, CALCULATIONS & CLINICAL
SCENARIOS (2026/27LATEST VERSION)
1. A patient with heart failure is prescribed digoxin. Which
electrolyte abnormality places the patient at greatest risk for
digoxin toxicity?
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypercalcemia
Correct Answer: C
Rationale:
Low potassium levels increase digoxin binding to the Na⁺/K⁺-
ATPase pump, significantly increasing toxicity risk (arrhythmias,
visual changes, nausea).
2. A nurse administers IV vancomycin. Which assessment
finding requires immediate intervention?
A. Mild flushing of the neck
B. Serum creatinine rising from 0.9 to 2.1 mg/dL
C. Decreased urine output
D. All of the above
,2
Correct Answer: D
Rationale:
Vancomycin can cause nephrotoxicity and Red Man Syndrome.
Rising creatinine, oliguria, and flushing all signal toxicity or
infusion-related reaction.
3. A patient taking warfarin begins therapy with trimethoprim-
sulfamethoxazole. What is the expected pharmacologic
outcome?
A. Decreased INR
B. No change in INR
C. Increased INR and bleeding risk
D. Warfarin resistance
Correct Answer: C
Rationale:
TMP-SMX inhibits warfarin metabolism via CYP450, increasing
anticoagulant effects and bleeding risk.
4. Which insulin has the highest risk of hypoglycemia if meals
are delayed?
A. Insulin glargine
B. Insulin detemir
,3
C. Insulin lispro
D. Insulin degludec
Correct Answer: C
Rationale:
Rapid-acting insulins peak quickly and require precise meal
timing; delayed meals increase hypoglycemia risk.
5. A patient with asthma is prescribed propranolol. Why is this
medication contraindicated?
A. Causes rebound hypertension
B. Blocks alpha receptors
C. Nonselective beta blockade worsens bronchoconstriction
D. Increases cortisol levels
Correct Answer: C
Rationale:
Propranolol blocks β₁ and β₂ receptors. Blocking β₂ receptors in
the lungs can precipitate bronchospasm.
6. Which drug class directly inhibits angiotensin II receptors?
A. ACE inhibitors
B. Beta blockers
, 4
C. Angiotensin II receptor blockers (ARBs)
D. Calcium channel blockers
Correct Answer: C
Rationale:
ARBs block angiotensin II from binding to its receptor, reducing
vasoconstriction and aldosterone release.
7. A patient receiving aminoglycosides should be monitored
closely for which adverse effects? (Select all that apply)
A. Nephrotoxicity
B. Ototoxicity
C. Hepatotoxicity
D. Neuromuscular blockade
Correct Answers: A, B, D
Rationale:
Aminoglycosides damage renal tubules, auditory nerves, and
can impair neuromuscular transmission.
8. Which opioid has the highest risk of QT prolongation?
A. Morphine
B. Fentanyl
ADVANCED PHARMACOLOGY NURSING EXAM –
DRUG CLASSES, CALCULATIONS & CLINICAL
SCENARIOS (2026/27LATEST VERSION)
1. A patient with heart failure is prescribed digoxin. Which
electrolyte abnormality places the patient at greatest risk for
digoxin toxicity?
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypercalcemia
Correct Answer: C
Rationale:
Low potassium levels increase digoxin binding to the Na⁺/K⁺-
ATPase pump, significantly increasing toxicity risk (arrhythmias,
visual changes, nausea).
2. A nurse administers IV vancomycin. Which assessment
finding requires immediate intervention?
A. Mild flushing of the neck
B. Serum creatinine rising from 0.9 to 2.1 mg/dL
C. Decreased urine output
D. All of the above
,2
Correct Answer: D
Rationale:
Vancomycin can cause nephrotoxicity and Red Man Syndrome.
Rising creatinine, oliguria, and flushing all signal toxicity or
infusion-related reaction.
3. A patient taking warfarin begins therapy with trimethoprim-
sulfamethoxazole. What is the expected pharmacologic
outcome?
A. Decreased INR
B. No change in INR
C. Increased INR and bleeding risk
D. Warfarin resistance
Correct Answer: C
Rationale:
TMP-SMX inhibits warfarin metabolism via CYP450, increasing
anticoagulant effects and bleeding risk.
4. Which insulin has the highest risk of hypoglycemia if meals
are delayed?
A. Insulin glargine
B. Insulin detemir
,3
C. Insulin lispro
D. Insulin degludec
Correct Answer: C
Rationale:
Rapid-acting insulins peak quickly and require precise meal
timing; delayed meals increase hypoglycemia risk.
5. A patient with asthma is prescribed propranolol. Why is this
medication contraindicated?
A. Causes rebound hypertension
B. Blocks alpha receptors
C. Nonselective beta blockade worsens bronchoconstriction
D. Increases cortisol levels
Correct Answer: C
Rationale:
Propranolol blocks β₁ and β₂ receptors. Blocking β₂ receptors in
the lungs can precipitate bronchospasm.
6. Which drug class directly inhibits angiotensin II receptors?
A. ACE inhibitors
B. Beta blockers
, 4
C. Angiotensin II receptor blockers (ARBs)
D. Calcium channel blockers
Correct Answer: C
Rationale:
ARBs block angiotensin II from binding to its receptor, reducing
vasoconstriction and aldosterone release.
7. A patient receiving aminoglycosides should be monitored
closely for which adverse effects? (Select all that apply)
A. Nephrotoxicity
B. Ototoxicity
C. Hepatotoxicity
D. Neuromuscular blockade
Correct Answers: A, B, D
Rationale:
Aminoglycosides damage renal tubules, auditory nerves, and
can impair neuromuscular transmission.
8. Which opioid has the highest risk of QT prolongation?
A. Morphine
B. Fentanyl
