NURS 5334 Advanced Pharmacology Final Exam
(2026/2027) | 100 Scenario-Based Questions with
Answers & Rationales
1. A 68-year-old patient with heart failure with reduced ejection fraction (HFrEF) is
prescribed lisinopril. After initiation, labs show elevated potassium levels. What is
the most appropriate next step?
A. Continue medication without changes
B. Discontinue lisinopril immediately
C. Evaluate potassium level severity and consider dose adjustment or alternative therapy
D. Add potassium supplement
✅ Answer: C
Explanation: ACE inhibitors can cause hyperkalemia. Management depends on severity—
monitoring or adjusting dose is appropriate rather than immediate discontinuation unless
severe.
2. A patient with atrial fibrillation is prescribed warfarin. The nurse notes an INR of 5.2
without bleeding symptoms. What is the priority intervention?
A. Administer vitamin K immediately
B. Hold warfarin and notify provider
C. Continue current dose
D. Increase warfarin dose
✅ Answer: B
3. A patient with type 2 diabetes is started on metformin. Which condition would
require immediate discontinuation of this medication?
A. Mild hyperglycemia
B. Elevated LDL cholesterol
,C. Acute renal failure
D. Hypertension
✅ Answer: C
4. A patient taking opioids for chronic pain develops respiratory depression. What is
the priority medication to administer?
A. Flumazenil
B. Naloxone
C. Atropine
D. Epinephrine
✅ Answer: B
5. A patient with asthma is using albuterol frequently with minimal relief. What does
this indicate about disease control?
A. Well-controlled asthma
B. Poorly controlled asthma requiring therapy adjustment
C. Medication overdose
D. Drug tolerance only
✅ Answer: B
6. A patient taking digoxin presents with nausea, visual disturbances, and
bradycardia. What is the most likely cause?
A. Drug tolerance
B. Digoxin toxicity
C. Hypoglycemia
D. Hypertension
✅ Answer: B
, 7. A patient is prescribed heparin for DVT prevention. Which lab value should be
monitored to evaluate therapeutic effectiveness?
A. INR
B. aPTT
C. Platelet count only
D. Hemoglobin
✅ Answer: B
8. A patient taking statins reports muscle pain and weakness. What is the most
serious potential complication?
A. Hyperglycemia
B. Rhabdomyolysis
C. Hypertension
D. Liver enlargement
✅ Answer: B
9. A patient with hypertension is prescribed a beta-blocker. What is a key expected
pharmacologic effect?
A. Increased heart rate
B. Decreased cardiac output
C. Increased vasoconstriction
D. Increased blood pressure
✅ Answer: B
10. A patient receiving insulin develops confusion and diaphoresis. What is the
priority action?
(2026/2027) | 100 Scenario-Based Questions with
Answers & Rationales
1. A 68-year-old patient with heart failure with reduced ejection fraction (HFrEF) is
prescribed lisinopril. After initiation, labs show elevated potassium levels. What is
the most appropriate next step?
A. Continue medication without changes
B. Discontinue lisinopril immediately
C. Evaluate potassium level severity and consider dose adjustment or alternative therapy
D. Add potassium supplement
✅ Answer: C
Explanation: ACE inhibitors can cause hyperkalemia. Management depends on severity—
monitoring or adjusting dose is appropriate rather than immediate discontinuation unless
severe.
2. A patient with atrial fibrillation is prescribed warfarin. The nurse notes an INR of 5.2
without bleeding symptoms. What is the priority intervention?
A. Administer vitamin K immediately
B. Hold warfarin and notify provider
C. Continue current dose
D. Increase warfarin dose
✅ Answer: B
3. A patient with type 2 diabetes is started on metformin. Which condition would
require immediate discontinuation of this medication?
A. Mild hyperglycemia
B. Elevated LDL cholesterol
,C. Acute renal failure
D. Hypertension
✅ Answer: C
4. A patient taking opioids for chronic pain develops respiratory depression. What is
the priority medication to administer?
A. Flumazenil
B. Naloxone
C. Atropine
D. Epinephrine
✅ Answer: B
5. A patient with asthma is using albuterol frequently with minimal relief. What does
this indicate about disease control?
A. Well-controlled asthma
B. Poorly controlled asthma requiring therapy adjustment
C. Medication overdose
D. Drug tolerance only
✅ Answer: B
6. A patient taking digoxin presents with nausea, visual disturbances, and
bradycardia. What is the most likely cause?
A. Drug tolerance
B. Digoxin toxicity
C. Hypoglycemia
D. Hypertension
✅ Answer: B
, 7. A patient is prescribed heparin for DVT prevention. Which lab value should be
monitored to evaluate therapeutic effectiveness?
A. INR
B. aPTT
C. Platelet count only
D. Hemoglobin
✅ Answer: B
8. A patient taking statins reports muscle pain and weakness. What is the most
serious potential complication?
A. Hyperglycemia
B. Rhabdomyolysis
C. Hypertension
D. Liver enlargement
✅ Answer: B
9. A patient with hypertension is prescribed a beta-blocker. What is a key expected
pharmacologic effect?
A. Increased heart rate
B. Decreased cardiac output
C. Increased vasoconstriction
D. Increased blood pressure
✅ Answer: B
10. A patient receiving insulin develops confusion and diaphoresis. What is the
priority action?
