NURS 5463 Advanced Pharmacology Practice
Exam Question and Answers with Rationales
Top rated Latest Version
A 58-year-old man with hypertension, type 2 diabetes mellitus, and
persistent microalbuminuria presents for follow-up. His blood pressure
is 152/92 mm Hg despite lifestyle modifications. Which medication is
the most appropriate initial therapy?
A. Hydrochlorothiazide
B. Lisinopril
C. Metoprolol
D. Diltiazem
*Correct Answer:* *B. Lisinopril*
*Rationale:*
ACE inhibitors are first-line therapy for patients with diabetes and
albuminuria because they lower blood pressure while slowing the
progression of diabetic nephropathy by reducing intraglomerular
pressure and proteinuria.
* *A:* Effective antihypertensive but offers less renal protection.
,* *C:* Beta-blockers are not first-line unless another indication exists
(e.g., coronary artery disease).
* *D:* Calcium channel blockers lower BP but are less effective in
reducing albuminuria.
---
### Question 2
A nurse practitioner prescribes lisinopril for a patient with newly
diagnosed hypertension. Which laboratory value should be monitored
most closely after initiation?
A. Hemoglobin
B. Serum potassium
C. Platelet count
D. Total cholesterol
*Correct Answer:* *B. Serum potassium*
*Rationale:*
ACE inhibitors decrease aldosterone secretion, increasing the risk of
*hyperkalemia*. Renal function (serum creatinine) should also be
monitored.
,* *A:* Not routinely affected.
* *C:* ACE inhibitors rarely affect platelets.
* *D:* No significant effect on cholesterol.
---
### Question 3
A patient taking warfarin begins treatment with trimethoprim-
sulfamethoxazole. Which outcome is most likely?
A. Decreased INR
B. Increased INR and bleeding risk
C. Reduced anticoagulant effect
D. No interaction
*Correct Answer:* *B. Increased INR and bleeding risk*
*Rationale:*
Trimethoprim-sulfamethoxazole inhibits warfarin metabolism,
significantly increasing anticoagulant effects and bleeding risk.
, * *A:* Incorrect; INR typically increases.
* *C:* Opposite effect occurs.
* *D:* This is a well-known, clinically significant interaction.
---
### Question 4
A patient with heart failure with reduced ejection fraction (HFrEF) has
an ejection fraction of 30%. Which medication has been shown to
reduce mortality?
A. Digoxin
B. Furosemide
C. Sacubitril/valsartan
D. Diltiazem
*Correct Answer:* *C. Sacubitril/valsartan*
*Rationale:*
Sacubitril/valsartan (ARNI) reduces mortality and heart failure
hospitalizations in HFrEF and is preferred over ACE inhibitors in
appropriate patients.
Exam Question and Answers with Rationales
Top rated Latest Version
A 58-year-old man with hypertension, type 2 diabetes mellitus, and
persistent microalbuminuria presents for follow-up. His blood pressure
is 152/92 mm Hg despite lifestyle modifications. Which medication is
the most appropriate initial therapy?
A. Hydrochlorothiazide
B. Lisinopril
C. Metoprolol
D. Diltiazem
*Correct Answer:* *B. Lisinopril*
*Rationale:*
ACE inhibitors are first-line therapy for patients with diabetes and
albuminuria because they lower blood pressure while slowing the
progression of diabetic nephropathy by reducing intraglomerular
pressure and proteinuria.
* *A:* Effective antihypertensive but offers less renal protection.
,* *C:* Beta-blockers are not first-line unless another indication exists
(e.g., coronary artery disease).
* *D:* Calcium channel blockers lower BP but are less effective in
reducing albuminuria.
---
### Question 2
A nurse practitioner prescribes lisinopril for a patient with newly
diagnosed hypertension. Which laboratory value should be monitored
most closely after initiation?
A. Hemoglobin
B. Serum potassium
C. Platelet count
D. Total cholesterol
*Correct Answer:* *B. Serum potassium*
*Rationale:*
ACE inhibitors decrease aldosterone secretion, increasing the risk of
*hyperkalemia*. Renal function (serum creatinine) should also be
monitored.
,* *A:* Not routinely affected.
* *C:* ACE inhibitors rarely affect platelets.
* *D:* No significant effect on cholesterol.
---
### Question 3
A patient taking warfarin begins treatment with trimethoprim-
sulfamethoxazole. Which outcome is most likely?
A. Decreased INR
B. Increased INR and bleeding risk
C. Reduced anticoagulant effect
D. No interaction
*Correct Answer:* *B. Increased INR and bleeding risk*
*Rationale:*
Trimethoprim-sulfamethoxazole inhibits warfarin metabolism,
significantly increasing anticoagulant effects and bleeding risk.
, * *A:* Incorrect; INR typically increases.
* *C:* Opposite effect occurs.
* *D:* This is a well-known, clinically significant interaction.
---
### Question 4
A patient with heart failure with reduced ejection fraction (HFrEF) has
an ejection fraction of 30%. Which medication has been shown to
reduce mortality?
A. Digoxin
B. Furosemide
C. Sacubitril/valsartan
D. Diltiazem
*Correct Answer:* *C. Sacubitril/valsartan*
*Rationale:*
Sacubitril/valsartan (ARNI) reduces mortality and heart failure
hospitalizations in HFrEF and is preferred over ACE inhibitors in
appropriate patients.
