NR 567 Exam 3 V2 | NR 567 Advanced
Pharmacology for the AGACNP | Actual
Q&A with Rationale (NR567 Exam 3) |
Chamberlain College of Nursing
1. A 68-year-old patient with Heart Failure with Reduced Ejection Fraction (HFrEF) is prescribed
Carvedilol. Which physiological response is the primary goal of this therapy in chronic heart
failure management?
A. Immediate increase in cardiac output and stroke volume
B. Promotion of rapid diuresis to reduce pulmonary congestion
C. Reversal of catecholamine-mediated myocardial remodeling and reduction in mortality
D. Increase in sinus node firing to improve heart rate
Correct Answer: C
Beta-blockers like Carvedilol are essential in HFrEF because they block the chronic
sympathetic nervous system activation that leads to progressive myocardial damage. While
they may initially decrease contractility, long-term use improves ejection fraction and
decreases the risk of death and hospitalization. This protective effect against deleterious
remodeling is a hallmark of current heart failure guidelines.
,2. A clinician is reviewing the laboratory results for a patient taking Amiodarone for refractory
ventricular tachycardia. Which of the following parameters must be monitored due to the
potential adverse effects of this medication? (Select All That Apply)
A. Thyroid-stimulating hormone (TSH)
B. Liver function tests (LFTs)
C. Pulmonary function tests (PFTs)
D. Serum calcium levels
E. Visual acuity and ophthalmic exams
F. Blood glucose levels
Correct Answer: A, B, C, E
Amiodarone is associated with significant multi-organ toxicities, necessitating
comprehensive baseline and periodic monitoring. It contains high levels of iodine, which can
cause both hyperthyroidism and hypothyroidism, and it can cause life-threatening pulmonary
fibrosis. Furthermore, patients are at risk for hepatotoxicity and corneal microdeposits or
optic neuropathy, requiring ophthalmological follow-up.
3. A patient with persistent atrial fibrillation is initiated on Warfarin (Coumadin). What is the
mechanism of action for this anticoagulant?
A. Direct inhibition of Factor Xa
B. Irreversible inhibition of cyclooxygenase-1
,C. Activation of antithrombin III
D. Competitive antagonism of Vitamin K epoxide reductase
Correct Answer: D
Warfarin works by inhibiting the enzyme Vitamin K epoxide reductase, which is necessary
for the recycling of Vitamin K. This leads to the depletion of active Vitamin K-dependent
clotting factors II, VII, IX, and X, as well as proteins C and S. Because it affects the synthesis of
new factors rather than existing ones, it takes several days to achieve full therapeutic effect.
4. Which electrolyte abnormality is most commonly associated with the use of high-dose Loop
diuretics such as Furosemide (Lasix) in acute care settings?
A. Hyperkalemia
B. Hypercalcemia
C. Hypernatremia
D. Hypokalemia
Correct Answer: D
Loop diuretics inhibit the Na-K-2Cl symporter in the thick ascending limb of the loop of
Henle, leading to significant excretion of potassium along with sodium and water. This loss
often requires supplementation to prevent cardiac arrhythmias or muscle weakness.
Clinicians must also monitor for hypomagnesemia and metabolic alkalosis in these patients.
, 5. A 55-year-old female presents with a dry, persistent cough after starting Lisinopril for
hypertension. What is the pathophysiological cause of this side effect?
A. Accumulation of bradykinin and substance P in the respiratory tract
B. Decreased production of Angiotensin II
C. Direct irritation of the pharyngeal mucosa
D. Systemic histamine release
Correct Answer: A
Angiotensin-converting enzyme (ACE) is also responsible for the breakdown of bradykinin;
therefore, ACE inhibitors lead to increased levels of bradykinin. In the lungs, high bradykinin
levels can cause pro-inflammatory effects and trigger the cough reflex. If this occurs, the
patient should typically be switched to an Angiotensin II Receptor Blocker (ARB) which does
not affect bradykinin metabolism.
6. When prescribing Spironolactone (Aldactone) to a patient already on an ACE inhibitor, which
laboratory value is of greatest concern?
A. Serum Potassium 5.4 mEq/L
B. Serum Glucose 110 mg/dL
C. Serum Sodium 138 mEq/L
D. Serum Urate 6.0 mg/dL
Correct Answer: A
Pharmacology for the AGACNP | Actual
Q&A with Rationale (NR567 Exam 3) |
Chamberlain College of Nursing
1. A 68-year-old patient with Heart Failure with Reduced Ejection Fraction (HFrEF) is prescribed
Carvedilol. Which physiological response is the primary goal of this therapy in chronic heart
failure management?
A. Immediate increase in cardiac output and stroke volume
B. Promotion of rapid diuresis to reduce pulmonary congestion
C. Reversal of catecholamine-mediated myocardial remodeling and reduction in mortality
D. Increase in sinus node firing to improve heart rate
Correct Answer: C
Beta-blockers like Carvedilol are essential in HFrEF because they block the chronic
sympathetic nervous system activation that leads to progressive myocardial damage. While
they may initially decrease contractility, long-term use improves ejection fraction and
decreases the risk of death and hospitalization. This protective effect against deleterious
remodeling is a hallmark of current heart failure guidelines.
,2. A clinician is reviewing the laboratory results for a patient taking Amiodarone for refractory
ventricular tachycardia. Which of the following parameters must be monitored due to the
potential adverse effects of this medication? (Select All That Apply)
A. Thyroid-stimulating hormone (TSH)
B. Liver function tests (LFTs)
C. Pulmonary function tests (PFTs)
D. Serum calcium levels
E. Visual acuity and ophthalmic exams
F. Blood glucose levels
Correct Answer: A, B, C, E
Amiodarone is associated with significant multi-organ toxicities, necessitating
comprehensive baseline and periodic monitoring. It contains high levels of iodine, which can
cause both hyperthyroidism and hypothyroidism, and it can cause life-threatening pulmonary
fibrosis. Furthermore, patients are at risk for hepatotoxicity and corneal microdeposits or
optic neuropathy, requiring ophthalmological follow-up.
3. A patient with persistent atrial fibrillation is initiated on Warfarin (Coumadin). What is the
mechanism of action for this anticoagulant?
A. Direct inhibition of Factor Xa
B. Irreversible inhibition of cyclooxygenase-1
,C. Activation of antithrombin III
D. Competitive antagonism of Vitamin K epoxide reductase
Correct Answer: D
Warfarin works by inhibiting the enzyme Vitamin K epoxide reductase, which is necessary
for the recycling of Vitamin K. This leads to the depletion of active Vitamin K-dependent
clotting factors II, VII, IX, and X, as well as proteins C and S. Because it affects the synthesis of
new factors rather than existing ones, it takes several days to achieve full therapeutic effect.
4. Which electrolyte abnormality is most commonly associated with the use of high-dose Loop
diuretics such as Furosemide (Lasix) in acute care settings?
A. Hyperkalemia
B. Hypercalcemia
C. Hypernatremia
D. Hypokalemia
Correct Answer: D
Loop diuretics inhibit the Na-K-2Cl symporter in the thick ascending limb of the loop of
Henle, leading to significant excretion of potassium along with sodium and water. This loss
often requires supplementation to prevent cardiac arrhythmias or muscle weakness.
Clinicians must also monitor for hypomagnesemia and metabolic alkalosis in these patients.
, 5. A 55-year-old female presents with a dry, persistent cough after starting Lisinopril for
hypertension. What is the pathophysiological cause of this side effect?
A. Accumulation of bradykinin and substance P in the respiratory tract
B. Decreased production of Angiotensin II
C. Direct irritation of the pharyngeal mucosa
D. Systemic histamine release
Correct Answer: A
Angiotensin-converting enzyme (ACE) is also responsible for the breakdown of bradykinin;
therefore, ACE inhibitors lead to increased levels of bradykinin. In the lungs, high bradykinin
levels can cause pro-inflammatory effects and trigger the cough reflex. If this occurs, the
patient should typically be switched to an Angiotensin II Receptor Blocker (ARB) which does
not affect bradykinin metabolism.
6. When prescribing Spironolactone (Aldactone) to a patient already on an ACE inhibitor, which
laboratory value is of greatest concern?
A. Serum Potassium 5.4 mEq/L
B. Serum Glucose 110 mg/dL
C. Serum Sodium 138 mEq/L
D. Serum Urate 6.0 mg/dL
Correct Answer: A
