NR 567 Exam 3 V3 | NR 567 Advanced
Pharmacology for the AGACNP | Actual
Q&A with Rationale (NR567 Exam 3) |
Chamberlain College of Nursing
1. An AGACNP is managing a patient with chronic heart failure who is starting on an ACE
inhibitor. Which of the following instructions is most important regarding the risk of
angioedema?
A. It only occurs within the first 24 hours of treatment.
B. African American patients have a lower risk than other ethnicities.
C. Angioedema is a medical emergency and can occur at any time during therapy.
D. Dry cough is a precursor to angioedema.
Answer: C
Rationale: Angioedema is a potentially life-threatening side effect of ACE inhibitors
characterized by swelling of the face, lips, and airway. It is crucial to educate patients that
this reaction can occur even after months or years of uneventful therapy. Immediate medical
attention is required should any symptoms of swelling develop.
2. Which of the following monitoring assessments are required for a patient receiving long-term
Amiodarone therapy for ventricular arrhythmias? (Select all that apply)
A. Chest X-ray
,B. Thyroid function tests (TSH, T3, T4)
C. Liver function tests (AST, ALT)
D. Daily serum creatinine
E. Annual ophthalmic examination
F. Skin assessment for blue-gray discoloration
Answer: A, B, C, E, F
Rationale: Amiodarone has a very long half-life and can cause significant toxicities in multiple
organ systems, including the lungs, thyroid, and liver. Pulmonary fibrosis is one of the most
serious side effects, necessitating regular chest imaging. Regular laboratory monitoring and
clinical exams are mandatory to detect these adverse effects early.
3. A patient is admitted with Digoxin toxicity. Which electrolyte abnormality most significantly
predisposes a patient to Digoxin-induced arrhythmias?
A. Hyperkalemia
B. Hypernatremia
C. Hypocalcemia
D. Hypokalemia
Answer: D
Rationale: Hypokalemia increases the affinity of Digoxin for the Na+/K+ ATPase pump,
thereby enhancing its inhibitory effect and increasing the risk of toxicity. Even within the
, ‘therapeutic’ serum range, low potassium levels can precipitate dangerous cardiac
arrhythmias. Clinicians must maintain serum potassium in the high-normal range for patients
on Digoxin.
4. When initiating a Beta-blocker in a patient with stable heart failure, which approach is
considered standard of care?
A. Start with the maximum tolerated dose to achieve rapid beta-blockade.
B. Only use non-selective beta-blockers like Propranolol.
C. Start at a very low dose and titrate upward every 2 weeks as tolerated.
D. Administer only during acute decompensation to reduce heart rate.
Answer: C
Rationale: Beta-blockers must be initiated when the patient is stable and ‘dry’ rather than
during an acute exacerbation of heart failure. The ‘start low, go slow’ approach prevents the
potential for initial negative inotropic effects to cause clinical worsening. Carvedilol,
Metoprolol Succinate, and Bisoprolol are the preferred agents evidenced to reduce mortality.
5. A patient is receiving Norepinephrine (Levophed) for septic shock. What is the primary
mechanism of action that supports blood pressure?
A. Purely Beta-1 agonist activity increasing heart rate.
B. V2 receptor stimulation causing water retention.
C. Dopaminergic stimulation of renal blood flow.
Pharmacology for the AGACNP | Actual
Q&A with Rationale (NR567 Exam 3) |
Chamberlain College of Nursing
1. An AGACNP is managing a patient with chronic heart failure who is starting on an ACE
inhibitor. Which of the following instructions is most important regarding the risk of
angioedema?
A. It only occurs within the first 24 hours of treatment.
B. African American patients have a lower risk than other ethnicities.
C. Angioedema is a medical emergency and can occur at any time during therapy.
D. Dry cough is a precursor to angioedema.
Answer: C
Rationale: Angioedema is a potentially life-threatening side effect of ACE inhibitors
characterized by swelling of the face, lips, and airway. It is crucial to educate patients that
this reaction can occur even after months or years of uneventful therapy. Immediate medical
attention is required should any symptoms of swelling develop.
2. Which of the following monitoring assessments are required for a patient receiving long-term
Amiodarone therapy for ventricular arrhythmias? (Select all that apply)
A. Chest X-ray
,B. Thyroid function tests (TSH, T3, T4)
C. Liver function tests (AST, ALT)
D. Daily serum creatinine
E. Annual ophthalmic examination
F. Skin assessment for blue-gray discoloration
Answer: A, B, C, E, F
Rationale: Amiodarone has a very long half-life and can cause significant toxicities in multiple
organ systems, including the lungs, thyroid, and liver. Pulmonary fibrosis is one of the most
serious side effects, necessitating regular chest imaging. Regular laboratory monitoring and
clinical exams are mandatory to detect these adverse effects early.
3. A patient is admitted with Digoxin toxicity. Which electrolyte abnormality most significantly
predisposes a patient to Digoxin-induced arrhythmias?
A. Hyperkalemia
B. Hypernatremia
C. Hypocalcemia
D. Hypokalemia
Answer: D
Rationale: Hypokalemia increases the affinity of Digoxin for the Na+/K+ ATPase pump,
thereby enhancing its inhibitory effect and increasing the risk of toxicity. Even within the
, ‘therapeutic’ serum range, low potassium levels can precipitate dangerous cardiac
arrhythmias. Clinicians must maintain serum potassium in the high-normal range for patients
on Digoxin.
4. When initiating a Beta-blocker in a patient with stable heart failure, which approach is
considered standard of care?
A. Start with the maximum tolerated dose to achieve rapid beta-blockade.
B. Only use non-selective beta-blockers like Propranolol.
C. Start at a very low dose and titrate upward every 2 weeks as tolerated.
D. Administer only during acute decompensation to reduce heart rate.
Answer: C
Rationale: Beta-blockers must be initiated when the patient is stable and ‘dry’ rather than
during an acute exacerbation of heart failure. The ‘start low, go slow’ approach prevents the
potential for initial negative inotropic effects to cause clinical worsening. Carvedilol,
Metoprolol Succinate, and Bisoprolol are the preferred agents evidenced to reduce mortality.
5. A patient is receiving Norepinephrine (Levophed) for septic shock. What is the primary
mechanism of action that supports blood pressure?
A. Purely Beta-1 agonist activity increasing heart rate.
B. V2 receptor stimulation causing water retention.
C. Dopaminergic stimulation of renal blood flow.
