,Question 1
A patient presents to the emergency department complaining of palpitations and an irregular
heartbeat that began several hours ago. After a comprehensive assessment, the APRN places the
patient on a cardiac monitor, which confirms atrial fibrillation. The provider prescribes dofetilide to
help restore and maintain normal cardiac rhythm. The patient asks whether the medication should be
taken with meals or on an empty stomach. Which instruction should the APRN provide?
A. Take the medication only on an empty stomach.
B. Take the medication only with a high-fat meal.
C. Take the medication with food or on an empty stomach.
D. Alternate between taking it with food and without food each day.
Correct Answer: C. Take the medication with food or on an empty stomach.
Dofetilide may be taken either with food or on an empty stomach because food does not significantly
affect its absorption or therapeutic effectiveness. Patients should take the medication consistently as
prescribed and adhere to scheduled monitoring because dofetilide has the potential to prolong the QT
interval and cause serious ventricular dysrhythmias.
Question 2
A 70-year-old man calls the outpatient cardiology clinic reporting chest pain that began shortly after
sexual activity. During the assessment, he states that he took sildenafil 50 mg approximately 8 hours
ago for erectile dysfunction and has nitroglycerin 0.3 mg tablets available at home. He asks if he should
take a nitroglycerin tablet to relieve the chest pain. What is the most appropriate response by the
APRN?
A. Take one nitroglycerin tablet immediately and monitor your symptoms.
B. Wait another hour before taking nitroglycerin.
C. Take half of the nitroglycerin dose because you recently used sildenafil.
D. Do not take the nitroglycerin and call 911 immediately.
Correct Answer: D. Do not take the nitroglycerin and call 911 immediately.
Sildenafil and nitroglycerin should never be taken together because their combined vasodilatory effects
can cause profound hypotension and life-threatening cardiovascular collapse. A patient experiencing
chest pain after taking sildenafil requires emergency medical evaluation rather than self-treatment with
nitrates.
,Question 3
A patient who recently learned they have bipolar disorder is preparing to begin lithium therapy. During
the teaching session, the APRN explains that several laboratory tests will be obtained before the
medication is started. The patient asks why these baseline tests are necessary before taking the first
dose. Which explanation should the APRN provide?
A. A baseline BUN and creatinine are needed to assess kidney function because lithium can decrease
renal function.
B. Baseline liver enzymes are required because lithium commonly causes severe liver damage.
C. Baseline coagulation studies are necessary because lithium increases bleeding risk.
D. Baseline lipid studies are needed because lithium significantly increases cholesterol levels.
Correct Answer: A. A baseline BUN and creatinine are needed to assess kidney function because
lithium can decrease renal function.
Lithium is primarily excreted by the kidneys, making baseline renal function essential before therapy
begins. Measuring BUN and creatinine allows the provider to identify existing renal impairment and
monitor for changes during treatment, helping reduce the risk of lithium toxicity.
Question 4
A newly licensed nurse is reviewing medications commonly prescribed for erectile dysfunction before
caring for patients in the outpatient clinic. The nurse asks the APRN which patient history would
indicate that sildenafil can be used safely without a known contraindication. Which patient is the best
candidate for sildenafil therapy?
A. A 62-year-old man taking nitroglycerin for chronic stable angina.
B. A 54-year-old male with controlled hypertension, mild eczema, and a history of uncomplicated
urolithiasis.
C. A 67-year-old man with symptomatic hypotension and frequent dizziness.
D. A 59-year-old man who recently experienced an acute myocardial infarction.
Correct Answer: B. A 54-year-old male with controlled hypertension, mild eczema, and a history of
uncomplicated urolithiasis.
Controlled hypertension, mild eczema, and a remote history of uncomplicated kidney stones are not
contraindications to sildenafil therapy. The greatest concern is concurrent nitrate therapy or unstable
cardiovascular disease, both of which substantially increase the risk of severe hypotension.
, Question 5
A 30-year-old patient with generalized anxiety disorder has been prescribed citalopram. During
medication teaching, the patient asks how the medication works to improve anxiety symptoms. Which
explanation by the APRN best describes the mechanism of action of citalopram?
A. Increases the release of dopamine from presynaptic neurons.
B. Blocks acetylcholine receptors within the central nervous system.
C. Influences receptor activity on target cells.
D. Prevents the metabolism of gamma-aminobutyric acid (GABA).
Correct Answer: C. Influences receptor activity on target cells.
Citalopram is a selective serotonin reuptake inhibitor that increases serotonin availability at synapses,
thereby influencing receptor activity on target cells. Enhanced serotonergic neurotransmission improves
communication between neurons and helps reduce symptoms of anxiety and depression over time.
Question 6
A patient with Huntington disease is experiencing worsening involuntary muscle twitching, dysphagia,
confusion, and progressive memory loss. The APRN prescribes baclofen to help manage the patient's
symptoms. The patient asks how this medication works in the nervous system. Which response is most
accurate?
A. Modulates the effects of glutamate at NMDA receptors.
B. Halts the breakdown of acetylcholine by acetylcholinesterase.
C. Alters the synthesis and release of norepinephrine, serotonin, and dopamine.
D. Inhibits neurotransmission by acting as a GABA agonist.
Correct Answer: D. Inhibits neurotransmission by acting as a GABA agonist.
Baclofen acts as a GABA agonist, enhancing inhibitory neurotransmission within the central nervous
system to reduce muscle spasticity and excessive muscle activity. Because Huntington disease is
associated with decreased GABA activity, baclofen helps restore inhibitory signaling and improve
symptom control.
Question 7
A 21-year-old patient is brought to the emergency department after suddenly losing consciousness and
developing generalized body stiffening followed by rhythmic jerking movements of the extremities.
A patient presents to the emergency department complaining of palpitations and an irregular
heartbeat that began several hours ago. After a comprehensive assessment, the APRN places the
patient on a cardiac monitor, which confirms atrial fibrillation. The provider prescribes dofetilide to
help restore and maintain normal cardiac rhythm. The patient asks whether the medication should be
taken with meals or on an empty stomach. Which instruction should the APRN provide?
A. Take the medication only on an empty stomach.
B. Take the medication only with a high-fat meal.
C. Take the medication with food or on an empty stomach.
D. Alternate between taking it with food and without food each day.
Correct Answer: C. Take the medication with food or on an empty stomach.
Dofetilide may be taken either with food or on an empty stomach because food does not significantly
affect its absorption or therapeutic effectiveness. Patients should take the medication consistently as
prescribed and adhere to scheduled monitoring because dofetilide has the potential to prolong the QT
interval and cause serious ventricular dysrhythmias.
Question 2
A 70-year-old man calls the outpatient cardiology clinic reporting chest pain that began shortly after
sexual activity. During the assessment, he states that he took sildenafil 50 mg approximately 8 hours
ago for erectile dysfunction and has nitroglycerin 0.3 mg tablets available at home. He asks if he should
take a nitroglycerin tablet to relieve the chest pain. What is the most appropriate response by the
APRN?
A. Take one nitroglycerin tablet immediately and monitor your symptoms.
B. Wait another hour before taking nitroglycerin.
C. Take half of the nitroglycerin dose because you recently used sildenafil.
D. Do not take the nitroglycerin and call 911 immediately.
Correct Answer: D. Do not take the nitroglycerin and call 911 immediately.
Sildenafil and nitroglycerin should never be taken together because their combined vasodilatory effects
can cause profound hypotension and life-threatening cardiovascular collapse. A patient experiencing
chest pain after taking sildenafil requires emergency medical evaluation rather than self-treatment with
nitrates.
,Question 3
A patient who recently learned they have bipolar disorder is preparing to begin lithium therapy. During
the teaching session, the APRN explains that several laboratory tests will be obtained before the
medication is started. The patient asks why these baseline tests are necessary before taking the first
dose. Which explanation should the APRN provide?
A. A baseline BUN and creatinine are needed to assess kidney function because lithium can decrease
renal function.
B. Baseline liver enzymes are required because lithium commonly causes severe liver damage.
C. Baseline coagulation studies are necessary because lithium increases bleeding risk.
D. Baseline lipid studies are needed because lithium significantly increases cholesterol levels.
Correct Answer: A. A baseline BUN and creatinine are needed to assess kidney function because
lithium can decrease renal function.
Lithium is primarily excreted by the kidneys, making baseline renal function essential before therapy
begins. Measuring BUN and creatinine allows the provider to identify existing renal impairment and
monitor for changes during treatment, helping reduce the risk of lithium toxicity.
Question 4
A newly licensed nurse is reviewing medications commonly prescribed for erectile dysfunction before
caring for patients in the outpatient clinic. The nurse asks the APRN which patient history would
indicate that sildenafil can be used safely without a known contraindication. Which patient is the best
candidate for sildenafil therapy?
A. A 62-year-old man taking nitroglycerin for chronic stable angina.
B. A 54-year-old male with controlled hypertension, mild eczema, and a history of uncomplicated
urolithiasis.
C. A 67-year-old man with symptomatic hypotension and frequent dizziness.
D. A 59-year-old man who recently experienced an acute myocardial infarction.
Correct Answer: B. A 54-year-old male with controlled hypertension, mild eczema, and a history of
uncomplicated urolithiasis.
Controlled hypertension, mild eczema, and a remote history of uncomplicated kidney stones are not
contraindications to sildenafil therapy. The greatest concern is concurrent nitrate therapy or unstable
cardiovascular disease, both of which substantially increase the risk of severe hypotension.
, Question 5
A 30-year-old patient with generalized anxiety disorder has been prescribed citalopram. During
medication teaching, the patient asks how the medication works to improve anxiety symptoms. Which
explanation by the APRN best describes the mechanism of action of citalopram?
A. Increases the release of dopamine from presynaptic neurons.
B. Blocks acetylcholine receptors within the central nervous system.
C. Influences receptor activity on target cells.
D. Prevents the metabolism of gamma-aminobutyric acid (GABA).
Correct Answer: C. Influences receptor activity on target cells.
Citalopram is a selective serotonin reuptake inhibitor that increases serotonin availability at synapses,
thereby influencing receptor activity on target cells. Enhanced serotonergic neurotransmission improves
communication between neurons and helps reduce symptoms of anxiety and depression over time.
Question 6
A patient with Huntington disease is experiencing worsening involuntary muscle twitching, dysphagia,
confusion, and progressive memory loss. The APRN prescribes baclofen to help manage the patient's
symptoms. The patient asks how this medication works in the nervous system. Which response is most
accurate?
A. Modulates the effects of glutamate at NMDA receptors.
B. Halts the breakdown of acetylcholine by acetylcholinesterase.
C. Alters the synthesis and release of norepinephrine, serotonin, and dopamine.
D. Inhibits neurotransmission by acting as a GABA agonist.
Correct Answer: D. Inhibits neurotransmission by acting as a GABA agonist.
Baclofen acts as a GABA agonist, enhancing inhibitory neurotransmission within the central nervous
system to reduce muscle spasticity and excessive muscle activity. Because Huntington disease is
associated with decreased GABA activity, baclofen helps restore inhibitory signaling and improve
symptom control.
Question 7
A 21-year-old patient is brought to the emergency department after suddenly losing consciousness and
developing generalized body stiffening followed by rhythmic jerking movements of the extremities.
