NURS 6521 FINAL EXAM 2025/2026 V3 WINTER QUARTER |
WALDEN UNIVERSITY | ADVANCED PHARMACOLOGY –
COMPLETE EXAM WITH ACCURATE QUESTIONS &
ANSWERS
NURS 6521 Final Exam-Style Practice Paper
Advanced Pharmacology
Course: NURS 6521 – Advanced Pharmacology
Institution: Walden University
Academic Year: 2025–2026
Term: Winter Quarter
Version: V3-Style Practice Examination
Content: Comprehensive practice exam with multiple-choice and short-
answer questions, answers, and rationales
Author/Creator: Original AI-generated study material
Important note: This is an original practice examination designed for
study and review.
Table of Contents
1. Cardiovascular Pharmacology — Questions 1–15
2. Endocrine Pharmacology — Questions 16–28
3. Respiratory Pharmacology — Questions 29–38
4. Gastrointestinal Pharmacology — Questions 39–46
5. Neurologic and Psychiatric Pharmacology — Questions 47–62
6. Infectious Disease and Antimicrobial Pharmacology — Questions 63–75
7. Musculoskeletal, Rheumatologic, and Pain Pharmacology — Questions 76–
83
, 8. Women's Health and Genitourinary Pharmacology — Questions 84–90
9. Hematologic and Oncologic Pharmacology — Questions 91–95
10. Dermatologic, Immunologic, and Miscellaneous Pharmacology —
Questions 96–100
Section I — Cardiovascular Pharmacology
Question 1 — Multiple Choice
A patient with hypertension is prescribed lisinopril. Which laboratory value is most important to
monitor after initiation of therapy?
A. Serum amylase
B. Serum potassium and creatinine
C. Hemoglobin A1c
D. Serum calcium
Correct answer: B. Serum potassium and creatinine
Rationale:
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors can decrease
aldosterone-mediated potassium excretion, potentially causing hyperkalemia, and may alter renal
function. Serum creatinine and potassium should therefore be assessed after initiation and dose
changes. A mild increase in creatinine may occur, but a substantial increase requires evaluation
for renal dysfunction or renal artery stenosis.
Question 2 — Multiple Choice
Which adverse effect is most characteristic of ACE inhibitors?
A. Persistent dry cough
B. Severe constipation
C. Hypoglycemia
D. Ototoxicity
Correct answer: A. Persistent dry cough
Rationale:
ACE inhibition decreases degradation of bradykinin, which can accumulate in the respiratory
tract and produce a persistent, nonproductive cough. Angioedema is another potentially serious
,ACE-inhibitor adverse effect. If clinically significant cough develops, an angiotensin II receptor
blocker (ARB) may be considered.
Question 3 — Short Answer
A patient taking warfarin has an INR of 5.8 without active bleeding. What is the general
pharmacologic concern?
Correct answer:
The patient has excessive anticoagulation and an increased risk of bleeding; warfarin therapy
should be held or adjusted according to the clinical situation and current anticoagulation-
management guidance.
Rationale:
Warfarin has a narrow therapeutic index. An elevated INR indicates increased anticoagulant
effect and bleeding risk. Management depends on the INR, presence or absence of bleeding,
underlying indication, and thrombotic risk. Vitamin K may be used in selected circumstances,
but treatment should not be based on the INR alone.
Question 4 — Multiple Choice
Which medication is a direct oral factor Xa inhibitor?
A. Dabigatran
B. Apixaban
C. Warfarin
D. Clopidogrel
Correct answer: B. Apixaban
Rationale:
Apixaban directly inhibits factor Xa and reduces thrombin generation. Rivaroxaban and
edoxaban are also direct factor Xa inhibitors. Dabigatran is a direct thrombin inhibitor, while
warfarin inhibits vitamin K-dependent clotting-factor synthesis.
Question 5 — Multiple Choice
A patient taking spironolactone should be monitored most closely for:
A. Hypokalemia
B. Hyperkalemia
, C. Hypocalcemia
D. Hypernatremia
Correct answer: B. Hyperkalemia
Rationale:
Spironolactone is a potassium-sparing diuretic and aldosterone antagonist. Reduced renal
potassium excretion can result in hyperkalemia, particularly in patients with chronic kidney
disease or those taking ACE inhibitors, ARBs, or potassium supplements.
Question 6 — Multiple Choice
Which finding in a patient taking digoxin is most concerning for toxicity?
A. Increased appetite
B. Yellow-green visual disturbances and nausea
C. Mild thirst
D. Increased urinary frequency
Correct answer: B. Yellow-green visual disturbances and nausea
Rationale:
Digoxin toxicity can produce gastrointestinal symptoms, neurologic symptoms, cardiac
dysrhythmias, and visual disturbances such as blurred or yellow-green vision. Risk increases
with renal impairment and electrolyte abnormalities, especially hypokalemia.
Question 7 — Short Answer
Why can hypokalemia increase the risk of digoxin toxicity?
Correct answer:
Low potassium increases digoxin binding to the sodium-potassium ATPase receptor, thereby
increasing its pharmacologic and toxic effects.
Rationale:
Potassium and digoxin interact at the sodium-potassium ATPase. When potassium is low, digoxin
has greater receptor binding, increasing the likelihood of toxicity. This is one reason potassium
status should be monitored carefully in patients receiving digoxin and diuretics.
Question 8 — Multiple Choice
Which medication is most appropriate for rapid relief of an acute episode of stable angina?
WALDEN UNIVERSITY | ADVANCED PHARMACOLOGY –
COMPLETE EXAM WITH ACCURATE QUESTIONS &
ANSWERS
NURS 6521 Final Exam-Style Practice Paper
Advanced Pharmacology
Course: NURS 6521 – Advanced Pharmacology
Institution: Walden University
Academic Year: 2025–2026
Term: Winter Quarter
Version: V3-Style Practice Examination
Content: Comprehensive practice exam with multiple-choice and short-
answer questions, answers, and rationales
Author/Creator: Original AI-generated study material
Important note: This is an original practice examination designed for
study and review.
Table of Contents
1. Cardiovascular Pharmacology — Questions 1–15
2. Endocrine Pharmacology — Questions 16–28
3. Respiratory Pharmacology — Questions 29–38
4. Gastrointestinal Pharmacology — Questions 39–46
5. Neurologic and Psychiatric Pharmacology — Questions 47–62
6. Infectious Disease and Antimicrobial Pharmacology — Questions 63–75
7. Musculoskeletal, Rheumatologic, and Pain Pharmacology — Questions 76–
83
, 8. Women's Health and Genitourinary Pharmacology — Questions 84–90
9. Hematologic and Oncologic Pharmacology — Questions 91–95
10. Dermatologic, Immunologic, and Miscellaneous Pharmacology —
Questions 96–100
Section I — Cardiovascular Pharmacology
Question 1 — Multiple Choice
A patient with hypertension is prescribed lisinopril. Which laboratory value is most important to
monitor after initiation of therapy?
A. Serum amylase
B. Serum potassium and creatinine
C. Hemoglobin A1c
D. Serum calcium
Correct answer: B. Serum potassium and creatinine
Rationale:
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors can decrease
aldosterone-mediated potassium excretion, potentially causing hyperkalemia, and may alter renal
function. Serum creatinine and potassium should therefore be assessed after initiation and dose
changes. A mild increase in creatinine may occur, but a substantial increase requires evaluation
for renal dysfunction or renal artery stenosis.
Question 2 — Multiple Choice
Which adverse effect is most characteristic of ACE inhibitors?
A. Persistent dry cough
B. Severe constipation
C. Hypoglycemia
D. Ototoxicity
Correct answer: A. Persistent dry cough
Rationale:
ACE inhibition decreases degradation of bradykinin, which can accumulate in the respiratory
tract and produce a persistent, nonproductive cough. Angioedema is another potentially serious
,ACE-inhibitor adverse effect. If clinically significant cough develops, an angiotensin II receptor
blocker (ARB) may be considered.
Question 3 — Short Answer
A patient taking warfarin has an INR of 5.8 without active bleeding. What is the general
pharmacologic concern?
Correct answer:
The patient has excessive anticoagulation and an increased risk of bleeding; warfarin therapy
should be held or adjusted according to the clinical situation and current anticoagulation-
management guidance.
Rationale:
Warfarin has a narrow therapeutic index. An elevated INR indicates increased anticoagulant
effect and bleeding risk. Management depends on the INR, presence or absence of bleeding,
underlying indication, and thrombotic risk. Vitamin K may be used in selected circumstances,
but treatment should not be based on the INR alone.
Question 4 — Multiple Choice
Which medication is a direct oral factor Xa inhibitor?
A. Dabigatran
B. Apixaban
C. Warfarin
D. Clopidogrel
Correct answer: B. Apixaban
Rationale:
Apixaban directly inhibits factor Xa and reduces thrombin generation. Rivaroxaban and
edoxaban are also direct factor Xa inhibitors. Dabigatran is a direct thrombin inhibitor, while
warfarin inhibits vitamin K-dependent clotting-factor synthesis.
Question 5 — Multiple Choice
A patient taking spironolactone should be monitored most closely for:
A. Hypokalemia
B. Hyperkalemia
, C. Hypocalcemia
D. Hypernatremia
Correct answer: B. Hyperkalemia
Rationale:
Spironolactone is a potassium-sparing diuretic and aldosterone antagonist. Reduced renal
potassium excretion can result in hyperkalemia, particularly in patients with chronic kidney
disease or those taking ACE inhibitors, ARBs, or potassium supplements.
Question 6 — Multiple Choice
Which finding in a patient taking digoxin is most concerning for toxicity?
A. Increased appetite
B. Yellow-green visual disturbances and nausea
C. Mild thirst
D. Increased urinary frequency
Correct answer: B. Yellow-green visual disturbances and nausea
Rationale:
Digoxin toxicity can produce gastrointestinal symptoms, neurologic symptoms, cardiac
dysrhythmias, and visual disturbances such as blurred or yellow-green vision. Risk increases
with renal impairment and electrolyte abnormalities, especially hypokalemia.
Question 7 — Short Answer
Why can hypokalemia increase the risk of digoxin toxicity?
Correct answer:
Low potassium increases digoxin binding to the sodium-potassium ATPase receptor, thereby
increasing its pharmacologic and toxic effects.
Rationale:
Potassium and digoxin interact at the sodium-potassium ATPase. When potassium is low, digoxin
has greater receptor binding, increasing the likelihood of toxicity. This is one reason potassium
status should be monitored carefully in patients receiving digoxin and diuretics.
Question 8 — Multiple Choice
Which medication is most appropriate for rapid relief of an acute episode of stable angina?
