NURS 5334 ADVANCED
PHARMACOLOGY FINAL EXAM GUIDE
QUESTIONS AND ANSWERS
1. A patient with hypertension and heart failure with reduced ejection fraction (HFrEF) is
prescribed an ACE inhibitor. Which physiological mechanism explains the potential for a dry,
non-productive cough?
A. Increased production of prostaglandins resulting in bronchospasm
B. Direct irritation of the bronchial mucosa by the chemical structure of lisinopril
C. Accumulation of bradykinin in the lungs due to inhibition of kinase II
D. Local vasoconstriction of the pulmonary vasculature leading to fluid shift
Answer: C
Conceptual Explanation: ACE inhibitors block the enzyme kinase II, which is responsible
for the breakdown of bradykinin. The resulting accumulation of bradykinin in the lungs can
trigger a dry cough in sensitive patients.
2. Which of the following laboratory parameters must be monitored most closely when a
patient is initiated on spironolactone for heart failure management?
A. Serum potassium and creatinine
,B. Serum sodium and chloride
C. Liver transaminases (ALT/AST)
D. Blood urea nitrogen (BUN) only
Answer: A
Conceptual Explanation: Spironolactone is a potassium-sparing diuretic. The risk of
hyperkalemia is significant, especially when used with ACE inhibitors or in patients with
renal impairment, necessitating monitoring of potassium and renal function.
3. A 55-year-old patient with Type 2 Diabetes is starting Metformin. Which contraindication is
most critical for the provider to assess before prescribing?
A. History of mild hypertension
B. BMI greater than 30
C. Estimated Glomerular Filtration Rate (eGFR) below 30 mL/min/1.73m2
D. Occasional consumption of a high-carbohydrate diet
Answer: C
Conceptual Explanation: Metformin is renally excreted and its use in patients with severe
renal impairment (eGFR < 30) is contraindicated due to the high risk of lactic acidosis.
4. When prescribing an SGLT2 inhibitor like Empagliflozin, the clinician should educate the
patient about which specific side effect?
A. Permanent discoloration of the teeth
, B. Severe hypoglycemia when used as monotherapy
C. Significant weight gain and peripheral edema
D. Genital mycotic infections and urinary tract infections
Answer: D
Conceptual Explanation: SGLT2 inhibitors lower glucose by promoting glucosuria. The
increased glucose in the urinary tract provides a medium for bacterial and fungal growth,
increasing the risk of UTIs and yeast infections.
5. A patient taking a high-potency statin reports new-onset muscle pain and dark-colored
urine. What is the most appropriate next step for the provider?
A. Discontinue the statin and order a Creatine Kinase (CK) level immediately
B. Encourage the patient to increase hydration and continue the medication
C. Switch the patient to a lower dose of a different statin immediately
D. Order a serum potassium and a urinalysis without stopping the drug
Answer: A
Conceptual Explanation: Muscle pain combined with dark urine (myoglobinuria) suggests
rhabdomyolysis. The statin must be stopped immediately, and CK levels assessed to
determine the extent of muscle injury.
PHARMACOLOGY FINAL EXAM GUIDE
QUESTIONS AND ANSWERS
1. A patient with hypertension and heart failure with reduced ejection fraction (HFrEF) is
prescribed an ACE inhibitor. Which physiological mechanism explains the potential for a dry,
non-productive cough?
A. Increased production of prostaglandins resulting in bronchospasm
B. Direct irritation of the bronchial mucosa by the chemical structure of lisinopril
C. Accumulation of bradykinin in the lungs due to inhibition of kinase II
D. Local vasoconstriction of the pulmonary vasculature leading to fluid shift
Answer: C
Conceptual Explanation: ACE inhibitors block the enzyme kinase II, which is responsible
for the breakdown of bradykinin. The resulting accumulation of bradykinin in the lungs can
trigger a dry cough in sensitive patients.
2. Which of the following laboratory parameters must be monitored most closely when a
patient is initiated on spironolactone for heart failure management?
A. Serum potassium and creatinine
,B. Serum sodium and chloride
C. Liver transaminases (ALT/AST)
D. Blood urea nitrogen (BUN) only
Answer: A
Conceptual Explanation: Spironolactone is a potassium-sparing diuretic. The risk of
hyperkalemia is significant, especially when used with ACE inhibitors or in patients with
renal impairment, necessitating monitoring of potassium and renal function.
3. A 55-year-old patient with Type 2 Diabetes is starting Metformin. Which contraindication is
most critical for the provider to assess before prescribing?
A. History of mild hypertension
B. BMI greater than 30
C. Estimated Glomerular Filtration Rate (eGFR) below 30 mL/min/1.73m2
D. Occasional consumption of a high-carbohydrate diet
Answer: C
Conceptual Explanation: Metformin is renally excreted and its use in patients with severe
renal impairment (eGFR < 30) is contraindicated due to the high risk of lactic acidosis.
4. When prescribing an SGLT2 inhibitor like Empagliflozin, the clinician should educate the
patient about which specific side effect?
A. Permanent discoloration of the teeth
, B. Severe hypoglycemia when used as monotherapy
C. Significant weight gain and peripheral edema
D. Genital mycotic infections and urinary tract infections
Answer: D
Conceptual Explanation: SGLT2 inhibitors lower glucose by promoting glucosuria. The
increased glucose in the urinary tract provides a medium for bacterial and fungal growth,
increasing the risk of UTIs and yeast infections.
5. A patient taking a high-potency statin reports new-onset muscle pain and dark-colored
urine. What is the most appropriate next step for the provider?
A. Discontinue the statin and order a Creatine Kinase (CK) level immediately
B. Encourage the patient to increase hydration and continue the medication
C. Switch the patient to a lower dose of a different statin immediately
D. Order a serum potassium and a urinalysis without stopping the drug
Answer: A
Conceptual Explanation: Muscle pain combined with dark urine (myoglobinuria) suggests
rhabdomyolysis. The statin must be stopped immediately, and CK levels assessed to
determine the extent of muscle injury.
