NR 567 ADVANCED PHARM MIDTERM EXAM GUIDE 200
QUESTIONS COMPLETE WITH VERIFIED ANSWERS AND
DETAILED RATIONALES
1. A patient with acute ischemic stroke is being evaluated for
thrombolytic therapy. Which factor would be an absolute
contraindication to receiving alteplase?
A) Age 72 years
B) Blood pressure 155/92 mmHg
C) History of intracranial hemorrhage 6 months ago
D) Blood glucose 145 mg/dL
Correct Answer: C - History of intracranial hemorrhage is an absolute
contraindication to thrombolytic therapy regardless of time frame. The
risk of recurrent hemorrhage outweighs any potential benefit. Age over
80, controlled hypertension, and mild hyperglycemia are not absolute
contraindications.
2. A patient is prescribed lovastatin for hyperlipidemia. The nurse
should instruct the patient to take this medication at what time of day
for maximum efficacy?
A) In the morning with breakfast
B) At bedtime
C) With lunch
D) At any time of day consistently
,Correct Answer: B - Statins should be taken in the evening because
cholesterol synthesis is highest during the night due to the body's
natural circadian rhythm of HMG-CoA reductase activity. Evening
administration maximizes the drug's effect on reducing cholesterol
production.
3. A patient on statin therapy reports severe muscle pain and
weakness. Which laboratory value should the provider check
immediately?
A) Serum potassium
B) CK (creatine kinase)
C) Serum sodium
D) BUN
Correct Answer: B - CK levels should be monitored to assess for muscle
breakdown (rhabdomyolysis), which is a serious adverse effect of
statins. Elevated CK indicates muscle injury and requires prompt
evaluation and possible discontinuation of the medication.
4. What is the primary mechanism of action of alteplase in the
treatment of acute myocardial infarction?
A) Inhibits platelet aggregation
B) Blocks calcium channels
C) Converts plasminogen to plasmin, digesting fibrin clots
D) Prevents thromboxane A2 synthesis
,Correct Answer: C - Alteplase binds with plasminogen to form an active
complex that converts plasminogen to plasmin, which then digests the
fibrin meshwork of clots. This promotes clot dissolution and restoration
of blood flow.
5. Which drug interaction should be considered when prescribing
atorvastatin?
A) Penicillin increases statin effectiveness
B) Grapefruit juice inhibits CYP3A4 metabolism
C) Acetaminophen increases myopathy risk
D) Ibuprofen enhances lipid-lowering effects
Correct Answer: B - Grapefruit juice inhibits CYP3A4, the enzyme that
metabolizes certain statins including atorvastatin, lovastatin, and
simvastatin. This inhibition can lead to increased statin levels and
toxicity, including myopathy and hepatotoxicity.
6. A patient is receiving alteplase for acute pulmonary embolism.
What is the recommended total dose and infusion duration?
A) 50 mg infused over 1 hour
B) 100 mg infused IV over 2 hours
C) 150 mg infused over 3 hours
D) 200 mg infused over 4 hours
Correct Answer: B - For acute pulmonary embolism, alteplase is
administered as 100 mg infused intravenously over 2 hours. This dosing
, regimen has been shown to be effective for clot dissolution in
pulmonary embolism.
7. A patient on simvastatin develops elevated liver enzymes. What is
the most appropriate initial action?
A) Increase the statin dose to achieve target LDL
B) Discontinue the statin immediately
C) Evaluate other causes and consider dose reduction or discontinuation
D) Add a fibrate to improve lipid profile
Correct Answer: C - Hepatotoxicity is a known side effect of statins.
When liver enzymes are elevated, the provider should evaluate for
other causes and consider dose reduction or discontinuation. Liver
function tests should be monitored before initiating treatment and
when clinically indicated.
8. Which of the following is a contraindication to thrombolytic
therapy?
A) Age greater than 75 years
B) Systolic blood pressure 145 mmHg
C) Active internal bleeding
D) History of diabetes mellitus
Correct Answer: C - Active internal bleeding is an absolute
contraindication to thrombolytic therapy due to the significant risk of
worsening hemorrhage. Other contraindications include prior
QUESTIONS COMPLETE WITH VERIFIED ANSWERS AND
DETAILED RATIONALES
1. A patient with acute ischemic stroke is being evaluated for
thrombolytic therapy. Which factor would be an absolute
contraindication to receiving alteplase?
A) Age 72 years
B) Blood pressure 155/92 mmHg
C) History of intracranial hemorrhage 6 months ago
D) Blood glucose 145 mg/dL
Correct Answer: C - History of intracranial hemorrhage is an absolute
contraindication to thrombolytic therapy regardless of time frame. The
risk of recurrent hemorrhage outweighs any potential benefit. Age over
80, controlled hypertension, and mild hyperglycemia are not absolute
contraindications.
2. A patient is prescribed lovastatin for hyperlipidemia. The nurse
should instruct the patient to take this medication at what time of day
for maximum efficacy?
A) In the morning with breakfast
B) At bedtime
C) With lunch
D) At any time of day consistently
,Correct Answer: B - Statins should be taken in the evening because
cholesterol synthesis is highest during the night due to the body's
natural circadian rhythm of HMG-CoA reductase activity. Evening
administration maximizes the drug's effect on reducing cholesterol
production.
3. A patient on statin therapy reports severe muscle pain and
weakness. Which laboratory value should the provider check
immediately?
A) Serum potassium
B) CK (creatine kinase)
C) Serum sodium
D) BUN
Correct Answer: B - CK levels should be monitored to assess for muscle
breakdown (rhabdomyolysis), which is a serious adverse effect of
statins. Elevated CK indicates muscle injury and requires prompt
evaluation and possible discontinuation of the medication.
4. What is the primary mechanism of action of alteplase in the
treatment of acute myocardial infarction?
A) Inhibits platelet aggregation
B) Blocks calcium channels
C) Converts plasminogen to plasmin, digesting fibrin clots
D) Prevents thromboxane A2 synthesis
,Correct Answer: C - Alteplase binds with plasminogen to form an active
complex that converts plasminogen to plasmin, which then digests the
fibrin meshwork of clots. This promotes clot dissolution and restoration
of blood flow.
5. Which drug interaction should be considered when prescribing
atorvastatin?
A) Penicillin increases statin effectiveness
B) Grapefruit juice inhibits CYP3A4 metabolism
C) Acetaminophen increases myopathy risk
D) Ibuprofen enhances lipid-lowering effects
Correct Answer: B - Grapefruit juice inhibits CYP3A4, the enzyme that
metabolizes certain statins including atorvastatin, lovastatin, and
simvastatin. This inhibition can lead to increased statin levels and
toxicity, including myopathy and hepatotoxicity.
6. A patient is receiving alteplase for acute pulmonary embolism.
What is the recommended total dose and infusion duration?
A) 50 mg infused over 1 hour
B) 100 mg infused IV over 2 hours
C) 150 mg infused over 3 hours
D) 200 mg infused over 4 hours
Correct Answer: B - For acute pulmonary embolism, alteplase is
administered as 100 mg infused intravenously over 2 hours. This dosing
, regimen has been shown to be effective for clot dissolution in
pulmonary embolism.
7. A patient on simvastatin develops elevated liver enzymes. What is
the most appropriate initial action?
A) Increase the statin dose to achieve target LDL
B) Discontinue the statin immediately
C) Evaluate other causes and consider dose reduction or discontinuation
D) Add a fibrate to improve lipid profile
Correct Answer: C - Hepatotoxicity is a known side effect of statins.
When liver enzymes are elevated, the provider should evaluate for
other causes and consider dose reduction or discontinuation. Liver
function tests should be monitored before initiating treatment and
when clinically indicated.
8. Which of the following is a contraindication to thrombolytic
therapy?
A) Age greater than 75 years
B) Systolic blood pressure 145 mmHg
C) Active internal bleeding
D) History of diabetes mellitus
Correct Answer: C - Active internal bleeding is an absolute
contraindication to thrombolytic therapy due to the significant risk of
worsening hemorrhage. Other contraindications include prior
