NURS 8024 Pharmacology Final Exam Study Guide - University of Cincinnati | 2026 Update
DNP / MSN Advanced Pharmacology
NURS 8024 PHARMACOLOGY FINAL
EXAM STUDY GUIDE
Questions and Answers | 2026 Update
University of Cincinnati
College of Nursing - Graduate Program (DNP / MSN)
Course: NURS 8024 - Advanced Pharmacology
Academic Year: 2026 | 2027
Format: 40 Multiple-Choice Questions + Grading Rubric
Abstract
This study guide presents a forty-item multiple-choice final examination aligned with the
University of Cincinnati NURS 8024 Advanced Pharmacology curriculum and reflects 2026|2027
academic standards. Items are distributed across four domains: cardiovascular, pulmonary, and
hematologic pharmacology; endocrine, neurological, and psychiatric pharmacology; infectious
disease, immunology, and oncology pharmacology; and advanced pharmacokinetics, geriatrics,
pharmacogenomics, and contemporary 2026 updates. Seventy-five percent of the items are
scenario-based and require graduate-level clinical reasoning, while twenty-five percent address
direct mechanisms, pharmacokinetic principles, and black-box warnings. Each item is
accompanied by a step-by-step rationale linking molecular mechanism to clinical decision-making,
with explicit identification of why distractors represent unsafe prescribing or mechanistic errors.
The accompanying grading rubric allocates 2.5 points per question (100 points total) and defines
partial-credit criteria and mastery thresholds consistent with DNP-level competency expectations.
Keywords: Advanced Pharmacology; DNP Prescribing; Pharmacokinetics; Pharmacogenomics;
Drug-Drug Interactions; Evidence-Based Pharmacotherapy; 2026 Clinical Practice Guidelines.
Cognitive Level Distribution: Recall 30% | Application 50% | Analysis 20%. Item Type Distribution:
Scenario-based 75% | Direct 25%. Reference Frameworks: 2022 AHA/ACC/HFSA Heart Failure Guidelines;
2017 ACC/AHA Hypertension Guidelines; ADA Standards of Care in Diabetes 2025-2026; IDSA Guidelines
2021-2024; AGS Beers Criteria 2023; CPIC Pharmacogenomic Guidelines 2024.
Page 1
,NURS 8024 Pharmacology Final Exam Study Guide - University of Cincinnati | 2026 Update
DNP / MSN Advanced Pharmacology
Section 1: Cardiovascular, Pulmonary, & Hematologic
Pharmacology (Q1 - Q10)
Q1: A 68-year-old male with HFrEF (EF 28%) is maintained on furosemide 40 mg BID, lisinopril
20 mg daily, and digoxin 0.125 mg daily. Today his potassium is 3.1 mEq/L and he reports mild
fatigue. The DNP's most appropriate evidence-based prescribing action is to:
A. Increase the digoxin dose to 0.25 mg daily to improve contractility.
B. Add oral potassium chloride and initiate low-dose spironolactone 12.5 mg daily after
confirming eGFR and potassium trends. [CORRECT]
C. Discontinue lisinopril immediately and substitute amlodipine to avoid hyperkalemia.
D. Switch furosemide to hydrochlorothiazide 25 mg daily to reduce potassium wasting.
Correct Answer: B
Rationale: Hypokalemia potentates digitalis toxicity by increasing myocardial binding of digoxin and
reducing Na+/K+-ATPase reserve. Spironolactone is guideline-directed medical therapy for
symptomatic HFrEF (NYHA II-IV) per the 2022 AHA/ACC/HFSA update because it reduces all-cause
mortality, and it concurrently mitigates loop-diuretic-induced potassium loss. Option A is unsafe
because higher digoxin doses in hypokalemia increase arrhythmia risk. Option C removes a
mortality-reducing ACE inhibitor. Option D is less effective in HFrEF and worsens potassium loss.
Potassium and renal function must be rechecked within 5-7 days of initiation or dose change.
Q2: Which statement best describes the pharmacodynamic mechanism of sacubitril/valsartan
(Entresto) and the principal prescribing constraint associated with its use?
A. It is an ARB combined with a neprilysin inhibitor; it must not be administered within 36
hours of an ACE inhibitor due to angioedema risk. [CORRECT]
B. It is an ACE inhibitor combined with a beta-blocker; it requires monitoring of heart rate and
bronchospasm.
C. It is an ARB combined with a dihydropyridine calcium-channel blocker; it is contraindicated in
hypertension.
D. It is a beta-blocker combined with a neprilysin inhibitor; it is contraindicated in asthma.
Correct Answer: A
Rationale: Sacubitril inhibits neprilysin, augmenting endogenous natriuretic peptides (BNP, ANP) that
produce vasodilation and natriuresis, while valsartan blocks the AT1 receptor. Combined ACE-inhibitor
use within 36 hours precipitates bradykinin accumulation and life-threatening angioedema. Option B
confuses the mechanism with beta-blockade. Option C misclassifies the components. Option D
incorrectly attributes beta-blockade to the product. Entresto is preferred over an ACE inhibitor for
symptomatic HFrEF with reduced EF (PARADIGM-HF trial).
Page 2
, NURS 8024 Pharmacology Final Exam Study Guide - University of Cincinnati | 2026 Update
DNP / MSN Advanced Pharmacology
Q3: A 62-year-old female post-STEMI is on atorvastatin 80 mg daily. She presents with diffuse
myalgias, dark tea-colored urine, and CK of 9,800 U/L. The correct DNP action is to:
A. Continue atorvastatin, add creatine supplementation, and reassess in 4 weeks.
B. Discontinue atorvastatin immediately, hospitalize for IV hydration with isotonic saline, and
evaluate renal function and urine myoglobin. [CORRECT]
C. Switch immediately to rosuvastatin 80 mg daily because it is hydrophilic and safer.
D. Add a fibrate to enhance lipid-lowering and continue atorvastatin.
Correct Answer: B
Rationale: The clinical picture is statin-induced rhabdomyolysis with myoglobinuric acute kidney
injury. Immediate discontinuation, aggressive isotonic IV hydration, and monitoring of CK, creatinine,
and urine output are indicated. Option A delays critical intervention. Option C is unsafe because
rechallenge with any statin in active rhabdomyolysis is contraindicated; rosuvastatin's hydrophilicity
reduces but does not eliminate risk. Option D is dangerous because fibrate-statin combinations markedly
increase myopathy risk, particularly with gemfibrozil.
Q4: A 24-year-old female with persistent asthma is prescribed fluticasone/salmeterol (Advair)
twice daily plus albuterol PRN. Which counseling point is most critical to prevent serious adverse
effects and disease exacerbation?
A. Use the salmeterol component as a rescue inhaler during acute bronchospasm.
B. Discontinue the inhaled corticosteroid once symptoms resolve to avoid adrenal suppression.
C. Rinse and spit after each inhaled corticosteroid dose to prevent oropharyngeal candidiasis
and hoarseness; never use salmeterol for acute rescue. [CORRECT]
D. Take both medications only at bedtime to synchronize with circadian cortisol.
Correct Answer: C
Rationale: Inhaled corticosteroids cause local immunosuppression, predisposing to oral candidiasis and
dysphonia; mouth rinsing and spacer use reduce risk. Salmeterol is a long-acting beta-2 agonist (LABA)
with a slow onset and carries a black-box warning against monotherapy and acute-rescue use because of
asthma-related death risk. Option A invites fatal exacerbation. Option B removes anti-inflammatory
controller therapy and worsens exacerbation frequency. Option D has no pharmacologic basis and
would leave daytime symptoms untreated.
Q5: A 76-year-old male on warfarin for atrial fibrillation presents with INR 8.2 and no evidence of
bleeding. Per contemporary ACC/AHA guidance, the most appropriate management is to:
A. Administer vitamin K 10 mg IV push and fresh frozen plasma immediately.
B. Hold the next warfarin dose(s) and administer oral vitamin K 1-2.5 mg, with repeat INR in
24 hours. [CORRECT]
C. Administer four-factor prothrombin complex concentrate (4F-PCC).
D. Increase the warfarin dose to overcome a presumed dietary deficiency.
Correct Answer: B
Rationale: For asymptomatic INR elevation above the therapeutic range without bleeding, the
recommended approach is to hold warfarin and give low-dose oral vitamin K (1-2.5 mg), which gently
reverses anticoagulation without overshooting into hypercoagulability. IV vitamin K 10 mg, FFP, and
4F-PCC are reserved for serious or life-threatening bleeding because they produce abrupt reversal and
carry thrombosis risk. Option D is contrary to basic anticoagulation principles. Recheck INR within 24
hours and resume warfarin at a reduced maintenance dose once INR approaches therapeutic range.
Page 3
DNP / MSN Advanced Pharmacology
NURS 8024 PHARMACOLOGY FINAL
EXAM STUDY GUIDE
Questions and Answers | 2026 Update
University of Cincinnati
College of Nursing - Graduate Program (DNP / MSN)
Course: NURS 8024 - Advanced Pharmacology
Academic Year: 2026 | 2027
Format: 40 Multiple-Choice Questions + Grading Rubric
Abstract
This study guide presents a forty-item multiple-choice final examination aligned with the
University of Cincinnati NURS 8024 Advanced Pharmacology curriculum and reflects 2026|2027
academic standards. Items are distributed across four domains: cardiovascular, pulmonary, and
hematologic pharmacology; endocrine, neurological, and psychiatric pharmacology; infectious
disease, immunology, and oncology pharmacology; and advanced pharmacokinetics, geriatrics,
pharmacogenomics, and contemporary 2026 updates. Seventy-five percent of the items are
scenario-based and require graduate-level clinical reasoning, while twenty-five percent address
direct mechanisms, pharmacokinetic principles, and black-box warnings. Each item is
accompanied by a step-by-step rationale linking molecular mechanism to clinical decision-making,
with explicit identification of why distractors represent unsafe prescribing or mechanistic errors.
The accompanying grading rubric allocates 2.5 points per question (100 points total) and defines
partial-credit criteria and mastery thresholds consistent with DNP-level competency expectations.
Keywords: Advanced Pharmacology; DNP Prescribing; Pharmacokinetics; Pharmacogenomics;
Drug-Drug Interactions; Evidence-Based Pharmacotherapy; 2026 Clinical Practice Guidelines.
Cognitive Level Distribution: Recall 30% | Application 50% | Analysis 20%. Item Type Distribution:
Scenario-based 75% | Direct 25%. Reference Frameworks: 2022 AHA/ACC/HFSA Heart Failure Guidelines;
2017 ACC/AHA Hypertension Guidelines; ADA Standards of Care in Diabetes 2025-2026; IDSA Guidelines
2021-2024; AGS Beers Criteria 2023; CPIC Pharmacogenomic Guidelines 2024.
Page 1
,NURS 8024 Pharmacology Final Exam Study Guide - University of Cincinnati | 2026 Update
DNP / MSN Advanced Pharmacology
Section 1: Cardiovascular, Pulmonary, & Hematologic
Pharmacology (Q1 - Q10)
Q1: A 68-year-old male with HFrEF (EF 28%) is maintained on furosemide 40 mg BID, lisinopril
20 mg daily, and digoxin 0.125 mg daily. Today his potassium is 3.1 mEq/L and he reports mild
fatigue. The DNP's most appropriate evidence-based prescribing action is to:
A. Increase the digoxin dose to 0.25 mg daily to improve contractility.
B. Add oral potassium chloride and initiate low-dose spironolactone 12.5 mg daily after
confirming eGFR and potassium trends. [CORRECT]
C. Discontinue lisinopril immediately and substitute amlodipine to avoid hyperkalemia.
D. Switch furosemide to hydrochlorothiazide 25 mg daily to reduce potassium wasting.
Correct Answer: B
Rationale: Hypokalemia potentates digitalis toxicity by increasing myocardial binding of digoxin and
reducing Na+/K+-ATPase reserve. Spironolactone is guideline-directed medical therapy for
symptomatic HFrEF (NYHA II-IV) per the 2022 AHA/ACC/HFSA update because it reduces all-cause
mortality, and it concurrently mitigates loop-diuretic-induced potassium loss. Option A is unsafe
because higher digoxin doses in hypokalemia increase arrhythmia risk. Option C removes a
mortality-reducing ACE inhibitor. Option D is less effective in HFrEF and worsens potassium loss.
Potassium and renal function must be rechecked within 5-7 days of initiation or dose change.
Q2: Which statement best describes the pharmacodynamic mechanism of sacubitril/valsartan
(Entresto) and the principal prescribing constraint associated with its use?
A. It is an ARB combined with a neprilysin inhibitor; it must not be administered within 36
hours of an ACE inhibitor due to angioedema risk. [CORRECT]
B. It is an ACE inhibitor combined with a beta-blocker; it requires monitoring of heart rate and
bronchospasm.
C. It is an ARB combined with a dihydropyridine calcium-channel blocker; it is contraindicated in
hypertension.
D. It is a beta-blocker combined with a neprilysin inhibitor; it is contraindicated in asthma.
Correct Answer: A
Rationale: Sacubitril inhibits neprilysin, augmenting endogenous natriuretic peptides (BNP, ANP) that
produce vasodilation and natriuresis, while valsartan blocks the AT1 receptor. Combined ACE-inhibitor
use within 36 hours precipitates bradykinin accumulation and life-threatening angioedema. Option B
confuses the mechanism with beta-blockade. Option C misclassifies the components. Option D
incorrectly attributes beta-blockade to the product. Entresto is preferred over an ACE inhibitor for
symptomatic HFrEF with reduced EF (PARADIGM-HF trial).
Page 2
, NURS 8024 Pharmacology Final Exam Study Guide - University of Cincinnati | 2026 Update
DNP / MSN Advanced Pharmacology
Q3: A 62-year-old female post-STEMI is on atorvastatin 80 mg daily. She presents with diffuse
myalgias, dark tea-colored urine, and CK of 9,800 U/L. The correct DNP action is to:
A. Continue atorvastatin, add creatine supplementation, and reassess in 4 weeks.
B. Discontinue atorvastatin immediately, hospitalize for IV hydration with isotonic saline, and
evaluate renal function and urine myoglobin. [CORRECT]
C. Switch immediately to rosuvastatin 80 mg daily because it is hydrophilic and safer.
D. Add a fibrate to enhance lipid-lowering and continue atorvastatin.
Correct Answer: B
Rationale: The clinical picture is statin-induced rhabdomyolysis with myoglobinuric acute kidney
injury. Immediate discontinuation, aggressive isotonic IV hydration, and monitoring of CK, creatinine,
and urine output are indicated. Option A delays critical intervention. Option C is unsafe because
rechallenge with any statin in active rhabdomyolysis is contraindicated; rosuvastatin's hydrophilicity
reduces but does not eliminate risk. Option D is dangerous because fibrate-statin combinations markedly
increase myopathy risk, particularly with gemfibrozil.
Q4: A 24-year-old female with persistent asthma is prescribed fluticasone/salmeterol (Advair)
twice daily plus albuterol PRN. Which counseling point is most critical to prevent serious adverse
effects and disease exacerbation?
A. Use the salmeterol component as a rescue inhaler during acute bronchospasm.
B. Discontinue the inhaled corticosteroid once symptoms resolve to avoid adrenal suppression.
C. Rinse and spit after each inhaled corticosteroid dose to prevent oropharyngeal candidiasis
and hoarseness; never use salmeterol for acute rescue. [CORRECT]
D. Take both medications only at bedtime to synchronize with circadian cortisol.
Correct Answer: C
Rationale: Inhaled corticosteroids cause local immunosuppression, predisposing to oral candidiasis and
dysphonia; mouth rinsing and spacer use reduce risk. Salmeterol is a long-acting beta-2 agonist (LABA)
with a slow onset and carries a black-box warning against monotherapy and acute-rescue use because of
asthma-related death risk. Option A invites fatal exacerbation. Option B removes anti-inflammatory
controller therapy and worsens exacerbation frequency. Option D has no pharmacologic basis and
would leave daytime symptoms untreated.
Q5: A 76-year-old male on warfarin for atrial fibrillation presents with INR 8.2 and no evidence of
bleeding. Per contemporary ACC/AHA guidance, the most appropriate management is to:
A. Administer vitamin K 10 mg IV push and fresh frozen plasma immediately.
B. Hold the next warfarin dose(s) and administer oral vitamin K 1-2.5 mg, with repeat INR in
24 hours. [CORRECT]
C. Administer four-factor prothrombin complex concentrate (4F-PCC).
D. Increase the warfarin dose to overcome a presumed dietary deficiency.
Correct Answer: B
Rationale: For asymptomatic INR elevation above the therapeutic range without bleeding, the
recommended approach is to hold warfarin and give low-dose oral vitamin K (1-2.5 mg), which gently
reverses anticoagulation without overshooting into hypercoagulability. IV vitamin K 10 mg, FFP, and
4F-PCC are reserved for serious or life-threatening bleeding because they produce abrupt reversal and
carry thrombosis risk. Option D is contrary to basic anticoagulation principles. Recheck INR within 24
hours and resume warfarin at a reduced maintenance dose once INR approaches therapeutic range.
Page 3
