NR 568 Advanced Pharmacology Practice
Exam 100 Questions with Answers and
Detailed Rationales
Instructions:
This practice exam is designed to help you prepare for the NR 568 Final
Exam. Each question includes the correct answer and a detailed rationale
explaining the pharmacological principles, mechanisms of action, clinical
considerations, and nursing implications.
SECTION 1: Cardiovascular Pharmacology (Questions
1-15)
Question 1:
A patient with heart failure (HFrEF) is prescribed sacubitril/valsartan
(Entresto). Which laboratory value requires the most immediate
monitoring?
A) Serum potassium
B) Serum sodium
C) Serum creatinine
D) Serum magnesium
Correct Answer: A) Serum potassium
Rationale: Sacubitril/valsartan contains an ARB (valsartan) which can
cause hyperkalemia by reducing aldosterone-mediated potassium
excretion. This risk is particularly elevated in patients with renal
,impairment, diabetes, or those taking other potassium-sparing
medications. The combination also includes sacubitril, a neprilysin inhibitor
that increases levels of natriuretic peptides, enhancing vasodilation and
diuresis. Monitoring serum potassium at baseline, 1-2 weeks after
initiation, and with dose adjustments is essential to prevent life-threatening
hyperkalemia. Serum sodium should be monitored as well due to the risk of
hyponatremia, but hyperkalemia is the more immediate and potentially fatal
concern requiring closest monitoring. Creatinine may rise initially but
typically stabilizes; magnesium is not a primary concern with this
medication.
Question 2:
A 72-year-old patient with atrial fibrillation is started on apixaban for stroke
prevention. Which of the following is the most important factor in
determining the appropriate dose?
A) Age alone
B) Weight alone
C) Age, weight, and serum creatinine
D) Serum creatinine alone
Correct Answer: C) Age, weight, and serum creatinine
Rationale: Apixaban dosing requires consideration of at least two of three
criteria for dose reduction: age ≥80 years, weight ≤60 kg, or serum
creatinine ≥1.5 mg/dL. If two or more criteria are met, the dose should be
reduced from 5 mg twice daily to 2.5 mg twice daily. This reflects the drug's
dual renal and hepatic elimination pathways. Unlike dabigatran which is
primarily renally cleared, apixaban uses both hepatic and renal routes,
making a single parameter insufficient. Age alone (Option A) is not
adequate as many elderly patients with normal renal function require full
dosing. Weight alone (Option B) is also insufficient without considering
renal function. Serum creatinine alone (Option D) is insufficient due to the
,drug's dual elimination pathways. This complex dosing regimen
emphasizes the importance of comprehensive patient assessment.
Question 3:
A patient taking amiodarone develops a new onset of blue-gray skin
discoloration on sun-exposed areas. What is the most appropriate nursing
intervention?
A) Discontinue amiodarone immediately
B) Apply topical corticosteroids and monitor
C) Educate patient that this is an expected side effect that may be
irreversible
D) Schedule a dermatology consult for biopsy
Correct Answer: C) Educate patient that this is an expected side effect that
may be irreversible
Rationale: Amiodarone-induced phototoxicity manifests as a blue-gray skin
discoloration, particularly on sun-exposed areas, and is related to the drug's
accumulation in dermal macrophages and lysosomes. This is a known side
effect that can occur with chronic use (often after months to years) and
may not be fully reversible even after drug discontinuation. The most
appropriate nursing intervention is patient education about this expected
side effect and sun protection measures. Option A is incorrect because
abrupt discontinuation can precipitate life-threatening arrhythmias;
amiodarone has a very long half-life (up to 50-60 days) and should only be
discontinued under careful medical supervision. Option B is not appropriate
for this cosmetic side effect. Option D is unnecessary for a known drug
side effect.
Question 4:
Which of the following medications is contraindicated in a patient with a
history of angioedema related to ACE inhibitor use?
, A) Valsartan
B) Losartan
C) Aliskiren
D) Enalapril
Correct Answer: D) Enalapril
Rationale: Enalapril is an ACE inhibitor and is contraindicated in patients
with a history of ACE inhibitor-induced angioedema. While ARBs (valsartan,
losartan) have a lower risk of angioedema and may be considered as
alternatives, they are not entirely without risk. The cross-reactivity risk
between ACE inhibitors and ARBs is approximately 0.4-2.2%. However, the
definitive contraindication is to the same drug class. Aliskiren is a direct
renin inhibitor and carries its own angioedema risk but is not an ACE
inhibitor. For patients with a documented ACE inhibitor-induced
angioedema, ACE inhibitors are absolutely contraindicated. The distinction
between drug classes is critical in safe prescribing.
Question 5:
A patient on digoxin therapy presents with nausea, vomiting, visual
disturbances (yellow halos), and confusion. Which ECG finding is most
characteristic of digoxin toxicity?
A) Prolonged QT interval
B) Wide QRS complex
C) Shortened PR interval
D) Bidirectional ventricular tachycardia
Correct Answer: D) Bidirectional ventricular tachycardia
Rationale: Digoxin toxicity produces characteristic arrhythmias including
bidirectional ventricular tachycardia, which is nearly pathognomonic for
digoxin toxicity. The mechanism involves enhanced automaticity and
delayed afterdepolarizations in Purkinje fibers. Other typical ECG findings
include prolonged PR interval, ST segment depression with "scooped"
Exam 100 Questions with Answers and
Detailed Rationales
Instructions:
This practice exam is designed to help you prepare for the NR 568 Final
Exam. Each question includes the correct answer and a detailed rationale
explaining the pharmacological principles, mechanisms of action, clinical
considerations, and nursing implications.
SECTION 1: Cardiovascular Pharmacology (Questions
1-15)
Question 1:
A patient with heart failure (HFrEF) is prescribed sacubitril/valsartan
(Entresto). Which laboratory value requires the most immediate
monitoring?
A) Serum potassium
B) Serum sodium
C) Serum creatinine
D) Serum magnesium
Correct Answer: A) Serum potassium
Rationale: Sacubitril/valsartan contains an ARB (valsartan) which can
cause hyperkalemia by reducing aldosterone-mediated potassium
excretion. This risk is particularly elevated in patients with renal
,impairment, diabetes, or those taking other potassium-sparing
medications. The combination also includes sacubitril, a neprilysin inhibitor
that increases levels of natriuretic peptides, enhancing vasodilation and
diuresis. Monitoring serum potassium at baseline, 1-2 weeks after
initiation, and with dose adjustments is essential to prevent life-threatening
hyperkalemia. Serum sodium should be monitored as well due to the risk of
hyponatremia, but hyperkalemia is the more immediate and potentially fatal
concern requiring closest monitoring. Creatinine may rise initially but
typically stabilizes; magnesium is not a primary concern with this
medication.
Question 2:
A 72-year-old patient with atrial fibrillation is started on apixaban for stroke
prevention. Which of the following is the most important factor in
determining the appropriate dose?
A) Age alone
B) Weight alone
C) Age, weight, and serum creatinine
D) Serum creatinine alone
Correct Answer: C) Age, weight, and serum creatinine
Rationale: Apixaban dosing requires consideration of at least two of three
criteria for dose reduction: age ≥80 years, weight ≤60 kg, or serum
creatinine ≥1.5 mg/dL. If two or more criteria are met, the dose should be
reduced from 5 mg twice daily to 2.5 mg twice daily. This reflects the drug's
dual renal and hepatic elimination pathways. Unlike dabigatran which is
primarily renally cleared, apixaban uses both hepatic and renal routes,
making a single parameter insufficient. Age alone (Option A) is not
adequate as many elderly patients with normal renal function require full
dosing. Weight alone (Option B) is also insufficient without considering
renal function. Serum creatinine alone (Option D) is insufficient due to the
,drug's dual elimination pathways. This complex dosing regimen
emphasizes the importance of comprehensive patient assessment.
Question 3:
A patient taking amiodarone develops a new onset of blue-gray skin
discoloration on sun-exposed areas. What is the most appropriate nursing
intervention?
A) Discontinue amiodarone immediately
B) Apply topical corticosteroids and monitor
C) Educate patient that this is an expected side effect that may be
irreversible
D) Schedule a dermatology consult for biopsy
Correct Answer: C) Educate patient that this is an expected side effect that
may be irreversible
Rationale: Amiodarone-induced phototoxicity manifests as a blue-gray skin
discoloration, particularly on sun-exposed areas, and is related to the drug's
accumulation in dermal macrophages and lysosomes. This is a known side
effect that can occur with chronic use (often after months to years) and
may not be fully reversible even after drug discontinuation. The most
appropriate nursing intervention is patient education about this expected
side effect and sun protection measures. Option A is incorrect because
abrupt discontinuation can precipitate life-threatening arrhythmias;
amiodarone has a very long half-life (up to 50-60 days) and should only be
discontinued under careful medical supervision. Option B is not appropriate
for this cosmetic side effect. Option D is unnecessary for a known drug
side effect.
Question 4:
Which of the following medications is contraindicated in a patient with a
history of angioedema related to ACE inhibitor use?
, A) Valsartan
B) Losartan
C) Aliskiren
D) Enalapril
Correct Answer: D) Enalapril
Rationale: Enalapril is an ACE inhibitor and is contraindicated in patients
with a history of ACE inhibitor-induced angioedema. While ARBs (valsartan,
losartan) have a lower risk of angioedema and may be considered as
alternatives, they are not entirely without risk. The cross-reactivity risk
between ACE inhibitors and ARBs is approximately 0.4-2.2%. However, the
definitive contraindication is to the same drug class. Aliskiren is a direct
renin inhibitor and carries its own angioedema risk but is not an ACE
inhibitor. For patients with a documented ACE inhibitor-induced
angioedema, ACE inhibitors are absolutely contraindicated. The distinction
between drug classes is critical in safe prescribing.
Question 5:
A patient on digoxin therapy presents with nausea, vomiting, visual
disturbances (yellow halos), and confusion. Which ECG finding is most
characteristic of digoxin toxicity?
A) Prolonged QT interval
B) Wide QRS complex
C) Shortened PR interval
D) Bidirectional ventricular tachycardia
Correct Answer: D) Bidirectional ventricular tachycardia
Rationale: Digoxin toxicity produces characteristic arrhythmias including
bidirectional ventricular tachycardia, which is nearly pathognomonic for
digoxin toxicity. The mechanism involves enhanced automaticity and
delayed afterdepolarizations in Purkinje fibers. Other typical ECG findings
include prolonged PR interval, ST segment depression with "scooped"
