,NUR 521 Advanced Pharmacology Exam 2
| University of Alabama | 26/27
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1. Which physiological process is most directly responsible for the movement of blood through the
circulatory system?
A) Osmotic pressure generated by plasma proteins
B) A pressure gradient generated by the pumping action of the heart
C) Active transport of ions across the vascular endothelium
D) Peristaltic contractions of smooth muscle in vessel walls
Correct Answer: A pressure gradient generated by the pumping action of the heart
Rationale: Blood flows from areas of higher pressure to areas of lower pressure. This pressure
gradient is created by the heart's pumping action. Osmotic pressure influences fluid exchange at the
capillary level but does not drive bulk flow. Active transport and peristalsis are not the primary forces
for systemic blood flow.
2. In which blood vessel type does the greatest drop in mean arterial pressure occur, and what is the
primary function of this vessel type?
A) Arteries; to distribute blood to various organs
B) Arterioles; to regulate resistance and control blood flow
C) Capillaries; to facilitate the exchange of nutrients and waste
D) Veins; to serve as a capacitance reservoir for blood
Correct Answer: Arterioles; to regulate resistance and control blood flow
Rationale: Arterioles are the primary site of vascular resistance. Their muscular walls allow for
significant vasoconstriction and vasodilation, which controls blood flow into capillary beds and
accounts for the largest drop in mean arterial pressure. Arteries are conducting vessels, capillaries are
exchange vessels, and veins are capacitance vessels.
,3. A patient with heart failure is started on a medication that reduces preload. Which hemodynamic
parameter is the most direct indicator of preload?
A) Systemic vascular resistance (SVR)
B) Cardiac output (CO)
C) Pulmonary capillary wedge pressure (PCWP)
D) Central venous pressure (CVP)
Correct Answer: Pulmonary capillary wedge pressure (PCWP)
Rationale: PCWP is a measurement of left atrial pressure and is considered the best clinical indicator
of left ventricular preload. CVP reflects right ventricular preload. SVR is a measure of afterload. CO is
the product of heart rate and stroke volume.
4. A patient is prescribed a beta-1 adrenergic receptor agonist. Which hemodynamic effect is expected
from this medication?
A) Decreased heart rate and decreased contractility
B) Increased heart rate and increased contractility
C) Vasodilation and decreased systemic vascular resistance
D) Vasoconstriction and increased systemic vascular resistance
Correct Answer: Increased heart rate and increased contractility
Rationale: Beta-1 adrenergic receptors are primarily located in the heart. Stimulation of these
receptors leads to an increase in heart rate (positive chronotropy) and an increase in the force of
contraction (positive inotropy). Vasodilation and vasoconstriction are mediated by other receptor
types.
5. The nurse is calculating a patient's mean arterial pressure (MAP). The patient's blood pressure is
142/86 mmHg. What is the MAP, and is it within the normal range?
A) 90 mmHg; within normal range
B) 105 mmHg; above normal range
C) 114 mmHg; above normal range
D) 74 mmHg; below normal range
Correct Answer: 105 mmHg; above normal range
, Rationale: MAP is calculated as: [(2 x Diastolic) + Systolic] / 3. Therefore, [(2 x 86) + 142] / 3 = (172 +
142) / 3 = = 104.6 ≈ 105 mmHg. A normal MAP is between 70 and 100 mmHg. A MAP of 105
mmHg is considered elevated and indicates hypertension.
6. A patient with a history of angina is prescribed a calcium channel blocker. The nurse understands
that this medication primarily works by:
A) Increasing the force of myocardial contraction
B) Blocking the influx of calcium into cardiac and vascular smooth muscle cells
C) Increasing the heart rate to improve cardiac output
D) Inhibiting the renin-angiotensin-aldosterone system
Correct Answer: Blocking the influx of calcium into cardiac and vascular smooth muscle cells
Rationale: Calcium channel blockers (CCBs) inhibit the influx of calcium ions through voltage-gated L-
type calcium channels. This leads to vasodilation of arteries and arterioles, reducing afterload, and can
also decrease heart rate and contractility. CCBs do not increase contractility or heart rate, nor do they
directly inhibit the RAAS.
7. A patient with a known allergy to sulfonamides is prescribed a new medication. Which of the
following drugs should the nurse question, as it has the highest risk of cross-sensitivity?
A) Furosemide
B) Metoprolol
C) Lisinopril
D) Amlodipine
Correct Answer: Furosemide
Rationale: Furosemide is a loop diuretic that contains a sulfonamide group. Patients with a history of
severe allergic reactions to sulfonamide antibiotics may have cross-reactivity with other sulfonamide-
containing drugs, such as furosemide, thiazides, and sulfonylureas.
8. A patient is prescribed a medication that is a potent inducer of the CYP3A4 enzyme system. The
nurse should monitor for a potential decrease in the therapeutic effect of which concomitant
medication?
| University of Alabama | 26/27
Guaranteed PDF)
1. Which physiological process is most directly responsible for the movement of blood through the
circulatory system?
A) Osmotic pressure generated by plasma proteins
B) A pressure gradient generated by the pumping action of the heart
C) Active transport of ions across the vascular endothelium
D) Peristaltic contractions of smooth muscle in vessel walls
Correct Answer: A pressure gradient generated by the pumping action of the heart
Rationale: Blood flows from areas of higher pressure to areas of lower pressure. This pressure
gradient is created by the heart's pumping action. Osmotic pressure influences fluid exchange at the
capillary level but does not drive bulk flow. Active transport and peristalsis are not the primary forces
for systemic blood flow.
2. In which blood vessel type does the greatest drop in mean arterial pressure occur, and what is the
primary function of this vessel type?
A) Arteries; to distribute blood to various organs
B) Arterioles; to regulate resistance and control blood flow
C) Capillaries; to facilitate the exchange of nutrients and waste
D) Veins; to serve as a capacitance reservoir for blood
Correct Answer: Arterioles; to regulate resistance and control blood flow
Rationale: Arterioles are the primary site of vascular resistance. Their muscular walls allow for
significant vasoconstriction and vasodilation, which controls blood flow into capillary beds and
accounts for the largest drop in mean arterial pressure. Arteries are conducting vessels, capillaries are
exchange vessels, and veins are capacitance vessels.
,3. A patient with heart failure is started on a medication that reduces preload. Which hemodynamic
parameter is the most direct indicator of preload?
A) Systemic vascular resistance (SVR)
B) Cardiac output (CO)
C) Pulmonary capillary wedge pressure (PCWP)
D) Central venous pressure (CVP)
Correct Answer: Pulmonary capillary wedge pressure (PCWP)
Rationale: PCWP is a measurement of left atrial pressure and is considered the best clinical indicator
of left ventricular preload. CVP reflects right ventricular preload. SVR is a measure of afterload. CO is
the product of heart rate and stroke volume.
4. A patient is prescribed a beta-1 adrenergic receptor agonist. Which hemodynamic effect is expected
from this medication?
A) Decreased heart rate and decreased contractility
B) Increased heart rate and increased contractility
C) Vasodilation and decreased systemic vascular resistance
D) Vasoconstriction and increased systemic vascular resistance
Correct Answer: Increased heart rate and increased contractility
Rationale: Beta-1 adrenergic receptors are primarily located in the heart. Stimulation of these
receptors leads to an increase in heart rate (positive chronotropy) and an increase in the force of
contraction (positive inotropy). Vasodilation and vasoconstriction are mediated by other receptor
types.
5. The nurse is calculating a patient's mean arterial pressure (MAP). The patient's blood pressure is
142/86 mmHg. What is the MAP, and is it within the normal range?
A) 90 mmHg; within normal range
B) 105 mmHg; above normal range
C) 114 mmHg; above normal range
D) 74 mmHg; below normal range
Correct Answer: 105 mmHg; above normal range
, Rationale: MAP is calculated as: [(2 x Diastolic) + Systolic] / 3. Therefore, [(2 x 86) + 142] / 3 = (172 +
142) / 3 = = 104.6 ≈ 105 mmHg. A normal MAP is between 70 and 100 mmHg. A MAP of 105
mmHg is considered elevated and indicates hypertension.
6. A patient with a history of angina is prescribed a calcium channel blocker. The nurse understands
that this medication primarily works by:
A) Increasing the force of myocardial contraction
B) Blocking the influx of calcium into cardiac and vascular smooth muscle cells
C) Increasing the heart rate to improve cardiac output
D) Inhibiting the renin-angiotensin-aldosterone system
Correct Answer: Blocking the influx of calcium into cardiac and vascular smooth muscle cells
Rationale: Calcium channel blockers (CCBs) inhibit the influx of calcium ions through voltage-gated L-
type calcium channels. This leads to vasodilation of arteries and arterioles, reducing afterload, and can
also decrease heart rate and contractility. CCBs do not increase contractility or heart rate, nor do they
directly inhibit the RAAS.
7. A patient with a known allergy to sulfonamides is prescribed a new medication. Which of the
following drugs should the nurse question, as it has the highest risk of cross-sensitivity?
A) Furosemide
B) Metoprolol
C) Lisinopril
D) Amlodipine
Correct Answer: Furosemide
Rationale: Furosemide is a loop diuretic that contains a sulfonamide group. Patients with a history of
severe allergic reactions to sulfonamide antibiotics may have cross-reactivity with other sulfonamide-
containing drugs, such as furosemide, thiazides, and sulfonylureas.
8. A patient is prescribed a medication that is a potent inducer of the CYP3A4 enzyme system. The
nurse should monitor for a potential decrease in the therapeutic effect of which concomitant
medication?
