ARIZONA COLLEGE OF NURSING
NUR 354: PHARMACOLOGY II — EXAM 3
Semester: Fall 2026 | | Time Allowed: 120 Minutes
Q1. Which lipoprotein contains the highest amount of cholesterol and transports it from the liver to tissues,
causing plaque buildup in coronary arteries?
A) Chylomicrons
B) Very Low-Density Lipoprotein (VLDL)
C) Low-Density Lipoprotein (LDL)
D) High-Density Lipoprotein (HDL)
✔ [Correct Answer: C] — Low-Density Lipoprotein (LDL)
Rationale: LDL (bad cholesterol) carries the highest amount of cholesterol from the liver to tissues and organs, causing
plaque buildup and increasing coronary artery disease risk. Normal level is < 100 mg/dL.
Q2. A nurse is providing education to a patient newly prescribed atorvastatin. Which statement by the patient
demonstrates understanding of administration guidelines?
A) I should stop the drug immediately if I do not notice cholesterol changes in 3 days.
B) I should drink a glass of fresh grapefruit juice every morning with my pill.
C) I should take this medication in the evening with food to reduce stomach upset.
D) I can continue taking red yeast rice supplements to boost the medication effect.
✔ [Correct Answer: C] — I should take this medication in the evening with food to reduce stomach upset.
Rationale: Statins are preferred at bedtime/nighttime because cholesterol synthesis peaks at night. Atorvastatin should
be taken with food to decrease GI discomfort. Grapefruit juice inhibits metabolism leading to toxicity, and red yeast
rice adds unmonitored natural statins.
Q3. A patient taking rosuvastatin reports new-onset muscle pain, muscle weakness, and dark-colored urine.
What is the priority nursing action?
A) Advise the patient that muscle fatigue is normal and will resolve in 4 weeks.
B) Notify the healthcare provider and request a Creatine Kinase (CK) lab level.
C) Administer an over-the-counter NSAID and instruct the patient to rest.
D) Encourage the patient to perform heavy leg stretching exercises.
✔ [Correct Answer: B] — Notify the healthcare provider and request a Creatine Kinase (CK) lab level.
Rationale: New-onset muscle pain and dark urine are signs of rhabdomyolysis, a fatal breakdown of skeletal muscle
tissue. Creatine kinase (CK) levels must be checked immediately to confirm muscle damage.
Confidential — Fall 2026 Official Examination Page 1
Paper
,ARIZONA COLLEGE OF NURSING — NUR 354 PHARMACOLOGY II EXAM 3 COMPREHENSIVE PAPER (FALL
2026)
Q4. Which lipid component accounts for approximately 90% of total energy storage in the body?
A) Phospholipids
B) Triglycerides
C) Steroids
D) Apoproteins
✔ [Correct Answer: B] — Triglycerides
Rationale: Triglycerides are neutral fats that serve as the major energy source, accounting for 90% of stored energy in
the human body.
Q5. Which lab finding meets the diagnostic criteria for Metabolic Syndrome when assessing cardiovascular
risk?
A) Serum LDL cholesterol > 190 mg/dL as an isolated finding
B) Serum potassium level < 3.2 mEq/L and elevated creatinine
C) Fasting blood glucose elevated, low HDL, large waistline, high blood pressure, and high triglycerides (3 or
more present)
D) Total serum cholesterol level of 180 mg/dL
✔ [Correct Answer: C] — Fasting blood glucose elevated, low HDL, large waistline, high blood pressure, and high
triglycerides (3 or more present)
Rationale: Metabolic syndrome requires the presence of at least 3 of the following 5 factors: large waistline, high blood
pressure, high fasting blood sugar, high triglycerides, and low HDL.
Q6. How long must a patient receive atorvastatin therapy before therapeutic reductions in blood-lipid levels are
typically recognized?
A) 6 months
B) 24 to 48 hours
C) At least 2 weeks
D) 30 to 60 days
✔ [Correct Answer: C] — At least 2 weeks
Rationale: At least 2 weeks of statin therapy is required before the therapeutic lipid-lowering effects are recognized in
clinical laboratory evaluations.
Q7. Which pregnancy category classification applies to HMG-CoA reductase inhibitors (statins) such as
atorvastatin?
A) Category X (Contraindicated in pregnancy and lactation)
B) Category A (Safe in all trimesters)
C) Category C (Risk cannot be ruled out)
D) Category B (No demonstrated human risk)
✔ [Correct Answer: A] — Category X (Contraindicated in pregnancy and lactation)
Rationale: Statins are Category X. They interfere with essential fetal lipid synthesis and are strictly contraindicated
during pregnancy and breastfeeding.
Confidential — Fall 2026 Official Examination Page 2
Paper
, ARIZONA COLLEGE OF NURSING — NUR 354 PHARMACOLOGY II EXAM 3 COMPREHENSIVE PAPER (FALL
2026)
Q8. A nurse is evaluating a lipid panel. Which result indicates a desirable level protective against
cardiovascular disease?
A) HDL cholesterol 18 mg/dL
B) HDL cholesterol > 60 mg/dL
C) Triglycerides 280 mg/dL
D) LDL cholesterol 160 mg/dL
✔ [Correct Answer: B] — HDL cholesterol > 60 mg/dL
Rationale: HDL (good cholesterol) removes cholesterol from tissues back to the liver for excretion. An HDL > 60 mg/dL
is protective against heart disease, while an HDL < 40-45 mg/dL represents increased risk.
Q9. Primary baseline laboratory monitoring prior to starting statin therapy includes which tests?
A) Lipid panel, AST/ALT (liver function tests), and baseline Creatine Kinase (CK)
B) Arterial blood gases and serum amylase
C) Serum digoxin level and PT/INR
D) aPTT and platelet count
✔ [Correct Answer: A] — Lipid panel, AST/ALT (liver function tests), and baseline Creatine Kinase (CK)
Rationale: Baseline assessments for statin therapy require a complete lipid panel, liver enzymes (AST/ALT) due to risk
of hepatotoxicity, and baseline CK to evaluate muscle tissue.
Q10. What is the primary cellular mechanism by which statins reduce circulating LDL levels by over 50%?
A) Binding bile acids in the small intestine to increase fecal elimination
B) Activating lipoprotein lipase to break down chylomicrons
C) Inhibiting cholesterol absorption at the brush border of the jejunum
D) Inhibiting HMG-CoA reductase and increasing LDL receptor activity in the liver
✔ [Correct Answer: D] — Inhibiting HMG-CoA reductase and increasing LDL receptor activity in the liver
Rationale: Statins inhibit HMG-CoA reductase (the rate-limiting enzyme in hepatic cholesterol synthesis). The liver
responds by upregulating LDL cell-surface receptors, pulling over 50% of LDL out of the bloodstream.
Q11. A patient is prescribed cholestyramine powder for hyperlipidemia. Which instructions must the nurse
emphasize regarding administration timing with other oral medications?
A) Dissolve cholestyramine in carbonated soda and take at bedtime with all vitamins.
B) Administer other oral drugs 2 hours before or 4 hours after taking cholestyramine.
C) Take all daily oral medications simultaneously mixed into the cholestyramine slurry.
D) Take cholestyramine strictly 15 minutes after swallowing other daily prescriptions.
✔ [Correct Answer: B] — Administer other oral drugs 2 hours before or 4 hours after taking cholestyramine.
Rationale: Cholestyramine binds to other drugs in the GI tract, preventing their absorption. Other medications must be
given 2 hours before or 4 hours after cholestyramine.
Confidential — Fall 2026 Official Examination Page 3
Paper
NUR 354: PHARMACOLOGY II — EXAM 3
Semester: Fall 2026 | | Time Allowed: 120 Minutes
Q1. Which lipoprotein contains the highest amount of cholesterol and transports it from the liver to tissues,
causing plaque buildup in coronary arteries?
A) Chylomicrons
B) Very Low-Density Lipoprotein (VLDL)
C) Low-Density Lipoprotein (LDL)
D) High-Density Lipoprotein (HDL)
✔ [Correct Answer: C] — Low-Density Lipoprotein (LDL)
Rationale: LDL (bad cholesterol) carries the highest amount of cholesterol from the liver to tissues and organs, causing
plaque buildup and increasing coronary artery disease risk. Normal level is < 100 mg/dL.
Q2. A nurse is providing education to a patient newly prescribed atorvastatin. Which statement by the patient
demonstrates understanding of administration guidelines?
A) I should stop the drug immediately if I do not notice cholesterol changes in 3 days.
B) I should drink a glass of fresh grapefruit juice every morning with my pill.
C) I should take this medication in the evening with food to reduce stomach upset.
D) I can continue taking red yeast rice supplements to boost the medication effect.
✔ [Correct Answer: C] — I should take this medication in the evening with food to reduce stomach upset.
Rationale: Statins are preferred at bedtime/nighttime because cholesterol synthesis peaks at night. Atorvastatin should
be taken with food to decrease GI discomfort. Grapefruit juice inhibits metabolism leading to toxicity, and red yeast
rice adds unmonitored natural statins.
Q3. A patient taking rosuvastatin reports new-onset muscle pain, muscle weakness, and dark-colored urine.
What is the priority nursing action?
A) Advise the patient that muscle fatigue is normal and will resolve in 4 weeks.
B) Notify the healthcare provider and request a Creatine Kinase (CK) lab level.
C) Administer an over-the-counter NSAID and instruct the patient to rest.
D) Encourage the patient to perform heavy leg stretching exercises.
✔ [Correct Answer: B] — Notify the healthcare provider and request a Creatine Kinase (CK) lab level.
Rationale: New-onset muscle pain and dark urine are signs of rhabdomyolysis, a fatal breakdown of skeletal muscle
tissue. Creatine kinase (CK) levels must be checked immediately to confirm muscle damage.
Confidential — Fall 2026 Official Examination Page 1
Paper
,ARIZONA COLLEGE OF NURSING — NUR 354 PHARMACOLOGY II EXAM 3 COMPREHENSIVE PAPER (FALL
2026)
Q4. Which lipid component accounts for approximately 90% of total energy storage in the body?
A) Phospholipids
B) Triglycerides
C) Steroids
D) Apoproteins
✔ [Correct Answer: B] — Triglycerides
Rationale: Triglycerides are neutral fats that serve as the major energy source, accounting for 90% of stored energy in
the human body.
Q5. Which lab finding meets the diagnostic criteria for Metabolic Syndrome when assessing cardiovascular
risk?
A) Serum LDL cholesterol > 190 mg/dL as an isolated finding
B) Serum potassium level < 3.2 mEq/L and elevated creatinine
C) Fasting blood glucose elevated, low HDL, large waistline, high blood pressure, and high triglycerides (3 or
more present)
D) Total serum cholesterol level of 180 mg/dL
✔ [Correct Answer: C] — Fasting blood glucose elevated, low HDL, large waistline, high blood pressure, and high
triglycerides (3 or more present)
Rationale: Metabolic syndrome requires the presence of at least 3 of the following 5 factors: large waistline, high blood
pressure, high fasting blood sugar, high triglycerides, and low HDL.
Q6. How long must a patient receive atorvastatin therapy before therapeutic reductions in blood-lipid levels are
typically recognized?
A) 6 months
B) 24 to 48 hours
C) At least 2 weeks
D) 30 to 60 days
✔ [Correct Answer: C] — At least 2 weeks
Rationale: At least 2 weeks of statin therapy is required before the therapeutic lipid-lowering effects are recognized in
clinical laboratory evaluations.
Q7. Which pregnancy category classification applies to HMG-CoA reductase inhibitors (statins) such as
atorvastatin?
A) Category X (Contraindicated in pregnancy and lactation)
B) Category A (Safe in all trimesters)
C) Category C (Risk cannot be ruled out)
D) Category B (No demonstrated human risk)
✔ [Correct Answer: A] — Category X (Contraindicated in pregnancy and lactation)
Rationale: Statins are Category X. They interfere with essential fetal lipid synthesis and are strictly contraindicated
during pregnancy and breastfeeding.
Confidential — Fall 2026 Official Examination Page 2
Paper
, ARIZONA COLLEGE OF NURSING — NUR 354 PHARMACOLOGY II EXAM 3 COMPREHENSIVE PAPER (FALL
2026)
Q8. A nurse is evaluating a lipid panel. Which result indicates a desirable level protective against
cardiovascular disease?
A) HDL cholesterol 18 mg/dL
B) HDL cholesterol > 60 mg/dL
C) Triglycerides 280 mg/dL
D) LDL cholesterol 160 mg/dL
✔ [Correct Answer: B] — HDL cholesterol > 60 mg/dL
Rationale: HDL (good cholesterol) removes cholesterol from tissues back to the liver for excretion. An HDL > 60 mg/dL
is protective against heart disease, while an HDL < 40-45 mg/dL represents increased risk.
Q9. Primary baseline laboratory monitoring prior to starting statin therapy includes which tests?
A) Lipid panel, AST/ALT (liver function tests), and baseline Creatine Kinase (CK)
B) Arterial blood gases and serum amylase
C) Serum digoxin level and PT/INR
D) aPTT and platelet count
✔ [Correct Answer: A] — Lipid panel, AST/ALT (liver function tests), and baseline Creatine Kinase (CK)
Rationale: Baseline assessments for statin therapy require a complete lipid panel, liver enzymes (AST/ALT) due to risk
of hepatotoxicity, and baseline CK to evaluate muscle tissue.
Q10. What is the primary cellular mechanism by which statins reduce circulating LDL levels by over 50%?
A) Binding bile acids in the small intestine to increase fecal elimination
B) Activating lipoprotein lipase to break down chylomicrons
C) Inhibiting cholesterol absorption at the brush border of the jejunum
D) Inhibiting HMG-CoA reductase and increasing LDL receptor activity in the liver
✔ [Correct Answer: D] — Inhibiting HMG-CoA reductase and increasing LDL receptor activity in the liver
Rationale: Statins inhibit HMG-CoA reductase (the rate-limiting enzyme in hepatic cholesterol synthesis). The liver
responds by upregulating LDL cell-surface receptors, pulling over 50% of LDL out of the bloodstream.
Q11. A patient is prescribed cholestyramine powder for hyperlipidemia. Which instructions must the nurse
emphasize regarding administration timing with other oral medications?
A) Dissolve cholestyramine in carbonated soda and take at bedtime with all vitamins.
B) Administer other oral drugs 2 hours before or 4 hours after taking cholestyramine.
C) Take all daily oral medications simultaneously mixed into the cholestyramine slurry.
D) Take cholestyramine strictly 15 minutes after swallowing other daily prescriptions.
✔ [Correct Answer: B] — Administer other oral drugs 2 hours before or 4 hours after taking cholestyramine.
Rationale: Cholestyramine binds to other drugs in the GI tract, preventing their absorption. Other medications must be
given 2 hours before or 4 hours after cholestyramine.
Confidential — Fall 2026 Official Examination Page 3
Paper
