NURS 5334 UTA ADVANCED PHARMACOLOGY LATEST EXAM 2026/2027
COMPLETE APPROVED QUESTIONS WITH WELL ELABORATED ANSWERS
AND DETAILED RATIONALES
1. A 67-year-old patient with hypertension, type 2 diabetes, and chronic
kidney disease is prescribed a new medication that is highly protein bound
and primarily metabolized by the liver. The patient asks why age and kidney
function are considered before selecting the dose. Which pharmacokinetic
principle best explains the concern?
A. Older adults always absorb medications more rapidly
B. Renal and hepatic changes can alter drug clearance and increase systemic
exposure
C. Protein binding eliminates age-related pharmacokinetic changes
D. Aging consistently increases hepatic enzyme activity
Answer: B
2. A patient taking warfarin is prescribed a new medication that inhibits
hepatic CYP2C9 activity. Several days later, the patient's INR is substantially
elevated. Which explanation best describes the interaction?
A. The new medication increases renal elimination of warfarin
B. The new medication decreases warfarin absorption
C. CYP2C9 inhibition can reduce warfarin metabolism and increase
anticoagulant exposure
D. Warfarin induces metabolism of the new medication
Answer: C
3. A patient with asthma uses albuterol several times each day and reports
nighttime wheezing. The FNP determines that the patient's asthma is not
adequately controlled. Which pharmacologic principle should guide long-
term therapy?
A. Frequent rescue-inhaler use should prompt reassessment and
optimization of controller therapy
B. Short-acting bronchodilators should be increased indefinitely without
reassessment
pg. 1
, C. Inhaled corticosteroids should be discontinued when rescue medication
use increases
D. Oral antibiotics should routinely be added for persistent wheezing
Answer: A
4. A patient taking an inhaled corticosteroid for persistent asthma reports
hoarseness and develops white plaques in the mouth. Which intervention is
most appropriate?
A. Stop all asthma therapy permanently
B. Increase the inhaled corticosteroid dose immediately
C. Replace the inhaled corticosteroid with an oral antibiotic
D. Reinforce mouth rinsing after inhalation and assess for oral candidiasis
Answer: D
5. A 55-year-old patient with hypertension is started on lisinopril. Two weeks
later, the patient reports a persistent dry cough but has no dyspnea or fever.
Which medication-related adverse effect is most likely responsible?
A. Bradykinin accumulation associated with ACE inhibition
B. Histamine depletion
C. Increased acetylcholine release
D. Dopamine receptor stimulation
Answer: A
6. A patient taking lisinopril develops facial swelling, tongue swelling, and
difficulty breathing shortly after taking the medication. Which action is the
priority?
A. Continue the medication and monitor at home
B. Administer the next dose with food
C. Recognize possible ACE-inhibitor-associated angioedema and initiate
emergency management
D. Switch to a higher ACE inhibitor dose
Answer: C
7. A patient with hypertension and diabetic kidney disease is being considered
for an ACE inhibitor. Which therapeutic effect makes this class particularly
pg. 2
, useful in this setting?
A. Direct stimulation of insulin secretion
B. Reduction of intraglomerular pressure and potential renal protection
C. Increased sodium retention
D. Suppression of pancreatic glucagon release
Answer: B
8. A patient taking an angiotensin receptor blocker develops elevated
potassium and worsening renal function after becoming dehydrated from
severe diarrhea. Which pharmacologic principle is most relevant?
A. Dehydration can reduce renal perfusion and increase the risk of adverse
effects from renally active medications
B. ARBs always increase renal clearance during dehydration
C. Hyperkalemia is unrelated to renin-angiotensin system blockade
D. Diarrhea prevents all ARB absorption
Answer: A
9. A patient with hypertension has a resting heart rate of 48 beats/minute and
asks about starting a beta blocker. Which consideration is most important?
A. Beta blockers routinely increase resting heart rate
B. Bradycardia may be worsened by beta blockade
C. Beta blockers have no cardiovascular effects
D. Bradycardia guarantees treatment failure with every antihypertensive
Answer: B
10. A patient with asthma requires treatment for hypertension. Which
medication class should be used cautiously because nonselective beta
blockade can provoke bronchospasm?
A. Thiazide diuretics
B. Calcium channel blockers
C. Nonselective beta blockers
D. Angiotensin receptor blockers
Answer: C
pg. 3
, 11. A patient taking amlodipine develops bilateral ankle edema without
dyspnea or signs of heart failure. Which mechanism best explains this
adverse effect?
A. Increased renal sodium excretion
B. Arteriolar dilation increasing capillary hydrostatic pressure
C. Direct myocardial toxicity
D. Reduced venous pressure caused by excessive diuresis
Answer: B
12. A patient with hypertension is prescribed hydrochlorothiazide. Which
laboratory abnormality should the FNP monitor particularly closely during
therapy?
A. Hypernatremia caused by universal sodium retention
B. Hyperkalemia
C. Hypokalemia and related electrolyte abnormalities
D. Severe hypermagnesemia in every patient
Answer: C
13. A patient taking a thiazide diuretic develops acute pain, redness, and
swelling of the first metatarsophalangeal joint. Which medication-related
effect should be considered?
A. Thiazide-associated hyperuricemia
B. Thiazide-induced hypoglycemia
C. Direct cartilage destruction
D. Increased uric acid elimination
Answer: A
14. A patient with hypertension and benign prostatic hyperplasia is started on
an alpha-1 adrenergic antagonist. Which counseling point is especially
important when therapy begins?
A. The medication always causes severe hypertension
B. The patient should expect permanent tachycardia
C. The patient should avoid all fluids
pg. 4
COMPLETE APPROVED QUESTIONS WITH WELL ELABORATED ANSWERS
AND DETAILED RATIONALES
1. A 67-year-old patient with hypertension, type 2 diabetes, and chronic
kidney disease is prescribed a new medication that is highly protein bound
and primarily metabolized by the liver. The patient asks why age and kidney
function are considered before selecting the dose. Which pharmacokinetic
principle best explains the concern?
A. Older adults always absorb medications more rapidly
B. Renal and hepatic changes can alter drug clearance and increase systemic
exposure
C. Protein binding eliminates age-related pharmacokinetic changes
D. Aging consistently increases hepatic enzyme activity
Answer: B
2. A patient taking warfarin is prescribed a new medication that inhibits
hepatic CYP2C9 activity. Several days later, the patient's INR is substantially
elevated. Which explanation best describes the interaction?
A. The new medication increases renal elimination of warfarin
B. The new medication decreases warfarin absorption
C. CYP2C9 inhibition can reduce warfarin metabolism and increase
anticoagulant exposure
D. Warfarin induces metabolism of the new medication
Answer: C
3. A patient with asthma uses albuterol several times each day and reports
nighttime wheezing. The FNP determines that the patient's asthma is not
adequately controlled. Which pharmacologic principle should guide long-
term therapy?
A. Frequent rescue-inhaler use should prompt reassessment and
optimization of controller therapy
B. Short-acting bronchodilators should be increased indefinitely without
reassessment
pg. 1
, C. Inhaled corticosteroids should be discontinued when rescue medication
use increases
D. Oral antibiotics should routinely be added for persistent wheezing
Answer: A
4. A patient taking an inhaled corticosteroid for persistent asthma reports
hoarseness and develops white plaques in the mouth. Which intervention is
most appropriate?
A. Stop all asthma therapy permanently
B. Increase the inhaled corticosteroid dose immediately
C. Replace the inhaled corticosteroid with an oral antibiotic
D. Reinforce mouth rinsing after inhalation and assess for oral candidiasis
Answer: D
5. A 55-year-old patient with hypertension is started on lisinopril. Two weeks
later, the patient reports a persistent dry cough but has no dyspnea or fever.
Which medication-related adverse effect is most likely responsible?
A. Bradykinin accumulation associated with ACE inhibition
B. Histamine depletion
C. Increased acetylcholine release
D. Dopamine receptor stimulation
Answer: A
6. A patient taking lisinopril develops facial swelling, tongue swelling, and
difficulty breathing shortly after taking the medication. Which action is the
priority?
A. Continue the medication and monitor at home
B. Administer the next dose with food
C. Recognize possible ACE-inhibitor-associated angioedema and initiate
emergency management
D. Switch to a higher ACE inhibitor dose
Answer: C
7. A patient with hypertension and diabetic kidney disease is being considered
for an ACE inhibitor. Which therapeutic effect makes this class particularly
pg. 2
, useful in this setting?
A. Direct stimulation of insulin secretion
B. Reduction of intraglomerular pressure and potential renal protection
C. Increased sodium retention
D. Suppression of pancreatic glucagon release
Answer: B
8. A patient taking an angiotensin receptor blocker develops elevated
potassium and worsening renal function after becoming dehydrated from
severe diarrhea. Which pharmacologic principle is most relevant?
A. Dehydration can reduce renal perfusion and increase the risk of adverse
effects from renally active medications
B. ARBs always increase renal clearance during dehydration
C. Hyperkalemia is unrelated to renin-angiotensin system blockade
D. Diarrhea prevents all ARB absorption
Answer: A
9. A patient with hypertension has a resting heart rate of 48 beats/minute and
asks about starting a beta blocker. Which consideration is most important?
A. Beta blockers routinely increase resting heart rate
B. Bradycardia may be worsened by beta blockade
C. Beta blockers have no cardiovascular effects
D. Bradycardia guarantees treatment failure with every antihypertensive
Answer: B
10. A patient with asthma requires treatment for hypertension. Which
medication class should be used cautiously because nonselective beta
blockade can provoke bronchospasm?
A. Thiazide diuretics
B. Calcium channel blockers
C. Nonselective beta blockers
D. Angiotensin receptor blockers
Answer: C
pg. 3
, 11. A patient taking amlodipine develops bilateral ankle edema without
dyspnea or signs of heart failure. Which mechanism best explains this
adverse effect?
A. Increased renal sodium excretion
B. Arteriolar dilation increasing capillary hydrostatic pressure
C. Direct myocardial toxicity
D. Reduced venous pressure caused by excessive diuresis
Answer: B
12. A patient with hypertension is prescribed hydrochlorothiazide. Which
laboratory abnormality should the FNP monitor particularly closely during
therapy?
A. Hypernatremia caused by universal sodium retention
B. Hyperkalemia
C. Hypokalemia and related electrolyte abnormalities
D. Severe hypermagnesemia in every patient
Answer: C
13. A patient taking a thiazide diuretic develops acute pain, redness, and
swelling of the first metatarsophalangeal joint. Which medication-related
effect should be considered?
A. Thiazide-associated hyperuricemia
B. Thiazide-induced hypoglycemia
C. Direct cartilage destruction
D. Increased uric acid elimination
Answer: A
14. A patient with hypertension and benign prostatic hyperplasia is started on
an alpha-1 adrenergic antagonist. Which counseling point is especially
important when therapy begins?
A. The medication always causes severe hypertension
B. The patient should expect permanent tachycardia
C. The patient should avoid all fluids
pg. 4
