NR 508 Advanced Pharmacology Midterm Exam
Chamberlain University | 75 Multiple Questions And
Answers With Rationales 100% Verified | 2026/2027
Question 1.
A patient is admitted with lower abdominal pain and nausea. The nurse performing the
initial assessment notes that the patient's abdomen is distended and firm, and hypoactive
bowel sounds are present. The patient has not had a stool for 3 days. The nurse will
contact the provider, who will:
A. Prescribe a stimulant laxative and discharge the patient.
B. Perform diagnostic testing.
C. Administer an enema and reassess in 1 hour.
D. Begin total parenteral nutrition immediately.
Correct Answer: B
Rationale:
A distended, firm abdomen with hypoactive bowel sounds and obstipation for 3 days suggests a
mechanical bowel obstruction or paralytic ileus. Diagnostic testing (abdominal X-ray, CT scan) is
required to determine etiology before treatment. Laxatives and enemas are contraindicated in
suspected obstruction, and TPN is not the immediate priority.
Question 2.
A 58-year-old patient with type 2 diabetes and stage 3 chronic kidney disease (eGFR 38
mL/min/1.73 m²) requires an oral antihyperglycemic agent. Which medication is most
appropriate?
A. Metformin 1000 mg PO BID
B. Glyburide 5 mg PO daily
C. Linagliptin 5 mg PO daily
D. Pioglitazone 30 mg PO daily
Correct Answer: C
Rationale:
,Linagliptin is a DPP-4 inhibitor that is primarily eliminated via the enterohepatic system and
requires no renal dose adjustment, making it safe in CKD. Metformin is contraindicated when
eGFR <30 mL/min/1.73 m² and should be used with caution at eGFR 30–45. Glyburide
accumulates in renal impairment and increases the risk of severe hypoglycemia. Pioglitazone
carries risks of fluid retention and heart failure, which are concerning in CKD.
Question 3.
Which of the following best describes the mechanism of action of metformin?
A. Increases insulin secretion from pancreatic beta cells
B. Decreases hepatic gluconeogenesis and increases insulin sensitivity
C. Inhibits alpha-glucosidase in the small intestine
D. Blocks potassium channels in pancreatic beta cells
Correct Answer: B
Rationale:
Metformin is a biguanide that decreases hepatic glucose production
(gluconeogenesis) and improves peripheral insulin sensitivity. It does not stimulate insulin
secretion, so it does not cause hypoglycemia when used alone. Alpha-glucosidase inhibition
describes acarbose; potassium channel blockade describes sulfonylureas.
Question 4.
A patient on warfarin has an INR of 6.8 and is not actively bleeding. Which intervention is
most appropriate?
A. Administer vitamin K 10 mg IV and hold warfarin
B. Hold warfarin and administer vitamin K 2.5 mg PO
C. Transfuse fresh frozen plasma immediately
D. Continue warfarin and recheck INR in 24 hours
Correct Answer: B
Rationale:
For an INR >6.0 without bleeding, guidelines recommend holding warfarin and administering
low-dose oral vitamin K (2.5 mg). IV vitamin K 10 mg is reserved for serious bleeding and risks
, anaphylactoid reactions and warfarin resistance. FFP is not indicated without active bleeding.
Continuing warfarin would worsen the coagulopathy.
Question 5.
Which antibiotic is contraindicated in a patient with a documented penicillin allergy?
A. Azithromycin
B. Cephalexin
C. Amoxicillin
D. Doxycycline
Correct Answer: C
Rationale:
Amoxicillin is an aminopenicillin and is contraindicated in penicillin allergy. Cephalexin may be
used with caution (cross-reactivity ~1–3%). Azithromycin and doxycycline are safe alternatives.
Question 6.
A 65-year-old patient with hypertension and heart failure with reduced ejection fraction
(HFrEF) should be started on which first-line antihypertensive?
A. Amlodipine
B. Carvedilol
C. Diltiazem
D. Clonidine
Correct Answer: B
Rationale:
Carvedilol is a beta-blocker with evidence for mortality benefit in HFrEF. Amlodipine and
diltiazem are not first-line for HFrEF; diltiazem is contraindicated in HFrEF. Clonidine is not first-
line and causes rebound hypertension.
Question 7.
Which lab value should be monitored in a patient taking spironolactone?
Chamberlain University | 75 Multiple Questions And
Answers With Rationales 100% Verified | 2026/2027
Question 1.
A patient is admitted with lower abdominal pain and nausea. The nurse performing the
initial assessment notes that the patient's abdomen is distended and firm, and hypoactive
bowel sounds are present. The patient has not had a stool for 3 days. The nurse will
contact the provider, who will:
A. Prescribe a stimulant laxative and discharge the patient.
B. Perform diagnostic testing.
C. Administer an enema and reassess in 1 hour.
D. Begin total parenteral nutrition immediately.
Correct Answer: B
Rationale:
A distended, firm abdomen with hypoactive bowel sounds and obstipation for 3 days suggests a
mechanical bowel obstruction or paralytic ileus. Diagnostic testing (abdominal X-ray, CT scan) is
required to determine etiology before treatment. Laxatives and enemas are contraindicated in
suspected obstruction, and TPN is not the immediate priority.
Question 2.
A 58-year-old patient with type 2 diabetes and stage 3 chronic kidney disease (eGFR 38
mL/min/1.73 m²) requires an oral antihyperglycemic agent. Which medication is most
appropriate?
A. Metformin 1000 mg PO BID
B. Glyburide 5 mg PO daily
C. Linagliptin 5 mg PO daily
D. Pioglitazone 30 mg PO daily
Correct Answer: C
Rationale:
,Linagliptin is a DPP-4 inhibitor that is primarily eliminated via the enterohepatic system and
requires no renal dose adjustment, making it safe in CKD. Metformin is contraindicated when
eGFR <30 mL/min/1.73 m² and should be used with caution at eGFR 30–45. Glyburide
accumulates in renal impairment and increases the risk of severe hypoglycemia. Pioglitazone
carries risks of fluid retention and heart failure, which are concerning in CKD.
Question 3.
Which of the following best describes the mechanism of action of metformin?
A. Increases insulin secretion from pancreatic beta cells
B. Decreases hepatic gluconeogenesis and increases insulin sensitivity
C. Inhibits alpha-glucosidase in the small intestine
D. Blocks potassium channels in pancreatic beta cells
Correct Answer: B
Rationale:
Metformin is a biguanide that decreases hepatic glucose production
(gluconeogenesis) and improves peripheral insulin sensitivity. It does not stimulate insulin
secretion, so it does not cause hypoglycemia when used alone. Alpha-glucosidase inhibition
describes acarbose; potassium channel blockade describes sulfonylureas.
Question 4.
A patient on warfarin has an INR of 6.8 and is not actively bleeding. Which intervention is
most appropriate?
A. Administer vitamin K 10 mg IV and hold warfarin
B. Hold warfarin and administer vitamin K 2.5 mg PO
C. Transfuse fresh frozen plasma immediately
D. Continue warfarin and recheck INR in 24 hours
Correct Answer: B
Rationale:
For an INR >6.0 without bleeding, guidelines recommend holding warfarin and administering
low-dose oral vitamin K (2.5 mg). IV vitamin K 10 mg is reserved for serious bleeding and risks
, anaphylactoid reactions and warfarin resistance. FFP is not indicated without active bleeding.
Continuing warfarin would worsen the coagulopathy.
Question 5.
Which antibiotic is contraindicated in a patient with a documented penicillin allergy?
A. Azithromycin
B. Cephalexin
C. Amoxicillin
D. Doxycycline
Correct Answer: C
Rationale:
Amoxicillin is an aminopenicillin and is contraindicated in penicillin allergy. Cephalexin may be
used with caution (cross-reactivity ~1–3%). Azithromycin and doxycycline are safe alternatives.
Question 6.
A 65-year-old patient with hypertension and heart failure with reduced ejection fraction
(HFrEF) should be started on which first-line antihypertensive?
A. Amlodipine
B. Carvedilol
C. Diltiazem
D. Clonidine
Correct Answer: B
Rationale:
Carvedilol is a beta-blocker with evidence for mortality benefit in HFrEF. Amlodipine and
diltiazem are not first-line for HFrEF; diltiazem is contraindicated in HFrEF. Clonidine is not first-
line and causes rebound hypertension.
Question 7.
Which lab value should be monitored in a patient taking spironolactone?
