WGU D116 – Advanced Pharmacology
for the Advanced Practice Nurse Original
Questions with Detailed Rationales
1. Patient prescribed levothyroxine 75 mcg daily. Which instruction is
correct for APRN to give?
A. Take with breakfast and coffee
B. Take at bedtime with calcium carbonate
C. Take on empty stomach 30-60 min before breakfast, separate
calcium, iron, soy, coffee by 4 hours, same time daily
D. Take only when feeling tired
Answer: C
Rationale: Food, calcium, iron, soy, coffee reduce levothyroxine
absorption up to 40%. Must take consistently on empty stomach.
Check TSH 4-6 weeks after change, monitor for hyperthyroid
symptoms. Increases warfarin effect.
2. Patient on metformin 1000 mg BID with eGFR 25 mL/min and
scheduled for contrast CT tomorrow. APRN action?
A. Continue metformin
B. Hold metformin today, check BUN/creatinine, hold 48h after
contrast per protocol, assess lactic acidosis risk, monitor B12 long-
term, counsel avoid excessive alcohol
C. Double dose
D. Metformin commonly causes hypoglycemia alone
Answer: B
Rationale: Metformin does NOT cause hypoglycemia alone. Lactic
, acidosis risk increases with renal impairment eGFR <30
contraindicated, dehydration, hypoxia, contrast, alcohol. Hold for
contrast, assess renal function. Long-term reduces B12
absorption.
3. Patient started lisinopril 10 mg daily for HTN. Which adverse effect
requires emergency care?
A. Dry cough
B. Angioedema of lips, tongue, face with difficulty breathing
C. Mild dizziness first dose
D. Increased urination
Answer: B
Rationale: ACE inhibitor causes bradykinin accumulation.
Angioedema is airway emergency, more common in Black patients
and with history angioedema. Dry cough common 10%,
hyperkalemia, teratogenic, first-dose hypotension. Do not
rechallenge with ACE or ARB after angioedema.
4. Warfarin patient INR 6.8 with active hematuria and epistaxis.
APRN orders?
A. Continue warfarin
B. Hold warfarin, give oral Vitamin K if non-life-threatening, IV
Vitamin K slow + 4-factor PCC for life-threatening bleed, check
interacting antibiotics, assess diet
C. Give protamine
D. Give aspirin
Answer: B
Rationale: Vitamin K takes 6-24h to synthesize factors in liver. PCC
provides immediate factors II, VII, IX, X. Oral Vitamin K preferred
, for non-bleeding high INR to avoid anaphylaxis with IV. Many
antibiotics and fluconazole raise INR.
5. Patient on atorvastatin 80 mg reports severe bilateral muscle pain,
weakness, dark cola urine after starting clarithromycin. Diagnosis
and action?
A. Continue statin
B. Suspect rhabdomyolysis, hold statin and clarithromycin, check
CK >10x ULN, LFTs, BMP for AKI, hydrate
C. Add grapefruit juice
D. Increase statin
Answer: B
Rationale: Clarithromycin is strong CYP3A4 inhibitor raising
atorvastatin level. Rhabdomyolysis releases myoglobin causing
AKI. Check CK, renal function. Educate to report muscle pain.
6. Metoprolol succinate 50 mg daily. Patient wants to stop because
HR 58. APRN teaching?
A. Stop abruptly today
B. Do not stop abruptly, taper over 1-2 weeks, risk rebound HTN,
tachycardia, angina, MI due to receptor upregulation, monitor HR,
BP, masks hypoglycemia tachycardia
C. No rebound risk
D. Stop and start prazosin same day
Answer: B
Rationale: Beta-blocker withdrawal causes sympathetic overdrive.
Taper. Masks hypoglycemia tachycardia but not sweating. Causes
bradycardia, fatigue, depression.
, 7. Digoxin 0.25 mg daily, K+ 2.9, Mg++ 1.5, HR 48, nausea, visual
halos, confusion. Level 2.4 ng/mL. APRN action?
A. Continue digoxin
B. Hold digoxin, correct K+ to 3.5-5 and Mg++ >2, check digoxin
level, renal function, ECG for AV block, consider Digoxin immune
Fab for severe toxicity
C. Give extra digoxin
D. K+ not important
Answer: B
Rationale: Therapeutic 0.8-2.0 ng/mL. Hypokalemia and
hypomagnesemia increase binding to Na/K ATPase causing toxicity
at normal level. Fab binds digoxin.
8. Heparin infusion for PE, aPTT 45 sec goal 60-80 sec. Patient
platelets dropped from 250k to 90k day 6. APRN action?
A. Continue heparin, platelets not important
B. Suspect HIT, stop all heparin and LMWH, order PF4 antibody,
avoid platelet transfusion, start non-heparin anticoagulant
argatroban
C. Give platelets
D. Increase heparin
Answer: B
Rationale: HIT type II immune-mediated 5-10 days, platelet drop
>50%, paradoxical clot risk. Stop heparin including flushes and
LMWH. Argatroban does not cross-react.
9. Clopidogrel 75 mg daily after DES stent + omeprazole for GERD.
Concern?
A. No interaction
B. Omeprazole inhibits CYP2C19 reducing clopidogrel activation,
for the Advanced Practice Nurse Original
Questions with Detailed Rationales
1. Patient prescribed levothyroxine 75 mcg daily. Which instruction is
correct for APRN to give?
A. Take with breakfast and coffee
B. Take at bedtime with calcium carbonate
C. Take on empty stomach 30-60 min before breakfast, separate
calcium, iron, soy, coffee by 4 hours, same time daily
D. Take only when feeling tired
Answer: C
Rationale: Food, calcium, iron, soy, coffee reduce levothyroxine
absorption up to 40%. Must take consistently on empty stomach.
Check TSH 4-6 weeks after change, monitor for hyperthyroid
symptoms. Increases warfarin effect.
2. Patient on metformin 1000 mg BID with eGFR 25 mL/min and
scheduled for contrast CT tomorrow. APRN action?
A. Continue metformin
B. Hold metformin today, check BUN/creatinine, hold 48h after
contrast per protocol, assess lactic acidosis risk, monitor B12 long-
term, counsel avoid excessive alcohol
C. Double dose
D. Metformin commonly causes hypoglycemia alone
Answer: B
Rationale: Metformin does NOT cause hypoglycemia alone. Lactic
, acidosis risk increases with renal impairment eGFR <30
contraindicated, dehydration, hypoxia, contrast, alcohol. Hold for
contrast, assess renal function. Long-term reduces B12
absorption.
3. Patient started lisinopril 10 mg daily for HTN. Which adverse effect
requires emergency care?
A. Dry cough
B. Angioedema of lips, tongue, face with difficulty breathing
C. Mild dizziness first dose
D. Increased urination
Answer: B
Rationale: ACE inhibitor causes bradykinin accumulation.
Angioedema is airway emergency, more common in Black patients
and with history angioedema. Dry cough common 10%,
hyperkalemia, teratogenic, first-dose hypotension. Do not
rechallenge with ACE or ARB after angioedema.
4. Warfarin patient INR 6.8 with active hematuria and epistaxis.
APRN orders?
A. Continue warfarin
B. Hold warfarin, give oral Vitamin K if non-life-threatening, IV
Vitamin K slow + 4-factor PCC for life-threatening bleed, check
interacting antibiotics, assess diet
C. Give protamine
D. Give aspirin
Answer: B
Rationale: Vitamin K takes 6-24h to synthesize factors in liver. PCC
provides immediate factors II, VII, IX, X. Oral Vitamin K preferred
, for non-bleeding high INR to avoid anaphylaxis with IV. Many
antibiotics and fluconazole raise INR.
5. Patient on atorvastatin 80 mg reports severe bilateral muscle pain,
weakness, dark cola urine after starting clarithromycin. Diagnosis
and action?
A. Continue statin
B. Suspect rhabdomyolysis, hold statin and clarithromycin, check
CK >10x ULN, LFTs, BMP for AKI, hydrate
C. Add grapefruit juice
D. Increase statin
Answer: B
Rationale: Clarithromycin is strong CYP3A4 inhibitor raising
atorvastatin level. Rhabdomyolysis releases myoglobin causing
AKI. Check CK, renal function. Educate to report muscle pain.
6. Metoprolol succinate 50 mg daily. Patient wants to stop because
HR 58. APRN teaching?
A. Stop abruptly today
B. Do not stop abruptly, taper over 1-2 weeks, risk rebound HTN,
tachycardia, angina, MI due to receptor upregulation, monitor HR,
BP, masks hypoglycemia tachycardia
C. No rebound risk
D. Stop and start prazosin same day
Answer: B
Rationale: Beta-blocker withdrawal causes sympathetic overdrive.
Taper. Masks hypoglycemia tachycardia but not sweating. Causes
bradycardia, fatigue, depression.
, 7. Digoxin 0.25 mg daily, K+ 2.9, Mg++ 1.5, HR 48, nausea, visual
halos, confusion. Level 2.4 ng/mL. APRN action?
A. Continue digoxin
B. Hold digoxin, correct K+ to 3.5-5 and Mg++ >2, check digoxin
level, renal function, ECG for AV block, consider Digoxin immune
Fab for severe toxicity
C. Give extra digoxin
D. K+ not important
Answer: B
Rationale: Therapeutic 0.8-2.0 ng/mL. Hypokalemia and
hypomagnesemia increase binding to Na/K ATPase causing toxicity
at normal level. Fab binds digoxin.
8. Heparin infusion for PE, aPTT 45 sec goal 60-80 sec. Patient
platelets dropped from 250k to 90k day 6. APRN action?
A. Continue heparin, platelets not important
B. Suspect HIT, stop all heparin and LMWH, order PF4 antibody,
avoid platelet transfusion, start non-heparin anticoagulant
argatroban
C. Give platelets
D. Increase heparin
Answer: B
Rationale: HIT type II immune-mediated 5-10 days, platelet drop
>50%, paradoxical clot risk. Stop heparin including flushes and
LMWH. Argatroban does not cross-react.
9. Clopidogrel 75 mg daily after DES stent + omeprazole for GERD.
Concern?
A. No interaction
B. Omeprazole inhibits CYP2C19 reducing clopidogrel activation,
