NUR 521 Advanced Pharmacology
– Exam 4 Blueprint Study Guide |
Practice Questions, Answers and
Rationales | University of Alabama
| 2026–2027
Description: This comprehensive revision resource contains 200 multiple-choice
questions (MCQs) covering the NUR 521 Advanced Pharmacology Exam 4 blueprint,
including cardiovascular, endocrine, respiratory, gastrointestinal, renal, anti-
infective, and central nervous system pharmacology, with correct answers marked
with ✅ and rationales for each. Questions are mixed in answer order to prevent
pattern guessing and strengthen clinical decision-making.
Keywords: NUR 521, Advanced Pharmacology, Exam 4, University of Alabama, MCQ,
practice questions, rationales, cardiovascular drugs, endocrine drugs, antibiotics,
respiratory pharmacology, CNS pharmacology, 2026–2027.
SECTION 1: Cardiovascular Pharmacology (Questions 1–40)
Q1. A patient with heart failure is prescribed lisinopril. Which mechanism best explains
its therapeutic benefit?
A. Blocks angiotensin II receptors
B. ✅ Inhibits ACE, reducing angiotensin II and aldosterone
C. Directly stimulates beta-1 receptors
D. Inhibits renin release from the kidney
,Rationale: ACE inhibitors reduce angiotensin II and aldosterone, decreasing preload and
afterload.
Q2. Which lab value requires immediate hold of spironolactone?
A. Potassium 3.1 mEq/L
B. Sodium 134 mEq/L
C. ✅ Potassium 5.8 mEq/L
D. Calcium 9.0 mg/dL
Rationale: Spironolactone is potassium-sparing; hyperkalemia is dangerous.
Q3. A patient on metoprolol reports fatigue and HR 48 bpm. What is the priority
action?
A. Give another dose
B. ✅ Hold the drug and notify the provider
C. Encourage caffeine intake
D. Increase dose
Rationale: Beta-blockers can cause bradycardia; hold and notify.
Q4. Which drug is first-line for chronic stable angina?
A. ✅ Beta-blocker
B. Loop diuretic
C. ACE inhibitor
D. Calcium channel blocker (non-dihydropyridine)
Rationale: Beta-blockers reduce myocardial oxygen demand.
Q5. Atorvastatin is best taken at what time?
A. Morning
B. ✅ Evening
C. Noon
D. With breakfast
,Rationale: Cholesterol synthesis peaks at night.
Q6. Which adverse effect is most concerning with amiodarone?
A. Constipation
B. ✅ Pulmonary toxicity
C. Hypertension
D. Hyperglycemia
Rationale: Amiodarone can cause pulmonary fibrosis.
Q7. A patient on warfarin has INR 6.5. What is the antidote?
A. Protamine sulfate
B. ✅ Vitamin K
C. Calcium gluconate
D. Naloxone
Rationale: Vitamin K reverses warfarin.
Q8. Which drug is a direct oral anticoagulant?
A. Warfarin
B. Heparin
C. ✅ Apixaban
D. Enoxaparin
Rationale: Apixaban is a DOAC.
Q9. Digoxin toxicity is potentiated by:
A. ✅ Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Hypocalcemia
Rationale: Low potassium increases digoxin toxicity.
, Q10. Which finding indicates digoxin toxicity?
A. HR 110
B. ✅ Visual halos
C. Hypertension
D. Hyperreflexia
Rationale: Visual disturbances are classic.
Q11. Nitroglycerin sublingual should be administered:
A. With food
B. ✅ At onset of chest pain
C. Only at bedtime
D. With water
Rationale: Rapid relief of angina.
Q12. Which is a contraindication to nitroglycerin?
A. Hypertension
B. ✅ Use of PDE-5 inhibitors
C. Diabetes
D. Asthma
Rationale: Severe hypotension can occur.
Q13. Furosemide works by:
A. ✅ Inhibiting Na-K-2Cl in loop of Henle
B. Blocking aldosterone
C. Inhibiting carbonic anhydrase
D. Blocking sodium channels
Rationale: Loop diuretic mechanism.
Q14. Which electrolyte imbalance is common with furosemide?
A. Hyperkalemia
– Exam 4 Blueprint Study Guide |
Practice Questions, Answers and
Rationales | University of Alabama
| 2026–2027
Description: This comprehensive revision resource contains 200 multiple-choice
questions (MCQs) covering the NUR 521 Advanced Pharmacology Exam 4 blueprint,
including cardiovascular, endocrine, respiratory, gastrointestinal, renal, anti-
infective, and central nervous system pharmacology, with correct answers marked
with ✅ and rationales for each. Questions are mixed in answer order to prevent
pattern guessing and strengthen clinical decision-making.
Keywords: NUR 521, Advanced Pharmacology, Exam 4, University of Alabama, MCQ,
practice questions, rationales, cardiovascular drugs, endocrine drugs, antibiotics,
respiratory pharmacology, CNS pharmacology, 2026–2027.
SECTION 1: Cardiovascular Pharmacology (Questions 1–40)
Q1. A patient with heart failure is prescribed lisinopril. Which mechanism best explains
its therapeutic benefit?
A. Blocks angiotensin II receptors
B. ✅ Inhibits ACE, reducing angiotensin II and aldosterone
C. Directly stimulates beta-1 receptors
D. Inhibits renin release from the kidney
,Rationale: ACE inhibitors reduce angiotensin II and aldosterone, decreasing preload and
afterload.
Q2. Which lab value requires immediate hold of spironolactone?
A. Potassium 3.1 mEq/L
B. Sodium 134 mEq/L
C. ✅ Potassium 5.8 mEq/L
D. Calcium 9.0 mg/dL
Rationale: Spironolactone is potassium-sparing; hyperkalemia is dangerous.
Q3. A patient on metoprolol reports fatigue and HR 48 bpm. What is the priority
action?
A. Give another dose
B. ✅ Hold the drug and notify the provider
C. Encourage caffeine intake
D. Increase dose
Rationale: Beta-blockers can cause bradycardia; hold and notify.
Q4. Which drug is first-line for chronic stable angina?
A. ✅ Beta-blocker
B. Loop diuretic
C. ACE inhibitor
D. Calcium channel blocker (non-dihydropyridine)
Rationale: Beta-blockers reduce myocardial oxygen demand.
Q5. Atorvastatin is best taken at what time?
A. Morning
B. ✅ Evening
C. Noon
D. With breakfast
,Rationale: Cholesterol synthesis peaks at night.
Q6. Which adverse effect is most concerning with amiodarone?
A. Constipation
B. ✅ Pulmonary toxicity
C. Hypertension
D. Hyperglycemia
Rationale: Amiodarone can cause pulmonary fibrosis.
Q7. A patient on warfarin has INR 6.5. What is the antidote?
A. Protamine sulfate
B. ✅ Vitamin K
C. Calcium gluconate
D. Naloxone
Rationale: Vitamin K reverses warfarin.
Q8. Which drug is a direct oral anticoagulant?
A. Warfarin
B. Heparin
C. ✅ Apixaban
D. Enoxaparin
Rationale: Apixaban is a DOAC.
Q9. Digoxin toxicity is potentiated by:
A. ✅ Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Hypocalcemia
Rationale: Low potassium increases digoxin toxicity.
, Q10. Which finding indicates digoxin toxicity?
A. HR 110
B. ✅ Visual halos
C. Hypertension
D. Hyperreflexia
Rationale: Visual disturbances are classic.
Q11. Nitroglycerin sublingual should be administered:
A. With food
B. ✅ At onset of chest pain
C. Only at bedtime
D. With water
Rationale: Rapid relief of angina.
Q12. Which is a contraindication to nitroglycerin?
A. Hypertension
B. ✅ Use of PDE-5 inhibitors
C. Diabetes
D. Asthma
Rationale: Severe hypotension can occur.
Q13. Furosemide works by:
A. ✅ Inhibiting Na-K-2Cl in loop of Henle
B. Blocking aldosterone
C. Inhibiting carbonic anhydrase
D. Blocking sodium channels
Rationale: Loop diuretic mechanism.
Q14. Which electrolyte imbalance is common with furosemide?
A. Hyperkalemia
