NURS 5334 Advanced Pharmacology Final Exam Practice Test
2026 (100 Questions) | Graduate-Level NCLEX-Style with
Answers & Rationales
1. A patient with hypertension is prescribed an ACE inhibitor. Which
mechanism BEST explains how this medication lowers blood pressure?
A. Blocks calcium entry into vascular smooth muscle
B. Inhibits conversion of angiotensin I to angiotensin II
C. Increases sodium excretion in the distal tubule
D. Directly relaxes arterial smooth muscle
✔️ Answer: B
Explanation: ACE inhibitors reduce angiotensin II, leading to vasodilation and decreased
aldosterone secretion.
2. A patient taking Warfarin presents with an INR of 5.2 without bleeding. What
is the MOST appropriate initial action?
A. Continue current dose
B. Administer vitamin K immediately IV
C. Hold the next dose and reassess
D. Start heparin therapy
✔️ Answer: C
Explanation: Elevated INR without bleeding is managed by holding doses and monitoring.
3. A patient is prescribed Metformin. Which condition is a
CONTRAINDICATION for its use?
A. Hypertension
B. Renal impairment
C. Hyperlipidemia
D. Obesity
✔️ Answer: B
Explanation: Metformin can cause lactic acidosis in patients with impaired renal function.
,4. A nurse practitioner prescribes a beta-blocker. What is the PRIMARY effect
of this drug on the heart?
A. Increases myocardial contractility
B. Decreases heart rate and cardiac output
C. Causes vasoconstriction
D. Increases preload
✔️ Answer: B
Explanation: Beta-blockers reduce heart rate and contractility, lowering cardiac output.
5. A patient taking Furosemide reports muscle cramps and weakness. What
electrolyte imbalance is MOST likely?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
✔️ Answer: B
Explanation: Loop diuretics cause potassium loss, leading to hypokalemia.
6. A patient is prescribed Lisinopril and develops a persistent dry cough. What is
the MOST likely cause?
A. Histamine release
B. Increased bradykinin levels
C. Sodium retention
D. Decreased prostaglandins
✔️ Answer: B
Explanation: ACE inhibitors increase bradykinin, causing cough.
7. A patient receiving opioid therapy develops respiratory depression. Which
medication should be administered?
, A. Flumazenil
B. Naloxone
C. Atropine
D. Protamine
✔️ Answer: B
Explanation: Naloxone reverses opioid effects.
8. A patient is taking Digoxin. Which symptom suggests toxicity?
A. Increased appetite
B. Visual disturbances (yellow halos)
C. Hypertension
D. Bradycardia only
✔️ Answer: B
Explanation: Visual changes are classic signs of digoxin toxicity.
9. A patient is prescribed a statin. What is the PRIMARY therapeutic effect?
A. Increase HDL only
B. Reduce LDL cholesterol
C. Increase triglycerides
D. Reduce glucose levels
✔️ Answer: B
Explanation: Statins primarily lower LDL cholesterol.
10. A patient on Heparin develops bleeding. What is the reversal agent?
A. Vitamin K
B. Protamine sulfate
C. Naloxone
D. Atropine
✔️ Answer: B
Explanation: Protamine sulfate neutralizes heparin.
2026 (100 Questions) | Graduate-Level NCLEX-Style with
Answers & Rationales
1. A patient with hypertension is prescribed an ACE inhibitor. Which
mechanism BEST explains how this medication lowers blood pressure?
A. Blocks calcium entry into vascular smooth muscle
B. Inhibits conversion of angiotensin I to angiotensin II
C. Increases sodium excretion in the distal tubule
D. Directly relaxes arterial smooth muscle
✔️ Answer: B
Explanation: ACE inhibitors reduce angiotensin II, leading to vasodilation and decreased
aldosterone secretion.
2. A patient taking Warfarin presents with an INR of 5.2 without bleeding. What
is the MOST appropriate initial action?
A. Continue current dose
B. Administer vitamin K immediately IV
C. Hold the next dose and reassess
D. Start heparin therapy
✔️ Answer: C
Explanation: Elevated INR without bleeding is managed by holding doses and monitoring.
3. A patient is prescribed Metformin. Which condition is a
CONTRAINDICATION for its use?
A. Hypertension
B. Renal impairment
C. Hyperlipidemia
D. Obesity
✔️ Answer: B
Explanation: Metformin can cause lactic acidosis in patients with impaired renal function.
,4. A nurse practitioner prescribes a beta-blocker. What is the PRIMARY effect
of this drug on the heart?
A. Increases myocardial contractility
B. Decreases heart rate and cardiac output
C. Causes vasoconstriction
D. Increases preload
✔️ Answer: B
Explanation: Beta-blockers reduce heart rate and contractility, lowering cardiac output.
5. A patient taking Furosemide reports muscle cramps and weakness. What
electrolyte imbalance is MOST likely?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
✔️ Answer: B
Explanation: Loop diuretics cause potassium loss, leading to hypokalemia.
6. A patient is prescribed Lisinopril and develops a persistent dry cough. What is
the MOST likely cause?
A. Histamine release
B. Increased bradykinin levels
C. Sodium retention
D. Decreased prostaglandins
✔️ Answer: B
Explanation: ACE inhibitors increase bradykinin, causing cough.
7. A patient receiving opioid therapy develops respiratory depression. Which
medication should be administered?
, A. Flumazenil
B. Naloxone
C. Atropine
D. Protamine
✔️ Answer: B
Explanation: Naloxone reverses opioid effects.
8. A patient is taking Digoxin. Which symptom suggests toxicity?
A. Increased appetite
B. Visual disturbances (yellow halos)
C. Hypertension
D. Bradycardia only
✔️ Answer: B
Explanation: Visual changes are classic signs of digoxin toxicity.
9. A patient is prescribed a statin. What is the PRIMARY therapeutic effect?
A. Increase HDL only
B. Reduce LDL cholesterol
C. Increase triglycerides
D. Reduce glucose levels
✔️ Answer: B
Explanation: Statins primarily lower LDL cholesterol.
10. A patient on Heparin develops bleeding. What is the reversal agent?
A. Vitamin K
B. Protamine sulfate
C. Naloxone
D. Atropine
✔️ Answer: B
Explanation: Protamine sulfate neutralizes heparin.
