WGU D116 PHARMACOLOGY REVIEW
WITH COMPLETE SOLUTIONS
A patient presents with complaint of pain and swelling of the big left toe. The patient has
never experienced this problem before. It is determined that the patient is having an
acute gouty attack. The patient's history is significant for an allergy to ibuprofen that
results in a rash.
Which treatment is appropriate for this patient?
Allopurinol
Indomethacin
Naproxen
Colchicine - CORRECT ANSWER-Colchicine
An adult patient with rheumatoid arthritis is being treated with methotrexate, folic acid,
hydroxychloroquine, etanercept, and aspirin. Liver and kidney function tests, complete
blood count (CBC), and platelet count are requested regularly.
Which additional procedure should be included to assess for adverse effects of the drug
regimen?
Lipid panel
Thyroid-stimulating hormone (TSH)
Ophthalmic exam
Hemoglobin A1c - CORRECT ANSWER-Ophthalmic exam
A patient has been diagnosed with rheumatoid arthritis, and the decision has been
made to start the patient on methotrexate and folic acid.
What is an appropriate starting dose of methotrexate for this patient? - CORRECT
ANSWER-7.5 mg by mouth once weekly
A patient presents to an emergency room complaining of palpitations and irregular
heartbeat. The advanced practice registered nurse (APRN) places the patient on a
cardiac monitor and observes atrial fibrillation. The APRN orders dofetilide.
How should the APRN recommend this medication be taken? - CORRECT ANSWER-
YES With food or an empty stomach
A 70-year-old male calls a clinic complaining of chest pain that started after having
sexual activity. He took sildenafil 50 mg about eight hours ago. He has nitroglycerin 0.3
mg on hand.
How should the advanced practice registered nurse respond? - CORRECT ANSWER-
Do not take the nitroglycerin and call 911
,Taking the medications together can cause a serious drop in blood pressure leading to
cardiovascular collapse.
A patient diagnosed with bipolar disorder who is in a mental health clinic is discussing
the possibility of beginning lithium with an advanced practice registered nurse (APRN).
The patient expresses understanding and wishes to proceed with treatment. The APRN
explains to the patient that this medication requires specific lab monitoring and wants to
draw baseline labs. The patient asks why the test is needed.
Which explanation should the APRN provide to this patient? - CORRECT ANSWER-A
baseline blood urea nitrogen (BUN) and creatinine (CREA) level needs to be drawn to
assess kidney function prior to treatment.
This drug can cause decreased renal function, and a baseline should be drawn for
future comparison.
An advanced practice registered nurse (APRN) is reviewing the medications that will be
commonly experienced with a new nurse to determine whether the drugs are safe for
the patients. The new nurse is given a scenario where a patient is being prescribed
sildenafil 25 mg po prn, a prototype drug for erectile dysfunction.
Which patient may take this drug safely? - CORRECT ANSWER-YES A 54-year-male
with a medical history of hypertension, mild eczema, and previous history of a
urolithiasis where all is well controlled and there are no current complications
A 30-year-old patient presents to a primary care clinic with a history of anxiety. The
advanced practice registered nurse reviews the mechanism of action by which many
neuropharmacological agents act and decides to prescribe citalopram.
What is the mechanism of action of this medication? - CORRECT ANSWER-YES
Influences receptor activity on target cells
Correct! This medication influences the activity in the receptors, and it targets cells.
A patient is admitted with a diagnosis of Huntington disease. On admission, the patient
exhibits uncontrolled twitching, difficulty walking, trouble swallowing, confusion, and
memory loss. The advanced practice registered nurse (APRN) prescribes baclofen.
What is the mechanism of action of this medication? - CORRECT ANSWER-NO
Modulates the effects of glutamate at NMDA receptors
YES Inhibits neurotransmitter GABA
NO Halts the breakdown of acetylcholine by acetylcholinesterase
Alters the synthesis and release of norepinephrine, serotonin, and dopamine
Incorrect. Cholinesterase inhibitors prevent the breakdown of acetylcholine by
acetylcholinesterase. They are used in patients with Alzheimer's.
Correct! Huntington's disease involves a deficiency of the neurotransmitters
acetylcholine and y-aminobutyric acid in the basal ganglia and extrapyramidal system.
A 21-year-old patient accompanied by a parent comes to a clinic for an emergency visit
with an advanced practice registered nurse (APRN) following a seizure. Upon
,interviewing the patient and the parent, the APRN determines that the seizure is
classified by marked impairment of consciousness and is followed by a period of central
nervous system (CNS) depression.
Which type of seizure is this patient experiencing? - CORRECT ANSWER-Atonic
NO Myoclonic
YES Tonic-clonic
Absence
Incorrect. Myoclonic seizures consist of a sudden muscle contraction that lasts for just
one second.
Correct! A tonic-clonic seizure is a type of seizure that is also called a convulsion. This
type of seizure can include muscle stiffness, loss of consciousness, and body jerking.
A patient has been taking oral oxycodone every six hours for back pain during the past
three years. The patient suddenly decides to stop taking the pain medication and is
trying an alternative therapy without a clinician's approval.
Which risk is of clinical concern? - CORRECT ANSWER-YES Physical dependence
Correct! The patient suddenly stopping the medication will cause physical symptoms
that can range from nausea to seizures.
An advanced practice registered nurse has diagnosed a 44-year-old male with
depression. A plan is developed to start treatment with medication. The patient has a
history of sexual dysfunction and is concerned about taking medication that may worsen
this condition.
Which antidepressant has the benefit of enhancing libido? - CORRECT ANSWER-YES
Bupropion
Correct! Bupropion does not cause sexual dysfunction. This will help the patient with a
history of sexual dysfunction. This will enhance the patient's libido, which will help with
both depression and sexual dysfunction.
A patient is wheezing and short of breath. The nurse assesses a heart rate of 88 beats
per minute, a respiratory rate of 24 breaths per minute, and a blood pressure of 124/78
mm Hg. The prescriber orders a nonspecific beta-agonist medication.
Besides evaluating the patient for a reduction in respiratory distress, the nurse should
monitor for which side effect? - CORRECT ANSWER-YES Tachycardia
Correct! Beta-agonists are used for asthma because of their beta2 effects on bronchial
smooth muscle, causing dilation. Beta1 effects cause tachycardia and hypertension.
Beta receptors do not exert effects on the bladder.
A patient is experiencing toxic side effects from atropine, including delirium and
hallucinations. Which medication should the provider administer? - CORRECT
ANSWER-YES Physostigmine
Correct! Physostigmine is the drug of choice for treating poisoning from atropine and
other drugs that cause muscarinic blockade. Donepezil is used to treat Alzheimer
, disease. Edrophonium is used to distinguish between a myasthenic crisis and a
cholinesterase inhibitor overdose. Neostigmine does not cross the blood-brain barrier
and would not effectively treat this patient's central nervous system (CNS) symptoms.
A patient brought to the emergency department requires sutures. The prescriber orders
a local anesthetic with epinephrine.
The epinephrine is ordered to ___________. - CORRECT ANSWER-allow a reduced
dose of the anesthetic
Correct! Epinephrine prolongs absorption of the anesthetic because it is an alpha1
agonist. It is frequently combined with a local anesthetic for this purpose so the amount
of anesthetic required may be reduced. Local anesthetics do not induce hypertension;
therefore, epinephrine would not be needed to prevent it. Epinephrine does not act as
an antiemetic and would not reduce anesthetic-induced nausea. Epinephrine is not
used to reduce the pain of an injection.
A patient has been diagnosed with Parkinson disease (PD) and begins treatment with
carbidopa. After several months of therapy, the patient reports no change in symptoms.
As the provider, you should do which of the following? - CORRECT ANSWER-Increase
the dose of carbidopa
Discuss the "on-off" phenomenon
Reevaluate the diagnosis
NO Add a dopamine agonist
Incorrect. Adding a dopamine agonist is not indicated.
A patient who is taking oral contraceptives begins taking valproic acid for seizures. After
a week of therapy with valproic acid, the patient tells the nurse that she is experiencing
nausea.
What should the nurse do? - CORRECT ANSWER-YES Ask the patient if she is taking
the valproic acid with food because taking the drug on an empty stomach can cause
gastrointestinal side effects
Correct! Gastrointestinal effects, including nausea, vomiting, and indigestion, are
common with valproic acid and can be minimized by taking the drug with food or using
an enteric-coated product. Hyperammonemia can occur when valproic acid is combined
with topiramate. Signs of pregnancy usually do not occur within a week, so this is less
likely. Hepatotoxicity is a rare adverse effect.
A patient with cerebral palsy who has been receiving baclofen via gastrostomy tube for
three months is admitted to the hospital for evaluation of new-onset seizures.
What might you suspect to be the cause of these seizures? - CORRECT ANSWER-
YES Missed doses of baclofen
Correct! Baclofen does not appear to cause physical dependence, but abrupt
discontinuation has been associated with adverse reactions. Abrupt withdrawal of oral
baclofen can cause visual hallucinations, paranoid ideation, and seizures and should be
WITH COMPLETE SOLUTIONS
A patient presents with complaint of pain and swelling of the big left toe. The patient has
never experienced this problem before. It is determined that the patient is having an
acute gouty attack. The patient's history is significant for an allergy to ibuprofen that
results in a rash.
Which treatment is appropriate for this patient?
Allopurinol
Indomethacin
Naproxen
Colchicine - CORRECT ANSWER-Colchicine
An adult patient with rheumatoid arthritis is being treated with methotrexate, folic acid,
hydroxychloroquine, etanercept, and aspirin. Liver and kidney function tests, complete
blood count (CBC), and platelet count are requested regularly.
Which additional procedure should be included to assess for adverse effects of the drug
regimen?
Lipid panel
Thyroid-stimulating hormone (TSH)
Ophthalmic exam
Hemoglobin A1c - CORRECT ANSWER-Ophthalmic exam
A patient has been diagnosed with rheumatoid arthritis, and the decision has been
made to start the patient on methotrexate and folic acid.
What is an appropriate starting dose of methotrexate for this patient? - CORRECT
ANSWER-7.5 mg by mouth once weekly
A patient presents to an emergency room complaining of palpitations and irregular
heartbeat. The advanced practice registered nurse (APRN) places the patient on a
cardiac monitor and observes atrial fibrillation. The APRN orders dofetilide.
How should the APRN recommend this medication be taken? - CORRECT ANSWER-
YES With food or an empty stomach
A 70-year-old male calls a clinic complaining of chest pain that started after having
sexual activity. He took sildenafil 50 mg about eight hours ago. He has nitroglycerin 0.3
mg on hand.
How should the advanced practice registered nurse respond? - CORRECT ANSWER-
Do not take the nitroglycerin and call 911
,Taking the medications together can cause a serious drop in blood pressure leading to
cardiovascular collapse.
A patient diagnosed with bipolar disorder who is in a mental health clinic is discussing
the possibility of beginning lithium with an advanced practice registered nurse (APRN).
The patient expresses understanding and wishes to proceed with treatment. The APRN
explains to the patient that this medication requires specific lab monitoring and wants to
draw baseline labs. The patient asks why the test is needed.
Which explanation should the APRN provide to this patient? - CORRECT ANSWER-A
baseline blood urea nitrogen (BUN) and creatinine (CREA) level needs to be drawn to
assess kidney function prior to treatment.
This drug can cause decreased renal function, and a baseline should be drawn for
future comparison.
An advanced practice registered nurse (APRN) is reviewing the medications that will be
commonly experienced with a new nurse to determine whether the drugs are safe for
the patients. The new nurse is given a scenario where a patient is being prescribed
sildenafil 25 mg po prn, a prototype drug for erectile dysfunction.
Which patient may take this drug safely? - CORRECT ANSWER-YES A 54-year-male
with a medical history of hypertension, mild eczema, and previous history of a
urolithiasis where all is well controlled and there are no current complications
A 30-year-old patient presents to a primary care clinic with a history of anxiety. The
advanced practice registered nurse reviews the mechanism of action by which many
neuropharmacological agents act and decides to prescribe citalopram.
What is the mechanism of action of this medication? - CORRECT ANSWER-YES
Influences receptor activity on target cells
Correct! This medication influences the activity in the receptors, and it targets cells.
A patient is admitted with a diagnosis of Huntington disease. On admission, the patient
exhibits uncontrolled twitching, difficulty walking, trouble swallowing, confusion, and
memory loss. The advanced practice registered nurse (APRN) prescribes baclofen.
What is the mechanism of action of this medication? - CORRECT ANSWER-NO
Modulates the effects of glutamate at NMDA receptors
YES Inhibits neurotransmitter GABA
NO Halts the breakdown of acetylcholine by acetylcholinesterase
Alters the synthesis and release of norepinephrine, serotonin, and dopamine
Incorrect. Cholinesterase inhibitors prevent the breakdown of acetylcholine by
acetylcholinesterase. They are used in patients with Alzheimer's.
Correct! Huntington's disease involves a deficiency of the neurotransmitters
acetylcholine and y-aminobutyric acid in the basal ganglia and extrapyramidal system.
A 21-year-old patient accompanied by a parent comes to a clinic for an emergency visit
with an advanced practice registered nurse (APRN) following a seizure. Upon
,interviewing the patient and the parent, the APRN determines that the seizure is
classified by marked impairment of consciousness and is followed by a period of central
nervous system (CNS) depression.
Which type of seizure is this patient experiencing? - CORRECT ANSWER-Atonic
NO Myoclonic
YES Tonic-clonic
Absence
Incorrect. Myoclonic seizures consist of a sudden muscle contraction that lasts for just
one second.
Correct! A tonic-clonic seizure is a type of seizure that is also called a convulsion. This
type of seizure can include muscle stiffness, loss of consciousness, and body jerking.
A patient has been taking oral oxycodone every six hours for back pain during the past
three years. The patient suddenly decides to stop taking the pain medication and is
trying an alternative therapy without a clinician's approval.
Which risk is of clinical concern? - CORRECT ANSWER-YES Physical dependence
Correct! The patient suddenly stopping the medication will cause physical symptoms
that can range from nausea to seizures.
An advanced practice registered nurse has diagnosed a 44-year-old male with
depression. A plan is developed to start treatment with medication. The patient has a
history of sexual dysfunction and is concerned about taking medication that may worsen
this condition.
Which antidepressant has the benefit of enhancing libido? - CORRECT ANSWER-YES
Bupropion
Correct! Bupropion does not cause sexual dysfunction. This will help the patient with a
history of sexual dysfunction. This will enhance the patient's libido, which will help with
both depression and sexual dysfunction.
A patient is wheezing and short of breath. The nurse assesses a heart rate of 88 beats
per minute, a respiratory rate of 24 breaths per minute, and a blood pressure of 124/78
mm Hg. The prescriber orders a nonspecific beta-agonist medication.
Besides evaluating the patient for a reduction in respiratory distress, the nurse should
monitor for which side effect? - CORRECT ANSWER-YES Tachycardia
Correct! Beta-agonists are used for asthma because of their beta2 effects on bronchial
smooth muscle, causing dilation. Beta1 effects cause tachycardia and hypertension.
Beta receptors do not exert effects on the bladder.
A patient is experiencing toxic side effects from atropine, including delirium and
hallucinations. Which medication should the provider administer? - CORRECT
ANSWER-YES Physostigmine
Correct! Physostigmine is the drug of choice for treating poisoning from atropine and
other drugs that cause muscarinic blockade. Donepezil is used to treat Alzheimer
, disease. Edrophonium is used to distinguish between a myasthenic crisis and a
cholinesterase inhibitor overdose. Neostigmine does not cross the blood-brain barrier
and would not effectively treat this patient's central nervous system (CNS) symptoms.
A patient brought to the emergency department requires sutures. The prescriber orders
a local anesthetic with epinephrine.
The epinephrine is ordered to ___________. - CORRECT ANSWER-allow a reduced
dose of the anesthetic
Correct! Epinephrine prolongs absorption of the anesthetic because it is an alpha1
agonist. It is frequently combined with a local anesthetic for this purpose so the amount
of anesthetic required may be reduced. Local anesthetics do not induce hypertension;
therefore, epinephrine would not be needed to prevent it. Epinephrine does not act as
an antiemetic and would not reduce anesthetic-induced nausea. Epinephrine is not
used to reduce the pain of an injection.
A patient has been diagnosed with Parkinson disease (PD) and begins treatment with
carbidopa. After several months of therapy, the patient reports no change in symptoms.
As the provider, you should do which of the following? - CORRECT ANSWER-Increase
the dose of carbidopa
Discuss the "on-off" phenomenon
Reevaluate the diagnosis
NO Add a dopamine agonist
Incorrect. Adding a dopamine agonist is not indicated.
A patient who is taking oral contraceptives begins taking valproic acid for seizures. After
a week of therapy with valproic acid, the patient tells the nurse that she is experiencing
nausea.
What should the nurse do? - CORRECT ANSWER-YES Ask the patient if she is taking
the valproic acid with food because taking the drug on an empty stomach can cause
gastrointestinal side effects
Correct! Gastrointestinal effects, including nausea, vomiting, and indigestion, are
common with valproic acid and can be minimized by taking the drug with food or using
an enteric-coated product. Hyperammonemia can occur when valproic acid is combined
with topiramate. Signs of pregnancy usually do not occur within a week, so this is less
likely. Hepatotoxicity is a rare adverse effect.
A patient with cerebral palsy who has been receiving baclofen via gastrostomy tube for
three months is admitted to the hospital for evaluation of new-onset seizures.
What might you suspect to be the cause of these seizures? - CORRECT ANSWER-
YES Missed doses of baclofen
Correct! Baclofen does not appear to cause physical dependence, but abrupt
discontinuation has been associated with adverse reactions. Abrupt withdrawal of oral
baclofen can cause visual hallucinations, paranoid ideation, and seizures and should be
