,NSG 533 Exam 3 | Advanced Pharmacology
(2026) Actual Q&A PDF | Wilkes
1. The nurse practitioner is educating a patient with HFrEF who is starting
carvedilol. Which statement should be included?
A) “Your symptoms may temporarily worsen, but long‑term survival improves.”
B) “You will feel better immediately after starting this medication.”
C) “Take this medication only when you feel short of breath.”
D) “Stop the medication if you experience any dizziness.”
Correct Answer: “Your symptoms may temporarily worsen, but long‑term
survival improves.”
Rationale: Beta‑blockers in heart failure are started at low doses and titrated
slowly. Patients may experience initial worsening of symptoms, but adherence
is crucial because these drugs improve long‑term outcomes and survival.
2. When transitioning a heart failure patient with worsening congestion from
hydrochlorothiazide to furosemide, the nurse practitioner should anticipate:
A) No change in potassium requirements.
B) Adding potassium supplementation due to increased potassium loss.
C) A decrease in diuretic efficacy.
D) Contraindication in renal impairment.
Correct Answer: Adding potassium supplementation due to increased potassium
loss.
,Rationale: Loop diuretics promote greater potassium excretion than thiazides,
so potassium supplementation or addition of a potassium‑sparing diuretic is
often necessary to prevent hypokalemia.
3. Which combination of symptoms is most indicative of digoxin toxicity?
A) Hypertension, tachycardia, weight gain.
B) Diarrhea, hyperkalemia, insomnia.
C) Nausea, visual halos, confusion.
D) Cough, fever, chest pain.
Correct Answer: Nausea, visual halos, confusion.
Rationale: Digoxin toxicity classically presents with gastrointestinal symptoms
(nausea, vomiting, anorexia), visual disturbances (yellow‑green halos,
photophobia), and CNS effects (confusion, weakness, fatigue).
4. When a patient taking sublingual nitroglycerin asks about using sildenafil, the
nurse practitioner explains that concurrent use:
A) Is safe if taken at different times of the day.
B) Increases the risk of priapism.
C) Enhances the antianginal effects of nitroglycerin.
D) Can cause life‑threatening hypotension.
Correct Answer: Can cause life‑threatening hypotension.
, Rationale: PDE‑5 inhibitors potentiate the vasodilatory effects of nitrates,
leading to severe and potentially fatal hypotension. They are absolutely
contraindicated together, and a nitrate‑free interval of at least 24‑48 hours is
required.
5. Which medication class should be avoided in a patient diagnosed with
Prinzmetal (variant) angina?
A) Beta‑blockers
B) Calcium channel blockers
C) Long‑acting nitrates
D) ACE inhibitors
Correct Answer: Beta‑blockers
Rationale: Beta‑blockers can worsen coronary vasospasm in Prinzmetal angina.
First‑line therapy is a non‑dihydropyridine calcium channel blocker (diltiazem or
verapamil) or a long‑acting nitrate.
6. According to hypertension step‑therapy guidelines, what is an appropriate
Step 2 regimen for a patient whose blood pressure remains uncontrolled on an
ACE inhibitor alone?
A) Add a beta‑blocker.
B) Add a calcium channel blocker or thiazide diuretic.
C) Add a second ACE inhibitor.
D) Switch to a loop diuretic only.
Correct Answer: Add a calcium channel blocker or thiazide diuretic.
(2026) Actual Q&A PDF | Wilkes
1. The nurse practitioner is educating a patient with HFrEF who is starting
carvedilol. Which statement should be included?
A) “Your symptoms may temporarily worsen, but long‑term survival improves.”
B) “You will feel better immediately after starting this medication.”
C) “Take this medication only when you feel short of breath.”
D) “Stop the medication if you experience any dizziness.”
Correct Answer: “Your symptoms may temporarily worsen, but long‑term
survival improves.”
Rationale: Beta‑blockers in heart failure are started at low doses and titrated
slowly. Patients may experience initial worsening of symptoms, but adherence
is crucial because these drugs improve long‑term outcomes and survival.
2. When transitioning a heart failure patient with worsening congestion from
hydrochlorothiazide to furosemide, the nurse practitioner should anticipate:
A) No change in potassium requirements.
B) Adding potassium supplementation due to increased potassium loss.
C) A decrease in diuretic efficacy.
D) Contraindication in renal impairment.
Correct Answer: Adding potassium supplementation due to increased potassium
loss.
,Rationale: Loop diuretics promote greater potassium excretion than thiazides,
so potassium supplementation or addition of a potassium‑sparing diuretic is
often necessary to prevent hypokalemia.
3. Which combination of symptoms is most indicative of digoxin toxicity?
A) Hypertension, tachycardia, weight gain.
B) Diarrhea, hyperkalemia, insomnia.
C) Nausea, visual halos, confusion.
D) Cough, fever, chest pain.
Correct Answer: Nausea, visual halos, confusion.
Rationale: Digoxin toxicity classically presents with gastrointestinal symptoms
(nausea, vomiting, anorexia), visual disturbances (yellow‑green halos,
photophobia), and CNS effects (confusion, weakness, fatigue).
4. When a patient taking sublingual nitroglycerin asks about using sildenafil, the
nurse practitioner explains that concurrent use:
A) Is safe if taken at different times of the day.
B) Increases the risk of priapism.
C) Enhances the antianginal effects of nitroglycerin.
D) Can cause life‑threatening hypotension.
Correct Answer: Can cause life‑threatening hypotension.
, Rationale: PDE‑5 inhibitors potentiate the vasodilatory effects of nitrates,
leading to severe and potentially fatal hypotension. They are absolutely
contraindicated together, and a nitrate‑free interval of at least 24‑48 hours is
required.
5. Which medication class should be avoided in a patient diagnosed with
Prinzmetal (variant) angina?
A) Beta‑blockers
B) Calcium channel blockers
C) Long‑acting nitrates
D) ACE inhibitors
Correct Answer: Beta‑blockers
Rationale: Beta‑blockers can worsen coronary vasospasm in Prinzmetal angina.
First‑line therapy is a non‑dihydropyridine calcium channel blocker (diltiazem or
verapamil) or a long‑acting nitrate.
6. According to hypertension step‑therapy guidelines, what is an appropriate
Step 2 regimen for a patient whose blood pressure remains uncontrolled on an
ACE inhibitor alone?
A) Add a beta‑blocker.
B) Add a calcium channel blocker or thiazide diuretic.
C) Add a second ACE inhibitor.
D) Switch to a loop diuretic only.
Correct Answer: Add a calcium channel blocker or thiazide diuretic.
