NURS 6521 Advanced Pharmacology
Exam Questions and Answers Latest
Version Top Rated A+
### Question 1
A 68-year-old patient with heart failure with reduced ejection fraction
(HFrEF) is prescribed sacubitril/valsartan. The NP understands that this
drug:
A. Increases angiotensin II levels to improve cardiac output
B. Inhibits neprilysin while blocking the AT1 receptor
C. Acts primarily as a beta-1 selective blocker
D. Is contraindicated in patients with a history of angioedema
*Answer: B*
*Rationale:* Sacubitril/valsartan (Entresto) is an angiotensin receptor-
neprilysin inhibitor (ARNI). Sacubitril inhibits neprilysin, increasing
natriuretic peptides, while valsartan blocks the angiotensin II type 1
receptor. This dual action reduces preload/afterload and mortality in
HFrEF. It is contraindicated with ACE inhibitors and requires a 36-hour
washout period.
### Question 2
Which statement best describes the pharmacokinetic change in a 78-
year-old patient compared to a 30-year-old adult?
,A. Increased hepatic blood flow leading to faster drug metabolism
B. Decreased lean body mass and total body water, increasing volume
of distribution for lipophilic drugs
C. Increased renal clearance due to compensatory glomerular
hyperfiltration
D. Decreased protein binding due to higher serum albumin levels
*Answer: B*
*Rationale:* Aging leads to decreased lean body mass and total body
water (affecting hydrophilic drugs) and increased body fat (increasing
volume of distribution and half-life of lipophilic drugs). Renal function
and hepatic metabolism typically decline, increasing risk of drug
accumulation and adverse effects.
### Question 3
A patient with type 2 diabetes is started on canagliflozin. The NP should
monitor for:
A. Hypoglycemia when used as monotherapy
B. Genital mycotic infections and euglycemic diabetic ketoacidosis
C. Significant weight gain
D. Hyperkalemia as the primary electrolyte disturbance
*Answer: B*
,*Rationale:* SGLT2 inhibitors like canagliflozin promote urinary glucose
excretion. Common adverse effects include genital yeast infections
(due to glucosuria) and increased risk of euglycemic DKA, especially in
patients with reduced insulin production or during illness/surgery. They
typically cause modest weight loss.
### Question 4
A patient on warfarin (INR goal 2–3) starts trimethoprim-
sulfamethoxazole for a UTI. The NP recognizes:
A. No interaction is expected
B. The antibiotic will decrease INR, requiring a warfarin dose increase
C. The antibiotic will increase INR due to CYP2C9 inhibition and
displacement from protein binding
D. The interaction only occurs with intravenous TMP-SMX
*Answer: C*
*Rationale:* Sulfonamides inhibit CYP2C9 (major metabolizer of S-
warfarin) and displace warfarin from albumin, potentiating
anticoagulation and raising bleeding risk. Close INR monitoring and
possible dose reduction are required.
### Question 5
Which drug is safest for mild persistent asthma in a pregnant patient?
A. Oral prednisone
B. Inhaled budesonide
, C. Montelukast
D. Theophylline
*Answer: B*
*Rationale:* Inhaled corticosteroids (budesonide has the most safety
data) are preferred for controlling persistent asthma in pregnancy.
Uncontrolled asthma poses greater risk to mother and fetus than
appropriately used inhaled steroids. Systemic steroids are reserved for
exacerbations.
### Question 6
A patient with major depressive disorder is prescribed phenelzine. The
NP provides dietary education regarding:
A. Avoidance of aged cheeses, cured meats, and tap beer (tyramine
restriction)
B. High potassium foods
C. Limitation of vitamin K-rich vegetables
D. Avoidance of grapefruit juice
*Answer: A*
*Rationale:* Phenelzine is a non-selective monoamine oxidase inhibitor
(MAOI). Tyramine-rich foods can cause hypertensive crisis due to
uninhibited norepinephrine release. Patient education on MAOI diet is
critical.
Exam Questions and Answers Latest
Version Top Rated A+
### Question 1
A 68-year-old patient with heart failure with reduced ejection fraction
(HFrEF) is prescribed sacubitril/valsartan. The NP understands that this
drug:
A. Increases angiotensin II levels to improve cardiac output
B. Inhibits neprilysin while blocking the AT1 receptor
C. Acts primarily as a beta-1 selective blocker
D. Is contraindicated in patients with a history of angioedema
*Answer: B*
*Rationale:* Sacubitril/valsartan (Entresto) is an angiotensin receptor-
neprilysin inhibitor (ARNI). Sacubitril inhibits neprilysin, increasing
natriuretic peptides, while valsartan blocks the angiotensin II type 1
receptor. This dual action reduces preload/afterload and mortality in
HFrEF. It is contraindicated with ACE inhibitors and requires a 36-hour
washout period.
### Question 2
Which statement best describes the pharmacokinetic change in a 78-
year-old patient compared to a 30-year-old adult?
,A. Increased hepatic blood flow leading to faster drug metabolism
B. Decreased lean body mass and total body water, increasing volume
of distribution for lipophilic drugs
C. Increased renal clearance due to compensatory glomerular
hyperfiltration
D. Decreased protein binding due to higher serum albumin levels
*Answer: B*
*Rationale:* Aging leads to decreased lean body mass and total body
water (affecting hydrophilic drugs) and increased body fat (increasing
volume of distribution and half-life of lipophilic drugs). Renal function
and hepatic metabolism typically decline, increasing risk of drug
accumulation and adverse effects.
### Question 3
A patient with type 2 diabetes is started on canagliflozin. The NP should
monitor for:
A. Hypoglycemia when used as monotherapy
B. Genital mycotic infections and euglycemic diabetic ketoacidosis
C. Significant weight gain
D. Hyperkalemia as the primary electrolyte disturbance
*Answer: B*
,*Rationale:* SGLT2 inhibitors like canagliflozin promote urinary glucose
excretion. Common adverse effects include genital yeast infections
(due to glucosuria) and increased risk of euglycemic DKA, especially in
patients with reduced insulin production or during illness/surgery. They
typically cause modest weight loss.
### Question 4
A patient on warfarin (INR goal 2–3) starts trimethoprim-
sulfamethoxazole for a UTI. The NP recognizes:
A. No interaction is expected
B. The antibiotic will decrease INR, requiring a warfarin dose increase
C. The antibiotic will increase INR due to CYP2C9 inhibition and
displacement from protein binding
D. The interaction only occurs with intravenous TMP-SMX
*Answer: C*
*Rationale:* Sulfonamides inhibit CYP2C9 (major metabolizer of S-
warfarin) and displace warfarin from albumin, potentiating
anticoagulation and raising bleeding risk. Close INR monitoring and
possible dose reduction are required.
### Question 5
Which drug is safest for mild persistent asthma in a pregnant patient?
A. Oral prednisone
B. Inhaled budesonide
, C. Montelukast
D. Theophylline
*Answer: B*
*Rationale:* Inhaled corticosteroids (budesonide has the most safety
data) are preferred for controlling persistent asthma in pregnancy.
Uncontrolled asthma poses greater risk to mother and fetus than
appropriately used inhaled steroids. Systemic steroids are reserved for
exacerbations.
### Question 6
A patient with major depressive disorder is prescribed phenelzine. The
NP provides dietary education regarding:
A. Avoidance of aged cheeses, cured meats, and tap beer (tyramine
restriction)
B. High potassium foods
C. Limitation of vitamin K-rich vegetables
D. Avoidance of grapefruit juice
*Answer: A*
*Rationale:* Phenelzine is a non-selective monoamine oxidase inhibitor
(MAOI). Tyramine-rich foods can cause hypertensive crisis due to
uninhibited norepinephrine release. Patient education on MAOI diet is
critical.
