NURS 6521N Exam 2 V3 | NURS 6521N
Advanced Pharmacology | Actual Q&A
with Rationale (NURS6521N Exam 2) |
Walden University
1. A 65-year-old patient with heart failure and a history of chronic obstructive pulmonary
disease (COPD) requires a beta-blocker. Which medication is the most appropriate choice to
minimize respiratory complications?
A. Propranolol
B. Nadolol
C. Metoprolol succinate
D. Carvedilol
Answer: C
Rationale: Metoprolol is a cardioselective beta-1 antagonist, making it a safer choice for
patients with reactive airway diseases like COPD. Non-selective beta-blockers like
propranolol can block beta-2 receptors in the lungs, leading to bronchoconstriction. Even
with cardioselective agents, the advanced practice nurse must monitor the patient closely
for any signs of respiratory distress.
2. Which electrolyte imbalance should the nurse practitioner monitor most closely in a
patient receiving high-dose Furosemide (Lasix) for pulmonary edema?
A. Hypernatremia
,B. Hypoglycemia
C. Hypercalcemia
D. Hypokalemia
Answer: D
Rationale: Loop diuretics like furosemide inhibit sodium-potassium-chloride
cotransporters in the thick ascending limb of the loop of Henle, leading to significant
potassium excretion. Hypokalemia is a common and potentially dangerous side effect that
can lead to cardiac dysrhythmias. Patients may require potassium supplementation or a
diet rich in potassium while on this therapy.
3. A patient is prescribed Warfarin (Coumadin) for atrial fibrillation. Which of the following
lab values is used to monitor the therapeutic effect of this medication?
A. INR
B. Platelet count
C. Serum albumin
D. aPTT
Answer: A
Rationale: The International Normalized Ratio (INR) is the standard measurement used to
assess the effectiveness of warfarin therapy. For most patients with atrial fibrillation, a
target INR between 2.0 and 3.0 is desired to prevent thromboembolic events. The
,practitioner must educate the patient on maintaining consistent vitamin K intake to avoid
fluctuations in these levels.
4. When prescribing an ACE inhibitor such as Lisinopril, the practitioner should inform the
patient about which common, benign but annoying side effect?
A. Weight gain
B. Dry, nonproductive cough
C. Constipation
D. Sedation
Answer: B
Rationale: ACE inhibitors prevent the breakdown of bradykinin and substance P, which
can accumulate in the respiratory tract and trigger a persistent dry cough. While this side
effect is not physically harmful, it is the most common reason patients discontinue the
medication. If the cough becomes intolerable, switching to an Angiotensin II Receptor
Blocker (ARB) is usually the next clinical step.
5. A patient with Type 2 Diabetes is scheduled for a CT scan with intravenous contrast. Which
medication must be withheld for 48 hours after the procedure?
A. Glyburide
B. Pioglitazone
C. Metformin
, D. Sitagliptin
Answer: C
Rationale: Metformin is primarily excreted by the kidneys, and iodinated contrast media
can cause acute renal failure. If renal function is impaired, metformin can accumulate and
increase the risk of lactic acidosis, a life-threatening condition. The medication should be
held before the procedure and resumed only after renal function is confirmed to be normal
48 hours later.
6. Which of the following is the mechanism of action for Statins (HMG-CoA reductase
inhibitors)?
A. Binding bile acids in the intestine
B. Inhibiting the absorption of cholesterol in the small intestine
C. Activating PPAR-alpha to increase fatty acid oxidation
D. Inhibiting the enzyme that catalyzes the rate-limiting step in hepatic cholesterol
synthesis
Answer: D
Rationale: Statins work by inhibiting HMG-CoA reductase, the primary enzyme
responsible for cholesterol production in the liver. By reducing internal cholesterol
production, hepatocytes increase the number of LDL receptors to pull more cholesterol
from the blood. This remains the gold standard treatment for reducing LDL-C and
preventing cardiovascular events.
Advanced Pharmacology | Actual Q&A
with Rationale (NURS6521N Exam 2) |
Walden University
1. A 65-year-old patient with heart failure and a history of chronic obstructive pulmonary
disease (COPD) requires a beta-blocker. Which medication is the most appropriate choice to
minimize respiratory complications?
A. Propranolol
B. Nadolol
C. Metoprolol succinate
D. Carvedilol
Answer: C
Rationale: Metoprolol is a cardioselective beta-1 antagonist, making it a safer choice for
patients with reactive airway diseases like COPD. Non-selective beta-blockers like
propranolol can block beta-2 receptors in the lungs, leading to bronchoconstriction. Even
with cardioselective agents, the advanced practice nurse must monitor the patient closely
for any signs of respiratory distress.
2. Which electrolyte imbalance should the nurse practitioner monitor most closely in a
patient receiving high-dose Furosemide (Lasix) for pulmonary edema?
A. Hypernatremia
,B. Hypoglycemia
C. Hypercalcemia
D. Hypokalemia
Answer: D
Rationale: Loop diuretics like furosemide inhibit sodium-potassium-chloride
cotransporters in the thick ascending limb of the loop of Henle, leading to significant
potassium excretion. Hypokalemia is a common and potentially dangerous side effect that
can lead to cardiac dysrhythmias. Patients may require potassium supplementation or a
diet rich in potassium while on this therapy.
3. A patient is prescribed Warfarin (Coumadin) for atrial fibrillation. Which of the following
lab values is used to monitor the therapeutic effect of this medication?
A. INR
B. Platelet count
C. Serum albumin
D. aPTT
Answer: A
Rationale: The International Normalized Ratio (INR) is the standard measurement used to
assess the effectiveness of warfarin therapy. For most patients with atrial fibrillation, a
target INR between 2.0 and 3.0 is desired to prevent thromboembolic events. The
,practitioner must educate the patient on maintaining consistent vitamin K intake to avoid
fluctuations in these levels.
4. When prescribing an ACE inhibitor such as Lisinopril, the practitioner should inform the
patient about which common, benign but annoying side effect?
A. Weight gain
B. Dry, nonproductive cough
C. Constipation
D. Sedation
Answer: B
Rationale: ACE inhibitors prevent the breakdown of bradykinin and substance P, which
can accumulate in the respiratory tract and trigger a persistent dry cough. While this side
effect is not physically harmful, it is the most common reason patients discontinue the
medication. If the cough becomes intolerable, switching to an Angiotensin II Receptor
Blocker (ARB) is usually the next clinical step.
5. A patient with Type 2 Diabetes is scheduled for a CT scan with intravenous contrast. Which
medication must be withheld for 48 hours after the procedure?
A. Glyburide
B. Pioglitazone
C. Metformin
, D. Sitagliptin
Answer: C
Rationale: Metformin is primarily excreted by the kidneys, and iodinated contrast media
can cause acute renal failure. If renal function is impaired, metformin can accumulate and
increase the risk of lactic acidosis, a life-threatening condition. The medication should be
held before the procedure and resumed only after renal function is confirmed to be normal
48 hours later.
6. Which of the following is the mechanism of action for Statins (HMG-CoA reductase
inhibitors)?
A. Binding bile acids in the intestine
B. Inhibiting the absorption of cholesterol in the small intestine
C. Activating PPAR-alpha to increase fatty acid oxidation
D. Inhibiting the enzyme that catalyzes the rate-limiting step in hepatic cholesterol
synthesis
Answer: D
Rationale: Statins work by inhibiting HMG-CoA reductase, the primary enzyme
responsible for cholesterol production in the liver. By reducing internal cholesterol
production, hepatocytes increase the number of LDL receptors to pull more cholesterol
from the blood. This remains the gold standard treatment for reducing LDL-C and
preventing cardiovascular events.
