NR 567 Exam 2 V2 | NR 567 Advanced
Pharmacology for the AGACNP | Actual
Q&A with Rationale (NR567 Exam 2) |
Chamberlain College of Nursing
1. An AGACNP is managing a 65-year-old patient with heart failure and a reduced ejection
fraction (HFrEF). Which of the following adverse effects are specifically associated with ACE
inhibitor therapy? (Select All That Apply)
A. Dry, non-productive cough
B. Hyperkalemia
C. Hypokalemia
D. Angioedema
E. Ototoxicity
F. Acute kidney injury in bilateral renal artery stenosis
Answer: A, B, D, F
Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II, leading to
vasodilation and reduced aldosterone secretion. The accumulation of bradykinin is the
primary mechanism behind the classic dry cough and the potentially life-threatening
angioedema. It is essential for the provider to monitor serum potassium and creatinine levels,
,as these medications can lead to hyperkalemia and renal insufficiency, particularly in patients
with pre-existing renal vascular disease.
2. A patient is prescribed Amiodarone for the management of refractory ventricular
tachycardia. Which diagnostic test must be performed periodically due to the drug’s risk of
pulmonary toxicity?
A. Chest X-ray and Pulmonary Function Tests
B. Electroencephalogram (EEG)
C. Dexa Scan
D. Urinalysis
Answer: A
Rationale: Amiodarone is a class III antiarrhythmic known for a variety of serious adverse
effects, including pulmonary fibrosis. Providers must obtain baseline and periodic chest
radiographs and pulmonary function tests to monitor for early signs of lung damage. Because
this drug has a very long half-life, its toxic effects can persist for several months after the
medication is discontinued.
3. When initiating Warfarin therapy, why is it necessary to overlap with a parenteral
anticoagulant like Heparin or Enoxaparin?
A. To prevent the immediate breakdown of clotting factors
B. To increase the absorption of Warfarin in the GI tract
C. To reduce the risk of Vitamin K toxicity
,D. To prevent skin necrosis and transient hypercoagulability caused by Protein C and S
depletion
Answer: D
Rationale: Warfarin inhibits the synthesis of Vitamin K-dependent clotting factors,
specifically factors II, VII, IX, and X, along with anticoagulant proteins C and S. Since Protein C
and S have shorter half-lives than the procoagulant factors, a transient prothrombotic state
can occur during the first few days of therapy. Bridging with Heparin ensures the patient is
therapeutically anticoagulated while the procoagulant factors are being depleted to the
desired level.
4. Which of the following medications is a first-line treatment for an acute exacerbation of
asthma in the acute care setting?
A. Salmeterol
B. Fluticasone
C. Tiotropium
D. Albuterol
Answer: D
Rationale: Albuterol is a short-acting beta-2 agonist (SABA) that provides rapid
bronchodilation by relaxing smooth muscle in the airway. It is the medication of choice for
immediate relief of symptoms such as wheezing and shortness of breath during an acute flare.
, Long-acting agonists and corticosteroids are intended for maintenance therapy and do not
act quickly enough to manage an acute crisis.
5. A patient with hypertension and a history of gout is being started on a diuretic. Which class
of diuretics should be avoided as it may exacerbate hyperuricemia?
A. Thiazide diuretics
B. Potassium-sparing diuretics
C. Loop diuretics
D. Carbonic anhydrase inhibitors
Answer: A
Rationale: Thiazide diuretics, such as Hydrochlorothiazide, compete with uric acid for
secretion in the renal tubules, leading to increased serum uric acid levels. This increase can
trigger painful gouty flares in susceptible patients. The AGACNP should consider alternative
antihypertensive agents or carefully monitor uric acid if this medication class is deemed
necessary.
6. A patient is diagnosed with Heparin-Induced Thrombocytopenia (HIT). Which of the
following actions should the AGACNP take immediately?
A. Switch to Low Molecular Weight Heparin (LMWH)
B. Begin immediate Warfarin loading doses
C. Administer a platelet transfusion
Pharmacology for the AGACNP | Actual
Q&A with Rationale (NR567 Exam 2) |
Chamberlain College of Nursing
1. An AGACNP is managing a 65-year-old patient with heart failure and a reduced ejection
fraction (HFrEF). Which of the following adverse effects are specifically associated with ACE
inhibitor therapy? (Select All That Apply)
A. Dry, non-productive cough
B. Hyperkalemia
C. Hypokalemia
D. Angioedema
E. Ototoxicity
F. Acute kidney injury in bilateral renal artery stenosis
Answer: A, B, D, F
Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II, leading to
vasodilation and reduced aldosterone secretion. The accumulation of bradykinin is the
primary mechanism behind the classic dry cough and the potentially life-threatening
angioedema. It is essential for the provider to monitor serum potassium and creatinine levels,
,as these medications can lead to hyperkalemia and renal insufficiency, particularly in patients
with pre-existing renal vascular disease.
2. A patient is prescribed Amiodarone for the management of refractory ventricular
tachycardia. Which diagnostic test must be performed periodically due to the drug’s risk of
pulmonary toxicity?
A. Chest X-ray and Pulmonary Function Tests
B. Electroencephalogram (EEG)
C. Dexa Scan
D. Urinalysis
Answer: A
Rationale: Amiodarone is a class III antiarrhythmic known for a variety of serious adverse
effects, including pulmonary fibrosis. Providers must obtain baseline and periodic chest
radiographs and pulmonary function tests to monitor for early signs of lung damage. Because
this drug has a very long half-life, its toxic effects can persist for several months after the
medication is discontinued.
3. When initiating Warfarin therapy, why is it necessary to overlap with a parenteral
anticoagulant like Heparin or Enoxaparin?
A. To prevent the immediate breakdown of clotting factors
B. To increase the absorption of Warfarin in the GI tract
C. To reduce the risk of Vitamin K toxicity
,D. To prevent skin necrosis and transient hypercoagulability caused by Protein C and S
depletion
Answer: D
Rationale: Warfarin inhibits the synthesis of Vitamin K-dependent clotting factors,
specifically factors II, VII, IX, and X, along with anticoagulant proteins C and S. Since Protein C
and S have shorter half-lives than the procoagulant factors, a transient prothrombotic state
can occur during the first few days of therapy. Bridging with Heparin ensures the patient is
therapeutically anticoagulated while the procoagulant factors are being depleted to the
desired level.
4. Which of the following medications is a first-line treatment for an acute exacerbation of
asthma in the acute care setting?
A. Salmeterol
B. Fluticasone
C. Tiotropium
D. Albuterol
Answer: D
Rationale: Albuterol is a short-acting beta-2 agonist (SABA) that provides rapid
bronchodilation by relaxing smooth muscle in the airway. It is the medication of choice for
immediate relief of symptoms such as wheezing and shortness of breath during an acute flare.
, Long-acting agonists and corticosteroids are intended for maintenance therapy and do not
act quickly enough to manage an acute crisis.
5. A patient with hypertension and a history of gout is being started on a diuretic. Which class
of diuretics should be avoided as it may exacerbate hyperuricemia?
A. Thiazide diuretics
B. Potassium-sparing diuretics
C. Loop diuretics
D. Carbonic anhydrase inhibitors
Answer: A
Rationale: Thiazide diuretics, such as Hydrochlorothiazide, compete with uric acid for
secretion in the renal tubules, leading to increased serum uric acid levels. This increase can
trigger painful gouty flares in susceptible patients. The AGACNP should consider alternative
antihypertensive agents or carefully monitor uric acid if this medication class is deemed
necessary.
6. A patient is diagnosed with Heparin-Induced Thrombocytopenia (HIT). Which of the
following actions should the AGACNP take immediately?
A. Switch to Low Molecular Weight Heparin (LMWH)
B. Begin immediate Warfarin loading doses
C. Administer a platelet transfusion
