NR 567 Exam 4 V3 | NR 567 Advanced
Pharmacology for the AGACNP | Actual
Q&A with Rationale (NR567 Exam 4) |
Chamberlain College of Nursing
1. When managing a patient in septic shock, which of the following interventions are
considered evidence-based first-line pharmacologic treatments according to the Surviving
Sepsis Campaign? (Select All That Apply)
A. Crystalloid fluid resuscitation at 30 mL/kg within the first 3 hours
B. Norepinephrine as the first-choice vasopressor to maintain MAP ≥ 65 mmHg
C. Administration of broad-spectrum empiric antibiotics within 1 hour
D. Low-dose dopamine for the purpose of renal protection
E. Routine administration of high-dose corticosteroids for all sepsis patients
F. Etomidate as a long-term sedative for mechanical ventilation
Correct Answer: A, B, C
Sepsis management emphasizes rapid fluid resuscitation and early antibiotic
administration to improve survival outcomes. Norepinephrine is preferred over other
vasopressors because it effectively increases blood pressure with less risk of tachycardia
and arrhythmias. Renal-dose dopamine has been debunked and is no longer recommended
in clinical practice guidelines.
,2. A patient is receiving a continuous infusion of Propofol (Diprivan) for sedation in the ICU.
Which laboratory parameter must the AGACNP monitor closely due to the formulation of this
medication?
A. Serum sodium
B. Prothrombin time (PT)
C. Serum calcium
D. Serum triglycerides
Correct Answer: D
Propofol is formulated in a 10% lipid emulsion, which provides approximately 1.1
kcal/mL of fat content. Prolonged use or high doses can lead to hypertriglyceridemia and
potentially progress to Propofol Infusion Syndrome (PRIS). Monitoring triglycerides is
essential to prevent pancreatic complications and metabolic acidosis.
3. When initiating Milrinone for a patient with acute decompensated heart failure, the
AGACNP understands that this medication acts through which primary mechanism?
A. Beta-1 adrenergic agonism
B. Phosphodiesterase-3 (PDE3) inhibition
C. Alpha-1 adrenergic antagonism
D. Calcium channel blockade
Correct Answer: B
, Milrinone is an inodilator that inhibits the PDE3 enzyme, leading to increased cyclic AMP
in the myocardium and vascular smooth muscle. This results in increased myocardial
contractility and significant peripheral vasodilation, which reduces both preload and
afterload. Unlike dobutamine, it does not rely on beta-receptors, making it useful for
patients on chronic beta-blocker therapy.
4. A patient with refractory ventricular fibrillation is receiving intravenous Amiodarone.
Which of the following potential toxicities or side effects are associated with this medication?
(Select All That Apply)
A. Pulmonary fibrosis
B. Thyroid dysfunction (hypothyroidism or hyperthyroidism)
C. Corneal micro-deposits
D. Hepatotoxicity
E. Acute nephrolithiasis
Correct Answer: A, B, C, D
Amiodarone is a highly effective anti-arrhythmic but is associated with extensive organ
toxicity due to its iodine content and long half-life. Monitoring of liver function, thyroid
levels, and pulmonary function tests is standard for patients on chronic therapy.
Nephrolithiasis is not a recognized adverse effect associated with amiodarone
administration.
, 5. What is the recommended reversal agent for a patient experiencing life-threatening
bleeding while on Dabigatran (Pradaxa)?
A. Protamine sulfate
B. Vitamin K
C. Andexanet alfa
D. Idarucizumab (Praxbind)
Correct Answer: D
Idarucizumab is a monoclonal antibody fragment that specifically binds to dabigatran and
its metabolites, neutralizing their anticoagulant effect. It is indicated when emergency
surgery or life-threatening bleeding occurs during dabigatran therapy. Andexanet alfa is
the reversal agent used specifically for Factor Xa inhibitors like apixaban and rivaroxaban.
6. An AGACNP is managing a patient with Heparin-Induced Thrombocytopenia (HIT). Which of
the following is the most appropriate alternative anticoagulant to initiate?
A. Enoxaparin (Lovenox)
B. Argatroban
C. Warfarin (Coumadin)
D. Aspirin
Correct Answer: B
Pharmacology for the AGACNP | Actual
Q&A with Rationale (NR567 Exam 4) |
Chamberlain College of Nursing
1. When managing a patient in septic shock, which of the following interventions are
considered evidence-based first-line pharmacologic treatments according to the Surviving
Sepsis Campaign? (Select All That Apply)
A. Crystalloid fluid resuscitation at 30 mL/kg within the first 3 hours
B. Norepinephrine as the first-choice vasopressor to maintain MAP ≥ 65 mmHg
C. Administration of broad-spectrum empiric antibiotics within 1 hour
D. Low-dose dopamine for the purpose of renal protection
E. Routine administration of high-dose corticosteroids for all sepsis patients
F. Etomidate as a long-term sedative for mechanical ventilation
Correct Answer: A, B, C
Sepsis management emphasizes rapid fluid resuscitation and early antibiotic
administration to improve survival outcomes. Norepinephrine is preferred over other
vasopressors because it effectively increases blood pressure with less risk of tachycardia
and arrhythmias. Renal-dose dopamine has been debunked and is no longer recommended
in clinical practice guidelines.
,2. A patient is receiving a continuous infusion of Propofol (Diprivan) for sedation in the ICU.
Which laboratory parameter must the AGACNP monitor closely due to the formulation of this
medication?
A. Serum sodium
B. Prothrombin time (PT)
C. Serum calcium
D. Serum triglycerides
Correct Answer: D
Propofol is formulated in a 10% lipid emulsion, which provides approximately 1.1
kcal/mL of fat content. Prolonged use or high doses can lead to hypertriglyceridemia and
potentially progress to Propofol Infusion Syndrome (PRIS). Monitoring triglycerides is
essential to prevent pancreatic complications and metabolic acidosis.
3. When initiating Milrinone for a patient with acute decompensated heart failure, the
AGACNP understands that this medication acts through which primary mechanism?
A. Beta-1 adrenergic agonism
B. Phosphodiesterase-3 (PDE3) inhibition
C. Alpha-1 adrenergic antagonism
D. Calcium channel blockade
Correct Answer: B
, Milrinone is an inodilator that inhibits the PDE3 enzyme, leading to increased cyclic AMP
in the myocardium and vascular smooth muscle. This results in increased myocardial
contractility and significant peripheral vasodilation, which reduces both preload and
afterload. Unlike dobutamine, it does not rely on beta-receptors, making it useful for
patients on chronic beta-blocker therapy.
4. A patient with refractory ventricular fibrillation is receiving intravenous Amiodarone.
Which of the following potential toxicities or side effects are associated with this medication?
(Select All That Apply)
A. Pulmonary fibrosis
B. Thyroid dysfunction (hypothyroidism or hyperthyroidism)
C. Corneal micro-deposits
D. Hepatotoxicity
E. Acute nephrolithiasis
Correct Answer: A, B, C, D
Amiodarone is a highly effective anti-arrhythmic but is associated with extensive organ
toxicity due to its iodine content and long half-life. Monitoring of liver function, thyroid
levels, and pulmonary function tests is standard for patients on chronic therapy.
Nephrolithiasis is not a recognized adverse effect associated with amiodarone
administration.
, 5. What is the recommended reversal agent for a patient experiencing life-threatening
bleeding while on Dabigatran (Pradaxa)?
A. Protamine sulfate
B. Vitamin K
C. Andexanet alfa
D. Idarucizumab (Praxbind)
Correct Answer: D
Idarucizumab is a monoclonal antibody fragment that specifically binds to dabigatran and
its metabolites, neutralizing their anticoagulant effect. It is indicated when emergency
surgery or life-threatening bleeding occurs during dabigatran therapy. Andexanet alfa is
the reversal agent used specifically for Factor Xa inhibitors like apixaban and rivaroxaban.
6. An AGACNP is managing a patient with Heparin-Induced Thrombocytopenia (HIT). Which of
the following is the most appropriate alternative anticoagulant to initiate?
A. Enoxaparin (Lovenox)
B. Argatroban
C. Warfarin (Coumadin)
D. Aspirin
Correct Answer: B
