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NURS 6521N Advanced Pharmacology Midterm Exam 2026-2027
BANK QUESTIONS WITH DETAILED VERIFIED ANSWERS
EXAM QUESTIONS WILL COME FROM HERE (100 % Latest
Already Graded A+
QUESTION 1
A 65-year-old male patient with a history of hypertension and type 2
diabetes is prescribed lisinopril. He develops a persistent dry cough and
reports that the cough is interfering with his sleep. Which of the
following is the most appropriate next step in managing this patient?
A) Add a combination product containing hydrochlorothiazide to the
lisinopril.
B) Discontinue the lisinopril and switch to an angiotensin receptor
blocker.
C) Prescribe an over-the-counter antitussive to manage the cough
symptom.
D) Increase the lisinopril dose to achieve better blood pressure control.
ANSWER: B
Explanation: The dry cough associated with angiotensin-converting
enzyme inhibitors is a class effect due to increased bradykinin levels.
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Switching to an angiotensin receptor blocker is appropriate because
ARBs do not affect bradykinin metabolism, and the cough will typically
resolve. Adding a diuretic or increasing the dose will not address the
underlying mechanism of the cough, and symptomatic management is
not ideal when a safe alternative exists.
QUESTION 2
A 45-year-old female with moderate persistent asthma is using a
fluticasone/salmeterol combination inhaler. She reports using it twice
daily but continues to experience nocturnal symptoms three times per
week. What is the most appropriate pharmacological adjustment?
A) Increase the fluticasone component of the combination inhaler.
B) Add a leukotriene receptor antagonist such as montelukast.
C) Switch to a short-acting beta-agonist alone for symptom control.
D) Discontinue the salmeterol component due to safety concerns.
ANSWER: B
Explanation: In patients with moderate persistent asthma who remain
symptomatic on a fixed-dose combination inhaled corticosteroid/long-
acting beta-agonist, adding a leukotriene receptor antagonist is a
recommended step-up therapy. Increasing the ICS component alone
may not address the additional inflammatory pathways. Salmeterol
should not be discontinued without replacement therapy, and SABA
monotherapy is insufficient for persistent asthma.
QUESTION 3
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A 70-year-old male with a history of heart failure with reduced ejection
fraction is prescribed digoxin. Which of the following concurrent
medications poses the greatest risk of increasing digoxin serum levels
to a toxic range?
A) Amlodipine
B) Furosemide
C) Clarithromycin
D) Metoprolol
ANSWER: C
Explanation: Clarithromycin is a potent inhibitor of P-glycoprotein and
reduces renal clearance of digoxin, significantly increasing its serum
concentration. Amlodipine and metoprolol have minimal effects on
digoxin levels, and furosemide may cause electrolyte imbalances but
does not directly elevate digoxin levels to the same degree.
QUESTION 4
A 55-year-old male is initiated on warfarin for atrial fibrillation. He asks
about dietary restrictions. Which of the following statements regarding
vitamin K and warfarin is accurate?
A) Patients should completely avoid all foods containing vitamin K.
B) Consistent daily intake of vitamin K is more important than
avoidance.
C) Vitamin K enhances the anticoagulant effect of warfarin.
D) Warfarin works by increasing vitamin K-dependent clotting factors.
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ANSWER: B
Explanation: The goal with warfarin is to maintain a consistent dietary
intake of vitamin K rather than eliminate it. Fluctuations in vitamin K
intake can cause unpredictable INR values. Warfarin inhibits vitamin K
epoxide reductase, reducing the production of active clotting factors, so
vitamin K actually antagonizes the effect of warfarin.
QUESTION 5
A patient with acute gout is prescribed colchicine. He has a history of
chronic kidney disease stage 3. What is the most critical adjustment
required for this patient?
A) No adjustment is needed because colchicine is not renally cleared.
B) The dose should be reduced, and the patient should be monitored
for myelosuppression.
C) Colchicine is contraindicated in all patients with kidney disease.
D) The dose should be increased to overcome reduced bioavailability.
ANSWER: B
Explanation: Colchicine undergoes significant renal excretion. In
patients with renal impairment, the dose must be reduced to avoid
toxicity, especially neutropenia and gastrointestinal distress. It is not
absolutely contraindicated, but careful dose titration and monitoring
are required.
NURS 6521N Advanced Pharmacology Midterm Exam 2026-2027
BANK QUESTIONS WITH DETAILED VERIFIED ANSWERS
EXAM QUESTIONS WILL COME FROM HERE (100 % Latest
Already Graded A+
QUESTION 1
A 65-year-old male patient with a history of hypertension and type 2
diabetes is prescribed lisinopril. He develops a persistent dry cough and
reports that the cough is interfering with his sleep. Which of the
following is the most appropriate next step in managing this patient?
A) Add a combination product containing hydrochlorothiazide to the
lisinopril.
B) Discontinue the lisinopril and switch to an angiotensin receptor
blocker.
C) Prescribe an over-the-counter antitussive to manage the cough
symptom.
D) Increase the lisinopril dose to achieve better blood pressure control.
ANSWER: B
Explanation: The dry cough associated with angiotensin-converting
enzyme inhibitors is a class effect due to increased bradykinin levels.
,2|Page
Switching to an angiotensin receptor blocker is appropriate because
ARBs do not affect bradykinin metabolism, and the cough will typically
resolve. Adding a diuretic or increasing the dose will not address the
underlying mechanism of the cough, and symptomatic management is
not ideal when a safe alternative exists.
QUESTION 2
A 45-year-old female with moderate persistent asthma is using a
fluticasone/salmeterol combination inhaler. She reports using it twice
daily but continues to experience nocturnal symptoms three times per
week. What is the most appropriate pharmacological adjustment?
A) Increase the fluticasone component of the combination inhaler.
B) Add a leukotriene receptor antagonist such as montelukast.
C) Switch to a short-acting beta-agonist alone for symptom control.
D) Discontinue the salmeterol component due to safety concerns.
ANSWER: B
Explanation: In patients with moderate persistent asthma who remain
symptomatic on a fixed-dose combination inhaled corticosteroid/long-
acting beta-agonist, adding a leukotriene receptor antagonist is a
recommended step-up therapy. Increasing the ICS component alone
may not address the additional inflammatory pathways. Salmeterol
should not be discontinued without replacement therapy, and SABA
monotherapy is insufficient for persistent asthma.
QUESTION 3
,3|Page
A 70-year-old male with a history of heart failure with reduced ejection
fraction is prescribed digoxin. Which of the following concurrent
medications poses the greatest risk of increasing digoxin serum levels
to a toxic range?
A) Amlodipine
B) Furosemide
C) Clarithromycin
D) Metoprolol
ANSWER: C
Explanation: Clarithromycin is a potent inhibitor of P-glycoprotein and
reduces renal clearance of digoxin, significantly increasing its serum
concentration. Amlodipine and metoprolol have minimal effects on
digoxin levels, and furosemide may cause electrolyte imbalances but
does not directly elevate digoxin levels to the same degree.
QUESTION 4
A 55-year-old male is initiated on warfarin for atrial fibrillation. He asks
about dietary restrictions. Which of the following statements regarding
vitamin K and warfarin is accurate?
A) Patients should completely avoid all foods containing vitamin K.
B) Consistent daily intake of vitamin K is more important than
avoidance.
C) Vitamin K enhances the anticoagulant effect of warfarin.
D) Warfarin works by increasing vitamin K-dependent clotting factors.
, 4|Page
ANSWER: B
Explanation: The goal with warfarin is to maintain a consistent dietary
intake of vitamin K rather than eliminate it. Fluctuations in vitamin K
intake can cause unpredictable INR values. Warfarin inhibits vitamin K
epoxide reductase, reducing the production of active clotting factors, so
vitamin K actually antagonizes the effect of warfarin.
QUESTION 5
A patient with acute gout is prescribed colchicine. He has a history of
chronic kidney disease stage 3. What is the most critical adjustment
required for this patient?
A) No adjustment is needed because colchicine is not renally cleared.
B) The dose should be reduced, and the patient should be monitored
for myelosuppression.
C) Colchicine is contraindicated in all patients with kidney disease.
D) The dose should be increased to overcome reduced bioavailability.
ANSWER: B
Explanation: Colchicine undergoes significant renal excretion. In
patients with renal impairment, the dose must be reduced to avoid
toxicity, especially neutropenia and gastrointestinal distress. It is not
absolutely contraindicated, but careful dose titration and monitoring
are required.
