NSG 3253 Pharmacotherapeutics for Nursing
Practice II Master Practice Exam | Questions,
Answers & Rationales – 2026/2027
Question 1
A nurse is monitoring a client who is receiving intravenous amiodarone
for recurrent ventricular fibrillation. Which adverse effect is most critical
for the nurse to assess during long-term therapy?
• A. Pulmonary toxicity resulting in interstitial lung disease and
cough
• B. Permanent yellow-brown discoloration of the skin and teeth
• C. Severe hypokalemia and profound metabolic alkalosis
• D. Rapid-onset bone marrow suppression and agranulocytosis
Correct Answer: A. Pulmonary toxicity resulting in interstitial lung
disease and cough
Detailed Rationale: Amiodarone contains iodine moieties and
accumulates in multiple tissues, notably lung tissue. It can cause severe
pulmonary toxicity, including fatal pulmonary fibrosis, requiring baseline
and ongoing respiratory assessments and chest radiography.
Question 2
,A client with atrial fibrillation is prescribed dabigatran, a direct
thrombin inhibitor. Which instruction should the nurse include in the
client's discharge teaching?
• A. "Swallow the capsules whole and keep them in their original
blister pack or container until use."
• B. "Crush the capsules and mix them in applesauce if you have
difficulty swallowing them whole."
• C. "Store your supply in a clear plastic pillbox on the kitchen
counter for easy daily access."
• D. "Stop taking the medication 7 days prior to any minor dental
cleaning without provider input."
Correct Answer: A. "Swallow the capsules whole and keep them in their
original blister pack or container until use."
Detailed Rationale: Dabigatran capsules are sensitive to moisture and
must remain in their original packaging until administration. Crushing or
opening the capsule increases bioavailability significantly, raising the
risk of severe bleeding.
Question 3
A client with chronic heart failure is prescribed sacubitril/valsartan.
What is a crucial medication history requirement before initiating this
ARNI?
• A. Must discontinue any ACE inhibitor at least 36 hours prior to
starting sacubitril/valsartan
• B. Must have a confirmed history of allergy to all beta-blockers
, • C. Must be taking a concurrent loop diuretic at maximum safe
dosage
• D. Must avoid all dietary sources of vitamin K indefinitely
Correct Answer: A. Must discontinue any ACE inhibitor at least 36 hours
prior to starting sacubitril/valsartan
Detailed Rationale: Combining an ACE inhibitor with
sacubitril/valsartan greatly increases the risk of angioedema due to
concurrent neprilysin and ACE inhibition causing bradykinin
accumulation. A 36-hour washout period is mandatory.
Question 4
A client taking clonidine for severe hypertension abruptly stops taking
the medication. What clinical manifestation should the nurse
anticipate?
• A. Rebound hypertension with severe headache, tachycardia, and
tremors
• B. Rapid-onset profound hypotension and cardiovascular collapse
• C. Acute hemolytic anemia and jaundice
• D. Sudden permanent bilateral hearing loss
Correct Answer: A. Rebound hypertension with severe headache,
tachycardia, and tremors
Detailed Rationale: Abrupt cessation of centrally acting alpha-2
agonists like clonidine triggers a massive sympathetic surge, causing
severe rebound hypertension, nervousness, tachycardia, and sweating.
Tapering over 2 to 4 days prevents this.
, Question 5
A nurse is educating a client starting an evolocumab prescription for
hyperlipidemia. What is the primary mechanism of action of this PCSK9
inhibitor?
• A. Inhibiting PCSK9 proteins, preventing the degradation of LDL
receptors and increasing hepatic clearance of LDL cholesterol
• B. Binding to bile acids in the intestine and promoting their fecal
excretion
• C. Inhibiting cholesterol absorption directly across the brush
border of the small intestine
• D. Stimulating lipoprotein lipase activity to clear circulating
triglycerides
Correct Answer: A. Inhibiting PCSK9 proteins, preventing the
degradation of LDL receptors and increasing hepatic clearance of LDL
cholesterol
Detailed Rationale: PCSK9 is a protein that binds to LDL receptors on
hepatocytes, marking them for destruction. Monoclonal antibodies like
evolocumab inhibit PCSK9, preserving LDL receptors and dramatically
lowering serum LDL levels.
Question 6
A nurse is reviewing the chart of a client prescribed liraglutide for type 2
diabetes mellitus. Which finding in the client's personal or family history
represents a strict black box warning contraindication?
• A. Personal or family history of medullary thyroid carcinoma or
Multiple Endocrine Neoplasia syndrome type 2
Practice II Master Practice Exam | Questions,
Answers & Rationales – 2026/2027
Question 1
A nurse is monitoring a client who is receiving intravenous amiodarone
for recurrent ventricular fibrillation. Which adverse effect is most critical
for the nurse to assess during long-term therapy?
• A. Pulmonary toxicity resulting in interstitial lung disease and
cough
• B. Permanent yellow-brown discoloration of the skin and teeth
• C. Severe hypokalemia and profound metabolic alkalosis
• D. Rapid-onset bone marrow suppression and agranulocytosis
Correct Answer: A. Pulmonary toxicity resulting in interstitial lung
disease and cough
Detailed Rationale: Amiodarone contains iodine moieties and
accumulates in multiple tissues, notably lung tissue. It can cause severe
pulmonary toxicity, including fatal pulmonary fibrosis, requiring baseline
and ongoing respiratory assessments and chest radiography.
Question 2
,A client with atrial fibrillation is prescribed dabigatran, a direct
thrombin inhibitor. Which instruction should the nurse include in the
client's discharge teaching?
• A. "Swallow the capsules whole and keep them in their original
blister pack or container until use."
• B. "Crush the capsules and mix them in applesauce if you have
difficulty swallowing them whole."
• C. "Store your supply in a clear plastic pillbox on the kitchen
counter for easy daily access."
• D. "Stop taking the medication 7 days prior to any minor dental
cleaning without provider input."
Correct Answer: A. "Swallow the capsules whole and keep them in their
original blister pack or container until use."
Detailed Rationale: Dabigatran capsules are sensitive to moisture and
must remain in their original packaging until administration. Crushing or
opening the capsule increases bioavailability significantly, raising the
risk of severe bleeding.
Question 3
A client with chronic heart failure is prescribed sacubitril/valsartan.
What is a crucial medication history requirement before initiating this
ARNI?
• A. Must discontinue any ACE inhibitor at least 36 hours prior to
starting sacubitril/valsartan
• B. Must have a confirmed history of allergy to all beta-blockers
, • C. Must be taking a concurrent loop diuretic at maximum safe
dosage
• D. Must avoid all dietary sources of vitamin K indefinitely
Correct Answer: A. Must discontinue any ACE inhibitor at least 36 hours
prior to starting sacubitril/valsartan
Detailed Rationale: Combining an ACE inhibitor with
sacubitril/valsartan greatly increases the risk of angioedema due to
concurrent neprilysin and ACE inhibition causing bradykinin
accumulation. A 36-hour washout period is mandatory.
Question 4
A client taking clonidine for severe hypertension abruptly stops taking
the medication. What clinical manifestation should the nurse
anticipate?
• A. Rebound hypertension with severe headache, tachycardia, and
tremors
• B. Rapid-onset profound hypotension and cardiovascular collapse
• C. Acute hemolytic anemia and jaundice
• D. Sudden permanent bilateral hearing loss
Correct Answer: A. Rebound hypertension with severe headache,
tachycardia, and tremors
Detailed Rationale: Abrupt cessation of centrally acting alpha-2
agonists like clonidine triggers a massive sympathetic surge, causing
severe rebound hypertension, nervousness, tachycardia, and sweating.
Tapering over 2 to 4 days prevents this.
, Question 5
A nurse is educating a client starting an evolocumab prescription for
hyperlipidemia. What is the primary mechanism of action of this PCSK9
inhibitor?
• A. Inhibiting PCSK9 proteins, preventing the degradation of LDL
receptors and increasing hepatic clearance of LDL cholesterol
• B. Binding to bile acids in the intestine and promoting their fecal
excretion
• C. Inhibiting cholesterol absorption directly across the brush
border of the small intestine
• D. Stimulating lipoprotein lipase activity to clear circulating
triglycerides
Correct Answer: A. Inhibiting PCSK9 proteins, preventing the
degradation of LDL receptors and increasing hepatic clearance of LDL
cholesterol
Detailed Rationale: PCSK9 is a protein that binds to LDL receptors on
hepatocytes, marking them for destruction. Monoclonal antibodies like
evolocumab inhibit PCSK9, preserving LDL receptors and dramatically
lowering serum LDL levels.
Question 6
A nurse is reviewing the chart of a client prescribed liraglutide for type 2
diabetes mellitus. Which finding in the client's personal or family history
represents a strict black box warning contraindication?
• A. Personal or family history of medullary thyroid carcinoma or
Multiple Endocrine Neoplasia syndrome type 2
