NSG 3253 Pharm II Comprehensive Final Exam Prep
2026/2027 | Practice Questions & Rationales
Question 1
What is a mandatory medication washout requirement when switching
a patient from an angiotensin-converting enzyme (ACE) inhibitor to
sacubitril/valsartan (an angiotensin receptor-neprilysin inhibitor) to
prevent angioedema?
• A. A minimum 36-hour washout period of the ACE inhibitor is
required before initiating sacubitril/valsartan.
• B. No waiting period is required; the medications can be taken on
the exact same day.
• C. A 14-day washout period is required to clear renal enzymes.
• D. The patient must stop all cardiac medications for one full week.
Correct Answer: A. A minimum 36-hour washout period of the ACE
inhibitor is required before initiating sacubitril/valsartan.
Detailed Rationale: Both ACE inhibitors and neprilysin inhibitors
increase bradykinin levels. Combining them or transitioning without a
36-hour washout significantly increases the risk of life-threatening
angioedema.
Question 2
What is the specific pharmacological reversal agent utilized for life-
threatening bleeding associated with direct factor Xa inhibitors like
rivaroxaban or apixaban?
, • A. Andexanet alfa
• B. Protamine sulfate
• C. Vitamin K phytadione
• D. Fresh frozen plasma alone
Correct Answer: A. Andexanet alfa
Detailed Rationale: Andexanet alfa is a recombinant modified decoy
factor Xa protein that binds and sequesters direct factor Xa inhibitors in
the bloodstream, rapidly reversing their anticoagulant effect.
Question 3
What is the correct administration technique when giving an
intravenous push of adenosine for paroxysmal supraventricular
tachycardia (SVT)?
• A. Administer as a rapid IV bolus over 1 to 2 seconds through an
antecubital or proximal IV site, followed immediately by a rapid
normal saline flush.
• B. Infuse slowly over 30 minutes in a large-volume piggyback bag.
• C. Administer via a continuous slow infusion pump over 24 hours.
• D. Give intramuscularly in the vastus lateralis muscle.
Correct Answer: A. Administer as a rapid IV bolus over 1 to 2 seconds
through an antecubital or proximal IV site, followed immediately by a
rapid normal saline flush.
Detailed Rationale: Adenosine has an extremely short half-life of less
than 10 seconds. Rapid IV push into a proximal site with an immediate
saline flush ensures the drug reaches the heart before being degraded.
,Question 4
What is the established therapeutic serum concentration range for
theophylline when used in the chronic management of chronic
obstructive pulmonary disease or asthma?
• A. 10 to 20 mcg/mL
• B. 0.6 to 1.2 mcg/mL
• C. 50 to 100 mcg/mL
• D. 2 to 5 mcg/mL
Correct Answer: A. 10 to 20 mcg/mL
Detailed Rationale: Theophylline has a narrow therapeutic index.
Serum levels between 10 and 20 mcg/mL provide bronchodilation,
while levels exceeding 20 mcg/mL risk severe toxicity, including cardiac
arrhythmias and seizures.
Question 5
What fundamental safety principle must the nurse follow when
preparing a single syringe containing regular insulin and intermediate-
acting NPH insulin?
• A. Draw up the clear (regular) insulin into the syringe first before
drawing the cloudy (NPH) insulin to prevent contaminating the
regular vial.
• B. Draw up the cloudy insulin first, followed by the clear insulin.
• C. Mix the two vials together inside the regular insulin bottle prior
to drawing.
, • D. Insulin formulations should never be combined in the same
syringe under any circumstances.
Correct Answer: A. Draw up the clear (regular) insulin into the syringe
first before drawing the cloudy (NPH) insulin to prevent contaminating
the regular vial.
Detailed Rationale: Following the "clear before cloudy" rule prevents
contaminating the regular (clear) insulin vial with NPH (cloudy)
suspension buffer, which alters the rapid onset profile of regular insulin.
Question 6
What prominent black box warning is associated with glucagon-like
peptide-1 (GLP-1) receptor agonists such as liraglutide or semaglutide?
• A. Risk of thyroid C-cell tumors (medullary thyroid carcinoma)
observed in animal studies.
• B. Severe bone marrow aplasia and profound agranulocytosis.
• C. Permanent retinal detachment and acute glaucoma.
• D. Rapid destruction of the aortic heart valve.
Correct Answer: A. Risk of thyroid C-cell tumors (medullary thyroid
carcinoma) observed in animal studies.
Detailed Rationale: GLP-1 receptor agonists carry a black box warning
regarding thyroid C-cell tumors based on rodent studies. They are
contraindicated in patients with a personal or family history of
medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome
type 2.
Question 7
2026/2027 | Practice Questions & Rationales
Question 1
What is a mandatory medication washout requirement when switching
a patient from an angiotensin-converting enzyme (ACE) inhibitor to
sacubitril/valsartan (an angiotensin receptor-neprilysin inhibitor) to
prevent angioedema?
• A. A minimum 36-hour washout period of the ACE inhibitor is
required before initiating sacubitril/valsartan.
• B. No waiting period is required; the medications can be taken on
the exact same day.
• C. A 14-day washout period is required to clear renal enzymes.
• D. The patient must stop all cardiac medications for one full week.
Correct Answer: A. A minimum 36-hour washout period of the ACE
inhibitor is required before initiating sacubitril/valsartan.
Detailed Rationale: Both ACE inhibitors and neprilysin inhibitors
increase bradykinin levels. Combining them or transitioning without a
36-hour washout significantly increases the risk of life-threatening
angioedema.
Question 2
What is the specific pharmacological reversal agent utilized for life-
threatening bleeding associated with direct factor Xa inhibitors like
rivaroxaban or apixaban?
, • A. Andexanet alfa
• B. Protamine sulfate
• C. Vitamin K phytadione
• D. Fresh frozen plasma alone
Correct Answer: A. Andexanet alfa
Detailed Rationale: Andexanet alfa is a recombinant modified decoy
factor Xa protein that binds and sequesters direct factor Xa inhibitors in
the bloodstream, rapidly reversing their anticoagulant effect.
Question 3
What is the correct administration technique when giving an
intravenous push of adenosine for paroxysmal supraventricular
tachycardia (SVT)?
• A. Administer as a rapid IV bolus over 1 to 2 seconds through an
antecubital or proximal IV site, followed immediately by a rapid
normal saline flush.
• B. Infuse slowly over 30 minutes in a large-volume piggyback bag.
• C. Administer via a continuous slow infusion pump over 24 hours.
• D. Give intramuscularly in the vastus lateralis muscle.
Correct Answer: A. Administer as a rapid IV bolus over 1 to 2 seconds
through an antecubital or proximal IV site, followed immediately by a
rapid normal saline flush.
Detailed Rationale: Adenosine has an extremely short half-life of less
than 10 seconds. Rapid IV push into a proximal site with an immediate
saline flush ensures the drug reaches the heart before being degraded.
,Question 4
What is the established therapeutic serum concentration range for
theophylline when used in the chronic management of chronic
obstructive pulmonary disease or asthma?
• A. 10 to 20 mcg/mL
• B. 0.6 to 1.2 mcg/mL
• C. 50 to 100 mcg/mL
• D. 2 to 5 mcg/mL
Correct Answer: A. 10 to 20 mcg/mL
Detailed Rationale: Theophylline has a narrow therapeutic index.
Serum levels between 10 and 20 mcg/mL provide bronchodilation,
while levels exceeding 20 mcg/mL risk severe toxicity, including cardiac
arrhythmias and seizures.
Question 5
What fundamental safety principle must the nurse follow when
preparing a single syringe containing regular insulin and intermediate-
acting NPH insulin?
• A. Draw up the clear (regular) insulin into the syringe first before
drawing the cloudy (NPH) insulin to prevent contaminating the
regular vial.
• B. Draw up the cloudy insulin first, followed by the clear insulin.
• C. Mix the two vials together inside the regular insulin bottle prior
to drawing.
, • D. Insulin formulations should never be combined in the same
syringe under any circumstances.
Correct Answer: A. Draw up the clear (regular) insulin into the syringe
first before drawing the cloudy (NPH) insulin to prevent contaminating
the regular vial.
Detailed Rationale: Following the "clear before cloudy" rule prevents
contaminating the regular (clear) insulin vial with NPH (cloudy)
suspension buffer, which alters the rapid onset profile of regular insulin.
Question 6
What prominent black box warning is associated with glucagon-like
peptide-1 (GLP-1) receptor agonists such as liraglutide or semaglutide?
• A. Risk of thyroid C-cell tumors (medullary thyroid carcinoma)
observed in animal studies.
• B. Severe bone marrow aplasia and profound agranulocytosis.
• C. Permanent retinal detachment and acute glaucoma.
• D. Rapid destruction of the aortic heart valve.
Correct Answer: A. Risk of thyroid C-cell tumors (medullary thyroid
carcinoma) observed in animal studies.
Detailed Rationale: GLP-1 receptor agonists carry a black box warning
regarding thyroid C-cell tumors based on rodent studies. They are
contraindicated in patients with a personal or family history of
medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome
type 2.
Question 7
