NURS 615 PHARM 2 EXAM PRACTICE | STUDY GUIDE | TESTBANK | PRACTICE
QUESTIONS & ANSWERS | EXAM PREPARATION | ADVANCED REVIEW |
COMPREHENSIVE PRACTICE EXAM | LATEST UPDATE 2026/2027
Examiner:
Maryville University (Course-Based Graduate Nursing Assessment)
TABLE OF CONTENTS
1. Advanced Pharmacokinetics and Pharmacodynamics
2. Cardiovascular Pharmacology
3. Endocrine Pharmacology
4. Infectious Disease Pharmacotherapy
5. Neurologic and Psychiatric Pharmacology
6. Respiratory Pharmacology
7. Gastrointestinal Pharmacology
8. Renal and Genitourinary Pharmacology
9. Pain Management and Controlled Substances
10. Special Populations and Clinical Decision-Making
DESCRIPTION
This comprehensive practice question set is designed as an advanced study
companion for graduate nursing pharmacology coursework commonly associated
with NURS 615 Pharmacology II. The questions emphasize clinical reasoning,
pharmacotherapeutic decision-making, adverse drug reaction recognition, medication
safety, patient-specific treatment selection, and evidence-informed prescribing
principles. Learners will encounter challenging patient scenarios involving multiple
comorbidities, drug interactions, contraindications, laboratory interpretation, dosage
adjustments, and therapeutic monitoring. These practice questions are intended to
reinforce concepts frequently emphasized in graduate pharmacology texts, course
lectures, clinical practice guidelines, and study resources. They are educational review
materials created to strengthen mastery of advanced pharmacology concepts and
prepare students for comprehensive course examinations through critical thinking
rather than memorization.
,QUESTION 1.
A 68-year-old patient with heart failure with reduced ejection fraction is taking
lisinopril. The patient develops persistent angioedema without airway compromise.
Which medication is the most appropriate alternative after discontinuing lisinopril?
A. Losartan
B. Sacubitril/valsartan immediately after ACE inhibitor discontinuation
C. Enalapril at a lower dose
D. Aliskiren
🔴 Correct Answer: A. Losartan
🔵 Explanation: Angioedema is a significant adverse effect of ACE inhibitors and
generally warrants permanent discontinuation. An angiotensin receptor blocker may
be considered cautiously because the incidence of recurrent angioedema is much
lower than with ACE inhibitors. Sacubitril/valsartan requires an appropriate washout
period after ACE inhibitor therapy due to increased angioedema risk, enalapril is
another ACE inhibitor, and aliskiren is not the preferred substitute in this scenario.
QUESTION 2.
A patient receiving warfarin is prescribed trimethoprim-sulfamethoxazole for a
urinary tract infection. Which management strategy is most appropriate?
A. Increase the warfarin dose
B. Continue both medications without monitoring
C. Closely monitor the INR and anticipate a possible warfarin dose reduction
D. Stop warfarin immediately
🔴 Correct Answer: C. Closely monitor the INR and anticipate a possible warfarin
dose reduction
🔵 Explanation: Trimethoprim-sulfamethoxazole significantly inhibits warfarin
metabolism, increasing anticoagulant effects and bleeding risk. Frequent INR
monitoring with appropriate dose adjustment is recommended. Increasing warfarin
would worsen anticoagulation, stopping it completely may unnecessarily expose the
patient to thrombosis, and ignoring the interaction is unsafe.
,QUESTION 3.
A patient with type 2 diabetes, chronic kidney disease, and albuminuria requires
additional glucose-lowering therapy. Which medication provides both glycemic
control and demonstrated renal protection?
A. Glyburide
B. Empagliflozin
C. Repaglinide
D. Acarbose
🔴 Correct Answer: B. Empagliflozin
🔵 Explanation: SGLT2 inhibitors such as empagliflozin have demonstrated
cardiovascular and renal protective benefits beyond glucose lowering in appropriately
selected patients. Glyburide carries a higher hypoglycemia risk in kidney disease,
while repaglinide and acarbose lack comparable renal outcome evidence.
QUESTION 4.
A patient develops severe muscle pain several weeks after beginning simvastatin
and clarithromycin simultaneously. Which mechanism best explains this adverse
reaction?
A. Increased renal elimination of simvastatin
B. CYP3A4 inhibition leading to elevated simvastatin concentrations
C. Enhanced hepatic metabolism of simvastatin
D. Reduced intestinal absorption of simvastatin
🔴 Correct Answer: B. CYP3A4 inhibition leading to elevated simvastatin
concentrations
🔵 Explanation: Clarithromycin strongly inhibits CYP3A4, substantially increasing
simvastatin serum concentrations and the risk of myopathy or rhabdomyolysis. The
other options describe mechanisms opposite to what occurs or are clinically
insignificant in explaining this interaction.
, QUESTION 5.
A patient with atrial fibrillation taking digoxin presents with nausea, confusion, and
yellow-green visual disturbances. Which electrolyte abnormality most likely
contributed?
A. Hyperkalemia
B. Hypermagnesemia
C. Hypokalemia
D. Hypercalcemia alone
🔴 Correct Answer: C. Hypokalemia
🔵 Explanation: Hypokalemia increases digoxin binding to the sodium-potassium
ATPase pump, predisposing patients to toxicity even when serum digoxin
concentrations are therapeutic. Hyperkalemia is more commonly associated with
severe toxicity rather than causing it, while the remaining options are less likely to
explain this presentation.
QUESTION 6.
A patient receiving unfractionated heparin develops thrombocytopenia and a new
deep vein thrombosis. Which is the best immediate action?
A. Increase the heparin infusion
B. Continue heparin and monitor platelets weekly
C. Stop heparin and initiate a non-heparin anticoagulant
D. Administer vitamin K
🔴 Correct Answer: C. Stop heparin and initiate a non-heparin anticoagulant
🔵 Explanation: This presentation is highly suggestive of heparin-induced
thrombocytopenia. All heparin products should be discontinued immediately, and an
alternative anticoagulant should be started. Vitamin K reverses warfarin rather than
heparin, and continuing or increasing heparin may worsen thrombosis.
QUESTIONS & ANSWERS | EXAM PREPARATION | ADVANCED REVIEW |
COMPREHENSIVE PRACTICE EXAM | LATEST UPDATE 2026/2027
Examiner:
Maryville University (Course-Based Graduate Nursing Assessment)
TABLE OF CONTENTS
1. Advanced Pharmacokinetics and Pharmacodynamics
2. Cardiovascular Pharmacology
3. Endocrine Pharmacology
4. Infectious Disease Pharmacotherapy
5. Neurologic and Psychiatric Pharmacology
6. Respiratory Pharmacology
7. Gastrointestinal Pharmacology
8. Renal and Genitourinary Pharmacology
9. Pain Management and Controlled Substances
10. Special Populations and Clinical Decision-Making
DESCRIPTION
This comprehensive practice question set is designed as an advanced study
companion for graduate nursing pharmacology coursework commonly associated
with NURS 615 Pharmacology II. The questions emphasize clinical reasoning,
pharmacotherapeutic decision-making, adverse drug reaction recognition, medication
safety, patient-specific treatment selection, and evidence-informed prescribing
principles. Learners will encounter challenging patient scenarios involving multiple
comorbidities, drug interactions, contraindications, laboratory interpretation, dosage
adjustments, and therapeutic monitoring. These practice questions are intended to
reinforce concepts frequently emphasized in graduate pharmacology texts, course
lectures, clinical practice guidelines, and study resources. They are educational review
materials created to strengthen mastery of advanced pharmacology concepts and
prepare students for comprehensive course examinations through critical thinking
rather than memorization.
,QUESTION 1.
A 68-year-old patient with heart failure with reduced ejection fraction is taking
lisinopril. The patient develops persistent angioedema without airway compromise.
Which medication is the most appropriate alternative after discontinuing lisinopril?
A. Losartan
B. Sacubitril/valsartan immediately after ACE inhibitor discontinuation
C. Enalapril at a lower dose
D. Aliskiren
🔴 Correct Answer: A. Losartan
🔵 Explanation: Angioedema is a significant adverse effect of ACE inhibitors and
generally warrants permanent discontinuation. An angiotensin receptor blocker may
be considered cautiously because the incidence of recurrent angioedema is much
lower than with ACE inhibitors. Sacubitril/valsartan requires an appropriate washout
period after ACE inhibitor therapy due to increased angioedema risk, enalapril is
another ACE inhibitor, and aliskiren is not the preferred substitute in this scenario.
QUESTION 2.
A patient receiving warfarin is prescribed trimethoprim-sulfamethoxazole for a
urinary tract infection. Which management strategy is most appropriate?
A. Increase the warfarin dose
B. Continue both medications without monitoring
C. Closely monitor the INR and anticipate a possible warfarin dose reduction
D. Stop warfarin immediately
🔴 Correct Answer: C. Closely monitor the INR and anticipate a possible warfarin
dose reduction
🔵 Explanation: Trimethoprim-sulfamethoxazole significantly inhibits warfarin
metabolism, increasing anticoagulant effects and bleeding risk. Frequent INR
monitoring with appropriate dose adjustment is recommended. Increasing warfarin
would worsen anticoagulation, stopping it completely may unnecessarily expose the
patient to thrombosis, and ignoring the interaction is unsafe.
,QUESTION 3.
A patient with type 2 diabetes, chronic kidney disease, and albuminuria requires
additional glucose-lowering therapy. Which medication provides both glycemic
control and demonstrated renal protection?
A. Glyburide
B. Empagliflozin
C. Repaglinide
D. Acarbose
🔴 Correct Answer: B. Empagliflozin
🔵 Explanation: SGLT2 inhibitors such as empagliflozin have demonstrated
cardiovascular and renal protective benefits beyond glucose lowering in appropriately
selected patients. Glyburide carries a higher hypoglycemia risk in kidney disease,
while repaglinide and acarbose lack comparable renal outcome evidence.
QUESTION 4.
A patient develops severe muscle pain several weeks after beginning simvastatin
and clarithromycin simultaneously. Which mechanism best explains this adverse
reaction?
A. Increased renal elimination of simvastatin
B. CYP3A4 inhibition leading to elevated simvastatin concentrations
C. Enhanced hepatic metabolism of simvastatin
D. Reduced intestinal absorption of simvastatin
🔴 Correct Answer: B. CYP3A4 inhibition leading to elevated simvastatin
concentrations
🔵 Explanation: Clarithromycin strongly inhibits CYP3A4, substantially increasing
simvastatin serum concentrations and the risk of myopathy or rhabdomyolysis. The
other options describe mechanisms opposite to what occurs or are clinically
insignificant in explaining this interaction.
, QUESTION 5.
A patient with atrial fibrillation taking digoxin presents with nausea, confusion, and
yellow-green visual disturbances. Which electrolyte abnormality most likely
contributed?
A. Hyperkalemia
B. Hypermagnesemia
C. Hypokalemia
D. Hypercalcemia alone
🔴 Correct Answer: C. Hypokalemia
🔵 Explanation: Hypokalemia increases digoxin binding to the sodium-potassium
ATPase pump, predisposing patients to toxicity even when serum digoxin
concentrations are therapeutic. Hyperkalemia is more commonly associated with
severe toxicity rather than causing it, while the remaining options are less likely to
explain this presentation.
QUESTION 6.
A patient receiving unfractionated heparin develops thrombocytopenia and a new
deep vein thrombosis. Which is the best immediate action?
A. Increase the heparin infusion
B. Continue heparin and monitor platelets weekly
C. Stop heparin and initiate a non-heparin anticoagulant
D. Administer vitamin K
🔴 Correct Answer: C. Stop heparin and initiate a non-heparin anticoagulant
🔵 Explanation: This presentation is highly suggestive of heparin-induced
thrombocytopenia. All heparin products should be discontinued immediately, and an
alternative anticoagulant should be started. Vitamin K reverses warfarin rather than
heparin, and continuing or increasing heparin may worsen thrombosis.
