NR 565 Final Exam Advanced Pharmacology Fundamentals 2027 – Complete High-Yield Practice Questions, Drug Classes, and Detailed Clinical Rationales (Grade A+)

NR 565 Final Exam – Advanced Pharmacology
Fundamentals (2027) – Complete Practice
Questions & Rationales



Question 1
A patient with heart failure with reduced ejection fraction (HFrEF) is
prescribed sacubitril/valsartan (Entresto). Which laboratory value should be
monitored before initiating therapy and periodically thereafter?

A. Serum sodium
B. Serum potassium
C. Serum creatinine
D. Liver function tests

*Correct Answer: B. Serum potassium. *

Rationale: Sacubitril/valsartan can cause hyperkalemia. Renal function and
potassium should be checked before starting and within 1-2 weeks of
initiating therapy .




Question 2
A patient on digoxin therapy for heart failure presents with nausea,
vomiting, and visual disturbances. Which electrolyte imbalance is most
likely contributing to digoxin toxicity?

A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypomagnesemia

,*Correct Answer: B. Hypokalemia. *

Rationale: Hypokalemia increases the risk of digoxin toxicity by increasing the
binding of digoxin to the Na/K-ATPase pump. Signs include nausea,
vomiting, and visual disturbances (yellow-green halos) .




Question 3
A 65-year-old patient with atrial fibrillation is started on apixaban (Eliquis)
for stroke prevention. What is the most important monitoring parameter for
this medication?

A. Serum creatinine and liver function
B. Renal function (CrCl) and signs of bleeding
C. Complete blood count only
D. Prothrombin time (PT/INR)

*Correct Answer: B. Renal function (CrCl) and signs of bleeding. *

Rationale: Apixaban is a DOAC eliminated renally. Monitoring renal function
is essential. Unlike warfarin, PT/INR is not used for monitoring. The most
important clinical monitoring is for signs of bleeding .




Question 4
A patient with a history of heparin-induced thrombocytopenia (HIT)
requires anticoagulation. Which agent should be avoided?

A. Argatroban
B. Fondaparinux
C. Apixaban
D. Unfractionated heparin

*Correct Answer: D. Unfractionated heparin. *

,Rationale: Heparin and low molecular weight heparins are contraindicated in
HIT. Argatroban or fondaparinux may be used as alternatives. DOACs are
also emerging as options .




Question 5
A patient is prescribed clopidogrel after a drug-eluting stent placement.
Which medication interaction should the nurse be most concerned about?

A. Metoprolol
B. Omeprazole
C. Lisinopril
D. Atorvastatin

*Correct Answer: B. Omeprazole. *

Rationale: Omeprazole (a PPI) inhibits CYP2C19, the enzyme responsible for
converting clopidogrel to its active metabolite, reducing its antiplatelet effect.
Pantoprazole is preferred .




Question 6
A patient on warfarin therapy is started on amiodarone for atrial fibrillation.
The nurse anticipates that the INR will:

A. Decrease
B. Increase
C. Remain the same
D. Become undetectable

*Correct Answer: B. Increase. *

, Rationale: Amiodarone inhibits CYP2C9 and CYP3A4, increasing warfarin
levels and INR. The warfarin dose should be reduced by 30-50% when
amiodarone is added .




Question 7
A 45-year-old female with a urinary tract infection reports a penicillin
allergy (hives). Which antibiotic should be avoided due to cross-reactivity?

A. Cephalexin
B. Nitrofurantoin
C. Ciprofloxacin
D. Doxycycline

*Correct Answer: A. Cephalexin. *

Rationale: Cephalosporins (cephalexin) have a 5-10% cross-reactivity risk in
patients with true IgE-mediated penicillin allergy. The other options do not
have cross-reactivity with penicillins .




Question 8
A patient is prescribed fluconazole for a vaginal yeast infection. Which
medication interaction should be monitored?

A. Metformin
B. Warfarin
C. Lisinopril
D. Levothyroxine

*Correct Answer: B. Warfarin. *