NR 565 Final Exam – Advanced Pharmacology
Fundamentals (2026) – Complete Practice
Questions & Rationales
Section 1: Cardiovascular Pharmacology
Question 1
A 58-year-old male with hypertension and type 2 diabetes is taking
lisinopril 20 mg daily. He reports a persistent dry cough that has worsened
over the past month. His BP is well controlled. What is the most appropriate
action?
A. Continue lisinopril and add a cough suppressant
B. Discontinue lisinopril and initiate losartan
C. Reduce lisinopril dose to 10 mg
D. Switch to a calcium channel blocker only
*Correct Answer: B. Discontinue lisinopril and initiate losartan. *
Rationale: ACE inhibitors like lisinopril cause a dry cough by increasing
bradykinin levels. This side effect is not dose-dependent and will not improve
with dose reduction. An ARB (losartan) provides similar cardiovascular and
renal protection without causing the cough .
Question 2
A 72-year-old female with heart failure and hypertension is prescribed
,spironolactone. Follow-up labs show a potassium of 5.8 mEq/L. She denies
symptoms. What is the best action?
A. Continue medication and recheck in 1 week
B. Discontinue spironolactone
C. Add a potassium supplement
D. Increase the spironolactone dose
*Correct Answer: B. Discontinue spironolactone. *
Rationale: Spironolactone is a potassium-sparing diuretic. A serum potassium
of 5.8 mEq/L is above the normal range and indicates hyperkalemia, which
requires stopping the medication to prevent cardiac arrhythmias .
Question 3
What is the primary advantage of ACE inhibitors over thiazide diuretics
regarding metabolic side effects?
A. ACE inhibitors are more likely to cause hyperkalemia
B. Thiazides can increase uric acid and glucose levels
C. Thiazides can cause hypokalemia
D. All of the above
*Correct Answer: D. All of the above. *
Rationale: Thiazide diuretics can cause hypokalemia, hyperuricemia, and
hyperglycemia. ACE inhibitors can increase potassium (hyperkalemia) but do
not affect uric acid and glucose levels .
Question 4
A patient on warfarin for a mechanical heart valve presents with an INR of
5.0 and minor bleeding. Which treatment strategy is most appropriate?
,A. Administer vitamin K 10 mg IV and repeat INR in 6 hours
B. Hold warfarin and give vitamin K 2.5 mg orally
C. Administer fresh frozen plasma immediately
D. Give prothrombin complex concentrate (PCC) 4-factor
*Correct Answer: B. Hold warfarin and give vitamin K 2.5 mg orally. *
Rationale: For INR >4.5 with minor bleeding, holding warfarin and giving
oral vitamin K (1-2.5 mg) is appropriate. IV vitamin K 10 mg and PCC are
reserved for major bleeding .
Question 5
A patient with hypertension is started on lisinopril. Which laboratory finding
is most important to monitor within 1-2 weeks of initiation?
A. Serum potassium and creatinine
B. Serum sodium and glucose
C. Liver function tests
D. Complete blood count
*Correct Answer: A. Serum potassium and creatinine. *
Rationale: ACE inhibitors can cause hyperkalemia and acute kidney injury,
especially in patients with renal impairment. Serum potassium and creatinine
should be monitored 1-2 weeks after initiation .
Section 2: Endocrine Pharmacology (Diabetes)
Question 6
A 72-year-old female with chronic kidney disease (eGFR 32 mL/min) and
, heart failure is prescribed metformin for newly diagnosed type 2 diabetes.
What should the NP recognize?
A. Continue metformin without changes
B. Reduce the dose by half
C. Discontinue metformin due to lactic acidosis risk
D. Add insulin therapy only at night
*Correct Answer: C. Discontinue metformin due to lactic acidosis risk. *
Rationale: Metformin is contraindicated when eGFR is <30 mL/min and
should be used with caution when <45 mL/min. The risk of lactic acidosis is
significant at this level of renal impairment .
Question 7
A patient with type 1 diabetes asks why sulfonylureas are not an option.
What is the best response?
A. They require functioning pancreatic beta cells to work
B. They decrease insulin secretion
C. Type 1 diabetes has absent/nonfunctional beta cells
D. They only work by increasing insulin sensitivity in muscle
*Correct Answer: C. Type 1 diabetes has absent/nonfunctional beta
cells. *
Rationale: Sulfonylureas stimulate insulin release from pancreatic beta cells.
In type 1 diabetes, these cells are destroyed, rendering the drug ineffective .
Question 8
Which diabetic medication has the highest risk of causing hypoglycemia?
Fundamentals (2026) – Complete Practice
Questions & Rationales
Section 1: Cardiovascular Pharmacology
Question 1
A 58-year-old male with hypertension and type 2 diabetes is taking
lisinopril 20 mg daily. He reports a persistent dry cough that has worsened
over the past month. His BP is well controlled. What is the most appropriate
action?
A. Continue lisinopril and add a cough suppressant
B. Discontinue lisinopril and initiate losartan
C. Reduce lisinopril dose to 10 mg
D. Switch to a calcium channel blocker only
*Correct Answer: B. Discontinue lisinopril and initiate losartan. *
Rationale: ACE inhibitors like lisinopril cause a dry cough by increasing
bradykinin levels. This side effect is not dose-dependent and will not improve
with dose reduction. An ARB (losartan) provides similar cardiovascular and
renal protection without causing the cough .
Question 2
A 72-year-old female with heart failure and hypertension is prescribed
,spironolactone. Follow-up labs show a potassium of 5.8 mEq/L. She denies
symptoms. What is the best action?
A. Continue medication and recheck in 1 week
B. Discontinue spironolactone
C. Add a potassium supplement
D. Increase the spironolactone dose
*Correct Answer: B. Discontinue spironolactone. *
Rationale: Spironolactone is a potassium-sparing diuretic. A serum potassium
of 5.8 mEq/L is above the normal range and indicates hyperkalemia, which
requires stopping the medication to prevent cardiac arrhythmias .
Question 3
What is the primary advantage of ACE inhibitors over thiazide diuretics
regarding metabolic side effects?
A. ACE inhibitors are more likely to cause hyperkalemia
B. Thiazides can increase uric acid and glucose levels
C. Thiazides can cause hypokalemia
D. All of the above
*Correct Answer: D. All of the above. *
Rationale: Thiazide diuretics can cause hypokalemia, hyperuricemia, and
hyperglycemia. ACE inhibitors can increase potassium (hyperkalemia) but do
not affect uric acid and glucose levels .
Question 4
A patient on warfarin for a mechanical heart valve presents with an INR of
5.0 and minor bleeding. Which treatment strategy is most appropriate?
,A. Administer vitamin K 10 mg IV and repeat INR in 6 hours
B. Hold warfarin and give vitamin K 2.5 mg orally
C. Administer fresh frozen plasma immediately
D. Give prothrombin complex concentrate (PCC) 4-factor
*Correct Answer: B. Hold warfarin and give vitamin K 2.5 mg orally. *
Rationale: For INR >4.5 with minor bleeding, holding warfarin and giving
oral vitamin K (1-2.5 mg) is appropriate. IV vitamin K 10 mg and PCC are
reserved for major bleeding .
Question 5
A patient with hypertension is started on lisinopril. Which laboratory finding
is most important to monitor within 1-2 weeks of initiation?
A. Serum potassium and creatinine
B. Serum sodium and glucose
C. Liver function tests
D. Complete blood count
*Correct Answer: A. Serum potassium and creatinine. *
Rationale: ACE inhibitors can cause hyperkalemia and acute kidney injury,
especially in patients with renal impairment. Serum potassium and creatinine
should be monitored 1-2 weeks after initiation .
Section 2: Endocrine Pharmacology (Diabetes)
Question 6
A 72-year-old female with chronic kidney disease (eGFR 32 mL/min) and
, heart failure is prescribed metformin for newly diagnosed type 2 diabetes.
What should the NP recognize?
A. Continue metformin without changes
B. Reduce the dose by half
C. Discontinue metformin due to lactic acidosis risk
D. Add insulin therapy only at night
*Correct Answer: C. Discontinue metformin due to lactic acidosis risk. *
Rationale: Metformin is contraindicated when eGFR is <30 mL/min and
should be used with caution when <45 mL/min. The risk of lactic acidosis is
significant at this level of renal impairment .
Question 7
A patient with type 1 diabetes asks why sulfonylureas are not an option.
What is the best response?
A. They require functioning pancreatic beta cells to work
B. They decrease insulin secretion
C. Type 1 diabetes has absent/nonfunctional beta cells
D. They only work by increasing insulin sensitivity in muscle
*Correct Answer: C. Type 1 diabetes has absent/nonfunctional beta
cells. *
Rationale: Sulfonylureas stimulate insulin release from pancreatic beta cells.
In type 1 diabetes, these cells are destroyed, rendering the drug ineffective .
Question 8
Which diabetic medication has the highest risk of causing hypoglycemia?
