NUR 635 FINAL EXAM 2026/2027 | GCU
ADVANCED PHARMACOLOGY EXAM
QUESTIONS & ANSWERS
NUR 635 FINAL EXAM 2026/2027 | GCU ADVANCED PHARMACOLOGY EXAM
QUESTIONS & ANSWERS
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DOCUMENT OVERVIEW:
• This comprehensive question exam review provides in-depth assessment of
advanced pharmacology concepts essential for graduate-level nursing practice,
including drug mechanisms, interactions, contraindications, and clinical applications
across all major drug classes.
• Use this material by studying 20-30 questions daily, focusing on rationales to
understand not just the correct answer but the underlying pharmacological
principles that will guide your clinical decision-making in advanced practice.
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1. A patient receiving warfarin therapy presents with an INR of 8.2. What is
the most appropriate initial management?
A) Continue current dose and recheck INR in 1 week
B) Increase warfarin dose to achieve therapeutic level faster
C) Administer fresh frozen plasma and vitamin K
D) Hold warfarin dose and administer vitamin K1 orally or IV
E) Discontinue warfarin permanently and switch to heparin
CORRECT ANSWER: D) Hold warfarin dose and administer vitamin K1 orally or
IV
RATIONALE: An INR of 8.2 is significantly elevated above the therapeutic range (2-3
for most indications). The appropriate management involves holding the warfarin
dose to prevent further elevation and administering vitamin K1 (phytonadione),
which is the specific antagonist for warfarin. Vitamin K1 takes 12-24 hours to work,
,making it suitable for non-emergency situations. Fresh frozen plasma would only
be indicated if there were active bleeding or if immediate reversal was needed.
Continuing the dose or increasing it would worsen the coagulopathy. While
switching to heparin is an option in some cases, holding warfarin and giving vitamin
K1 is the standard initial approach.
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═════════
2. Which of the following antibiotics is contraindicated in patients with a
history of penicillin allergy?
A) Fluoroquinolones
B) Macrolides
C) Cephalosporins
D) Aminoglycosides
E) Tetracyclines
CORRECT ANSWER: C) Cephalosporins
RATIONALE: Although the cross-reactivity between penicillins and cephalosporins
is lower than previously thought (approximately 1-3%), cephalosporins still carry a
risk of allergic reaction in patients with documented penicillin allergy due to similar
beta-lactam ring structures. The risk is highest with first-generation cephalosporins
and lower with third-generation agents. Fluoroquinolones, macrolides,
aminoglycosides, and tetracyclines do not share the beta-lactam structure and are
generally safe alternatives for penicillin-allergic patients. However, if a
cephalosporin is essential, third-generation agents may be used with extreme
caution if there is no history of anaphylaxis.
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═════════
3. A patient on metformin is scheduled for a cardiac catheterization with IV
contrast. What action should the nurse take?
A) Continue metformin as scheduled
,B) Hold metformin 48 hours before and after contrast exposure
C) Reduce metformin dose by 50% on the day of procedure
D) Switch to insulin the day before the procedure
E) Give metformin with a light meal before the procedure
CORRECT ANSWER: B) Hold metformin 48 hours before and after contrast
exposure
RATIONALE: Metformin must be held in patients receiving iodinated IV contrast
due to the increased risk of contrast-induced nephropathy, which can impair renal
function and lead to metformin accumulation and lactic acidosis. The standard
recommendation is to discontinue metformin 48 hours before contrast exposure
and to restart it only after renal function has been confirmed as normal (usually 48
hours post-procedure). This precaution is particularly important in patients with
baseline renal impairment or diabetes. Simply reducing the dose does not provide
adequate protection, and continuing metformin increases the risk of serious
complications.
═══════════════════════════════════════════════════════
═════════
4. Which of the following is a direct-acting oral anticoagulant (DOAC) that
inhibits factor IIa?
A) Rivaroxaban
B) Apixaban
C) Dabigatran
D) Edoxaban
E) Betrixaban
CORRECT ANSWER: C) Dabigatran
RATIONALE: Dabigatran is a direct thrombin inhibitor (factor IIa inhibitor), making it
the only DOAC that directly targets thrombin. Rivaroxaban, apixaban, edoxaban,
and betrixaban are all factor Xa inhibitors. Understanding the mechanism of
, different anticoagulants is crucial for appropriate selection, monitoring, and
management of drug interactions. Dabigatran has a shorter half-life than factor Xa
inhibitors and requires specific monitoring considerations.
═══════════════════════════════════════════════════════
═════════
5. A patient with hypertension is started on lisinopril. After 3 weeks, the
patient reports a persistent dry cough. What is the most appropriate nursing
action?
A) Instruct the patient to stop the medication immediately
B) Assess for other signs of angioedema and advise patient this is normal, expected
side effect
C) Switch to a different ACE inhibitor with lower risk of cough
D) Add an antihistamine to manage the symptom
E) Increase the dose to override the adverse effect
CORRECT ANSWER: B) Assess for other signs of angioedema and advise patient
this is normal, expected side effect
RATIONALE: A persistent dry cough is an expected and common side effect of ACE
inhibitors, occurring in 10-20% of patients. This occurs because ACE inhibitors block
bradykinin degradation, leading to bradykinin accumulation in the lungs. The cough
is bothersome but not dangerous unless accompanied by signs of angioedema
(swelling of lips, tongue, throat) or stridor, which would require immediate
discontinuation. The nurse should reassure the patient that the cough typically
resolves within days to weeks as the body adjusts, though some patients may need
to switch medications. Adding an antihistamine is ineffective as the mechanism is
not histamine-related. This is not a reason to stop the medication abruptly unless
angioedema develops.
═══════════════════════════════════════════════════════
═════════
6. Which cytochrome P450 enzyme is responsible for metabolizing the
majority of medications?
ADVANCED PHARMACOLOGY EXAM
QUESTIONS & ANSWERS
NUR 635 FINAL EXAM 2026/2027 | GCU ADVANCED PHARMACOLOGY EXAM
QUESTIONS & ANSWERS
═══════════════════════════════════════════════════════
═════════
DOCUMENT OVERVIEW:
• This comprehensive question exam review provides in-depth assessment of
advanced pharmacology concepts essential for graduate-level nursing practice,
including drug mechanisms, interactions, contraindications, and clinical applications
across all major drug classes.
• Use this material by studying 20-30 questions daily, focusing on rationales to
understand not just the correct answer but the underlying pharmacological
principles that will guide your clinical decision-making in advanced practice.
═══════════════════════════════════════════════════════
═════════
1. A patient receiving warfarin therapy presents with an INR of 8.2. What is
the most appropriate initial management?
A) Continue current dose and recheck INR in 1 week
B) Increase warfarin dose to achieve therapeutic level faster
C) Administer fresh frozen plasma and vitamin K
D) Hold warfarin dose and administer vitamin K1 orally or IV
E) Discontinue warfarin permanently and switch to heparin
CORRECT ANSWER: D) Hold warfarin dose and administer vitamin K1 orally or
IV
RATIONALE: An INR of 8.2 is significantly elevated above the therapeutic range (2-3
for most indications). The appropriate management involves holding the warfarin
dose to prevent further elevation and administering vitamin K1 (phytonadione),
which is the specific antagonist for warfarin. Vitamin K1 takes 12-24 hours to work,
,making it suitable for non-emergency situations. Fresh frozen plasma would only
be indicated if there were active bleeding or if immediate reversal was needed.
Continuing the dose or increasing it would worsen the coagulopathy. While
switching to heparin is an option in some cases, holding warfarin and giving vitamin
K1 is the standard initial approach.
═══════════════════════════════════════════════════════
═════════
2. Which of the following antibiotics is contraindicated in patients with a
history of penicillin allergy?
A) Fluoroquinolones
B) Macrolides
C) Cephalosporins
D) Aminoglycosides
E) Tetracyclines
CORRECT ANSWER: C) Cephalosporins
RATIONALE: Although the cross-reactivity between penicillins and cephalosporins
is lower than previously thought (approximately 1-3%), cephalosporins still carry a
risk of allergic reaction in patients with documented penicillin allergy due to similar
beta-lactam ring structures. The risk is highest with first-generation cephalosporins
and lower with third-generation agents. Fluoroquinolones, macrolides,
aminoglycosides, and tetracyclines do not share the beta-lactam structure and are
generally safe alternatives for penicillin-allergic patients. However, if a
cephalosporin is essential, third-generation agents may be used with extreme
caution if there is no history of anaphylaxis.
═══════════════════════════════════════════════════════
═════════
3. A patient on metformin is scheduled for a cardiac catheterization with IV
contrast. What action should the nurse take?
A) Continue metformin as scheduled
,B) Hold metformin 48 hours before and after contrast exposure
C) Reduce metformin dose by 50% on the day of procedure
D) Switch to insulin the day before the procedure
E) Give metformin with a light meal before the procedure
CORRECT ANSWER: B) Hold metformin 48 hours before and after contrast
exposure
RATIONALE: Metformin must be held in patients receiving iodinated IV contrast
due to the increased risk of contrast-induced nephropathy, which can impair renal
function and lead to metformin accumulation and lactic acidosis. The standard
recommendation is to discontinue metformin 48 hours before contrast exposure
and to restart it only after renal function has been confirmed as normal (usually 48
hours post-procedure). This precaution is particularly important in patients with
baseline renal impairment or diabetes. Simply reducing the dose does not provide
adequate protection, and continuing metformin increases the risk of serious
complications.
═══════════════════════════════════════════════════════
═════════
4. Which of the following is a direct-acting oral anticoagulant (DOAC) that
inhibits factor IIa?
A) Rivaroxaban
B) Apixaban
C) Dabigatran
D) Edoxaban
E) Betrixaban
CORRECT ANSWER: C) Dabigatran
RATIONALE: Dabigatran is a direct thrombin inhibitor (factor IIa inhibitor), making it
the only DOAC that directly targets thrombin. Rivaroxaban, apixaban, edoxaban,
and betrixaban are all factor Xa inhibitors. Understanding the mechanism of
, different anticoagulants is crucial for appropriate selection, monitoring, and
management of drug interactions. Dabigatran has a shorter half-life than factor Xa
inhibitors and requires specific monitoring considerations.
═══════════════════════════════════════════════════════
═════════
5. A patient with hypertension is started on lisinopril. After 3 weeks, the
patient reports a persistent dry cough. What is the most appropriate nursing
action?
A) Instruct the patient to stop the medication immediately
B) Assess for other signs of angioedema and advise patient this is normal, expected
side effect
C) Switch to a different ACE inhibitor with lower risk of cough
D) Add an antihistamine to manage the symptom
E) Increase the dose to override the adverse effect
CORRECT ANSWER: B) Assess for other signs of angioedema and advise patient
this is normal, expected side effect
RATIONALE: A persistent dry cough is an expected and common side effect of ACE
inhibitors, occurring in 10-20% of patients. This occurs because ACE inhibitors block
bradykinin degradation, leading to bradykinin accumulation in the lungs. The cough
is bothersome but not dangerous unless accompanied by signs of angioedema
(swelling of lips, tongue, throat) or stridor, which would require immediate
discontinuation. The nurse should reassure the patient that the cough typically
resolves within days to weeks as the body adjusts, though some patients may need
to switch medications. Adding an antihistamine is ineffective as the mechanism is
not histamine-related. This is not a reason to stop the medication abruptly unless
angioedema develops.
═══════════════════════════════════════════════════════
═════════
6. Which cytochrome P450 enzyme is responsible for metabolizing the
majority of medications?
