NR565 Advanced Pharmacology Midterm
Practice Exam 100 Multiple Choice
Questions with Answers and Rationales
1. A 72-year-old patient with hypertension and type 2
diabetes is prescribed lisinopril. Which laboratory value
should the nurse monitor most closely during the first
month of therapy?
A) Serum potassium
B) Serum creatinine
C) Hemoglobin A1c
D) Liver function tests
Rationale: ACE inhibitors like lisinopril can cause a reversible
increase in serum creatinine due to decreased glomerular
filtration pressure. This effect is especially important in patients
with diabetes who may have underlying renal impairment.
Serum creatinine should be monitored within 1-2 weeks of
initiation and with dose changes. While potassium should also be
monitored, creatinine elevation is the more immediate concern
for renal function assessment.
,2. Which medication is considered FIRST-LINE therapy for
neuropathic pain in a patient with diabetes?
A) Ibuprofen
B) Acetaminophen
C) Duloxetine
D) Tramadol
Rationale: Duloxetine is an FDA-approved SNRI for diabetic
peripheral neuropathy and is considered first-line therapy along
with pregabalin. NSAIDs and acetaminophen are not effective for
neuropathic pain. Tramadol is a second-line option. The 2025
guidelines continue to support SNRIs and gabapentinoids as first-
line treatments for neuropathic pain.
3. A patient is prescribed warfarin for atrial fibrillation.
Which instruction is most important for the nurse to
include in patient teaching?
A) Take with food to prevent gastrointestinal upset
B) Avoid eating large amounts of green leafy vegetables
C) Take with a full glass of water
D) Monitor for signs of hyperglycemia
Rationale: Warfarin's mechanism inhibits vitamin K-dependent
clotting factors. Green leafy vegetables are high in vitamin K and
can antagonize warfarin's effects, leading to decreased INR and
increased thrombotic risk. Patients should maintain consistent
,vitamin K intake rather than avoiding these foods entirely, but
the most critical teaching is about the interaction with vitamin K-
rich foods.
4. A patient with heart failure is prescribed furosemide.
Which electrolyte imbalance is MOST concerning with this
medication?
A) Hyperkalemia
B) Hypokalemia
C) Hypermagnesemia
D) Hypercalcemia
Rationale: Furosemide is a loop diuretic that inhibits sodium-
potassium-chloride cotransport in the loop of Henle, leading to
increased excretion of potassium. Hypokalemia can precipitate
cardiac arrhythmias, especially in patients with heart failure who
may also be taking digoxin. This is the most clinically significant
electrolyte disturbance associated with loop diuretics.
5. A 45-year-old female with major depressive disorder has
failed treatment with two SSRIs. The provider is considering
switching to an MAOI. What is the most important teaching
point regarding this medication class?
, A) Take with grapefruit juice to enhance absorption
B) Avoid foods high in tyramine
C) Monitor for sedation and drowsiness
D) Take the medication at bedtime
Rationale: MAOIs inhibit the breakdown of tyramine, which can
lead to hypertensive crisis if tyramine-rich foods (aged cheeses,
cured meats, fermented products) are consumed. This is a
potentially fatal interaction and the most critical safety concern
with MAOI therapy. Grapefruit juice interactions are more
relevant to statins and calcium channel blockers.
6. A patient is started on metformin for type 2 diabetes.
Which adverse effect is most common and often requires
dose titration?
A) Hypoglycemia
B) Weight gain
C) Gastrointestinal distress
D) Peripheral edema
Rationale: Metformin commonly causes GI distress including
nausea, diarrhea, and abdominal pain. These symptoms are
dose-related and often improve with slow dose titration and
taking the medication with meals. Unlike sulfonylureas,
metformin does not typically cause hypoglycemia when used
alone. Weight loss, not gain, is associated with metformin.
Practice Exam 100 Multiple Choice
Questions with Answers and Rationales
1. A 72-year-old patient with hypertension and type 2
diabetes is prescribed lisinopril. Which laboratory value
should the nurse monitor most closely during the first
month of therapy?
A) Serum potassium
B) Serum creatinine
C) Hemoglobin A1c
D) Liver function tests
Rationale: ACE inhibitors like lisinopril can cause a reversible
increase in serum creatinine due to decreased glomerular
filtration pressure. This effect is especially important in patients
with diabetes who may have underlying renal impairment.
Serum creatinine should be monitored within 1-2 weeks of
initiation and with dose changes. While potassium should also be
monitored, creatinine elevation is the more immediate concern
for renal function assessment.
,2. Which medication is considered FIRST-LINE therapy for
neuropathic pain in a patient with diabetes?
A) Ibuprofen
B) Acetaminophen
C) Duloxetine
D) Tramadol
Rationale: Duloxetine is an FDA-approved SNRI for diabetic
peripheral neuropathy and is considered first-line therapy along
with pregabalin. NSAIDs and acetaminophen are not effective for
neuropathic pain. Tramadol is a second-line option. The 2025
guidelines continue to support SNRIs and gabapentinoids as first-
line treatments for neuropathic pain.
3. A patient is prescribed warfarin for atrial fibrillation.
Which instruction is most important for the nurse to
include in patient teaching?
A) Take with food to prevent gastrointestinal upset
B) Avoid eating large amounts of green leafy vegetables
C) Take with a full glass of water
D) Monitor for signs of hyperglycemia
Rationale: Warfarin's mechanism inhibits vitamin K-dependent
clotting factors. Green leafy vegetables are high in vitamin K and
can antagonize warfarin's effects, leading to decreased INR and
increased thrombotic risk. Patients should maintain consistent
,vitamin K intake rather than avoiding these foods entirely, but
the most critical teaching is about the interaction with vitamin K-
rich foods.
4. A patient with heart failure is prescribed furosemide.
Which electrolyte imbalance is MOST concerning with this
medication?
A) Hyperkalemia
B) Hypokalemia
C) Hypermagnesemia
D) Hypercalcemia
Rationale: Furosemide is a loop diuretic that inhibits sodium-
potassium-chloride cotransport in the loop of Henle, leading to
increased excretion of potassium. Hypokalemia can precipitate
cardiac arrhythmias, especially in patients with heart failure who
may also be taking digoxin. This is the most clinically significant
electrolyte disturbance associated with loop diuretics.
5. A 45-year-old female with major depressive disorder has
failed treatment with two SSRIs. The provider is considering
switching to an MAOI. What is the most important teaching
point regarding this medication class?
, A) Take with grapefruit juice to enhance absorption
B) Avoid foods high in tyramine
C) Monitor for sedation and drowsiness
D) Take the medication at bedtime
Rationale: MAOIs inhibit the breakdown of tyramine, which can
lead to hypertensive crisis if tyramine-rich foods (aged cheeses,
cured meats, fermented products) are consumed. This is a
potentially fatal interaction and the most critical safety concern
with MAOI therapy. Grapefruit juice interactions are more
relevant to statins and calcium channel blockers.
6. A patient is started on metformin for type 2 diabetes.
Which adverse effect is most common and often requires
dose titration?
A) Hypoglycemia
B) Weight gain
C) Gastrointestinal distress
D) Peripheral edema
Rationale: Metformin commonly causes GI distress including
nausea, diarrhea, and abdominal pain. These symptoms are
dose-related and often improve with slow dose titration and
taking the medication with meals. Unlike sulfonylureas,
metformin does not typically cause hypoglycemia when used
alone. Weight loss, not gain, is associated with metformin.
