NUR 242 ADVANCED PHARMACOLOGY
AND PATHOPHYSIOLOGY
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A patient with chronic heart failure is prescribed Sacubitril/Valsartan (Entresto). Which
mechanism of action distinguishes this drug from standard ACE inhibitors?
A. It directly blocks the effects of aldosterone on the distal tubule.
B. It acts as a selective beta-1 adrenergic antagonist.
C. It inhibits neprilysin, increasing the levels of natriuretic peptides.
D. It prevents the conversion of Angiotensin I to Angiotensin II in the lungs.
Answer: C
Conceptual Explanation: Entresto is an ARNI (Angiotensin Receptor-Neprilysin Inhibitor).
Sacubitril inhibits neprilysin, an enzyme that breaks down natriuretic peptides, thereby
enhancing diuresis and vasodilation.
,2. Which laboratory value is the most sensitive indicator of acute kidney injury (AKI) stage
progression according to KDIGO criteria?
A. Serum Creatinine and Urine Output
B. Blood Urea Nitrogen (BUN)
C. Glomerular Filtration Rate (GFR)
D. Serum Potassium levels
Answer: A
Conceptual Explanation: KDIGO (Kidney Disease: Improving Global Outcomes) stages AKI
based on changes in serum creatinine from baseline and the duration/volume of urine
output.
3. A patient is receiving a Heparin infusion. The nurse notes a 50% drop in platelet count from
the baseline within 5 days of starting therapy. What is the priority intervention?
A. Continue the infusion and monitor for bleeding.
B. Administer Vitamin K intramuscularly.
C. Prepare for a platelet transfusion.
D. Discontinue all heparin products and notify the provider.
Answer: D
, Conceptual Explanation: This clinical picture is highly suggestive of Heparin-Induced
Thrombocytopenia (HIT). The priority is to stop all heparin and switch to an alternative
anticoagulant like Argatroban.
4. When managing a patient with Diabetic Ketoacidosis (DKA), at what blood glucose level
should the nurse anticipate adding Dextrose to the IV fluids?
A. 200-250 mg/dL
B. 300 mg/dL
C. 400 mg/dL
D. 100 mg/dL
Answer: A
Conceptual Explanation: When glucose reaches 200-250 mg/dL in DKA, dextrose is
added to prevent hypoglycemia and to allow for the continued administration of insulin to
resolve ketosis.
5. Which cardiac rhythm is characterized by a ‘sawtooth’ pattern and usually requires rate
control or cardioversion?
A. Atrial Fibrillation
B. Ventricular Tachycardia
C. Atrial Flutter
D. First-degree AV block
AND PATHOPHYSIOLOGY
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A patient with chronic heart failure is prescribed Sacubitril/Valsartan (Entresto). Which
mechanism of action distinguishes this drug from standard ACE inhibitors?
A. It directly blocks the effects of aldosterone on the distal tubule.
B. It acts as a selective beta-1 adrenergic antagonist.
C. It inhibits neprilysin, increasing the levels of natriuretic peptides.
D. It prevents the conversion of Angiotensin I to Angiotensin II in the lungs.
Answer: C
Conceptual Explanation: Entresto is an ARNI (Angiotensin Receptor-Neprilysin Inhibitor).
Sacubitril inhibits neprilysin, an enzyme that breaks down natriuretic peptides, thereby
enhancing diuresis and vasodilation.
,2. Which laboratory value is the most sensitive indicator of acute kidney injury (AKI) stage
progression according to KDIGO criteria?
A. Serum Creatinine and Urine Output
B. Blood Urea Nitrogen (BUN)
C. Glomerular Filtration Rate (GFR)
D. Serum Potassium levels
Answer: A
Conceptual Explanation: KDIGO (Kidney Disease: Improving Global Outcomes) stages AKI
based on changes in serum creatinine from baseline and the duration/volume of urine
output.
3. A patient is receiving a Heparin infusion. The nurse notes a 50% drop in platelet count from
the baseline within 5 days of starting therapy. What is the priority intervention?
A. Continue the infusion and monitor for bleeding.
B. Administer Vitamin K intramuscularly.
C. Prepare for a platelet transfusion.
D. Discontinue all heparin products and notify the provider.
Answer: D
, Conceptual Explanation: This clinical picture is highly suggestive of Heparin-Induced
Thrombocytopenia (HIT). The priority is to stop all heparin and switch to an alternative
anticoagulant like Argatroban.
4. When managing a patient with Diabetic Ketoacidosis (DKA), at what blood glucose level
should the nurse anticipate adding Dextrose to the IV fluids?
A. 200-250 mg/dL
B. 300 mg/dL
C. 400 mg/dL
D. 100 mg/dL
Answer: A
Conceptual Explanation: When glucose reaches 200-250 mg/dL in DKA, dextrose is
added to prevent hypoglycemia and to allow for the continued administration of insulin to
resolve ketosis.
5. Which cardiac rhythm is characterized by a ‘sawtooth’ pattern and usually requires rate
control or cardioversion?
A. Atrial Fibrillation
B. Ventricular Tachycardia
C. Atrial Flutter
D. First-degree AV block
