WGU D116 ADVANCED PHARMACOLOGY
FOR THE ADVANCED PRACTICE NURSE FINAL EXAM (OA)
QUESTIONS AND CORRECT VERIFIED ANSWERS WITH
RATIONALES 100% GUARANTEED PASS!!
<LATEST VERSION>
1. A 72-year-old patient with hypertension and chronic kidney disease is
prescribed a medication that is primarily eliminated by the kidneys. Two weeks
later, the patient develops dizziness and excessive sedation despite taking the
prescribed dose. Which pharmacokinetic change most likely explains this finding?
A. Increased hepatic first-pass metabolism
B. Decreased renal clearance
C. Increased volume of distribution
D. Accelerated gastrointestinal absorption
Answer: B
Rationale: Reduced renal function decreases elimination of medications that
depend heavily on renal excretion. Drug accumulation can therefore produce
exaggerated or prolonged effects even when the prescribed dose has not changed.
,2. A patient taking simvastatin for hyperlipidemia is prescribed clarithromycin for
a respiratory infection. Which action by the APRN is most appropriate?
A. Continue both medications because clarithromycin increases simvastatin
absorption only temporarily
B. Increase the simvastatin dose because clarithromycin reduces its effectiveness
C. Avoid the combination because clarithromycin can markedly increase
simvastatin exposure
D. Administer the medications several hours apart to eliminate the interaction
Answer: C
Rationale: Clarithromycin strongly inhibits CYP3A4, which can substantially
increase exposure to simvastatin and raise the risk of myopathy and
rhabdomyolysis. Separating administration times does not reliably prevent this
metabolic interaction.
3. A patient taking warfarin has an INR of 5.8 and reports no active bleeding. The
patient recently started trimethoprim-sulfamethoxazole for a urinary tract infection.
Which explanation best accounts for the elevated INR?
A. Increased vitamin K production by intestinal bacteria
B. Reduced warfarin metabolism and an additive anticoagulant effect
C. Increased renal excretion of warfarin
D. Reduced absorption of warfarin caused by the antibiotic
Answer: B
Rationale: Trimethoprim-sulfamethoxazole can increase warfarin exposure
through metabolic inhibition and can also alter vitamin K availability. The
combination substantially increases bleeding risk and requires prompt
reassessment of therapy.
,4. A 19-year-old patient taking sertraline begins using tramadol for worsening back
pain. Several days later, the patient develops agitation, diaphoresis, diarrhea,
hyperreflexia, and inducible clonus. Which condition should the APRN suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Malignant hyperthermia
Answer: B
Rationale: Serotonin syndrome results from excessive serotonergic activity.
Tramadol has serotonergic properties, and combining it with an SSRI such as
sertraline increases risk. Hyperreflexia and clonus are particularly characteristic
findings.
5. A patient with heart failure is taking furosemide and digoxin. The patient reports
new anorexia, nausea, and yellow-green visual disturbances. Which additional
laboratory result would most strongly increase concern for digoxin toxicity?
A. Potassium 2.7 mEq/L
B. Sodium 140 mEq/L
C. Calcium 8.9 mg/dL
D. Magnesium 2.1 mg/dL
Answer: A
Rationale: Hypokalemia increases myocardial sensitivity to digoxin and
substantially increases toxicity risk. Furosemide can cause potassium depletion,
making electrolyte monitoring particularly important in patients receiving digoxin.
, 6. A patient with asthma is prescribed a new medication for hypertension. Soon
after starting therapy, the patient develops wheezing that responds poorly to
albuterol. Which medication is most likely responsible?
A. Metoprolol
B. Losartan
C. Amlodipine
D. Propranolol
Answer: D
Rationale: Propranolol is a nonselective beta-blocker that antagonizes both beta-1
and beta-2 receptors. Beta-2 blockade can cause bronchoconstriction and reduce
responsiveness to inhaled beta-2 agonists. Metoprolol is relatively beta-1 selective
and is generally less likely to produce this effect.
7. A patient with hypertension develops a persistent dry cough several weeks after
starting lisinopril. There is no fever, wheezing, or evidence of infection. Which
medication is the most appropriate substitute?
A. Losartan
B. Aliskiren
C. Propranolol
D. Hydrochlorothiazide
Answer: A
Rationale: ACE inhibitors can cause a persistent dry cough because of increased
bradykinin. An ARB such as losartan provides renin-angiotensin system blockade
without producing the same degree of bradykinin accumulation.
FOR THE ADVANCED PRACTICE NURSE FINAL EXAM (OA)
QUESTIONS AND CORRECT VERIFIED ANSWERS WITH
RATIONALES 100% GUARANTEED PASS!!
<LATEST VERSION>
1. A 72-year-old patient with hypertension and chronic kidney disease is
prescribed a medication that is primarily eliminated by the kidneys. Two weeks
later, the patient develops dizziness and excessive sedation despite taking the
prescribed dose. Which pharmacokinetic change most likely explains this finding?
A. Increased hepatic first-pass metabolism
B. Decreased renal clearance
C. Increased volume of distribution
D. Accelerated gastrointestinal absorption
Answer: B
Rationale: Reduced renal function decreases elimination of medications that
depend heavily on renal excretion. Drug accumulation can therefore produce
exaggerated or prolonged effects even when the prescribed dose has not changed.
,2. A patient taking simvastatin for hyperlipidemia is prescribed clarithromycin for
a respiratory infection. Which action by the APRN is most appropriate?
A. Continue both medications because clarithromycin increases simvastatin
absorption only temporarily
B. Increase the simvastatin dose because clarithromycin reduces its effectiveness
C. Avoid the combination because clarithromycin can markedly increase
simvastatin exposure
D. Administer the medications several hours apart to eliminate the interaction
Answer: C
Rationale: Clarithromycin strongly inhibits CYP3A4, which can substantially
increase exposure to simvastatin and raise the risk of myopathy and
rhabdomyolysis. Separating administration times does not reliably prevent this
metabolic interaction.
3. A patient taking warfarin has an INR of 5.8 and reports no active bleeding. The
patient recently started trimethoprim-sulfamethoxazole for a urinary tract infection.
Which explanation best accounts for the elevated INR?
A. Increased vitamin K production by intestinal bacteria
B. Reduced warfarin metabolism and an additive anticoagulant effect
C. Increased renal excretion of warfarin
D. Reduced absorption of warfarin caused by the antibiotic
Answer: B
Rationale: Trimethoprim-sulfamethoxazole can increase warfarin exposure
through metabolic inhibition and can also alter vitamin K availability. The
combination substantially increases bleeding risk and requires prompt
reassessment of therapy.
,4. A 19-year-old patient taking sertraline begins using tramadol for worsening back
pain. Several days later, the patient develops agitation, diaphoresis, diarrhea,
hyperreflexia, and inducible clonus. Which condition should the APRN suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Malignant hyperthermia
Answer: B
Rationale: Serotonin syndrome results from excessive serotonergic activity.
Tramadol has serotonergic properties, and combining it with an SSRI such as
sertraline increases risk. Hyperreflexia and clonus are particularly characteristic
findings.
5. A patient with heart failure is taking furosemide and digoxin. The patient reports
new anorexia, nausea, and yellow-green visual disturbances. Which additional
laboratory result would most strongly increase concern for digoxin toxicity?
A. Potassium 2.7 mEq/L
B. Sodium 140 mEq/L
C. Calcium 8.9 mg/dL
D. Magnesium 2.1 mg/dL
Answer: A
Rationale: Hypokalemia increases myocardial sensitivity to digoxin and
substantially increases toxicity risk. Furosemide can cause potassium depletion,
making electrolyte monitoring particularly important in patients receiving digoxin.
, 6. A patient with asthma is prescribed a new medication for hypertension. Soon
after starting therapy, the patient develops wheezing that responds poorly to
albuterol. Which medication is most likely responsible?
A. Metoprolol
B. Losartan
C. Amlodipine
D. Propranolol
Answer: D
Rationale: Propranolol is a nonselective beta-blocker that antagonizes both beta-1
and beta-2 receptors. Beta-2 blockade can cause bronchoconstriction and reduce
responsiveness to inhaled beta-2 agonists. Metoprolol is relatively beta-1 selective
and is generally less likely to produce this effect.
7. A patient with hypertension develops a persistent dry cough several weeks after
starting lisinopril. There is no fever, wheezing, or evidence of infection. Which
medication is the most appropriate substitute?
A. Losartan
B. Aliskiren
C. Propranolol
D. Hydrochlorothiazide
Answer: A
Rationale: ACE inhibitors can cause a persistent dry cough because of increased
bradykinin. An ARB such as losartan provides renin-angiotensin system blockade
without producing the same degree of bradykinin accumulation.
