NR566 ADVANCED PHARMACOLOGY
MIDTERM COMPREHENSIVE EXAM
QUESTIONS WITH 100% CORRECT
ANSWERS
1. A 54-year-old patient with a history of heart failure and hypertension is prescribed an ACE
inhibitor. Which of the following laboratory values requires immediate intervention?
A. Serum sodium of 135 mEq/L
B. Serum potassium of 5.6 mEq/L
C. Serum creatinine of 1.1 mg/dL
D. Serum glucose of 110 mg/dL
Answer: B
Conceptual Explanation: ACE inhibitors can cause hyperkalemia by inhibiting aldosterone
secretion. A potassium level of 5.6 mEq/L is elevated and carries a risk for cardiac
dysrhythmias.
2. When initiating Metformin therapy for a patient with Type 2 Diabetes, which
contraindication is most critical for the APRN to assess?
A. Body Mass Index (BMI) greater than 30
B. Estimated Glomerular Filtration Rate (eGFR) less than 30 mL/min/1.73m²
,C. History of gestational diabetes
D. Patient age over 65 years
Answer: B
Conceptual Explanation: Metformin is contraindicated in patients with severe renal
impairment (eGFR < 30) due to the increased risk of lactic acidosis.
3. Which mechanism of action best describes how Thiazide diuretics lower blood pressure in
the long term?
A. Reduction of peripheral vascular resistance
B. Direct inhibition of the renin-angiotensin system
C. Permanent depletion of total body water
D. Antagonism of beta-1 adrenergic receptors
Answer: A
Conceptual Explanation: While the initial effect is diuresis, the long-term
antihypertensive effect of thiazides is due to a reduction in peripheral vascular resistance.
4. A patient taking Warfarin for atrial fibrillation presents with an INR of 7.0 and no active
bleeding. According to evidence-based guidelines, what is the appropriate action?
A. Administer 10 mg of Vitamin K intravenously
B. Increase the warfarin dose to stabilize the INR
C. Hold warfarin and administer oral Vitamin K
, D. Administer protamine sulfate immediately
Answer: C
Conceptual Explanation: For INR values between 4.5 and 10 with no bleeding, the
recommendation is to hold warfarin and consider low-dose oral Vitamin K.
5. Which characteristic of Inhaled Corticosteroids (ICS) is the primary reason they are
considered first-line for persistent asthma?
A. They provide immediate bronchodilation during acute attacks
B. They reduce airway inflammation and hyper-responsiveness
C. They have zero systemic absorption
D. They can be used on an as-needed basis only
Answer: B
Conceptual Explanation: ICS address the underlying inflammatory process of asthma,
reducing the frequency and severity of exacerbations.
6. A patient is prescribed Amiodarone for refractory ventricular tachycardia. Which
monitoring parameter is specific to this medication’s unique toxicity profile?
A. Daily blood pressure monitoring
B. Weekly serum potassium levels
C. Annual chest X-ray and pulmonary function tests
D. Monthly hearing tests
MIDTERM COMPREHENSIVE EXAM
QUESTIONS WITH 100% CORRECT
ANSWERS
1. A 54-year-old patient with a history of heart failure and hypertension is prescribed an ACE
inhibitor. Which of the following laboratory values requires immediate intervention?
A. Serum sodium of 135 mEq/L
B. Serum potassium of 5.6 mEq/L
C. Serum creatinine of 1.1 mg/dL
D. Serum glucose of 110 mg/dL
Answer: B
Conceptual Explanation: ACE inhibitors can cause hyperkalemia by inhibiting aldosterone
secretion. A potassium level of 5.6 mEq/L is elevated and carries a risk for cardiac
dysrhythmias.
2. When initiating Metformin therapy for a patient with Type 2 Diabetes, which
contraindication is most critical for the APRN to assess?
A. Body Mass Index (BMI) greater than 30
B. Estimated Glomerular Filtration Rate (eGFR) less than 30 mL/min/1.73m²
,C. History of gestational diabetes
D. Patient age over 65 years
Answer: B
Conceptual Explanation: Metformin is contraindicated in patients with severe renal
impairment (eGFR < 30) due to the increased risk of lactic acidosis.
3. Which mechanism of action best describes how Thiazide diuretics lower blood pressure in
the long term?
A. Reduction of peripheral vascular resistance
B. Direct inhibition of the renin-angiotensin system
C. Permanent depletion of total body water
D. Antagonism of beta-1 adrenergic receptors
Answer: A
Conceptual Explanation: While the initial effect is diuresis, the long-term
antihypertensive effect of thiazides is due to a reduction in peripheral vascular resistance.
4. A patient taking Warfarin for atrial fibrillation presents with an INR of 7.0 and no active
bleeding. According to evidence-based guidelines, what is the appropriate action?
A. Administer 10 mg of Vitamin K intravenously
B. Increase the warfarin dose to stabilize the INR
C. Hold warfarin and administer oral Vitamin K
, D. Administer protamine sulfate immediately
Answer: C
Conceptual Explanation: For INR values between 4.5 and 10 with no bleeding, the
recommendation is to hold warfarin and consider low-dose oral Vitamin K.
5. Which characteristic of Inhaled Corticosteroids (ICS) is the primary reason they are
considered first-line for persistent asthma?
A. They provide immediate bronchodilation during acute attacks
B. They reduce airway inflammation and hyper-responsiveness
C. They have zero systemic absorption
D. They can be used on an as-needed basis only
Answer: B
Conceptual Explanation: ICS address the underlying inflammatory process of asthma,
reducing the frequency and severity of exacerbations.
6. A patient is prescribed Amiodarone for refractory ventricular tachycardia. Which
monitoring parameter is specific to this medication’s unique toxicity profile?
A. Daily blood pressure monitoring
B. Weekly serum potassium levels
C. Annual chest X-ray and pulmonary function tests
D. Monthly hearing tests
