NR 293 Pharmacology Exam 3 | 75 Questions And Answers
With Detailed Rationale | 2026/2027 Updates
Question 1.
A patient with acute decompensated heart failure is prescribed ebiratide. The nurse understands that
ebiratide works by:
A. Inhibiting angiotensin-converting enzyme
B. Binding to B-type natriuretic peptide receptors, causing vasodilation and diuresis
C. Blocking beta-adrenergic receptors
D. Inhibiting aldosterone secretion
Correct Answer: B
Rationale:
Nesiritide is a recombinant form of B-type natriuretic peptide (BNP) that binds to natriuretic peptide receptors, causing
vasodilation, natriuresis, and diuresis. It is used for short-term management of acute decompensated heart failure. A is
incorrect because that describes ACE inhibitors. C is incorrect because that describes beta-blockers. D is incorrect
because spironolactone inhibits aldosterone.
Question 2.
A nurse is caring for a patient receiving milrinone for heart failure. The nurse understands that
milrinone is a phosphodiesterase inhibitor that:
A. Decreases cardiac contractility and increases afterload
B. Increases cardiac contractility and causes vasodilation
C. Blocks calcium channels in the heart
D. Inhibits sodium-potassium ATPase
Correct Answer: B
Rationale:
Milrinone is a phosphodiesterase-3 inhibitor that increases intracellular cAMP, leading to positive inotropy (increased
contractility) and vasodilation (decreased preload and afterload). A is incorrect because it increases, not decreases,
contractility. C is incorrect because that describes calcium channel blockers. D is incorrect because that describes digoxin.
Question 3.
A patient with variant (Prinzmetal's) angina is prescribed nifedipine. The nurse understands that
nifedipine is particularly effective for this type of angina because it:
A. Increases heart rate
B. Prevents coronary artery vasospasm by blocking calcium channels in vascular smooth muscle
C. Decreases myocardial oxygen demand by slowing conduction
D. Dissolves coronary thrombi
Correct Answer: B
Rationale:
Variant angina is caused by coronary artery vasospasm. Nifedipine, a dihydropyridine calcium channel blocker, prevents
vasospasm by inhibiting calcium influx into vascular smooth muscle. A is incorrect because reflex tachycardia is a side
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,effect, not the therapeutic mechanism. C is incorrect because that describes beta-blockers. D is incorrect because
thrombolytics dissolve clots.
Question 4.
A nurse is reviewing a prescription for ivabradine for a patient with heart failure. The nurse understands
that ivabradine works by:
A. Blocking beta-1 adrenergic receptors
B. Inhibiting the funny current (If) in the sinoatrial node, reducing heart rate without affecting contractility
C. Blocking calcium channels in the atrioventricular node
D. Stimulating the vagus nerve
Correct Answer: B
Rationale:
Ivabradine selectively inhibits the funny current (If), a mixed sodium-potassium inward current that controls spontaneous
diastolic depolarization in the SA node. This reduces heart rate without affecting myocardial contractility, making it useful
in patients who cannot tolerate beta-blockers. A is incorrect because that describes beta-blockers. C is incorrect because
that describes non-dihydropyridine calcium channel blockers. D is incorrect because it does not stimulate the vagus nerve.
Question 5.
A patient with hyperlipidemia is prescribed ezetimibe in combination with a statin. The nurse
understands that this combination is beneficial because:
A. Ezetimibe and statins have identical mechanisms of action
B. They lower LDL through complementary mechanisms: statins decrease synthesis while
ezetimibedecreases absorption
C. Ezetimibe prevents the myopathy caused by statins
D. Statins enhance the absorption of ezetimibe
Correct Answer: B
Rationale:
Statins inhibit HMG-CoA reductase in the liver, reducing cholesterol synthesis. Ezetimibe inhibits NPC1L1 in the intestine,
reducing cholesterol absorption. Together they provide additive LDL lowering. A is incorrect because their mechanisms
are different. C is incorrect because ezetimibe does not prevent statin myopathy. D is incorrect because statins do not
enhance ezetimibe absorption.
Question 6.
A patient is prescribed colesevelam for type 2 diabetes and hyperlipidemia. The nurse understands that
colesevelam is a bile acid sequestrant that:
A. Is absorbed systemically and lowers glucose by stimulating insulin release
B. Is not systemically absorbed and lowers both glucose and LDL cholesterol
C. Works only in the kidney to increase glucose excretion
D. Inhibits pancreatic lipase
Correct Answer: B
Rationale:
Page 2
, Colesevelam is a non-absorbed bile acid sequestrant that binds bile acids in the intestine, increasing LDL clearance. It
also has a glucose-lowering effect through mechanisms not fully understood, possibly involving GLP-1 release or altered
bile acid signaling. A is incorrect because it is not absorbed. C is incorrect because that describes SGLT2 inhibitors. D is
incorrect because that describes orlistat.
Question 7.
A nurse is caring for a patient receiving tissue plasminogen activator (alteplase) for an acute ischemic
stroke. The most important time limitation for administration is:
A. Must be given within 4.5 hours of symptom onset
B. Must be given within 12 hours of symptom onset
C. Must be given within 24 hours of symptom onset
D. Can be given up to 72 hours after symptom onset
Correct Answer: A
Rationale:
Alteplase for acute ischemic stroke must be administered within 4.5 hours of known symptom onset (or last known well)
in eligible patients. Beyond this window, the risk of hemorrhagic transformation outweighs benefits. B, C, and D are
incorrect because these timeframes exceed the approved treatment window.
Question 8.
A patient with nonvalvular atrial fibrillation is prescribed rivaroxaban. The nurse should instruct the
patient to take this medication:
A. With the evening meal to improve absorption
B. On an empty stomach every morning
C. Only on days when atrial fibrillation symptoms occur
D. With an antacid to prevent stomach upset
Correct Answer: A
Rationale:
Rivaroxaban 15 mg and 20 mg doses should be taken with food to increase bioavailability. The 10 mg dose can be taken
without regard to meals. B is incorrect because higher doses require food. C is incorrect because rivaroxaban is taken
daily for stroke prevention, not PRN. D is incorrect because antacids are not required.
Question 9.
A nurse is preparing to administer argatroban to a patient with heparin-induced thrombocytopenia
(HIT). The nurse understands that argatroban is preferred over heparin in this patient because:
A. It is cheaper than heparin
B. It is a direct thrombin inhibitor that does not cross-react with heparin antibodies
C. It has a longer half-life than heparin
D. It can be reversed with protamine sulfate
Correct Answer: B
Rationale:
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With Detailed Rationale | 2026/2027 Updates
Question 1.
A patient with acute decompensated heart failure is prescribed ebiratide. The nurse understands that
ebiratide works by:
A. Inhibiting angiotensin-converting enzyme
B. Binding to B-type natriuretic peptide receptors, causing vasodilation and diuresis
C. Blocking beta-adrenergic receptors
D. Inhibiting aldosterone secretion
Correct Answer: B
Rationale:
Nesiritide is a recombinant form of B-type natriuretic peptide (BNP) that binds to natriuretic peptide receptors, causing
vasodilation, natriuresis, and diuresis. It is used for short-term management of acute decompensated heart failure. A is
incorrect because that describes ACE inhibitors. C is incorrect because that describes beta-blockers. D is incorrect
because spironolactone inhibits aldosterone.
Question 2.
A nurse is caring for a patient receiving milrinone for heart failure. The nurse understands that
milrinone is a phosphodiesterase inhibitor that:
A. Decreases cardiac contractility and increases afterload
B. Increases cardiac contractility and causes vasodilation
C. Blocks calcium channels in the heart
D. Inhibits sodium-potassium ATPase
Correct Answer: B
Rationale:
Milrinone is a phosphodiesterase-3 inhibitor that increases intracellular cAMP, leading to positive inotropy (increased
contractility) and vasodilation (decreased preload and afterload). A is incorrect because it increases, not decreases,
contractility. C is incorrect because that describes calcium channel blockers. D is incorrect because that describes digoxin.
Question 3.
A patient with variant (Prinzmetal's) angina is prescribed nifedipine. The nurse understands that
nifedipine is particularly effective for this type of angina because it:
A. Increases heart rate
B. Prevents coronary artery vasospasm by blocking calcium channels in vascular smooth muscle
C. Decreases myocardial oxygen demand by slowing conduction
D. Dissolves coronary thrombi
Correct Answer: B
Rationale:
Variant angina is caused by coronary artery vasospasm. Nifedipine, a dihydropyridine calcium channel blocker, prevents
vasospasm by inhibiting calcium influx into vascular smooth muscle. A is incorrect because reflex tachycardia is a side
Page 1
,effect, not the therapeutic mechanism. C is incorrect because that describes beta-blockers. D is incorrect because
thrombolytics dissolve clots.
Question 4.
A nurse is reviewing a prescription for ivabradine for a patient with heart failure. The nurse understands
that ivabradine works by:
A. Blocking beta-1 adrenergic receptors
B. Inhibiting the funny current (If) in the sinoatrial node, reducing heart rate without affecting contractility
C. Blocking calcium channels in the atrioventricular node
D. Stimulating the vagus nerve
Correct Answer: B
Rationale:
Ivabradine selectively inhibits the funny current (If), a mixed sodium-potassium inward current that controls spontaneous
diastolic depolarization in the SA node. This reduces heart rate without affecting myocardial contractility, making it useful
in patients who cannot tolerate beta-blockers. A is incorrect because that describes beta-blockers. C is incorrect because
that describes non-dihydropyridine calcium channel blockers. D is incorrect because it does not stimulate the vagus nerve.
Question 5.
A patient with hyperlipidemia is prescribed ezetimibe in combination with a statin. The nurse
understands that this combination is beneficial because:
A. Ezetimibe and statins have identical mechanisms of action
B. They lower LDL through complementary mechanisms: statins decrease synthesis while
ezetimibedecreases absorption
C. Ezetimibe prevents the myopathy caused by statins
D. Statins enhance the absorption of ezetimibe
Correct Answer: B
Rationale:
Statins inhibit HMG-CoA reductase in the liver, reducing cholesterol synthesis. Ezetimibe inhibits NPC1L1 in the intestine,
reducing cholesterol absorption. Together they provide additive LDL lowering. A is incorrect because their mechanisms
are different. C is incorrect because ezetimibe does not prevent statin myopathy. D is incorrect because statins do not
enhance ezetimibe absorption.
Question 6.
A patient is prescribed colesevelam for type 2 diabetes and hyperlipidemia. The nurse understands that
colesevelam is a bile acid sequestrant that:
A. Is absorbed systemically and lowers glucose by stimulating insulin release
B. Is not systemically absorbed and lowers both glucose and LDL cholesterol
C. Works only in the kidney to increase glucose excretion
D. Inhibits pancreatic lipase
Correct Answer: B
Rationale:
Page 2
, Colesevelam is a non-absorbed bile acid sequestrant that binds bile acids in the intestine, increasing LDL clearance. It
also has a glucose-lowering effect through mechanisms not fully understood, possibly involving GLP-1 release or altered
bile acid signaling. A is incorrect because it is not absorbed. C is incorrect because that describes SGLT2 inhibitors. D is
incorrect because that describes orlistat.
Question 7.
A nurse is caring for a patient receiving tissue plasminogen activator (alteplase) for an acute ischemic
stroke. The most important time limitation for administration is:
A. Must be given within 4.5 hours of symptom onset
B. Must be given within 12 hours of symptom onset
C. Must be given within 24 hours of symptom onset
D. Can be given up to 72 hours after symptom onset
Correct Answer: A
Rationale:
Alteplase for acute ischemic stroke must be administered within 4.5 hours of known symptom onset (or last known well)
in eligible patients. Beyond this window, the risk of hemorrhagic transformation outweighs benefits. B, C, and D are
incorrect because these timeframes exceed the approved treatment window.
Question 8.
A patient with nonvalvular atrial fibrillation is prescribed rivaroxaban. The nurse should instruct the
patient to take this medication:
A. With the evening meal to improve absorption
B. On an empty stomach every morning
C. Only on days when atrial fibrillation symptoms occur
D. With an antacid to prevent stomach upset
Correct Answer: A
Rationale:
Rivaroxaban 15 mg and 20 mg doses should be taken with food to increase bioavailability. The 10 mg dose can be taken
without regard to meals. B is incorrect because higher doses require food. C is incorrect because rivaroxaban is taken
daily for stroke prevention, not PRN. D is incorrect because antacids are not required.
Question 9.
A nurse is preparing to administer argatroban to a patient with heparin-induced thrombocytopenia
(HIT). The nurse understands that argatroban is preferred over heparin in this patient because:
A. It is cheaper than heparin
B. It is a direct thrombin inhibitor that does not cross-react with heparin antibodies
C. It has a longer half-life than heparin
D. It can be reversed with protamine sulfate
Correct Answer: B
Rationale:
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