WILKES UNIVERSITY NSG 533 ADVANCED PHARMACOLOGY EXAM 1
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A; | INSTANT DOWNLOAD PDF.
Core Domains
• Pharmacokinetics and pharmacodynamics
• Cardiovascular and hematologic pharmacotherapy
• Endocrine and metabolic medications
• Anti-infective therapy and antimicrobial stewardship
• Neuropsychiatric and pain medications
• Respiratory, gastrointestinal, and renal pharmacology
• Medication safety, ethics, and professional standards
• Regulatory compliance and clinical decision-making
Introduction
This assessment evaluates advanced pharmacology knowledge and clinical judgment for graduate nursing practice. It
assesses mechanisms of action, therapeutic uses, adverse effects, contraindications, interactions, monitoring, patient
education, and safe medication administration. The examination uses multiple-choice and scenario-based questions to test
foundational theory alongside applied professional knowledge. Emphasis is placed on translating pharmacologic principles into
real-world decisions, recognizing urgent toxicity, promoting adherence, managing risk, and applying ethical, regulatory, and
evidence-informed standards of care.
Question 1: A patient taking lisinopril develops swelling of the lips and tongue. What is the priority action?
A. Administer the next dose with food
■ B. Hold the drug and obtain emergency evaluation
C. Give potassium replacement
D. Place the patient supine and reassess tomorrow
■ RATIONALE: Angioedema is a potentially life-threatening adverse effect of ACE inhibitors; the drug must be stopped and
emergency airway assessment obtained.
Question 2: Which pharmacokinetic process describes movement of a drug from the bloodstream into tissues?
■ A. Distribution
B. Absorption
C. Metabolism
D. Excretion
■ RATIONALE: Distribution is the reversible movement of drug from plasma into body compartments and tissues.
Question 3: A patient receiving warfarin has an INR of 6.2 without bleeding. Which prescription should the nurse
anticipate?
A. Give aspirin
B. Increase the warfarin dose
■ C. Hold warfarin and notify the prescriber
D. Administer protamine sulfate
■ RATIONALE: A markedly elevated INR requires withholding warfarin and prompt prescriber-directed management;
protamine reverses heparin, not warfarin.
Question 4: Which teaching is most important for a patient prescribed a transdermal clonidine patch?
A. Apply heat over the patch
■ B. Remove the old patch before applying a new one
,C. Cut the patch in half if dizzy
D. Stop abruptly when blood pressure improves
■ RATIONALE: The old patch should be removed to prevent dose stacking; heat and abrupt discontinuation can increase risk.
Question 5: A patient with asthma is prescribed propranolol. What is the main concern?
■ A. Bronchospasm
B. Hyperglycemia
C. Urinary retention
D. Ototoxicity
■ RATIONALE: Nonselective beta blockade can cause bronchoconstriction and may worsen asthma.
Question 6: Which receptor action best explains the therapeutic effect of naloxone?
A. Muscarinic agonism
B. Dopamine blockade
■ C. Opioid receptor antagonism
D. GABA enhancement
■ RATIONALE: Naloxone competitively antagonizes opioid receptors and reverses opioid-induced respiratory depression.
Question 7: A patient taking lithium reports coarse tremor, vomiting, and unsteady gait. What should the nurse do
first?
A. Give the scheduled dose
B. Restrict sodium
■ C. Hold lithium and obtain a level
D. Administer calcium
■ RATIONALE: These are concerning for lithium toxicity; withholding the drug and urgently assessing serum concentration and
renal status is appropriate.
Question 8: Which medication is generally preferred for rapid relief of an acute migraine attack?
■ A. Sumatriptan
B. Donepezil
C. Methimazole
D. Alendronate
■ RATIONALE: Sumatriptan is a serotonin 5-HT1 agonist used for acute migraine treatment when appropriate.
Question 9: A patient taking metformin is scheduled for iodinated contrast imaging. Which action is appropriate?
A. Continue without assessment
■ B. Hold as directed and assess renal function
C. Add potassium routinely
D. Give with grapefruit juice
■ RATIONALE: Metformin may need temporary interruption around contrast exposure in patients at risk for renal dysfunction
because of lactic acidosis concerns.
Question 10: Which finding most strongly suggests serotonin syndrome?
A. Bradycardia and dry skin
■ B. Clonus, hyperreflexia, and fever
C. Painless jaundice only
D. Severe constipation without neurologic signs
■ RATIONALE: Serotonin excess commonly produces autonomic instability, hyperthermia, agitation, clonus, and hyperreflexia.
Question 11: Why should extended-release tablets generally not be crushed?
, A. Crushing increases protein binding
■ B. It can release the dose too rapidly
C. It prevents renal elimination
D. It always causes an allergic reaction
■ RATIONALE: Crushing can destroy the modified-release mechanism and cause dose dumping or toxicity.
Question 12: A patient receiving vancomycin develops flushing and pruritus during infusion. Which intervention is
most appropriate?
A. Increase the infusion rate
■ B. Stop or slow the infusion and notify the prescriber
C. Administer vitamin K
D. Give a second full dose
■ RATIONALE: Rapid vancomycin infusion can cause an infusion reaction; slowing or stopping the infusion and evaluating the
patient is indicated.
Question 13: Which laboratory value is especially important before initiating spironolactone?
■ A. Potassium
B. Amylase
C. Hemoglobin A1c only
D. Platelet count only
■ RATIONALE: Spironolactone can cause hyperkalemia, particularly with renal impairment or other potassium-raising drugs.
Question 14: A patient prescribed levothyroxine asks when to take it. What is the best instruction?
A. At bedtime with calcium
■ B. In the morning on an empty stomach
C. Only when symptomatic
D. With an iron supplement
■ RATIONALE: Consistent administration on an empty stomach improves absorption; calcium and iron can reduce it.
Question 15: Which medication reverses the effects of unfractionated heparin?
A. Phytonadione
B. Idarucizumab
■ C. Protamine sulfate
D. Flumazenil
■ RATIONALE: Protamine binds and neutralizes unfractionated heparin.
Question 16: A patient using an inhaled corticosteroid should be taught to:
■ A. Rinse the mouth after use
B. Stop all bronchodilators
C. Use it only for immediate rescue
D. Swallow the medication after inhalation
■ RATIONALE: Rinsing reduces local candidiasis and dysphonia associated with inhaled corticosteroids.
Question 17: What is the primary safety concern when initiating an SSRI in a young adult?
A. Immediate renal failure
■ B. Increased suicidal thoughts or behavior
C. Permanent hearing loss
D. Severe hypothermia in all patients
■ RATIONALE: Early treatment and dose changes require monitoring for worsening depression or suicidal ideation.
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A; | INSTANT DOWNLOAD PDF.
Core Domains
• Pharmacokinetics and pharmacodynamics
• Cardiovascular and hematologic pharmacotherapy
• Endocrine and metabolic medications
• Anti-infective therapy and antimicrobial stewardship
• Neuropsychiatric and pain medications
• Respiratory, gastrointestinal, and renal pharmacology
• Medication safety, ethics, and professional standards
• Regulatory compliance and clinical decision-making
Introduction
This assessment evaluates advanced pharmacology knowledge and clinical judgment for graduate nursing practice. It
assesses mechanisms of action, therapeutic uses, adverse effects, contraindications, interactions, monitoring, patient
education, and safe medication administration. The examination uses multiple-choice and scenario-based questions to test
foundational theory alongside applied professional knowledge. Emphasis is placed on translating pharmacologic principles into
real-world decisions, recognizing urgent toxicity, promoting adherence, managing risk, and applying ethical, regulatory, and
evidence-informed standards of care.
Question 1: A patient taking lisinopril develops swelling of the lips and tongue. What is the priority action?
A. Administer the next dose with food
■ B. Hold the drug and obtain emergency evaluation
C. Give potassium replacement
D. Place the patient supine and reassess tomorrow
■ RATIONALE: Angioedema is a potentially life-threatening adverse effect of ACE inhibitors; the drug must be stopped and
emergency airway assessment obtained.
Question 2: Which pharmacokinetic process describes movement of a drug from the bloodstream into tissues?
■ A. Distribution
B. Absorption
C. Metabolism
D. Excretion
■ RATIONALE: Distribution is the reversible movement of drug from plasma into body compartments and tissues.
Question 3: A patient receiving warfarin has an INR of 6.2 without bleeding. Which prescription should the nurse
anticipate?
A. Give aspirin
B. Increase the warfarin dose
■ C. Hold warfarin and notify the prescriber
D. Administer protamine sulfate
■ RATIONALE: A markedly elevated INR requires withholding warfarin and prompt prescriber-directed management;
protamine reverses heparin, not warfarin.
Question 4: Which teaching is most important for a patient prescribed a transdermal clonidine patch?
A. Apply heat over the patch
■ B. Remove the old patch before applying a new one
,C. Cut the patch in half if dizzy
D. Stop abruptly when blood pressure improves
■ RATIONALE: The old patch should be removed to prevent dose stacking; heat and abrupt discontinuation can increase risk.
Question 5: A patient with asthma is prescribed propranolol. What is the main concern?
■ A. Bronchospasm
B. Hyperglycemia
C. Urinary retention
D. Ototoxicity
■ RATIONALE: Nonselective beta blockade can cause bronchoconstriction and may worsen asthma.
Question 6: Which receptor action best explains the therapeutic effect of naloxone?
A. Muscarinic agonism
B. Dopamine blockade
■ C. Opioid receptor antagonism
D. GABA enhancement
■ RATIONALE: Naloxone competitively antagonizes opioid receptors and reverses opioid-induced respiratory depression.
Question 7: A patient taking lithium reports coarse tremor, vomiting, and unsteady gait. What should the nurse do
first?
A. Give the scheduled dose
B. Restrict sodium
■ C. Hold lithium and obtain a level
D. Administer calcium
■ RATIONALE: These are concerning for lithium toxicity; withholding the drug and urgently assessing serum concentration and
renal status is appropriate.
Question 8: Which medication is generally preferred for rapid relief of an acute migraine attack?
■ A. Sumatriptan
B. Donepezil
C. Methimazole
D. Alendronate
■ RATIONALE: Sumatriptan is a serotonin 5-HT1 agonist used for acute migraine treatment when appropriate.
Question 9: A patient taking metformin is scheduled for iodinated contrast imaging. Which action is appropriate?
A. Continue without assessment
■ B. Hold as directed and assess renal function
C. Add potassium routinely
D. Give with grapefruit juice
■ RATIONALE: Metformin may need temporary interruption around contrast exposure in patients at risk for renal dysfunction
because of lactic acidosis concerns.
Question 10: Which finding most strongly suggests serotonin syndrome?
A. Bradycardia and dry skin
■ B. Clonus, hyperreflexia, and fever
C. Painless jaundice only
D. Severe constipation without neurologic signs
■ RATIONALE: Serotonin excess commonly produces autonomic instability, hyperthermia, agitation, clonus, and hyperreflexia.
Question 11: Why should extended-release tablets generally not be crushed?
, A. Crushing increases protein binding
■ B. It can release the dose too rapidly
C. It prevents renal elimination
D. It always causes an allergic reaction
■ RATIONALE: Crushing can destroy the modified-release mechanism and cause dose dumping or toxicity.
Question 12: A patient receiving vancomycin develops flushing and pruritus during infusion. Which intervention is
most appropriate?
A. Increase the infusion rate
■ B. Stop or slow the infusion and notify the prescriber
C. Administer vitamin K
D. Give a second full dose
■ RATIONALE: Rapid vancomycin infusion can cause an infusion reaction; slowing or stopping the infusion and evaluating the
patient is indicated.
Question 13: Which laboratory value is especially important before initiating spironolactone?
■ A. Potassium
B. Amylase
C. Hemoglobin A1c only
D. Platelet count only
■ RATIONALE: Spironolactone can cause hyperkalemia, particularly with renal impairment or other potassium-raising drugs.
Question 14: A patient prescribed levothyroxine asks when to take it. What is the best instruction?
A. At bedtime with calcium
■ B. In the morning on an empty stomach
C. Only when symptomatic
D. With an iron supplement
■ RATIONALE: Consistent administration on an empty stomach improves absorption; calcium and iron can reduce it.
Question 15: Which medication reverses the effects of unfractionated heparin?
A. Phytonadione
B. Idarucizumab
■ C. Protamine sulfate
D. Flumazenil
■ RATIONALE: Protamine binds and neutralizes unfractionated heparin.
Question 16: A patient using an inhaled corticosteroid should be taught to:
■ A. Rinse the mouth after use
B. Stop all bronchodilators
C. Use it only for immediate rescue
D. Swallow the medication after inhalation
■ RATIONALE: Rinsing reduces local candidiasis and dysphonia associated with inhaled corticosteroids.
Question 17: What is the primary safety concern when initiating an SSRI in a young adult?
A. Immediate renal failure
■ B. Increased suicidal thoughts or behavior
C. Permanent hearing loss
D. Severe hypothermia in all patients
■ RATIONALE: Early treatment and dose changes require monitoring for worsening depression or suicidal ideation.
