NR 566 Midterm Exam (2026) |
Chamberlain Advanced Pharmacology
Actual Questions and Answers (PDF)
1. A patient with a history of heart failure is prescribed furosemide. The primary
mechanism of action of this drug is to:
• A) Inhibit aldosterone receptors in the distal tubule.
• B) Block sodium and chloride reabsorption in the ascending loop of Henle.
• C) Inhibit carbonic anhydrase in the proximal tubule.
• D) Block sodium channels in the collecting duct.
Correct Answer:
• B) Block sodium and chloride reabsorption in the ascending loop of Henle.
Rationale:
• Furosemide is a loop diuretic. Its primary site of action is the thick
ascending limb of the loop of Henle, where it inhibits the Na-K-2Cl
cotransporter. This action significantly reduces sodium and water
reabsorption, leading to potent diuresis and a reduction in preload, which is
beneficial in heart failure.
2. Which of the following drugs is a direct-acting oral anticoagulant (DOAC) that
directly inhibits factor Xa?
• A) Warfarin
• B) Dabigatran
• C) Apixaban
• D) Clopidogrel
,Correct Answer:
• C) Apixaban
Rationale:
• Apixaban is a direct-acting oral anticoagulant (DOAC) that selectively
and reversibly inhibits factor Xa, a key enzyme in the coagulation cascade.
Warfarin inhibits vitamin K-dependent clotting factors, dabigatran is a direct
thrombin inhibitor, and clopidogrel is an antiplatelet agent.
3. A patient is prescribed an ACE inhibitor. Which of the following is a common,
non-productive side effect that the nurse practitioner should warn the patient
about?
• A) Bradycardia
• B) Dry, persistent cough
• C) Hyperkalemia
• D) Angioedema
Correct Answer:
• B) Dry, persistent cough
Rationale:
• A dry, persistent cough is a very common side effect of ACE inhibitors,
occurring in up to 20% of patients. It is caused by the accumulation of
bradykinin and substance P in the lungs. While hyperkalemia and
angioedema are also potential side effects, angioedema is a rare but serious
adverse effect, and the cough is a common reason for non-adherence.
Bradycardia is not a typical side effect.
4. The primary mechanism of action for metformin in treating Type 2 Diabetes
Mellitus is:
• A) Increasing insulin secretion from pancreatic beta cells.
, • B) Decreasing hepatic glucose production and increasing insulin sensitivity.
• C) Inhibiting alpha-glucosidase in the small intestine.
• D) Enhancing glucose reabsorption in the kidneys.
Correct Answer:
• B) Decreasing hepatic glucose production and increasing insulin sensitivity.
Rationale:
• Metformin is a biguanide. Its primary mechanism of action is to reduce
hepatic glucose production (gluconeogenesis). It also increases peripheral
insulin sensitivity and decreases intestinal absorption of glucose. It does not
cause insulin secretion, making it less likely to cause hypoglycemia.
5. A patient with a severe penicillin allergy is diagnosed with community-
acquired pneumonia. Which of the following antibiotics is an appropriate
alternative?
• A) Amoxicillin
• B) Cephalexin
• C) Azithromycin
• D) Piperacillin-tazobactam
Correct Answer:
• C) Azithromycin
Rationale:
• Azithromycin is a macrolide antibiotic and is a safe and effective
alternative for treating community-acquired pneumonia in patients with a
penicillin allergy. Amoxicillin is a penicillin. Cephalexin is a first-generation
cephalosporin and should be avoided or used with extreme caution due to
potential cross-reactivity. Piperacillin-tazobactam is a penicillin derivative.
, 6. What is the primary therapeutic effect of beta-blockers like metoprolol in
treating hypertension?
• A) Vasodilation of peripheral arteries.
• B) Reduced heart rate and contractility.
• C) Increased fluid excretion by the kidneys.
• D) Inhibition of the renin-angiotensin-aldosterone system.
Correct Answer:
• B) Reduced heart rate and contractility.
Rationale:
• Beta-blockers work by blocking the effects of epinephrine and
norepinephrine on beta-adrenergic receptors. Beta-1 receptor blockade in
the heart leads to a decreased heart rate (negative chronotropy) and
decreased force of contraction (negative inotropy), which lowers cardiac
output and thus reduces blood pressure.
7. A patient is started on atorvastatin. The NP should monitor for which of the
following potential adverse effects?
• A) Hyperglycemia and weight gain.
• B) Photosensitivity and rash.
• C) Muscle pain and elevated liver enzymes.
• D) Constipation and dry mouth.
Correct Answer:
• C) Muscle pain and elevated liver enzymes.
Rationale:
• Statins, including atorvastatin, can cause myopathy, which can range
from mild myalgias to severe rhabdomyolysis. They can also cause
Chamberlain Advanced Pharmacology
Actual Questions and Answers (PDF)
1. A patient with a history of heart failure is prescribed furosemide. The primary
mechanism of action of this drug is to:
• A) Inhibit aldosterone receptors in the distal tubule.
• B) Block sodium and chloride reabsorption in the ascending loop of Henle.
• C) Inhibit carbonic anhydrase in the proximal tubule.
• D) Block sodium channels in the collecting duct.
Correct Answer:
• B) Block sodium and chloride reabsorption in the ascending loop of Henle.
Rationale:
• Furosemide is a loop diuretic. Its primary site of action is the thick
ascending limb of the loop of Henle, where it inhibits the Na-K-2Cl
cotransporter. This action significantly reduces sodium and water
reabsorption, leading to potent diuresis and a reduction in preload, which is
beneficial in heart failure.
2. Which of the following drugs is a direct-acting oral anticoagulant (DOAC) that
directly inhibits factor Xa?
• A) Warfarin
• B) Dabigatran
• C) Apixaban
• D) Clopidogrel
,Correct Answer:
• C) Apixaban
Rationale:
• Apixaban is a direct-acting oral anticoagulant (DOAC) that selectively
and reversibly inhibits factor Xa, a key enzyme in the coagulation cascade.
Warfarin inhibits vitamin K-dependent clotting factors, dabigatran is a direct
thrombin inhibitor, and clopidogrel is an antiplatelet agent.
3. A patient is prescribed an ACE inhibitor. Which of the following is a common,
non-productive side effect that the nurse practitioner should warn the patient
about?
• A) Bradycardia
• B) Dry, persistent cough
• C) Hyperkalemia
• D) Angioedema
Correct Answer:
• B) Dry, persistent cough
Rationale:
• A dry, persistent cough is a very common side effect of ACE inhibitors,
occurring in up to 20% of patients. It is caused by the accumulation of
bradykinin and substance P in the lungs. While hyperkalemia and
angioedema are also potential side effects, angioedema is a rare but serious
adverse effect, and the cough is a common reason for non-adherence.
Bradycardia is not a typical side effect.
4. The primary mechanism of action for metformin in treating Type 2 Diabetes
Mellitus is:
• A) Increasing insulin secretion from pancreatic beta cells.
, • B) Decreasing hepatic glucose production and increasing insulin sensitivity.
• C) Inhibiting alpha-glucosidase in the small intestine.
• D) Enhancing glucose reabsorption in the kidneys.
Correct Answer:
• B) Decreasing hepatic glucose production and increasing insulin sensitivity.
Rationale:
• Metformin is a biguanide. Its primary mechanism of action is to reduce
hepatic glucose production (gluconeogenesis). It also increases peripheral
insulin sensitivity and decreases intestinal absorption of glucose. It does not
cause insulin secretion, making it less likely to cause hypoglycemia.
5. A patient with a severe penicillin allergy is diagnosed with community-
acquired pneumonia. Which of the following antibiotics is an appropriate
alternative?
• A) Amoxicillin
• B) Cephalexin
• C) Azithromycin
• D) Piperacillin-tazobactam
Correct Answer:
• C) Azithromycin
Rationale:
• Azithromycin is a macrolide antibiotic and is a safe and effective
alternative for treating community-acquired pneumonia in patients with a
penicillin allergy. Amoxicillin is a penicillin. Cephalexin is a first-generation
cephalosporin and should be avoided or used with extreme caution due to
potential cross-reactivity. Piperacillin-tazobactam is a penicillin derivative.
, 6. What is the primary therapeutic effect of beta-blockers like metoprolol in
treating hypertension?
• A) Vasodilation of peripheral arteries.
• B) Reduced heart rate and contractility.
• C) Increased fluid excretion by the kidneys.
• D) Inhibition of the renin-angiotensin-aldosterone system.
Correct Answer:
• B) Reduced heart rate and contractility.
Rationale:
• Beta-blockers work by blocking the effects of epinephrine and
norepinephrine on beta-adrenergic receptors. Beta-1 receptor blockade in
the heart leads to a decreased heart rate (negative chronotropy) and
decreased force of contraction (negative inotropy), which lowers cardiac
output and thus reduces blood pressure.
7. A patient is started on atorvastatin. The NP should monitor for which of the
following potential adverse effects?
• A) Hyperglycemia and weight gain.
• B) Photosensitivity and rash.
• C) Muscle pain and elevated liver enzymes.
• D) Constipation and dry mouth.
Correct Answer:
• C) Muscle pain and elevated liver enzymes.
Rationale:
• Statins, including atorvastatin, can cause myopathy, which can range
from mild myalgias to severe rhabdomyolysis. They can also cause
