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NSG 533 Exam 2 2026/2027 | Wilkes Advanced Pharmacology | Verified Q&A | Grade A | Pass Guaranteed

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Pass the NSG 533 Advanced Pharmacology Exam 2 at Wilkes University 2026/2027 with this comprehensive guide of verified questions, answers, and detailed rationales. This resource contains actual exam-style questions with accurate answers and rationales covering pharmacology core concepts—including cardiovascular medications (antihypertensives, antiarrhythmics, heart failure agents, anticoagulants), endocrine drugs (insulin, oral antidiabetics, thyroid agents, corticosteroids), respiratory pharmacology (bronchodilators, inhaled corticosteroids, anticholinergics), gastrointestinal medications (PPIs, antiemetics, laxatives), anti-infective agents (antibiotics, antivirals, antifungals), and CNS medications (anticonvulsants, antidepressants, antipsychotics). Topics also include drug interactions, adverse effect monitoring, patient education, and individualized prescribing considerations. Each solution is verified and Grade A to mirror the official Wilkes NSG 533 exam format. With authentic content and our Pass Guarantee, you will ace your NSG 533 Exam 2 with confidence. Download now and excel in Advanced Pharmacology!

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NSG 533 Exam 2 - Advanced Pharmacology | Wilkes University | 2026/2027 Edition Page 1




NSG533 / NSG 533 EXAM 2 (LATEST ):
ADVANCED PHARMACOLOGY
Questions and Verified Answers | 100% Correct | Grade A - Wilkes



Course NSG 533 - Advanced Pharmacology Institution Wilkes University

Exam Exam 2 - Comprehensive Edition Latest

Total 100 Multiple Choice Cognitive Mix 20% Recall / 50% Application / 30%
Questions Analysis

Format 75% Scenario-based, 25% Direct Standards AACN Essentials, Advanced
Knowledge Pharmacology Competencies


Examination Overview: This comprehensive examination assesses advanced pharmacological competency across six
core domains aligned with the Wilkes University NSG 533 course syllabus and the AACN Essentials of Master's
Education in Nursing. Each item is constructed to evaluate not only recall of pharmacological principles but also the
ability to apply this knowledge in complex clinical scenarios requiring medication selection, side effect management,
monitoring parameter recognition, and patient education. Rationales integrate advanced pharmacology principles,
mechanisms of action, and evidence-based practice to support deep learning and clinical reasoning development
expected of graduate-level advanced practice nursing students.



Section 1: Cardiovascular Pharmacology
Q1: A 62-year-old African American male with newly diagnosed hypertension (BP 156/94 mmHg) and a
history of gout presents to the clinic. According to JNC 8 and AACN advanced pharmacology principles,
which of the following antihypertensive agents is most appropriate as initial monotherapy for this patient?
A. Lisinopril 10 mg daily
B. Amlodipine 5 mg daily *[CORRECT]*
C. Hydrochlorothiazide 25 mg daily
D. Propranolol 40 mg BID
Correct Answer: B
Rationale: Calcium channel blockers (CCBs) such as amlodipine are preferred first-line agents for African American
patients with hypertension because they produce greater BP reduction in this population compared to ACE inhibitors or
beta-blockers. Thiazides are also first-line but are contraindicated or cautioned in gout due to hyperuricemia. ACE
inhibitors like lisinopril are less effective monotherapy in African Americans and carry risk of angioedema.
Beta-blockers are not first-line for uncomplicated hypertension.

Q2: A 58-year-old female is started on lisinopril 20 mg daily for hypertension. At her 2-week follow-up, she
reports a persistent dry, hacking cough that began shortly after starting the medication. Her vitals are
stable and chest exam is clear. What is the most appropriate next step in medication management?
A. Discontinue lisinopril and switch to losartan 50 mg daily *[CORRECT]*
B. Continue lisinopril and add a cough suppressant with codeine



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C. Reduce lisinopril dose to 5 mg daily and re-evaluate in 2 weeks
D. Discontinue lisinopril and switch to atenolol 50 mg daily
Correct Answer: A
Rationale: The dry cough is a classic adverse effect of ACE inhibitors caused by accumulation of bradykinin in the
respiratory tract, occurring in up to 20% of patients. The appropriate intervention is to discontinue the ACE inhibitor
and switch to an angiotensin II receptor blocker (ARB) such as losartan, which does not inhibit bradykinin breakdown
and therefore does not cause the cough. Dose reduction is ineffective; the cough persists at any dose. Adding a cough
suppressant masks a medication-induced problem rather than addressing its cause.

Q3: A patient with heart failure with reduced ejection fraction (HFrEF, EF 30%) is being optimized on
guideline-directed medical therapy (GDMT). Which combination of medications represents the four
foundational pillars of HFrEF treatment per the 2022 AHA/ACC/HFSA guidelines?
A. Digoxin, furosemide, hydralazine-nitrate, spironolactone
B. ACE inhibitor (or ARNI), evidence-based beta-blocker, mineralocorticoid receptor antagonist,
SGLT2 inhibitor *[CORRECT]*
C. Loop diuretic, thiazide diuretic, ACE inhibitor, digoxin
D. ARB, CCB, beta-blocker, nitrate
Correct Answer: B
Rationale: The four pillars of GDMT for HFrEF are: (1) ACE inhibitor/ARB/ARNI (sacubitril/valsartan preferred), (2)
evidence-based beta-blocker (carvedilol, metoprolol succinate, or bisoprolol), (3) mineralocorticoid receptor
antagonist (spironolactone or eplerenone), and (4) SGLT2 inhibitor (dapagliflozin or empagliflozin). This combination
reduces mortality and hospitalizations. Digoxin and diuretics provide symptom relief but do not reduce mortality. CCBs
(except amlodipine in selected cases) are contraindicated in HFrEF.

Q4: A 71-year-old patient with atrial fibrillation has been on warfarin for 6 months with consistently
therapeutic INRs (2.0-3.0). The patient is being transitioned to apixaban for convenience. What is the
correct transition strategy?
A. Stop warfarin, wait 3 days, then start apixaban
B. Stop warfarin, start apixaban when INR < 2.0 *[CORRECT]*
C. Start apixaban immediately while continuing warfarin for 5 days overlap
D. Stop warfarin, give vitamin K 10 mg IV, then start apixaban 24 hours later
Correct Answer: B
Rationale: When transitioning from warfarin to a DOAC such as apixaban, the warfarin is discontinued and the DOAC
is started when the INR falls below 2.0. Starting immediately risks over-anticoagulation, and overlap therapy is
incorrect (overlap is for heparin-to-warfarin bridging). Vitamin K is only administered for warfarin reversal in bleeding
or supratherapeutic INR; routine use here is inappropriate and would delay anticoagulation unnecessarily.

Q5: A 67-year-old male with a history of myocardial infarction is on atorvastatin 80 mg daily. His most
recent lipid panel shows LDL-C 75 mg/dL. He reports new-onset muscle aches and weakness in his thighs.
Creatine kinase (CK) is 850 U/L (normal < 200). What is the most appropriate action?
A. Continue atorvastatin and reassure the patient that muscle symptoms are unrelated
B. Discontinue atorvastatin immediately and re-evaluate symptoms and CK in 2-4 weeks
*[CORRECT]*
C. Reduce atorvastatin to 20 mg daily and add ezetimibe 10 mg
D. Switch to rosuvastatin 40 mg daily
Correct Answer: B


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Rationale: The patient has statin-associated muscle symptoms (SAMS) with elevated CK > 4x upper limit of normal,
which warrants immediate discontinuation of the statin and re-evaluation in 2-4 weeks. If symptoms resolve and CK
normalizes, a lower-intensity statin or alternate-day dosing may be attempted, often with ezetimibe as adjunctive
therapy. Simply reducing the dose or switching statins without first confirming the relationship between symptoms and
the drug is inappropriate and risks progression to rhabdomyolysis.

Q6: A patient with acute decompensated heart failure is receiving IV furosemide. Which of the following
laboratory changes is most likely to occur as a result of this therapy?
A. Hyperkalemia, hypercalcemia, metabolic alkalosis
B. Hypokalemia, hypocalcemia, metabolic alkalosis
C. Hypokalemia, hyperuricemia, metabolic alkalosis *[CORRECT]*
D. Hyperkalemia, hyponatremia, metabolic acidosis
Correct Answer: C
Rationale: Loop diuretics like furosemide inhibit the Na-K-2Cl cotransporter in the thick ascending limb, causing
increased excretion of potassium, sodium, and water. They also cause hyperuricemia by competing with uric acid for
secretion in the proximal tubule. The resulting volume contraction activates the renin-angiotensin-aldosterone system,
causing increased hydrogen ion secretion and metabolic alkalosis. Hypercalcemia is incorrect; loop diuretics actually
increase calcium excretion (unlike thiazides, which retain calcium).

Q7: A 55-year-old male is started on spironolactone 25 mg daily as part of his heart failure regimen. Three
weeks later, he reports bilateral breast tenderness and enlargement. Which laboratory abnormality is also
most likely present?
A. Hyponatremia
B. Hyperkalemia *[CORRECT]*
C. Hypoglycemia
D. Hypomagnesemia
Correct Answer: B
Rationale: Spironolactone is a non-selective mineralocorticoid receptor antagonist that also binds to androgen and
progesterone receptors, causing gynecomastia, breast tenderness, and sexual dysfunction in up to 10% of male patients.
Because it inhibits potassium excretion in the collecting duct, hyperkalemia is the most significant adverse effect and
must be monitored closely, especially in patients with renal impairment or those taking ACE inhibitors/ARBs. Switching
to eplerenone (selective MRA) may reduce endocrine side effects.

Q8: A patient is prescribed sublingual nitroglycerin 0.4 mg PRN for angina. Which statement by the
patient indicates the need for further education?
A. "I will sit down before taking this medication."
B. "I can take up to three tablets 5 minutes apart, and if pain persists, I should call 911."
C. "I should store the tablets in their original amber glass bottle and replace them every 6 months."
D. "If I get a headache, I should stop taking the medication immediately and call my doctor."
*[CORRECT]*
Correct Answer: D
Rationale: Headache is a common and expected side effect of nitroglycerin due to cerebral vasodilation and does not
require discontinuation of therapy. Patients should be advised to use acetaminophen for headache relief and continue
using nitroglycerin as prescribed. Sitting down before administration reduces orthostatic hypotension risk. The
5-minute interval (up to 3 doses) and 911 activation protocol are correct. Storage in amber glass bottles prevents
degradation from light, and replacement every 6 months ensures potency.




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, NSG 533 Exam 2 - Advanced Pharmacology | Wilkes University | 2026/2027 Edition Page 4




Q9: A patient with atrial fibrillation with rapid ventricular response (HR 150) and normal LV function is
to receive an antiarrhythmic for rhythm control. Per the Vaughan-Williams classification, which agent is a
Class III potassium channel blocker most appropriate for long-term maintenance of sinus rhythm?
A. Lidocaine
B. Diltiazem
C. Amiodarone *[CORRECT]*
D. Procainamide
Correct Answer: C
Rationale: Amiodarone is a Class III antiarrhythmic in the Vaughan-Williams classification, primarily a potassium
channel blocker (though it has Class I, II, and IV activity as well). It is highly effective for maintaining sinus rhythm in
atrial fibrillation, especially in patients with structural heart disease. Lidocaine is Class IB (used for ventricular
arrhythmias), diltiazem is Class IV (calcium channel blocker), and procainamide is Class IA.

Q10: A 64-year-old male has been on amiodarone 200 mg daily for 18 months for atrial fibrillation. He
presents with a new non-productive cough and exertional dyspnea. Chest X-ray reveals bilateral
interstitial infiltrates. Which adverse effect is most likely responsible for these findings?
A. Pulmonary fibrosis *[CORRECT]*
B. Congestive heart failure exacerbation
C. Pneumococcal pneumonia
D. Bronchiolitis obliterans
Correct Answer: A
Rationale: Amiodarone pulmonary toxicity (APT) is a serious, potentially fatal adverse effect occurring in 1-5% of
patients, characterized by interstitial pneumonitis and pulmonary fibrosis. The drug has a long half-life (up to 100 days)
and accumulates in lung tissue. Patients typically present with cough, dyspnea, and interstitial infiltrates on imaging.
Immediate discontinuation of amiodarone and treatment with corticosteroids is required. Other amiodarone toxicities
include thyroid dysfunction, hepatotoxicity, corneal microdeposits, and blue-gray skin discoloration.

Q11: A 70-year-old patient with chronic kidney disease (eGFR 28 mL/min/1.73m²) and atrial fibrillation
(CHA2DS2-VASc = 4) requires anticoagulation. Which direct oral anticoagulant (DOAC) does NOT
require dose adjustment based on renal function?
A. Dabigatran
B. Rivaroxaban
C. Apixaban
D. Warfarin *[CORRECT]*
Correct Answer: D
Rationale: Warfarin is metabolized primarily by hepatic CYP2C9 and does not require renal dose adjustment, making it
suitable for patients with severe renal impairment. Dabigatran is primarily renally cleared (~80%) and is
contraindicated or requires significant dose reduction when CrCl < 30 mL/min. Rivaroxaban and apixaban have some
renal clearance and require dose adjustments based on renal function and other patient factors. Warfarin requires INR
monitoring, but in advanced CKD, it is often preferred over DOACs.

Q12: A patient presents to the emergency department with symptoms suggestive of acute STEMI. The
healthcare team is preparing to administer aspirin and a P2Y12 inhibitor as part of dual antiplatelet
therapy (DAPT). Which P2Y12 inhibitor has the most rapid onset and is preferred for acute coronary
syndromes in patients undergoing percutaneous coronary intervention (PCI)?
A. Clopidogrel


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