NR 565 Midterm Exam V3 2026 | Advanced
Pharmacology Study Guide, Exam Questions
& Answers | NR 565 Midterm Exam Prep
NR 565 MIDTERM EXAM V3 2026 | ADVANCED PHARMACOLOGY STUDY GUIDE
DOCUMENT OVERVIEW
• This comprehensive -question study guide is designed to prepare you for the NR
565 Midterm Exam by testing knowledge across all major pharmacology concepts,
drug classifications, mechanisms of action, and clinical applications essential for
advanced practice nursing.
• Use this material to identify knowledge gaps, reinforce key concepts through
repeated practice, and build confidence in applying pharmacological principles to
clinical decision-making and safe medication management in advanced practice
settings.
QUESTION 1
A 65-year-old patient with hypertension is prescribed lisinopril. Which of the
following best describes the mechanism of action of this medication?
A) Blocks calcium channels in vascular smooth muscle
B) Inhibits angiotensin-converting enzyme (ACE)
C) Blocks beta-adrenergic receptors
D) Inhibits phosphodiesterase type 5
E) Blocks sodium channels in cardiac tissue
CORRECT ANSWER: B) Inhibits angiotensin-converting enzyme (ACE)
Lisinopril is an ACE inhibitor that works by blocking the conversion of angiotensin I
to angiotensin II, thereby reducing vasoconstriction and aldosterone release. This
,leads to decreased blood pressure, reduced cardiac workload, and improved renal
perfusion. ACE inhibitors are first-line agents for hypertension management,
particularly in patients with diabetes or chronic kidney disease. The drug prevents
the formation of a potent vasoconstrictor and reduces sodium and water retention,
making it highly effective in managing both hypertension and heart failure.
Understanding the mechanism is critical for predicting drug interactions and
recognizing potential adverse effects such as a dry cough (due to bradykinin
accumulation) or hyperkalemia.
QUESTION 2
A patient taking metformin develops severe diarrhea and abdominal pain.
Laboratory values show a pH of 7.28 and elevated lactate levels. What is the most
likely complication occurring?
A) Diabetic ketoacidosis (DKA)
B) Hyperglycemic hyperosmolar state (HHS)
C) Metformin-associated lactic acidosis (MALA)
D) Acute gastroenteritis with coincidental acidosis
E) Alcoholic ketoacidosis
CORRECT ANSWER: C) Metformin-associated lactic acidosis (MALA)
Metformin-associated lactic acidosis is a rare but serious adverse effect, particularly
in patients with renal impairment, liver disease, or conditions causing tissue
hypoxia. The accumulation of metformin in the body leads to increased lactate
production and decreased lactate clearance, resulting in severe metabolic acidosis.
Clinical presentation includes gastrointestinal symptoms (nausea, diarrhea,
vomiting), respiratory distress, and altered mental status. Risk factors include renal
dysfunction (eGFR <30 mL/min), acute illness, dehydration, and iodinated contrast
exposure. This complication carries high morbidity and mortality if not recognized
,and treated promptly with supportive care and hemodialysis to remove metformin.
Metformin should be withheld in patients with acute illness, dehydration, or before
procedures requiring contrast agents.
QUESTION 3
A patient is prescribed warfarin for atrial fibrillation. Which vitamin deficiency
would result from excessive warfarin therapy?
A) Vitamin A deficiency
B) Vitamin B12 deficiency
C) Vitamin K deficiency
D) Vitamin D deficiency
E) Vitamin C deficiency
CORRECT ANSWER: C) Vitamin K deficiency
Warfarin exerts its anticoagulant effect by inhibiting the synthesis of vitamin K-
dependent clotting factors (factors II, VII, IX, and X). Excessive warfarin therapy leads
to profound vitamin K deficiency, manifesting as an increased international
normalized ratio (INR), prolonged prothrombin time (PT), and increased bleeding
risk. While warfarin doesn't cause actual vitamin K deficiency per se, it functionally
antagonizes vitamin K metabolism. Patients on warfarin therapy require regular INR
monitoring, with therapeutic range typically 2-3 for most indications. If over-
anticoagulation occurs, vitamin K (phytonadione) administration reverses the effect
by restoring the synthesis of vitamin K-dependent clotting factors. Dietary vitamin K
intake should be consistent, as fluctuations can affect warfarin efficacy.
, QUESTION 4
A 45-year-old female patient develops hyponatremia while taking sertraline. Which
mechanism best explains this adverse effect?
A) Direct inhibition of sodium reabsorption in the proximal tubule
B) Increased release of antidiuretic hormone (ADH) leading to SIADH
C) Blockade of sodium channels in the collecting duct
D) Increased renal perfusion leading to increased sodium excretion
E) Inhibition of the renin-angiotensin system
CORRECT ANSWER: B) Increased release of antidiuretic hormone (ADH) leading
to SIADH
Selective serotonin reuptake inhibitors (SSRIs) like sertraline can cause syndrome of
inappropriate antidiuretic hormone secretion (SIADH), leading to hyponatremia.
The mechanism involves increased ADH release, resulting in excessive free water
reabsorption in the collecting duct without proportional sodium reabsorption. This
causes dilutional hyponatremia with decreased serum osmolality. SIADH associated
with SSRIs typically occurs within the first two weeks of therapy or after dose
increases. Clinical manifestations include nausea, headache, confusion, lethargy,
and in severe cases, seizures and coma. Risk is higher in elderly patients and those
on other medications causing SIADH (carbamazepine, vincristine, desmopressin).
Management includes fluid restriction, discontinuation of the offending agent, or
switching to an alternative antidepressant. Monitoring of sodium levels is essential
in the initial weeks of SSRI therapy.
QUESTION 5
Pharmacology Study Guide, Exam Questions
& Answers | NR 565 Midterm Exam Prep
NR 565 MIDTERM EXAM V3 2026 | ADVANCED PHARMACOLOGY STUDY GUIDE
DOCUMENT OVERVIEW
• This comprehensive -question study guide is designed to prepare you for the NR
565 Midterm Exam by testing knowledge across all major pharmacology concepts,
drug classifications, mechanisms of action, and clinical applications essential for
advanced practice nursing.
• Use this material to identify knowledge gaps, reinforce key concepts through
repeated practice, and build confidence in applying pharmacological principles to
clinical decision-making and safe medication management in advanced practice
settings.
QUESTION 1
A 65-year-old patient with hypertension is prescribed lisinopril. Which of the
following best describes the mechanism of action of this medication?
A) Blocks calcium channels in vascular smooth muscle
B) Inhibits angiotensin-converting enzyme (ACE)
C) Blocks beta-adrenergic receptors
D) Inhibits phosphodiesterase type 5
E) Blocks sodium channels in cardiac tissue
CORRECT ANSWER: B) Inhibits angiotensin-converting enzyme (ACE)
Lisinopril is an ACE inhibitor that works by blocking the conversion of angiotensin I
to angiotensin II, thereby reducing vasoconstriction and aldosterone release. This
,leads to decreased blood pressure, reduced cardiac workload, and improved renal
perfusion. ACE inhibitors are first-line agents for hypertension management,
particularly in patients with diabetes or chronic kidney disease. The drug prevents
the formation of a potent vasoconstrictor and reduces sodium and water retention,
making it highly effective in managing both hypertension and heart failure.
Understanding the mechanism is critical for predicting drug interactions and
recognizing potential adverse effects such as a dry cough (due to bradykinin
accumulation) or hyperkalemia.
QUESTION 2
A patient taking metformin develops severe diarrhea and abdominal pain.
Laboratory values show a pH of 7.28 and elevated lactate levels. What is the most
likely complication occurring?
A) Diabetic ketoacidosis (DKA)
B) Hyperglycemic hyperosmolar state (HHS)
C) Metformin-associated lactic acidosis (MALA)
D) Acute gastroenteritis with coincidental acidosis
E) Alcoholic ketoacidosis
CORRECT ANSWER: C) Metformin-associated lactic acidosis (MALA)
Metformin-associated lactic acidosis is a rare but serious adverse effect, particularly
in patients with renal impairment, liver disease, or conditions causing tissue
hypoxia. The accumulation of metformin in the body leads to increased lactate
production and decreased lactate clearance, resulting in severe metabolic acidosis.
Clinical presentation includes gastrointestinal symptoms (nausea, diarrhea,
vomiting), respiratory distress, and altered mental status. Risk factors include renal
dysfunction (eGFR <30 mL/min), acute illness, dehydration, and iodinated contrast
exposure. This complication carries high morbidity and mortality if not recognized
,and treated promptly with supportive care and hemodialysis to remove metformin.
Metformin should be withheld in patients with acute illness, dehydration, or before
procedures requiring contrast agents.
QUESTION 3
A patient is prescribed warfarin for atrial fibrillation. Which vitamin deficiency
would result from excessive warfarin therapy?
A) Vitamin A deficiency
B) Vitamin B12 deficiency
C) Vitamin K deficiency
D) Vitamin D deficiency
E) Vitamin C deficiency
CORRECT ANSWER: C) Vitamin K deficiency
Warfarin exerts its anticoagulant effect by inhibiting the synthesis of vitamin K-
dependent clotting factors (factors II, VII, IX, and X). Excessive warfarin therapy leads
to profound vitamin K deficiency, manifesting as an increased international
normalized ratio (INR), prolonged prothrombin time (PT), and increased bleeding
risk. While warfarin doesn't cause actual vitamin K deficiency per se, it functionally
antagonizes vitamin K metabolism. Patients on warfarin therapy require regular INR
monitoring, with therapeutic range typically 2-3 for most indications. If over-
anticoagulation occurs, vitamin K (phytonadione) administration reverses the effect
by restoring the synthesis of vitamin K-dependent clotting factors. Dietary vitamin K
intake should be consistent, as fluctuations can affect warfarin efficacy.
, QUESTION 4
A 45-year-old female patient develops hyponatremia while taking sertraline. Which
mechanism best explains this adverse effect?
A) Direct inhibition of sodium reabsorption in the proximal tubule
B) Increased release of antidiuretic hormone (ADH) leading to SIADH
C) Blockade of sodium channels in the collecting duct
D) Increased renal perfusion leading to increased sodium excretion
E) Inhibition of the renin-angiotensin system
CORRECT ANSWER: B) Increased release of antidiuretic hormone (ADH) leading
to SIADH
Selective serotonin reuptake inhibitors (SSRIs) like sertraline can cause syndrome of
inappropriate antidiuretic hormone secretion (SIADH), leading to hyponatremia.
The mechanism involves increased ADH release, resulting in excessive free water
reabsorption in the collecting duct without proportional sodium reabsorption. This
causes dilutional hyponatremia with decreased serum osmolality. SIADH associated
with SSRIs typically occurs within the first two weeks of therapy or after dose
increases. Clinical manifestations include nausea, headache, confusion, lethargy,
and in severe cases, seizures and coma. Risk is higher in elderly patients and those
on other medications causing SIADH (carbamazepine, vincristine, desmopressin).
Management includes fluid restriction, discontinuation of the offending agent, or
switching to an alternative antidepressant. Monitoring of sodium levels is essential
in the initial weeks of SSRI therapy.
QUESTION 5
