NSG 533: Advanced Pharmacology
Exam 2 Comprehensive Review
Wilkes University School of Nursing — Graduate Advanced Practice
Nursing Program
200 Multiple-Choice Questions with Detailed Clinical Rationales
Module 1: Autonomic Nervous System & Cardiovascular
Pharmacology
Question 1: A 58-year-old male with stage 2 hypertension and a history
of stable angina is initiated on a cardioselective beta-blocker. Which
medication is most appropriate?
A) Propranolol
B) Metoprolol succinate
C) Labetalol
D) Carvedilol
Correct Answer: B
Rationale: Metoprolol succinate is a beta-1 selective blocker, making it
ideal for hypertension and angina while minimizing bronchospasm risk
in patients without severe reactive airway disease.
Question 2: A patient with chronic heart failure with reduced ejection
fraction (HFrEF) is prescribed an angiotensin receptor-neprilysin
inhibitor (ARNI). What is the primary mechanism of action of
sacubitril?
A) Inhibits angiotensin-converting enzyme
B) Blocks neprilysin, increasing natriuretic peptides
C) Selectively blocks aldosterone receptors
D) Directly stimulates beta-2 receptors in vascular smooth muscle
,Correct Answer: B
Rationale: Sacubitril inhibits neprilysin, leading to increased levels of
endogenous vasoactive peptides, including natriuretic peptides, which
promote vasodilation, natriuresis, and reduced cardiac remodeling.
Question 3: Which antiarrhythmic agent is classified as a potassium
channel blocker (Class III) and is frequently associated with pulmonary
toxicity, thyroid dysfunction, and corneal microdeposits?
A) Lidocaine
B) Verapamil
C) Amiodarone
D) Flecainide
Correct Answer: C
Rationale: Amiodarone is a broad-spectrum Class III antiarrhythmic
with significant multi-organ side effect profiles requiring rigorous
surveillance of pulmonary, thyroid, and hepatic function.
Question 4: A 65-year-old female presents with acute decompensated
heart failure and severe peripheral edema. She is prescribed intravenous
furosemide. What electrolyte imbalance requires the closest monitoring?
A) Hypercalcemia and hypermagnesemia
B) Hypokalemia, hypomagnesemia, and hyponatremia
C) Hyperkalemia and hypernatremia
D) Hyperphosphatemia
Correct Answer: B
Rationale: Loop diuretics inhibit the Na+/K+/2Cl- cotransporter in the
thick ascending limb of the loop of Henle, resulting in significant
urinary excretion of sodium, potassium, chloride, calcium, and
magnesium.
,Question 5: Which medication class is considered first-line
monotherapy for hypertension in non-Black patients according to current
guidelines?
A) Direct renin inhibitors
B) Loop diuretics
C) ACE inhibitors or ARBs
D) Alpha-1 blockers
Correct Answer: C
Rationale: ACE inhibitors and ARBs provide proven renal and
cardiovascular protection and are first-line agents in non-Black
hypertensive populations.
Question 6: A 58-year-old male with stage 2 hypertension and a history
of stable angina is initiated on a cardioselective beta-blocker. Which
medication is most appropriate?
A) Propranolol
B) Metoprolol succinate
C) Labetalol
D) Carvedilol
Correct Answer: B
Rationale: Metoprolol succinate is a beta-1 selective blocker, making it
ideal for hypertension and angina while minimizing bronchospasm risk
in patients without severe reactive airway disease.
Question 7: A patient with chronic heart failure with reduced ejection
fraction (HFrEF) is prescribed an angiotensin receptor-neprilysin
inhibitor (ARNI). What is the primary mechanism of action of
sacubitril?
A) Inhibits angiotensin-converting enzyme
B) Blocks neprilysin, increasing natriuretic peptides
C) Selectively blocks aldosterone receptors
, D) Directly stimulates beta-2 receptors in vascular smooth muscle
Correct Answer: B
Rationale: Sacubitril inhibits neprilysin, leading to increased levels of
endogenous vasoactive peptides, including natriuretic peptides, which
promote vasodilation, natriuresis, and reduced cardiac remodeling.
Question 8: Which antiarrhythmic agent is classified as a potassium
channel blocker (Class III) and is frequently associated with pulmonary
toxicity, thyroid dysfunction, and corneal microdeposits?
A) Lidocaine
B) Verapamil
C) Amiodarone
D) Flecainide
Correct Answer: C
Rationale: Amiodarone is a broad-spectrum Class III antiarrhythmic
with significant multi-organ side effect profiles requiring rigorous
surveillance of pulmonary, thyroid, and hepatic function.
Question 9: A 65-year-old female presents with acute decompensated
heart failure and severe peripheral edema. She is prescribed intravenous
furosemide. What electrolyte imbalance requires the closest monitoring?
A) Hypercalcemia and hypermagnesemia
B) Hypokalemia, hypomagnesemia, and hyponatremia
C) Hyperkalemia and hypernatremia
D) Hyperphosphatemia
Correct Answer: B
Rationale: Loop diuretics inhibit the Na+/K+/2Cl- cotransporter in the
thick ascending limb of the loop of Henle, resulting in significant
urinary excretion of sodium, potassium, chloride, calcium, and
magnesium.
Exam 2 Comprehensive Review
Wilkes University School of Nursing — Graduate Advanced Practice
Nursing Program
200 Multiple-Choice Questions with Detailed Clinical Rationales
Module 1: Autonomic Nervous System & Cardiovascular
Pharmacology
Question 1: A 58-year-old male with stage 2 hypertension and a history
of stable angina is initiated on a cardioselective beta-blocker. Which
medication is most appropriate?
A) Propranolol
B) Metoprolol succinate
C) Labetalol
D) Carvedilol
Correct Answer: B
Rationale: Metoprolol succinate is a beta-1 selective blocker, making it
ideal for hypertension and angina while minimizing bronchospasm risk
in patients without severe reactive airway disease.
Question 2: A patient with chronic heart failure with reduced ejection
fraction (HFrEF) is prescribed an angiotensin receptor-neprilysin
inhibitor (ARNI). What is the primary mechanism of action of
sacubitril?
A) Inhibits angiotensin-converting enzyme
B) Blocks neprilysin, increasing natriuretic peptides
C) Selectively blocks aldosterone receptors
D) Directly stimulates beta-2 receptors in vascular smooth muscle
,Correct Answer: B
Rationale: Sacubitril inhibits neprilysin, leading to increased levels of
endogenous vasoactive peptides, including natriuretic peptides, which
promote vasodilation, natriuresis, and reduced cardiac remodeling.
Question 3: Which antiarrhythmic agent is classified as a potassium
channel blocker (Class III) and is frequently associated with pulmonary
toxicity, thyroid dysfunction, and corneal microdeposits?
A) Lidocaine
B) Verapamil
C) Amiodarone
D) Flecainide
Correct Answer: C
Rationale: Amiodarone is a broad-spectrum Class III antiarrhythmic
with significant multi-organ side effect profiles requiring rigorous
surveillance of pulmonary, thyroid, and hepatic function.
Question 4: A 65-year-old female presents with acute decompensated
heart failure and severe peripheral edema. She is prescribed intravenous
furosemide. What electrolyte imbalance requires the closest monitoring?
A) Hypercalcemia and hypermagnesemia
B) Hypokalemia, hypomagnesemia, and hyponatremia
C) Hyperkalemia and hypernatremia
D) Hyperphosphatemia
Correct Answer: B
Rationale: Loop diuretics inhibit the Na+/K+/2Cl- cotransporter in the
thick ascending limb of the loop of Henle, resulting in significant
urinary excretion of sodium, potassium, chloride, calcium, and
magnesium.
,Question 5: Which medication class is considered first-line
monotherapy for hypertension in non-Black patients according to current
guidelines?
A) Direct renin inhibitors
B) Loop diuretics
C) ACE inhibitors or ARBs
D) Alpha-1 blockers
Correct Answer: C
Rationale: ACE inhibitors and ARBs provide proven renal and
cardiovascular protection and are first-line agents in non-Black
hypertensive populations.
Question 6: A 58-year-old male with stage 2 hypertension and a history
of stable angina is initiated on a cardioselective beta-blocker. Which
medication is most appropriate?
A) Propranolol
B) Metoprolol succinate
C) Labetalol
D) Carvedilol
Correct Answer: B
Rationale: Metoprolol succinate is a beta-1 selective blocker, making it
ideal for hypertension and angina while minimizing bronchospasm risk
in patients without severe reactive airway disease.
Question 7: A patient with chronic heart failure with reduced ejection
fraction (HFrEF) is prescribed an angiotensin receptor-neprilysin
inhibitor (ARNI). What is the primary mechanism of action of
sacubitril?
A) Inhibits angiotensin-converting enzyme
B) Blocks neprilysin, increasing natriuretic peptides
C) Selectively blocks aldosterone receptors
, D) Directly stimulates beta-2 receptors in vascular smooth muscle
Correct Answer: B
Rationale: Sacubitril inhibits neprilysin, leading to increased levels of
endogenous vasoactive peptides, including natriuretic peptides, which
promote vasodilation, natriuresis, and reduced cardiac remodeling.
Question 8: Which antiarrhythmic agent is classified as a potassium
channel blocker (Class III) and is frequently associated with pulmonary
toxicity, thyroid dysfunction, and corneal microdeposits?
A) Lidocaine
B) Verapamil
C) Amiodarone
D) Flecainide
Correct Answer: C
Rationale: Amiodarone is a broad-spectrum Class III antiarrhythmic
with significant multi-organ side effect profiles requiring rigorous
surveillance of pulmonary, thyroid, and hepatic function.
Question 9: A 65-year-old female presents with acute decompensated
heart failure and severe peripheral edema. She is prescribed intravenous
furosemide. What electrolyte imbalance requires the closest monitoring?
A) Hypercalcemia and hypermagnesemia
B) Hypokalemia, hypomagnesemia, and hyponatremia
C) Hyperkalemia and hypernatremia
D) Hyperphosphatemia
Correct Answer: B
Rationale: Loop diuretics inhibit the Na+/K+/2Cl- cotransporter in the
thick ascending limb of the loop of Henle, resulting in significant
urinary excretion of sodium, potassium, chloride, calcium, and
magnesium.
