NSG 533 Exam 3 Advanced Pharmacology Test Bank (PDF) –
200 Q&A with Verified Answers & Rationales |Latest Updated
This Year Study Guide
Summarized Most Tested Areas
Based on the official NSG 533 Exam 3 blueprint, the following domains carry the most weight and are the
most heavily tested:
Cardiovascular Pharmacology – 25% (50 questions): Heart failure (GDMT, sacubitril/valsartan,
spironolactone), hypertension (first-line agents, ACE inhibitor cough), anticoagulants (warfarin,
DOACs, antidotes), statins, digoxin monitoring, diuretics
Endocrine & Metabolic Pharmacology – 25% (50 questions): Diabetes (metformin, SGLT2
inhibitors, GLP-1 agonists, insulin types), thyroid disorders (levothyroxine, methimazole),
osteoporosis (bisphosphonates, SERMs, calcitonin), corticosteroids
Neurological & Psychopharmacology – 20% (40 questions): Seizure medications
(carbamazepine, ethosuximide, phenytoin, lamotrigine, valproic acid), Parkinson's disease
(levodopa-carbidopa, entacapone, pramipexole), migraine (sumatriptan, propranolol, topiramate,
erenumab), antidepressants (SSRIs, SNRIs, bupropion), antipsychotics
Gastrointestinal Pharmacology – 15% (30 questions): PPIs, H2 blockers, sucralfate,
antiemetics (ondansetron, metoclopramide), laxatives, antidiarrheals, IBD medications
(sulfasalazine, infliximab, adalimumab)
Antimicrobial Therapy & Special Populations – 15% (30 questions): Antibiotic classes
(penicillins, macrolides, fluoroquinolones, tetracyclines, aminoglycosides, vancomycin), antifungals,
antivirals, TB medications, special population considerations (renal impairment, pregnancy, older
adults)
Section 1: Cardiovascular Pharmacology (Q1–Q50)
Q1. A patient taking lisinopril for hypertension develops a persistent, dry, non-
productive cough. Which mechanism is responsible for this side effect?
A. Inhibition of prostaglandins in the renal tubules
,B. Direct irritation of the bronchial mucosa by the drug molecule
C. Accumulation of bradykinin in the respiratory tract
D. Increased sensitivity of the cough reflex due to hyperkalemia
Answer: C
Rationale: ACE inhibitors block the enzyme that converts angiotensin I to angiotensin II, but
this same enzyme is responsible for the breakdown of bradykinin. When the enzyme is
inhibited, bradykinin levels rise in the lungs, triggering a dry cough in approximately 10–20%
of patients. This side effect is not dose-dependent and typically necessitates switching the
patient to an ARB.
Q2. Which of the following medications is considered a first-line treatment for a
patient with newly diagnosed Stage 1 hypertension and no comorbid conditions?
A. Clonidine
B. Spironolactone
C. Amlodipine
D. Hydralazine
Answer: C
Rationale: According to JNC 8 and AHA/ACC guidelines, calcium channel blockers (CCBs)
like amlodipine are recommended as first-line therapy. Thiazide diuretics, ACE inhibitors,
,and ARBs are also primary options. Spironolactone and clonidine are reserved for resistant
hypertension or specific compelling indications.
Q3. A patient with a history of heart failure is prescribed spironolactone. The nurse
practitioner should monitor for which electrolyte imbalance?
A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypocalcemia
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic that acts as an aldosterone
antagonist in the distal nephron. By inhibiting aldosterone, the kidney retains potassium
while excreting sodium and water. This mechanism significantly increases the risk of
hyperkalemia, particularly in patients with renal impairment or those taking ACE inhibitors or
ARBs.
Q4. A patient with heart failure is prescribed digoxin. Which electrolyte imbalance
increases the risk of digoxin toxicity?
A. Hyperkalemia
B. Hypokalemia
, C. Hypernatremia
D. Hypercalcemia
Answer: B
Rationale: Hypokalemia increases the binding of digoxin to the sodium-potassium ATPase
pump, enhancing its toxic effects. Patients on loop or thiazide diuretics are at particular risk
and require close potassium monitoring.
Q5. Which medication is a direct oral anticoagulant (DOAC) that inhibits factor Xa?
A. Warfarin
B. Heparin
C. Apixaban
D. Clopidogrel
Answer: C
Rationale: Apixaban is a direct oral anticoagulant that selectively inhibits factor Xa, a key
enzyme in the coagulation cascade. Unlike warfarin, DOACs do not require routine INR
monitoring.
Q6. A patient on warfarin has an INR of 5.5. Which action is most appropriate?
A. Administer vitamin K and hold warfarin
B. Increase warfarin dose
200 Q&A with Verified Answers & Rationales |Latest Updated
This Year Study Guide
Summarized Most Tested Areas
Based on the official NSG 533 Exam 3 blueprint, the following domains carry the most weight and are the
most heavily tested:
Cardiovascular Pharmacology – 25% (50 questions): Heart failure (GDMT, sacubitril/valsartan,
spironolactone), hypertension (first-line agents, ACE inhibitor cough), anticoagulants (warfarin,
DOACs, antidotes), statins, digoxin monitoring, diuretics
Endocrine & Metabolic Pharmacology – 25% (50 questions): Diabetes (metformin, SGLT2
inhibitors, GLP-1 agonists, insulin types), thyroid disorders (levothyroxine, methimazole),
osteoporosis (bisphosphonates, SERMs, calcitonin), corticosteroids
Neurological & Psychopharmacology – 20% (40 questions): Seizure medications
(carbamazepine, ethosuximide, phenytoin, lamotrigine, valproic acid), Parkinson's disease
(levodopa-carbidopa, entacapone, pramipexole), migraine (sumatriptan, propranolol, topiramate,
erenumab), antidepressants (SSRIs, SNRIs, bupropion), antipsychotics
Gastrointestinal Pharmacology – 15% (30 questions): PPIs, H2 blockers, sucralfate,
antiemetics (ondansetron, metoclopramide), laxatives, antidiarrheals, IBD medications
(sulfasalazine, infliximab, adalimumab)
Antimicrobial Therapy & Special Populations – 15% (30 questions): Antibiotic classes
(penicillins, macrolides, fluoroquinolones, tetracyclines, aminoglycosides, vancomycin), antifungals,
antivirals, TB medications, special population considerations (renal impairment, pregnancy, older
adults)
Section 1: Cardiovascular Pharmacology (Q1–Q50)
Q1. A patient taking lisinopril for hypertension develops a persistent, dry, non-
productive cough. Which mechanism is responsible for this side effect?
A. Inhibition of prostaglandins in the renal tubules
,B. Direct irritation of the bronchial mucosa by the drug molecule
C. Accumulation of bradykinin in the respiratory tract
D. Increased sensitivity of the cough reflex due to hyperkalemia
Answer: C
Rationale: ACE inhibitors block the enzyme that converts angiotensin I to angiotensin II, but
this same enzyme is responsible for the breakdown of bradykinin. When the enzyme is
inhibited, bradykinin levels rise in the lungs, triggering a dry cough in approximately 10–20%
of patients. This side effect is not dose-dependent and typically necessitates switching the
patient to an ARB.
Q2. Which of the following medications is considered a first-line treatment for a
patient with newly diagnosed Stage 1 hypertension and no comorbid conditions?
A. Clonidine
B. Spironolactone
C. Amlodipine
D. Hydralazine
Answer: C
Rationale: According to JNC 8 and AHA/ACC guidelines, calcium channel blockers (CCBs)
like amlodipine are recommended as first-line therapy. Thiazide diuretics, ACE inhibitors,
,and ARBs are also primary options. Spironolactone and clonidine are reserved for resistant
hypertension or specific compelling indications.
Q3. A patient with a history of heart failure is prescribed spironolactone. The nurse
practitioner should monitor for which electrolyte imbalance?
A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypocalcemia
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic that acts as an aldosterone
antagonist in the distal nephron. By inhibiting aldosterone, the kidney retains potassium
while excreting sodium and water. This mechanism significantly increases the risk of
hyperkalemia, particularly in patients with renal impairment or those taking ACE inhibitors or
ARBs.
Q4. A patient with heart failure is prescribed digoxin. Which electrolyte imbalance
increases the risk of digoxin toxicity?
A. Hyperkalemia
B. Hypokalemia
, C. Hypernatremia
D. Hypercalcemia
Answer: B
Rationale: Hypokalemia increases the binding of digoxin to the sodium-potassium ATPase
pump, enhancing its toxic effects. Patients on loop or thiazide diuretics are at particular risk
and require close potassium monitoring.
Q5. Which medication is a direct oral anticoagulant (DOAC) that inhibits factor Xa?
A. Warfarin
B. Heparin
C. Apixaban
D. Clopidogrel
Answer: C
Rationale: Apixaban is a direct oral anticoagulant that selectively inhibits factor Xa, a key
enzyme in the coagulation cascade. Unlike warfarin, DOACs do not require routine INR
monitoring.
Q6. A patient on warfarin has an INR of 5.5. Which action is most appropriate?
A. Administer vitamin K and hold warfarin
B. Increase warfarin dose
