Western Governors University
MRAHP • 611D
A DIFFERENT WAY TO LEARN
WGU
Graduate Nursing • Advanced Pharmacology for the APRN
EST. 1997
WGU D116 — Advanced Pharmacology
A DVA N C E D P H A R M ACO LO G Y FO R T H E A DVA N C E D P RACT I C E N U RS E
INSTITUTION Western Governors University COURSE CODE D116
COURSE TITLE Advanced Pharmacology for the APRN EXAM Complete Expanded Review
FORMAT Questions, Answers & Rationales QUESTION COUNT 196 Practice Items
E X A M I N AT I O N I N S T R U C T I O N S
▸ Select the single best answer unless the item states "Select all that apply."
▸ For medication-math items, use dimensional analysis and complete a final unit check.
▸ For pregnancy questions, identify gestational age, decide whether the finding is expected or concerning, then determine the priority action.
▸ For labor questions, think contractions → cervical change → fetal response → maternal response → priority action.
▸ Use the answers and rationales immediately below each question for active-recall review.
You Already Know This
You already know the major drug classes and mechanisms. You know that beta-blockers end in "-olol," ACE inhibitors end in "-pril," and most
benzodiazepines end in "-pam."
D116 Advanced Pharmacology is about applying that knowledge to prescribing and monitoring decisions.
The difficulty comes from connecting pharmacokinetics, pharmacodynamics, and patient-specific factors — recognizing which drug is
contraindicated, which lab value changes safety, which interaction requires intervention, and which patient cannot safely receive a standard
dose.
The drug names matter. But so does knowing what the drug does to this patient.
Where Is Your Preparation Breaking Down?
If you are missing D116 questions, do not automatically respond by memorizing more drug names. Check where the reasoning chain breaks.
PharmacokineticsCan you predict how absorption, distribution, PharmacodynamicsCan you connect the mechanism of action to
metabolism, and excretion affect this patient? therapeutic and adverse effects?
ContraindicationCan you identify the patient who cannot safely MonitoringCan you identify the lab value, vital sign, or assessment
receive a medication? that changes safety?
InteractionsCan you recognize which combinations require SafetyCan you identify the prescribing action that prevents immediate
monitoring or avoidance? harm?
, 01 PHARMACOKINETICS, PHARMACODYNAMICS & SAFE PRESCRIBING 5 questions
1. An advanced practice registered nurse has diagnosed a 44-year-old male with depression. A plan is developed to start treatment with
medication. The patient has a history of sexual dysfunction and is concerned about taking medication that may worsen this condition.
Which antidepressant has the benefit of enhancing libido?
A) Bupropion
ANSWER Bupropion
RATIONALE Correct! Bupropion does not cause sexual dysfunction. This will help the patient with a history of sexual dysfunction. This will
enhance the patient's libido, which will help with both depression and sexual dysfunction.
2. A patient is wheezing and short of breath. The nurse assesses a heart rate of 88 beats per minute, a respiratory rate of 24 breaths per
minute, and a blood pressure of 124/78 mm Hg. The prescriber orders a nonspecific beta-agonist medication. Besides evaluating the
patient for a reduction in respiratory distress, the nurse should monitor for which side effect?
A) Tachycardia
ANSWER Tachycardia
RATIONALE Correct! Beta-agonists are used for asthma because of their beta2 effects on bronchial smooth muscle, causing dilation. Beta1
effects cause tachycardia and hypertension. Beta receptors do not exert effects on the bladder.
3. A patient is experiencing toxic side effects from atropine, including delirium and hallucinations. Which medication should the provider
administer?
A) Physostigmine
ANSWER Physostigmine
RATIONALE Correct! Physostigmine is the drug of choice for treating poisoning from atropine and other drugs that cause muscarinic blockade.
Donepezil is used to treat Alzheimer disease. Edrophonium is used to distinguish between a myasthenic crisis and a
cholinesterase inhibitor overdose. Neostigmine does not cross the blood-brain barrier and would not effectively treat this
patient's central nervous system (CNS) symptoms.
4. A patient brought to the emergency department requires sutures. The prescriber orders a local anesthetic with epinephrine. The
epinephrine is ordered to ___________.
A) allow a reduced dose of the anesthetic
ANSWER allow a reduced dose of the anesthetic
RATIONALE Correct! Epinephrine prolongs absorption of the anesthetic because it is an alpha1 agonist. It is frequently combined with a local
anesthetic for this purpose so the amount of anesthetic required may be reduced. Local anesthetics do not induce hypertension;
therefore, epinephrine would not be needed to prevent it. Epinephrine does not act as an antiemetic and would not reduce
anesthetic-induced nausea. Epinephrine is not used to reduce the pain of an injection.
5. A patient has been diagnosed with Parkinson disease (PD) and begins treatment with carbidopa. After several months of therapy, the
patient reports no change in symptoms. As the provider, you should do which of the following?
A) Increase the dose of carbidopa alone
B) Discuss the on-off phenomenon
C) Reevaluate the diagnosis and medication regimen
D) Add a dopamine agonist without reassessing the regimen
ANSWER Reevaluate the diagnosis and medication regimen
RATIONALE Carbidopa is primarily used with levodopa to inhibit peripheral conversion of levodopa to dopamine. Carbidopa alone does not
provide adequate antiparkinsonian therapy. If symptoms do not improve, the diagnosis, adherence, and medication regimen
should be reassessed rather than simply increasing carbidopa alone.
, Bonus Points
A medication's pharmacokinetics describes what the body does to the drug: absorption, distribution, metabolism, and excretion.
Pharmacodynamics describes what the drug does to the body, including receptor effects and physiologic responses.
Reduced kidney function can increase exposure to drugs that depend on renal clearance.
A narrow therapeutic index requires closer monitoring because the therapeutic and toxic concentrations are relatively close together.
Current D116 material places substantial emphasis on medication safety, reconciliation, adherence, and monitoring rather than simply memorizing
drug names.
02 CNS, PSYCHIATRIC MEDICATIONS & PAIN MANAGEMENT 5 questions
6. A patient who is taking oral contraceptives begins taking valproic acid for seizures. After a week of therapy with valproic acid, the
patient tells the nurse that she is experiencing nausea. What should the nurse do?
A) Ask the patient if she is taking the valproic acid with food because taking the drug on an empty stomach can cause gastrointestinal side
effects
ANSWER Ask the patient if she is taking the valproic acid with food because taking the drug on an empty stomach can cause gastrointestinal
side effects
RATIONALE Correct! Gastrointestinal effects, including nausea, vomiting, and indigestion, are common with valproic acid and can be
minimized by taking the drug with food or using an enteric-coated product. Hyperammonemia can occur when valproic acid is
combined with topiramate. Signs of pregnancy usually do not occur within a week, so this is less likely. Hepatotoxicity is a rare
adverse effect.
7. A patient with cerebral palsy who has been receiving baclofen via gastrostomy tube for three months is admitted to the hospital for
evaluation of new-onset seizures. What might you suspect to be the cause of these seizures?
A) Missed doses of baclofen
ANSWER Missed doses of baclofen
RATIONALE Correct! Baclofen does not appear to cause physical dependence, but abrupt discontinuation has been associated with adverse
reactions. Abrupt withdrawal of oral baclofen can cause visual hallucinations, paranoid ideation, and seizures and should be
considered when a patient develops these symptoms. Seizures are not a symptom of baclofen toxicity.
8. A nurse is preparing a patient to go home from the emergency department after receiving sutures for a laceration on one hand. The
provider used lidocaine with epinephrine as a local anesthetic. Which symptom in this patient causes the most concern?
A) Nervousness and tachycardia
ANSWER Nervousness and tachycardia
RATIONALE Correct! Absorption of the vasoconstrictor can cause systemic effects, including nervousness and tachycardia. If severe, alpha-
and beta-adrenergic antagonists can be given. Local anesthetics are nonselective modifiers of neuronal function and can block
motor neurons, so it is expected that patients may have difficulty with movement. The sensation of pressure also is affected and is
an expected effect. As the local anesthetic wears off, the sensation of pain will return.
9. A patient who has recurrent migraine headaches is prescribed sumatriptan. Which aspect of this patient's history is of concern when
taking this drug?
A) Coronary artery disease
ANSWER Coronary artery disease. Adverse events include coronary vasospasm.
RATIONALE Incorrect. There is no contraindication for asthma, diabetes, or renal disease.
, 10. A patient who has been taking a monoamine oxidase inhibitor (MAOI) for depression for several months tells the provider that the
medication has not helped with symptoms. You plan to switch the patient to an SSRI. What should you instruct the nurse to teach this
patient?
A) "Stop taking the MAOI two weeks before starting the SSRI."
ANSWER "Stop taking the MAOI two weeks before starting the SSRI."
RATIONALE Correct! MAOIs increase serotonin receptor (5-HT) availability, thus greatly increasing the risk of serotonin syndrome. MAOIs
should be withdrawn at least 14 days before an SSRI is started. An SSRI should never be given at the same time as an MAOI. It is
not necessary to wait five weeks before starting an SSRI.
Bonus Points
Naloxone reverses opioid effects but may have a shorter duration than some opioids, so recurrent respiratory depression can occur.
Bupropion has relatively low sexual adverse-effect burden compared with many serotonergic antidepressants, but seizure risk remains clinically
important.
MAOI interactions require deliberate medication reconciliation, including prescription drugs, OTC products, and supplements.
Severe abdominal pain in a patient receiving valproate is not simply a routine nausea complaint.
CNS medications frequently require attention to renal function, hepatic function, drug interactions, sedation, falls, and patient-specific risk factors.
03 CARDIOVASCULAR & RENAL PHARMACOLOGY 6 questions
11. A patient is admitted to a hospital for treatment for first-time symptoms of mania and is exhibiting euphoric mania. Which medication
should you order?
A) Lithium
ANSWER Lithium
RATIONALE Correct! In almost all cases of mania, divalproex sodium is the drug of choice, except for euphoric mania symptoms. Lithium is
used to treat euphoric mania. Olanzapine and risperidone are used to treat other symptoms that are associated with borderline
personality disorder (BPD).
12. A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal
retractions, and frothy, pink sputum. Which drug should the provider administer for this patient?
A) Furosemide
ANSWER Furosemide
RATIONALE Correct! Furosemide, a potent diuretic, is used when rapid or massive mobilization of fluids is needed. This patient shows severe
signs of congestive heart failure with respiratory distress and pulmonary edema and needs immediate mobilization of fluid.
Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema because their diuretic effects are less rapid.
Mannitol is indicated for patients with increased intracranial pressure and must be discontinued immediately if signs of
pulmonary congestion or heart failure occur.
13. A patient with a recent onset of nephrosclerosis has been taking an ACE inhibitor and a thiazide diuretic. The patient's initial blood
pressure was 148/100 mm Hg. After one month of drug therapy, the patient's blood pressure is 130/90 mm Hg. What should the nurse
discuss with the provider?
A) Adding a calcium channel blocker to this patient's drug regimen
ANSWER Adding a calcium channel blocker to this patient's drug regimen
RATIONALE Correct! In patients with renal disease, the goal of antihypertensive therapy is to lower the blood pressure to 130/80 mm Hg or
less.
MRAHP • 611D
A DIFFERENT WAY TO LEARN
WGU
Graduate Nursing • Advanced Pharmacology for the APRN
EST. 1997
WGU D116 — Advanced Pharmacology
A DVA N C E D P H A R M ACO LO G Y FO R T H E A DVA N C E D P RACT I C E N U RS E
INSTITUTION Western Governors University COURSE CODE D116
COURSE TITLE Advanced Pharmacology for the APRN EXAM Complete Expanded Review
FORMAT Questions, Answers & Rationales QUESTION COUNT 196 Practice Items
E X A M I N AT I O N I N S T R U C T I O N S
▸ Select the single best answer unless the item states "Select all that apply."
▸ For medication-math items, use dimensional analysis and complete a final unit check.
▸ For pregnancy questions, identify gestational age, decide whether the finding is expected or concerning, then determine the priority action.
▸ For labor questions, think contractions → cervical change → fetal response → maternal response → priority action.
▸ Use the answers and rationales immediately below each question for active-recall review.
You Already Know This
You already know the major drug classes and mechanisms. You know that beta-blockers end in "-olol," ACE inhibitors end in "-pril," and most
benzodiazepines end in "-pam."
D116 Advanced Pharmacology is about applying that knowledge to prescribing and monitoring decisions.
The difficulty comes from connecting pharmacokinetics, pharmacodynamics, and patient-specific factors — recognizing which drug is
contraindicated, which lab value changes safety, which interaction requires intervention, and which patient cannot safely receive a standard
dose.
The drug names matter. But so does knowing what the drug does to this patient.
Where Is Your Preparation Breaking Down?
If you are missing D116 questions, do not automatically respond by memorizing more drug names. Check where the reasoning chain breaks.
PharmacokineticsCan you predict how absorption, distribution, PharmacodynamicsCan you connect the mechanism of action to
metabolism, and excretion affect this patient? therapeutic and adverse effects?
ContraindicationCan you identify the patient who cannot safely MonitoringCan you identify the lab value, vital sign, or assessment
receive a medication? that changes safety?
InteractionsCan you recognize which combinations require SafetyCan you identify the prescribing action that prevents immediate
monitoring or avoidance? harm?
, 01 PHARMACOKINETICS, PHARMACODYNAMICS & SAFE PRESCRIBING 5 questions
1. An advanced practice registered nurse has diagnosed a 44-year-old male with depression. A plan is developed to start treatment with
medication. The patient has a history of sexual dysfunction and is concerned about taking medication that may worsen this condition.
Which antidepressant has the benefit of enhancing libido?
A) Bupropion
ANSWER Bupropion
RATIONALE Correct! Bupropion does not cause sexual dysfunction. This will help the patient with a history of sexual dysfunction. This will
enhance the patient's libido, which will help with both depression and sexual dysfunction.
2. A patient is wheezing and short of breath. The nurse assesses a heart rate of 88 beats per minute, a respiratory rate of 24 breaths per
minute, and a blood pressure of 124/78 mm Hg. The prescriber orders a nonspecific beta-agonist medication. Besides evaluating the
patient for a reduction in respiratory distress, the nurse should monitor for which side effect?
A) Tachycardia
ANSWER Tachycardia
RATIONALE Correct! Beta-agonists are used for asthma because of their beta2 effects on bronchial smooth muscle, causing dilation. Beta1
effects cause tachycardia and hypertension. Beta receptors do not exert effects on the bladder.
3. A patient is experiencing toxic side effects from atropine, including delirium and hallucinations. Which medication should the provider
administer?
A) Physostigmine
ANSWER Physostigmine
RATIONALE Correct! Physostigmine is the drug of choice for treating poisoning from atropine and other drugs that cause muscarinic blockade.
Donepezil is used to treat Alzheimer disease. Edrophonium is used to distinguish between a myasthenic crisis and a
cholinesterase inhibitor overdose. Neostigmine does not cross the blood-brain barrier and would not effectively treat this
patient's central nervous system (CNS) symptoms.
4. A patient brought to the emergency department requires sutures. The prescriber orders a local anesthetic with epinephrine. The
epinephrine is ordered to ___________.
A) allow a reduced dose of the anesthetic
ANSWER allow a reduced dose of the anesthetic
RATIONALE Correct! Epinephrine prolongs absorption of the anesthetic because it is an alpha1 agonist. It is frequently combined with a local
anesthetic for this purpose so the amount of anesthetic required may be reduced. Local anesthetics do not induce hypertension;
therefore, epinephrine would not be needed to prevent it. Epinephrine does not act as an antiemetic and would not reduce
anesthetic-induced nausea. Epinephrine is not used to reduce the pain of an injection.
5. A patient has been diagnosed with Parkinson disease (PD) and begins treatment with carbidopa. After several months of therapy, the
patient reports no change in symptoms. As the provider, you should do which of the following?
A) Increase the dose of carbidopa alone
B) Discuss the on-off phenomenon
C) Reevaluate the diagnosis and medication regimen
D) Add a dopamine agonist without reassessing the regimen
ANSWER Reevaluate the diagnosis and medication regimen
RATIONALE Carbidopa is primarily used with levodopa to inhibit peripheral conversion of levodopa to dopamine. Carbidopa alone does not
provide adequate antiparkinsonian therapy. If symptoms do not improve, the diagnosis, adherence, and medication regimen
should be reassessed rather than simply increasing carbidopa alone.
, Bonus Points
A medication's pharmacokinetics describes what the body does to the drug: absorption, distribution, metabolism, and excretion.
Pharmacodynamics describes what the drug does to the body, including receptor effects and physiologic responses.
Reduced kidney function can increase exposure to drugs that depend on renal clearance.
A narrow therapeutic index requires closer monitoring because the therapeutic and toxic concentrations are relatively close together.
Current D116 material places substantial emphasis on medication safety, reconciliation, adherence, and monitoring rather than simply memorizing
drug names.
02 CNS, PSYCHIATRIC MEDICATIONS & PAIN MANAGEMENT 5 questions
6. A patient who is taking oral contraceptives begins taking valproic acid for seizures. After a week of therapy with valproic acid, the
patient tells the nurse that she is experiencing nausea. What should the nurse do?
A) Ask the patient if she is taking the valproic acid with food because taking the drug on an empty stomach can cause gastrointestinal side
effects
ANSWER Ask the patient if she is taking the valproic acid with food because taking the drug on an empty stomach can cause gastrointestinal
side effects
RATIONALE Correct! Gastrointestinal effects, including nausea, vomiting, and indigestion, are common with valproic acid and can be
minimized by taking the drug with food or using an enteric-coated product. Hyperammonemia can occur when valproic acid is
combined with topiramate. Signs of pregnancy usually do not occur within a week, so this is less likely. Hepatotoxicity is a rare
adverse effect.
7. A patient with cerebral palsy who has been receiving baclofen via gastrostomy tube for three months is admitted to the hospital for
evaluation of new-onset seizures. What might you suspect to be the cause of these seizures?
A) Missed doses of baclofen
ANSWER Missed doses of baclofen
RATIONALE Correct! Baclofen does not appear to cause physical dependence, but abrupt discontinuation has been associated with adverse
reactions. Abrupt withdrawal of oral baclofen can cause visual hallucinations, paranoid ideation, and seizures and should be
considered when a patient develops these symptoms. Seizures are not a symptom of baclofen toxicity.
8. A nurse is preparing a patient to go home from the emergency department after receiving sutures for a laceration on one hand. The
provider used lidocaine with epinephrine as a local anesthetic. Which symptom in this patient causes the most concern?
A) Nervousness and tachycardia
ANSWER Nervousness and tachycardia
RATIONALE Correct! Absorption of the vasoconstrictor can cause systemic effects, including nervousness and tachycardia. If severe, alpha-
and beta-adrenergic antagonists can be given. Local anesthetics are nonselective modifiers of neuronal function and can block
motor neurons, so it is expected that patients may have difficulty with movement. The sensation of pressure also is affected and is
an expected effect. As the local anesthetic wears off, the sensation of pain will return.
9. A patient who has recurrent migraine headaches is prescribed sumatriptan. Which aspect of this patient's history is of concern when
taking this drug?
A) Coronary artery disease
ANSWER Coronary artery disease. Adverse events include coronary vasospasm.
RATIONALE Incorrect. There is no contraindication for asthma, diabetes, or renal disease.
, 10. A patient who has been taking a monoamine oxidase inhibitor (MAOI) for depression for several months tells the provider that the
medication has not helped with symptoms. You plan to switch the patient to an SSRI. What should you instruct the nurse to teach this
patient?
A) "Stop taking the MAOI two weeks before starting the SSRI."
ANSWER "Stop taking the MAOI two weeks before starting the SSRI."
RATIONALE Correct! MAOIs increase serotonin receptor (5-HT) availability, thus greatly increasing the risk of serotonin syndrome. MAOIs
should be withdrawn at least 14 days before an SSRI is started. An SSRI should never be given at the same time as an MAOI. It is
not necessary to wait five weeks before starting an SSRI.
Bonus Points
Naloxone reverses opioid effects but may have a shorter duration than some opioids, so recurrent respiratory depression can occur.
Bupropion has relatively low sexual adverse-effect burden compared with many serotonergic antidepressants, but seizure risk remains clinically
important.
MAOI interactions require deliberate medication reconciliation, including prescription drugs, OTC products, and supplements.
Severe abdominal pain in a patient receiving valproate is not simply a routine nausea complaint.
CNS medications frequently require attention to renal function, hepatic function, drug interactions, sedation, falls, and patient-specific risk factors.
03 CARDIOVASCULAR & RENAL PHARMACOLOGY 6 questions
11. A patient is admitted to a hospital for treatment for first-time symptoms of mania and is exhibiting euphoric mania. Which medication
should you order?
A) Lithium
ANSWER Lithium
RATIONALE Correct! In almost all cases of mania, divalproex sodium is the drug of choice, except for euphoric mania symptoms. Lithium is
used to treat euphoric mania. Olanzapine and risperidone are used to treat other symptoms that are associated with borderline
personality disorder (BPD).
12. A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal
retractions, and frothy, pink sputum. Which drug should the provider administer for this patient?
A) Furosemide
ANSWER Furosemide
RATIONALE Correct! Furosemide, a potent diuretic, is used when rapid or massive mobilization of fluids is needed. This patient shows severe
signs of congestive heart failure with respiratory distress and pulmonary edema and needs immediate mobilization of fluid.
Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema because their diuretic effects are less rapid.
Mannitol is indicated for patients with increased intracranial pressure and must be discontinued immediately if signs of
pulmonary congestion or heart failure occur.
13. A patient with a recent onset of nephrosclerosis has been taking an ACE inhibitor and a thiazide diuretic. The patient's initial blood
pressure was 148/100 mm Hg. After one month of drug therapy, the patient's blood pressure is 130/90 mm Hg. What should the nurse
discuss with the provider?
A) Adding a calcium channel blocker to this patient's drug regimen
ANSWER Adding a calcium channel blocker to this patient's drug regimen
RATIONALE Correct! In patients with renal disease, the goal of antihypertensive therapy is to lower the blood pressure to 130/80 mm Hg or
less.
