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NSG 533/NSG 533 ADVANCED PHARMACOLOGY FINAL
COMPREHENSIVE EXAM 2025 (Module 1, 2, 3, 4 & 5)
|ACTUAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES |ALREADY
GRADED A+.
A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30
breaths/minute, intercostal retractions, and frothy, pink sputum. After the patient's provider renders a
diagnosis of heart failure, which diuretic will be prescribed to address these assessment findings?
a.) Furosemide
b.) Hydrochlorothiazide
c.) Mannitol
d.) Spirinolactone
a) Furosemide
Furosemide, a potent diuretic, is used when rapid or massive mobilization of fluids is needed. This patient
shows signs and symptoms of severe heart failure and needs immediate reduction of fluid overload.
Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema, because they are less
efficacious, and diuresis is less rapid. Mannitol is indicated for patients with increased intracranial pressure and
muse by discontinued immediately if signs of pulmonary congestion or heart failure occur.
The provider orders furosemide for a patient who takes digoxin and is admitted to the hospital for
treatment of heart failure. The morning assessment identifies an irregular heart rate of 86beats/minute, a
respiratory rate of 22 breaths/minute, and a blood pressure of 130/82mmHg. Crackles are heard in both
lungs. Which laboratory result will be of the greatest concern to the provider?
a.) Blood glucose level of 120mg/dL
b.) Oxygen saturation of 90%
c.) Potassium level of 3.4 mEq/L
d.) Sodium level of 140 mEq/L
c.) Potassium level of 3.4 mEq/L
This patient has an irregular, rapid heartbeat that might be caused by a dysrhythmia. This patient's serum
potassium level is low, which can trigger fatal dysrhythmias, especially in patients taking dioxin. Furosemide
contributes to loss of potassium through its effects on the distal nephron. Potassium-sparing diuretics often are
used in conjunction with furosemide to prevent this complication. This patients serum glucose and sodium
levels are normal and of no concern at this point, although they can be affected by furosemide. The oxygen
saturation is somewhat low and needs to be monitored, although it will likely improve with diuresis.
, Page |2
Verapamil is prescribed for the client who takes digoxin. The provider will monitor closely for which
adverse reaction.
a.) AV blockade
b.) Gingival hyperplasia
c.) Migraine headaches
d.) Reflex tachycardia
a.) AV blockade
Verapamil and digoxin both suppress impulse conduction through the AV node, when the two drugs are used
concurrently, the risk of AV blockade is increased. Gingival hyperplasia can occur in rate cases with verapamil,
but is not an acute symptom. Verapamil can be used to prevent migraine, although its use for this purpose is
under investigation. Verapamil and digoxin both suppress the heart rate, so tachycardia is not anticipated. The
calcium channel block nifedipine, not verapamil, causes reflex tachycardia.
Which medication will the provider prescribe for a patient admitted with severe hypertensive crisis?
a.) Captopril PO
b.) Hydralazine PO
c.) Minoxidil PO
d.) Sodium nitroprusside IV
d.) Sodium nitroprusside IV
Sodium nitroprusside, the drug of choice for hypertensive emergencies, is given intravenously. ACE inhibitors,
such as captopril, are not used. Hydralazine may be used by should be given IV instead of PO. Minoxidil is
effective, but its severe side effects make it a second-line drug.
A patient had a blood pressure of 150/95mmHg and 148/90mmHg on two seperate office visits. This is
consistent with a blood pressure of 145/92mmHg taken in an ambulatory setting. The patients diagnostic
tests are all normal. What will the patients provider order to best manage the patients hypertension?
a.) A beta blocker
b.) A loop diuretic and spironolactone
c.) A thiazide diuretic.
d.) An alpha1 blocker.
c.) A thiazide diuretic.
The patient has primary, or essential, hypertension as evidenced by systolic pressure greater than 140 and
diastolic pressure greater than 90, along with normal tests ruling out another primary cause. Thiazide diuretics
are first-line drugs for hypertension. Beta blockers are effective but are most often used to counter reflex
, Page |3
tachycardia associated with reduced blood pressure caused by therapeutic agents. Loop diuretics cause greater
diuresis than is usually needed and so are not first-line drugs, alpha1 blockers are not drugs of first choice
A patient with diabetes develops hypertension. Which type of medication will the provider prescribe to
treat hypertension in this patient?
a.) Angiotensin-converting enzyme (ACE) inhibitors
b.) Beta blockers
c.) Direct-acting vasodilators
d.) Thiazide diuretics.
a.) Angiotensin-converting enzyme (ACE) inhibitors
ACE inhibitors slow the progression of kidney injury in diabetic patients with renal damage. Beta blockers can
mask signs of hypoglycemia and must be used with caution in diabetics. Direct-acting vasodilators are third-line
drugs for chronic hypertension. Thiazide diuretics promote hyperglycemia.
A patient reports a family history of hypertension and cardiovascular disease but has no other risk
factors. Current blood pressure is 126/82mgHg and the patient has a normal weight and body mass index
for height and age. What will be the provider's focus when providing patient education?
a.) Angiotensin-converting enzyme (ACE) inhibitors and calcium channel blocker medications.
b.) The DASH diet, sodium restriction, and exercise.
c.) Increased calcium and potassium supplements
d.) Thiazide diuretics and lifestyle changes.
b.) The DASH diet, sodium restriction, and exercise.
This patient has elevated hypertension without other risk factors. Lifestyle changes are indicated at this point. If
blood pressure rises to hypertensive levels, other measures, including drug therapy, will be initiated. Calcium
and potassium supplements are not indicated.
A patient is taking an angiotensin-converting enzyme (ACE) inhibitor to treat hypertension tells the
provider that she wants to become pregnant. What response will the provider give to the patient.
a.) "Controlling your blood pressure will decrease your risk of preeclampsia."
b.) "We need to consider changing you to an angiotensin receptor blocker during pregnancy."
c.) "It will be safe to continue taking the ACE inhibitor during your pregnancy."
d.) "Lets discuss using methyldopa instead of the ACE inhibitor while you are pregnant"
d.) "Lets discuss using methyldopa instead of the ACE inhibitor while you are pregnant"
, Page |4
Methyldopa has limited effects on uteroplacental and fetal hemodynamics and does not adversely affect the
fetus or neonate. Controlling blood pressure does not lower the risk of preeclampsia. ACE inhibitors and ARBS
are specifically contraindicated in pregnancy.
A patient with a recent onset of nephrosclerosis has been taking an angiotensin-converting enzyme (ACE)
inhibitor, and a thiazide diuretic. The patient's initial blood pressure was 148/100 mmHg. After 1 month
of drug therapy, the patient's blood pressure is 130/90 mmHg. What action will the provider take to
address the patient's blood pressure?
a.) Add a calcium channel blocker to this patients drug regimen.
b.) Lower doses of the antihypertensive medications.
c.) Order a high potassium diet.
d.) Add spironolactone to the drug regimen.
a.) Add a calcium channel blocker to this patients drug regimen.
In patients with renal disease, the goal of antihypertensive therapy is to lower the blood pressure to 130/80 or
less. Adding a third medication is often indicated. Lowering the dose of the medications is not indicated because
the patients blood pressure is not in the target range. Adding potassium to the diet and using a potassium-sparing
diuretic are contraindicated.
A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the
nurse notes a heart rate of 96 beats/minute, a blood pressure of 150/90, bibasilar crackles, 2+ pitting
edema of the ankles, and distention of the jugular veins. What will the provider order in response to this
assessment data?
a.) Angiotensin-converting enzyme (ACE) inhibitor
b.) Digoxin
c.) Furosemide
d.) Spironolactone
c.) Furosemide
This patient shows signs of fluid volume overload and needs a diuretic. Furosemide is a loop diuretic, which can
produce profound diuresis very quickly even when the glomerular filtration rate is low. An ACE inhibitor will
not reduce fluid volume overload. Digoxin has a positive inotropic effect on the hearty, which may improve
renal perfusion, but this is not its primary effect. Spironolactone is a potassium-sparing diuretic with weak
diuresis effects; it is used in conjunction with other diuretics to improve electrolyte balance.
A patient with heart failure who takes an angiotensin-converting enzyme (ACE) inhibitor, a thiazide
diuretic, and a beta blocker for several months comes to the clinic for evaluation. As part of the ongoing
NSG 533/NSG 533 ADVANCED PHARMACOLOGY FINAL
COMPREHENSIVE EXAM 2025 (Module 1, 2, 3, 4 & 5)
|ACTUAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES |ALREADY
GRADED A+.
A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30
breaths/minute, intercostal retractions, and frothy, pink sputum. After the patient's provider renders a
diagnosis of heart failure, which diuretic will be prescribed to address these assessment findings?
a.) Furosemide
b.) Hydrochlorothiazide
c.) Mannitol
d.) Spirinolactone
a) Furosemide
Furosemide, a potent diuretic, is used when rapid or massive mobilization of fluids is needed. This patient
shows signs and symptoms of severe heart failure and needs immediate reduction of fluid overload.
Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema, because they are less
efficacious, and diuresis is less rapid. Mannitol is indicated for patients with increased intracranial pressure and
muse by discontinued immediately if signs of pulmonary congestion or heart failure occur.
The provider orders furosemide for a patient who takes digoxin and is admitted to the hospital for
treatment of heart failure. The morning assessment identifies an irregular heart rate of 86beats/minute, a
respiratory rate of 22 breaths/minute, and a blood pressure of 130/82mmHg. Crackles are heard in both
lungs. Which laboratory result will be of the greatest concern to the provider?
a.) Blood glucose level of 120mg/dL
b.) Oxygen saturation of 90%
c.) Potassium level of 3.4 mEq/L
d.) Sodium level of 140 mEq/L
c.) Potassium level of 3.4 mEq/L
This patient has an irregular, rapid heartbeat that might be caused by a dysrhythmia. This patient's serum
potassium level is low, which can trigger fatal dysrhythmias, especially in patients taking dioxin. Furosemide
contributes to loss of potassium through its effects on the distal nephron. Potassium-sparing diuretics often are
used in conjunction with furosemide to prevent this complication. This patients serum glucose and sodium
levels are normal and of no concern at this point, although they can be affected by furosemide. The oxygen
saturation is somewhat low and needs to be monitored, although it will likely improve with diuresis.
, Page |2
Verapamil is prescribed for the client who takes digoxin. The provider will monitor closely for which
adverse reaction.
a.) AV blockade
b.) Gingival hyperplasia
c.) Migraine headaches
d.) Reflex tachycardia
a.) AV blockade
Verapamil and digoxin both suppress impulse conduction through the AV node, when the two drugs are used
concurrently, the risk of AV blockade is increased. Gingival hyperplasia can occur in rate cases with verapamil,
but is not an acute symptom. Verapamil can be used to prevent migraine, although its use for this purpose is
under investigation. Verapamil and digoxin both suppress the heart rate, so tachycardia is not anticipated. The
calcium channel block nifedipine, not verapamil, causes reflex tachycardia.
Which medication will the provider prescribe for a patient admitted with severe hypertensive crisis?
a.) Captopril PO
b.) Hydralazine PO
c.) Minoxidil PO
d.) Sodium nitroprusside IV
d.) Sodium nitroprusside IV
Sodium nitroprusside, the drug of choice for hypertensive emergencies, is given intravenously. ACE inhibitors,
such as captopril, are not used. Hydralazine may be used by should be given IV instead of PO. Minoxidil is
effective, but its severe side effects make it a second-line drug.
A patient had a blood pressure of 150/95mmHg and 148/90mmHg on two seperate office visits. This is
consistent with a blood pressure of 145/92mmHg taken in an ambulatory setting. The patients diagnostic
tests are all normal. What will the patients provider order to best manage the patients hypertension?
a.) A beta blocker
b.) A loop diuretic and spironolactone
c.) A thiazide diuretic.
d.) An alpha1 blocker.
c.) A thiazide diuretic.
The patient has primary, or essential, hypertension as evidenced by systolic pressure greater than 140 and
diastolic pressure greater than 90, along with normal tests ruling out another primary cause. Thiazide diuretics
are first-line drugs for hypertension. Beta blockers are effective but are most often used to counter reflex
, Page |3
tachycardia associated with reduced blood pressure caused by therapeutic agents. Loop diuretics cause greater
diuresis than is usually needed and so are not first-line drugs, alpha1 blockers are not drugs of first choice
A patient with diabetes develops hypertension. Which type of medication will the provider prescribe to
treat hypertension in this patient?
a.) Angiotensin-converting enzyme (ACE) inhibitors
b.) Beta blockers
c.) Direct-acting vasodilators
d.) Thiazide diuretics.
a.) Angiotensin-converting enzyme (ACE) inhibitors
ACE inhibitors slow the progression of kidney injury in diabetic patients with renal damage. Beta blockers can
mask signs of hypoglycemia and must be used with caution in diabetics. Direct-acting vasodilators are third-line
drugs for chronic hypertension. Thiazide diuretics promote hyperglycemia.
A patient reports a family history of hypertension and cardiovascular disease but has no other risk
factors. Current blood pressure is 126/82mgHg and the patient has a normal weight and body mass index
for height and age. What will be the provider's focus when providing patient education?
a.) Angiotensin-converting enzyme (ACE) inhibitors and calcium channel blocker medications.
b.) The DASH diet, sodium restriction, and exercise.
c.) Increased calcium and potassium supplements
d.) Thiazide diuretics and lifestyle changes.
b.) The DASH diet, sodium restriction, and exercise.
This patient has elevated hypertension without other risk factors. Lifestyle changes are indicated at this point. If
blood pressure rises to hypertensive levels, other measures, including drug therapy, will be initiated. Calcium
and potassium supplements are not indicated.
A patient is taking an angiotensin-converting enzyme (ACE) inhibitor to treat hypertension tells the
provider that she wants to become pregnant. What response will the provider give to the patient.
a.) "Controlling your blood pressure will decrease your risk of preeclampsia."
b.) "We need to consider changing you to an angiotensin receptor blocker during pregnancy."
c.) "It will be safe to continue taking the ACE inhibitor during your pregnancy."
d.) "Lets discuss using methyldopa instead of the ACE inhibitor while you are pregnant"
d.) "Lets discuss using methyldopa instead of the ACE inhibitor while you are pregnant"
, Page |4
Methyldopa has limited effects on uteroplacental and fetal hemodynamics and does not adversely affect the
fetus or neonate. Controlling blood pressure does not lower the risk of preeclampsia. ACE inhibitors and ARBS
are specifically contraindicated in pregnancy.
A patient with a recent onset of nephrosclerosis has been taking an angiotensin-converting enzyme (ACE)
inhibitor, and a thiazide diuretic. The patient's initial blood pressure was 148/100 mmHg. After 1 month
of drug therapy, the patient's blood pressure is 130/90 mmHg. What action will the provider take to
address the patient's blood pressure?
a.) Add a calcium channel blocker to this patients drug regimen.
b.) Lower doses of the antihypertensive medications.
c.) Order a high potassium diet.
d.) Add spironolactone to the drug regimen.
a.) Add a calcium channel blocker to this patients drug regimen.
In patients with renal disease, the goal of antihypertensive therapy is to lower the blood pressure to 130/80 or
less. Adding a third medication is often indicated. Lowering the dose of the medications is not indicated because
the patients blood pressure is not in the target range. Adding potassium to the diet and using a potassium-sparing
diuretic are contraindicated.
A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the
nurse notes a heart rate of 96 beats/minute, a blood pressure of 150/90, bibasilar crackles, 2+ pitting
edema of the ankles, and distention of the jugular veins. What will the provider order in response to this
assessment data?
a.) Angiotensin-converting enzyme (ACE) inhibitor
b.) Digoxin
c.) Furosemide
d.) Spironolactone
c.) Furosemide
This patient shows signs of fluid volume overload and needs a diuretic. Furosemide is a loop diuretic, which can
produce profound diuresis very quickly even when the glomerular filtration rate is low. An ACE inhibitor will
not reduce fluid volume overload. Digoxin has a positive inotropic effect on the hearty, which may improve
renal perfusion, but this is not its primary effect. Spironolactone is a potassium-sparing diuretic with weak
diuresis effects; it is used in conjunction with other diuretics to improve electrolyte balance.
A patient with heart failure who takes an angiotensin-converting enzyme (ACE) inhibitor, a thiazide
diuretic, and a beta blocker for several months comes to the clinic for evaluation. As part of the ongoing
