NURS 5334 Advanced Pharmacology (2026–2027)
ACTUAL EXAM TEST BANK 230 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+||NEWEST VERSION
Quiz 2 Test Bank | UTA |
1. ACE Inhibitor + Renal Function (HF Patient)
A 68-year-old male with a history of heart failure with reduced ejection fraction (HFrEF),
hypertension, and stage 2 chronic kidney disease is started on enalapril 5 mg PO daily. Prior
labs show a baseline creatinine of 1.0 mg/dL and potassium of 4.3 mEq/L. Three days later, the
patient returns for follow-up reporting mild fatigue but no chest pain or dyspnea. Laboratory
results show:
• Creatinine: 1.9 mg/dL
• Potassium: 5.8 mEq/L
• Blood pressure: 110/70 mmHg
What is the most appropriate interpretation of these findings?
A. This is expected and therapeutic; continue enalapril without changes
B. The patient is experiencing ACE inhibitor–induced reduction in glomerular filtration pressure
C. The patient has acute tubular necrosis requiring emergent dialysis
D. The patient is experiencing allergic interstitial nephritis requiring corticosteroids
Correct Answer: B
Rationale:
ACE inhibitors such as enalapril block angiotensin II–mediated efferent arteriole
vasoconstriction, which normally maintains glomerular filtration pressure. In patients with
heart failure or CKD, this can lead to a predictable drop in GFR and a mild rise in creatinine
(acceptable up to ~30%), along with hyperkalemia due to decreased aldosterone secretion.
However, this patient's creatinine rise is >30% with significant hyperkalemia, requiring
reassessment of dosing or discontinuation. It is not ATN or allergic nephritis.
,2. Anticoagulation Transition (Warfarin → DOAC)
A 74-year-old female with nonvalvular atrial fibrillation has been on warfarin therapy for
several years. Her current INR today is 2.5. The provider plans to switch her to apixaban due to
difficulty maintaining stable INR levels.
What is the most appropriate nursing action?
A. Start apixaban immediately and continue warfarin for 5 days
B. Discontinue warfarin and start apixaban when INR is below 2.0
C. Administer both medications together until INR is therapeutic
D. Stop warfarin and begin heparin bridging before apixaban
Correct Answer: B
Rationale:
When transitioning from warfarin to a direct oral anticoagulant (DOAC) like apixaban, warfarin
should be discontinued and apixaban started once the INR is below 2.0 to avoid excessive
anticoagulation and bleeding risk. Overlapping therapy increases hemorrhage risk.
3. Opioid + Benzodiazepine Respiratory Depression
A 58-year-old postoperative patient is receiving morphine IV for pain control and lorazepam for
anxiety and muscle spasms. One hour after administration, the nurse notes:
• Respiratory rate: 6 breaths/min
• Oxygen saturation: 82%
• Patient is difficult to arouse
What is the most likely mechanism causing this condition?
A. Histamine release causing bronchoconstriction
B. Additive suppression of the brainstem respiratory center
C. Serotonin excess causing neuromuscular hyperactivity
D. Dopamine receptor blockade in the medulla
Correct Answer: B
Rationale:
,Both opioids (mu receptors) and benzodiazepines (GABA-A potentiation) depress the central
nervous system, particularly the medullary respiratory center, leading to profound respiratory
depression when combined. This is a classic high-risk drug interaction.
4. Metformin in CKD
A 63-year-old patient with type 2 diabetes mellitus is taking metformin 1000 mg twice daily.
The patient’s labs show:
• eGFR: 28 mL/min/1.73 m²
• Creatinine: 2.1 mg/dL
The provider asks the nurse for recommendations.
What is the best nursing recommendation?
A. Continue metformin because it improves insulin sensitivity
B. Increase monitoring of lactate levels but continue therapy
C. Discontinue metformin due to risk of lactic acidosis
D. Switch to a sulfonylurea without dose adjustment
Correct Answer: C
Rationale:
Metformin is contraindicated when eGFR <30 mL/min/1.73 m² due to the risk of lactic acidosis,
a rare but potentially fatal complication. Accumulation occurs due to impaired renal clearance.
5. Lithium + Thiazide Interaction
A patient with bipolar disorder is stabilized on lithium carbonate. The provider adds
hydrochlorothiazide for hypertension. One week later, the patient presents with:
• Coarse tremor
• Diarrhea
• Confusion
• Ataxia
What is the mechanism of toxicity?
, A. Increased lithium excretion leading to dehydration
B. Sodium depletion causing increased lithium reabsorption in the kidney
C. Enzyme induction increasing lithium metabolism
D. Protein-binding displacement in plasma
Correct Answer: B
Rationale:
Thiazide diuretics cause sodium loss, and the kidneys compensate by increasing sodium (and
lithium) reabsorption in the proximal tubule. Lithium is not metabolized and is entirely renally
excreted, so this leads to lithium toxicity.
6. Warfarin + Antibiotics Interaction
A 72-year-old patient on stable warfarin therapy (INR 2.3) is prescribed trimethoprim-
sulfamethoxazole (TMP-SMX) for a urinary tract infection.
What is the most likely effect?
A. Decreased INR due to CYP450 induction
B. Increased INR due to CYP inhibition and reduced gut vitamin K
C. No change in anticoagulation effect
D. Increased platelet aggregation
Correct Answer: B
Rationale:
TMP-SMX increases warfarin effect by:
• Inhibiting CYP2C9 metabolism of warfarin
• Reducing gut flora that synthesize vitamin K
This leads to increased INR and bleeding risk.
7. Severe Asthma Not Controlled on ICS + LABA
A 45-year-old patient with severe persistent asthma is on high-dose inhaled corticosteroid
(fluticasone) and a long-acting beta-agonist (salmeterol). Despite adherence, the patient
reports daily symptoms and nighttime awakenings.
What is the most appropriate next step?
ACTUAL EXAM TEST BANK 230 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+||NEWEST VERSION
Quiz 2 Test Bank | UTA |
1. ACE Inhibitor + Renal Function (HF Patient)
A 68-year-old male with a history of heart failure with reduced ejection fraction (HFrEF),
hypertension, and stage 2 chronic kidney disease is started on enalapril 5 mg PO daily. Prior
labs show a baseline creatinine of 1.0 mg/dL and potassium of 4.3 mEq/L. Three days later, the
patient returns for follow-up reporting mild fatigue but no chest pain or dyspnea. Laboratory
results show:
• Creatinine: 1.9 mg/dL
• Potassium: 5.8 mEq/L
• Blood pressure: 110/70 mmHg
What is the most appropriate interpretation of these findings?
A. This is expected and therapeutic; continue enalapril without changes
B. The patient is experiencing ACE inhibitor–induced reduction in glomerular filtration pressure
C. The patient has acute tubular necrosis requiring emergent dialysis
D. The patient is experiencing allergic interstitial nephritis requiring corticosteroids
Correct Answer: B
Rationale:
ACE inhibitors such as enalapril block angiotensin II–mediated efferent arteriole
vasoconstriction, which normally maintains glomerular filtration pressure. In patients with
heart failure or CKD, this can lead to a predictable drop in GFR and a mild rise in creatinine
(acceptable up to ~30%), along with hyperkalemia due to decreased aldosterone secretion.
However, this patient's creatinine rise is >30% with significant hyperkalemia, requiring
reassessment of dosing or discontinuation. It is not ATN or allergic nephritis.
,2. Anticoagulation Transition (Warfarin → DOAC)
A 74-year-old female with nonvalvular atrial fibrillation has been on warfarin therapy for
several years. Her current INR today is 2.5. The provider plans to switch her to apixaban due to
difficulty maintaining stable INR levels.
What is the most appropriate nursing action?
A. Start apixaban immediately and continue warfarin for 5 days
B. Discontinue warfarin and start apixaban when INR is below 2.0
C. Administer both medications together until INR is therapeutic
D. Stop warfarin and begin heparin bridging before apixaban
Correct Answer: B
Rationale:
When transitioning from warfarin to a direct oral anticoagulant (DOAC) like apixaban, warfarin
should be discontinued and apixaban started once the INR is below 2.0 to avoid excessive
anticoagulation and bleeding risk. Overlapping therapy increases hemorrhage risk.
3. Opioid + Benzodiazepine Respiratory Depression
A 58-year-old postoperative patient is receiving morphine IV for pain control and lorazepam for
anxiety and muscle spasms. One hour after administration, the nurse notes:
• Respiratory rate: 6 breaths/min
• Oxygen saturation: 82%
• Patient is difficult to arouse
What is the most likely mechanism causing this condition?
A. Histamine release causing bronchoconstriction
B. Additive suppression of the brainstem respiratory center
C. Serotonin excess causing neuromuscular hyperactivity
D. Dopamine receptor blockade in the medulla
Correct Answer: B
Rationale:
,Both opioids (mu receptors) and benzodiazepines (GABA-A potentiation) depress the central
nervous system, particularly the medullary respiratory center, leading to profound respiratory
depression when combined. This is a classic high-risk drug interaction.
4. Metformin in CKD
A 63-year-old patient with type 2 diabetes mellitus is taking metformin 1000 mg twice daily.
The patient’s labs show:
• eGFR: 28 mL/min/1.73 m²
• Creatinine: 2.1 mg/dL
The provider asks the nurse for recommendations.
What is the best nursing recommendation?
A. Continue metformin because it improves insulin sensitivity
B. Increase monitoring of lactate levels but continue therapy
C. Discontinue metformin due to risk of lactic acidosis
D. Switch to a sulfonylurea without dose adjustment
Correct Answer: C
Rationale:
Metformin is contraindicated when eGFR <30 mL/min/1.73 m² due to the risk of lactic acidosis,
a rare but potentially fatal complication. Accumulation occurs due to impaired renal clearance.
5. Lithium + Thiazide Interaction
A patient with bipolar disorder is stabilized on lithium carbonate. The provider adds
hydrochlorothiazide for hypertension. One week later, the patient presents with:
• Coarse tremor
• Diarrhea
• Confusion
• Ataxia
What is the mechanism of toxicity?
, A. Increased lithium excretion leading to dehydration
B. Sodium depletion causing increased lithium reabsorption in the kidney
C. Enzyme induction increasing lithium metabolism
D. Protein-binding displacement in plasma
Correct Answer: B
Rationale:
Thiazide diuretics cause sodium loss, and the kidneys compensate by increasing sodium (and
lithium) reabsorption in the proximal tubule. Lithium is not metabolized and is entirely renally
excreted, so this leads to lithium toxicity.
6. Warfarin + Antibiotics Interaction
A 72-year-old patient on stable warfarin therapy (INR 2.3) is prescribed trimethoprim-
sulfamethoxazole (TMP-SMX) for a urinary tract infection.
What is the most likely effect?
A. Decreased INR due to CYP450 induction
B. Increased INR due to CYP inhibition and reduced gut vitamin K
C. No change in anticoagulation effect
D. Increased platelet aggregation
Correct Answer: B
Rationale:
TMP-SMX increases warfarin effect by:
• Inhibiting CYP2C9 metabolism of warfarin
• Reducing gut flora that synthesize vitamin K
This leads to increased INR and bleeding risk.
7. Severe Asthma Not Controlled on ICS + LABA
A 45-year-old patient with severe persistent asthma is on high-dose inhaled corticosteroid
(fluticasone) and a long-acting beta-agonist (salmeterol). Despite adherence, the patient
reports daily symptoms and nighttime awakenings.
What is the most appropriate next step?
