Midterm Exam: NR567/ NR 567 (Latest 2026/ 2027 Update) Advanced Pharmacology for the AGACNP Review| Questions and Verified Answers| 100% Correct – Chamberlain

Midterm Exam: NR567/ NR 567 (Latest 2026/ 2027 Update) Advanced Pharmacology for the AGACNP Review| Questions and Verified Answers| 100% Correct – Chamberlain Question: Which of the following is the least preferable initial treatment of choice for status epilepticus?? Answer: Propofol (Diprivan) Question: Which of the following statements is not true?? Answer: Sedative hypnotics can be utilized as an anticonvulsant; zolpidem (Ambien) and lorazepam (Ativan) are excellent options for managing seizures.- Zolpidem is not used as an anti-seizure Question: Adding epinephrine to a local anesthetic, such as 1% lidocaine for local infiltration, has which of the following benefits?? Answer: Extends the duration of the anesthesia block, useful for longer procedures Question: Your patient reports a history of anaphylaxis to an "ester-type" local anesthetic. Which of the following, if given, would be most likely to provoke an allergic response in this patient?? Answer: Tetracaine (Pontocaine) Question: An OR patient receives propofol for induction. What is the most likely adverse response associated with the administration of this pharmaceutical agent?? Answer: Hypotension and respiratory depression Question: Which of the following is the least appropriate medication for a patient with suspected increased intracranial pressure?? Answer: Ketamine (Ketalar) Question: It is noted that a trauma ICU patient is receiving adequate pain relief during painful procedures, but has increased skeletal muscle tone, an elevation in HR and BP, and post-procedure hallucinations and agitation as the drug wears off. Which of the following pharmaceutical agents is likely to create these effects?? Answer: Ketamine (Ketalar) Question: You are managing a patient who presented to the emergency department with a severe headache. Shortly upon arrival, the patient's neurological status rapidly deteriorates requiring airway management. Rapid sequence intubation is performed, and the patient suddenly develops a fever, hypertension, tachycardia, metabolic acidosis, hyperkalemia, and muscle rigidity. Which induction agent was most likely used?? Answer: Succinylcholine chloride Question: You are selecting a neuromuscular blocking agent with the least cardiovascular side effect profile for an elderly patient with coronary artery disease. Which of the following medications should be avoided?? Answer: Pancuronium (Pavulon) Question: Your ICU patient is admitted following multisystem trauma secondary to a motor vehicle collision. The patient is ventilated and will be maintained on a neuromuscular blocking continuous agent to maintain neuromuscular blockage and deep sedation. Which of the following is a true statement?? Answer: If dantrolene is needed postoperatively on the NMBA, care should be taken to ensure muscle strength has returned prior to extubation Question: Your patient presents with essential hypertension, and in reviewing lab results, you note that the circulating plasma renin and catecholamine levels are high. You decide to lower blood pressure by reducing both cardiac output and systemic vascular resistance (blocking both alpha- and beta-adrenergic receptors) with a single pharmaceutical agent. Which of the following is most likely to achieve this goal?? Answer: Labetalol (Trandate) Question: A nonselective beta-blocker was initiated for your patient. Which of the following diagnoses warrants initiating this pharmaceutical agent?? Answer: Hyperthyroid crisis Question: You are managing a patient with a history of coronary artery disease and transient ischemic attacks. Low-dose aspirin treatment is considered, but the patient has a reported history of aspirin allergy. Which of the following is the best alternative?? Answer: Clopidogrel (Plavix) Question: Which of the following adverse effects is likely when an angiotensin-converting enzyme inhibitor (ACEI) is used with spironolactone therapy?? Answer: Hyperkalemia Question: All of the following are beneficial effects of beta-blocker therapy for use in patients with cirrhosis except ___? Answer: Increased Cardiac Output Question: Reducing cardiovascular events in patients with moderate to severe uncomplicated hypertension is an important consideration when choosing initial therapy. Which of the following is not recommended as a first-line treatment to reduce cardiovascular events?? Answer: Beta agonist receptor blockers Question: Which medication class would be most advantageous to use in treating a patient with hypertension and symptomatic benign prostatic hyperplasia (BPH)?? Answer: Alpha-1 blocker Question: A 49-year-old female is treated with unfractionated heparin post-myocardial infarction. The patient has developed several episodes of epistaxis, and now has + occult blood guaiac testing per digital rectal exam. Records reveal that she may have received an overdose of the anticoagulant. Which of the following will counteract the effects of heparin?? Answer: Protamine sulfate Question: You are considering using an ACE inhibitor to treat a patient with essential hypertension. Which of the following patient-related contraindications must be investigated and excluded before prescribing this medication?? Answer: Preganancy Question: What is the most likely adverse response associated with aspirin for prophylaxis in patients with a high risk of atherosclerotic cardiovascular disease?? Answer: Hemorrhagic Stroke Question: Which of the following agents is used for the treatment of neutropenia?? Answer: Granulocyte colony-stimulating factor (G-CSF) Question: Which of the following patients is most at risk of iron deficiency anemia and may need iron replacement therapy?? Answer: A 49 year old who underwent gastrectomy Question: Which of the following pharmacological agents can be used as a temporary inhibitor of corticosteroid synthesis in Cushing's disease?? Answer: Ketoconazole (Nizoral) Question: Glucocorticoids have which of the following actions?? Answer: Decrease antibody production Question: Which of the following insulins has the most rapid onset of action?? Answer: Lispro (Humalog) Question: A 28-year-old male presents with symptoms consistent with diabetic ketoacidosis. Serum glucose is 470mg/dL and serum potassium level is 4.0 mEq/L. Which of the following is the expected course of action?? Answer: Insulin infusion at 0.1units/kg/hr with intravenous 0.9% normal saline and potassium replacement Question: Which of the following medication classes is the least likely to cause the adverse effect of hypoglycemia?? Answer: Biguanide Question: Which of the following is included in the treatment of hyperosmolar, hyperglycemic syndrome? Answer: Aggressive rehydration with 0.9% NS intravenously and correction of electrolyte abnormalities Question: When prescribing intravenous acyclovir (Zovirax), the nurse practitioner knows that? Answer: Adequate hydration should also be maintained Question: A 13-year-old male with moderately persistent asthma has been diagnosed with type A influenza. Which of the following statements is the most important to consider when prescribing treatment with oseltamivir (Tamiflu)?? Answer: the medication should be started within the first 48 hours of influenza symptoms Question: If considering starting a patient on the nucleoside reverse transcriptase inhibitor abacavir (Ziagen) which of the following is recommended prior to prescribing the medication?? Answer: HLA B*5701 testing Question: The drug of choice for the treatment of disease due to Histoplasma?? Answer: Itraconazole (Sporanox) Question: Which of the following statements is true regarding metronidazole (Flagyl)?? Answer: Alcohol should be avoided Question: You are treating a patient for fungemia with amphotericin B. The nurse practitioner knows which of the following is a common complication of treatment?? Answer: Renal failure Question: Which of the following, used in combination with sulfadiazine, is considered first-line therapy to treat toxoplasmosis?? Answer: Pyrimethamine (Daraprim) Question: Which of the following is an appropriate example of antibiotic stewardship?? Answer: Providing one dose of antibiotics preoperatively then discontinuing p831 Question: The nurse practitioner suspects meningitis. Which of the following is the most appropriate antibiotic choice?? Answer: Ceftriaxone (Rocephin) p831 Question: Which generation of cephalosporin is the best option to treat an Enterobacter infection?? Answer: Fourth generation p833 Question: Which of the following terms best describes the process by which an antibiotic capable of inhibiting or retarding bacterial growth allows the body's defense mechanisms to respond to the infection?? Answer: Bacteriostatic ex: clindamycin, macrolides, sulfonamides, tetracyclines Question: Which of the following statements best describes the use of gentamicin (Garamycin)?? Answer: Gentamycin (Garamycin) is used to treat resistant gram-negative bacterial infections Question: You are managing a patient with a dental abscess who is unable to get into the dentist until next week. The patient is stable for outpatient treatment. This patient also has a penicillin allergy. Which antibiotic should be prescribed?? Answer: Clindamycin (Cleocin) p851 or Ciprofloxacin (look it up) Question: Surgical prophylactic treatment should include which of the following principles?? Answer: The shortest possible course of the most effective and least toxic antibiotic should be ordered, ideally as a single dose Question: Tetracyclines may cause which of the following adverse reactions/side effects?? Answer: Hepatic damage in pregnant females p848 Question: The results of a Gram stain for a patient who underwent surgical debridement for osteomyelitis show Gram-negative bacteria. Which antibiotic should be initiated?? Answer: Cefepime (Maxipime)p833 Question: What is BEERS criteria?? Answer: Recommendations of medications inappropriate for elderly (65 and older), prescriber ultimately decides Question: Which of the following is the first-line treatment for clostridium difficile colitis?? Answer: Oral vancomycin (Vancocin) Question: Amnestic medications used in the treatment of chronic pain? Answer: -Ketamine-venlafaxine-Milnacipran-Imipramine Question: Medications indicated for shock? Answer: IVF - 30ml/kg/hr Broad spectrum ATB - Zoysn and Vancomycin Vasopressin (Norepinephrine)(dobutamine is arguably the inotropic agent of choice when increased cardiac output is needed) Question: Alternative indication for glucagon use besides hypoglycemia? Answer: -Intravenous glucagon is commonly used in the endoscopic retrograde cholangiopancreatography procedure to facilitate the relaxation of the sphincter of Oddi.-sometimes used in the treatment of beta blocker overdose because of the drug's ability to increase cAMP production in the heart independent of β-receptor function. Question: Medications indicated for myocardial infarction (part 1)? Answer: Aspirin. The 911 operator might tell you to take aspirin, or emergency medical personnel might give you aspirin immediately. Aspirin reduces blood clotting, thus helping maintain blood flow through a narrowed artery. Thrombolytics. These drugs, also called clotbusters, help dissolve a blood clot that's blocking blood flow to your heart. The earlier you receive a thrombolytic drug after a heart attack, the greater the chance you'll survive and have less heart damage. Antiplatelet agents. Emergency room doctors may give you other drugs known as platelet aggregation inhibitors to help prevent new clots and keep existing clots from getting larger. Other blood-thinning medications. You'll likely be given other medications, such as heparin, to make your blood less "sticky" and less likely to form clots. Heparin is given by IV or by aninjection under your skin. Question: Medications indicated for myocardial infarction (part 2)? Answer: Pain relievers. You might be given a pain reliever, such as morphine. Nitroglycerin. This medication, used to treat chest pain (angina), can help improve blood flow to the heart by widening (dilating) the blood vessels. Beta-blockers. These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure, making your heart's job easier. Beta-blockers can limit the amount of heart muscle damage and prevent future heart attacks. ACE inhibitors. These drugs lower blood pressure and reduce stress on the heart. Statins. These drugs help control your blood cholesterol Question: Insulin infusion CSII therapy? Answer: appropriate for patients with type 1 diabetes who are motivated, mechanically inclined, educated about diabetes (diet, insulin action, treatment of hypoglycemia and hyperglycemia), and willing to monitor their blood glucose four to six times a day. Known complications of CSII include ketoacidosis, which can occur when insulin delivery is interrupted, and skin infections. Another disadvantage is its cost and the additional time needed by the clinician and staff to initiate therapy. Almost all patients use rapidly acting insulin analogs in their pumps. Question: Insulin Infusion V-Go? Answer: (Valeritas) is a mechanical patch pump designed specifically for people with type 2 diabetes who use a basal/bolus insulin regimen. The device is preset to deliver one of three fixed and flat basal rates (20, 30, or 40 units) for 24 hours (at which point it must be replaced) and there is a button that delivers two units per press to help cover meals. Question: Sedative-hypnotic agents uses? Answer: 1. Sedation/Anxiolysis 2. Insomnia 3. General Anesthesia 4. Seizures 5. Alcohol Withdrawal 6. Adjunctive Management Question: Opioid Conversions? Answer: 60 mg oxycodone X 1.5 MME = 90 mg oral morphine Question: Rapid sequence intubation (RSI) agent classes- mechanisms of action, indications for use, side effects, contraindications, and be able to identify by name? Answer: involves the administration of an induction agent for loss of consciousness and neuromuscular blockade for paralysislidocaine or fentanyl, 3-5 minutes before intubation to facilitate the procedure. Paralytic and induction agents must be administered immediately beforeSuccinylcholine (Anectine) Question: Treatments for Chronic Pain? Answer: buprenorphine patch (Butrans) Lidocaine and mexiletine Ziconotide, a blocker of voltage-gated N-type calcium channels, is approved for producing analgesia in patients with refractory chronic pain Multi modal approach Question: The patient appears awake but is unconscious and has no response to painful stimuli. What medication does the nurse suspect this patient has received?? Answer: Ketamine Question: Which nonbarbiturate anesthetic when used with halothane (Fluothane) can cause severe cardiac depression?? Answer: Ketamine Question: The operating room nurse is developing the care plan for a 10year-old child with asthma who is scheduled for a tonsillectomy and who will receive halothane as the anesthetic agent. Why is this an appropriate drug for this patient?? Answer: Halothane dilates the bronchi Question: How can the nurse assess the degree of neuromuscular blockage the patient is experiencing?? Answer: peripheral nerve stimulator Question: Why will the nurse administer a small dose of nondepolarizing neuromuscular junction (NMJ) blocker before administering succinylcholine?? Answer: To reduce discomfort of depolarization of muscles Question: The nurse administers a sedative followed by a neuromuscular junction (NMJ) blocker after which the neonatologist attempts to intubate the patient without success. While waiting for the anesthesiologist to come to the unit to establish an artificial airway, what is the nurse's priority of care?? Answer: Use a bag-valve mask to ventilate the patient Question: The nurse is caring for the ICU patient who is mechanically ventilated and receiving a NMJ blocker, a sedative, and an analgesic. What are priorities of nursing care for the patient?? Answer: - Reposition patient frequently - Ensure care of the patient's eyes - Monitor temperature Question: The nurse is caring for an older patient who is taking 25mg per day of hydrochlorothiazide. The nurse will closely monitor which lab value in this patient?? Answer: serum potassium Question: The nurse is caring for an 82-year old patient who takes digoxin to treat chronic a-fib. When caring for this patient, to monitor for drug side effects, what will the nurse carefully assess?? Answer: Heart rate Question: The nurse is caring for an 80-year-old patient who is taking warfarin (coumadin). Which action does the nurse understand is important when caring for this patient?? Answer: Initiating a fall risk protocol Question: The nurse is caring for a patient in the emergency department with a 2-inch laceration to the left arm caused by broken glass. The nurse suspects a local anesthetic will be administered by what method?? Answer: Infiltration Question: What nursing interventions would help minimize the risk of a headache in a patient recovering from spinal anesthesia?? Answer: Maintain patient in recumbent position Question: The nurse should recognize what drug is classified as an amide local anesthetic?? Answer: Lidocaine (Xylocaine) Question: A 21-year-old patient is positioned on the operating table in preparation for knee surgery. After the anesthesiologist induces the patient, what is the next phase of anesthesia?? Answer: medullary paralysis Question: The nurse is collecting a nursing history from a preoperative patient who is to receive local anesthesia. While taking the admission history, the patient says she is allergic to lidocaine. What is the nurse's priority action?? Answer: Notify the anesthesiologist Question: The nurse is caring for a patient in stage 2 of general anesthesia. What is the case priority for this patient?? Answer: Monitor vital signs Question: The patient received Midazolam in combination with an inhaled anesthetic and a narcotic during surgery. The post anesthesia care unit (PACU) nurse anticipates this combination of drugs will have what impacts on the patient's stay in the unit?? Answer: Extended time needed in the unit