NSG 6025 ADVANCED PHARMACOLOGY FINAL EXAM–
QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED
ANSWERS PLUS RATIONALES | GUARANTEED PASS | LATEST
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1. A 68-year-old male with a history of heart failure and chronic kidney disease presents
for medication review. His current regimen includes lisinopril, furosemide, and
spironolactone. Laboratory results reveal a serum potassium level of 5.8 mEq/L and a
serum creatinine increase of 30% from baseline. Which of the following is the most
appropriate initial pharmacological adjustment?
A. Discontinue spironolactone and monitor potassium and renal function within one week
B. Add a thiazide diuretic to enhance potassium excretion
C. Increase the lisinopril dosage to maximize renal protection
D. Double the furosemide dose to correct hyperkalemia immediately
Spironolactone is a potassium-sparing diuretic that, when combined with an ACE inhibitor
like lisinopril in the setting of chronic kidney disease, significantly increases the risk of severe
hyperkalemia and acute kidney injury. Discontinuing spironolactone directly addresses the
hyperkalemia and rising creatinine. Adding a thiazide does not sufficiently mitigate severe
hyperkalemia in this context, increasing lisinopril would worsen both hyperkalemia and renal
function, and doubling furosemide without addressing the offending agent is inappropriate
and risks volume depletion.
2. A nurse practitioner is prescribing a new medication for a 45-year-old female diagnosed
with major depressive disorder who also has a history of controlled angle-closure
glaucoma. Which of the following antidepressant classes should be avoided due to its
anticholinergic properties?
A. Selective serotonin reuptake inhibitors
B. Serotonin-norepinephrine reuptake inhibitors
C. Tricyclic antidepressants
D. Atypical antidepressants such as bupropion
Tricyclic antidepressants possess potent anticholinergic activity, which can induce mydriasis
and precipitate an acute attack of angle-closure glaucoma. Selective serotonin reuptake
,inhibitors and serotonin-norepinephrine reuptake inhibitors have a much lower
anticholinergic profile, and bupropion does not carry the same degree of mydriatic risk,
making tricyclic antidepressants the primary class to avoid.
3. A 55-year-old patient with type 2 diabetes mellitus and stage 3 chronic kidney disease is
evaluated for glycemic control. Current HbA1c is 8.2%. The provider decides to add an
agent that provides cardiovascular and renal protection independent of glycemic control.
Which medication class is the most appropriate choice?
A. Sulfonylureas
B. Sodium-glucose cotransporter-2 inhibitors
C. Dipeptidyl peptidase-4 inhibitors
D. Meglitinides
Sodium-glucose cotransporter-2 inhibitors have demonstrated robust renal and cardiovascular
protective effects in patients with chronic kidney disease and heart failure, independent of
their glucose-lowering efficacy. Sulfonylureas carry a high risk of hypoglycemia and lack
organ protection, dipeptidyl peptidase-4 inhibitors are weight-neutral and lack significant
renal/cardiovascular protective benefits, and meglitinides are short-acting secretagogues with
no organ-protective data.
4. A 32-year-old pregnant patient at 28 weeks gestation presents with persistent asthma
symptoms requiring daily controller therapy. Which of the following inhaled
corticosteroids is considered the preferred first-line controller agent with the most
established safety profile in pregnancy?
A. Fluticasone
B. Budesonide
C. Beclomethasone
D. Mometasone
Budesonide is classified as a Pregnancy Category B medication and is supported by the most
extensive human safety data demonstrating safety during pregnancy. While other inhaled
corticosteroids are used, budesonide remains the preferred agent in clinical guidelines for
managing asthma during gestation.
5. An advanced practice registered nurse is managing a patient initiated on warfarin
therapy for deep vein thrombosis. The patient is concurrently prescribed a medication
known to induce cytochrome P450 3A4 and 2C9 enzymes. What is the expected impact on
the patient's International Normalized Ratio?
,A. The International Normalized Ratio will decrease, requiring an increase in warfarin
dosage
B. The International Normalized Ratio will increase, requiring a decrease in warfarin dosage
C. The International Normalized Ratio will remain unchanged due to rapid compensatory
mechanisms
D. The International Normalized Ratio will fluctuate wildly, necessitating immediate
discontinuation of warfarin
Induction of cytochrome P450 enzymes increases the hepatic metabolism and clearance of
warfarin, leading to lower plasma concentrations and a subsequent decrease in the
International Normalized Ratio, which places the patient at risk for thrombotic events unless
the warfarin dose is increased. Inhibition of these enzymes would increase the International
Normalized Ratio and bleeding risk.
6. A 60-year-old male with hypertension and benign prostatic hyperplasia is prescribed a
medication that relaxes smooth muscle in the bladder neck and prostate capsule, while also
lowering blood pressure via alpha-1 blockade. Which drug is most likely prescribed?
A. Metoprolol
B. Terazosin
C. Lisinopril
D. Hydrochlorothiazide
Terazosin is an alpha-1 adrenergic receptor antagonist that relaxes smooth muscle in the
bladder neck and prostate, improving urinary flow in benign prostatic hyperplasia, while also
causing peripheral vasodilation to lower blood pressure. Metoprolol is a beta-blocker,
lisinopril is an ACE inhibitor, and hydrochlorothiazide is a thiazide diuretic, none of which
specifically target prostatic smooth muscle alpha receptors.
7. A pediatric patient weighing 20 kg is prescribed an antibiotic with a recommended
dosage of 40 mg/kg/day divided into two daily doses. The available suspension is 200 mg/5
mL. How many milliliters should the nurse practitioner instruct the parent to administer
per dose?
A. 2.5 mL
B. 5.0 mL
C. 7.5 mL
, D. 10.0 mL
Calculating the total daily dose: 20 kg multiplied by 40 mg/kg/day equals 800 mg/day. Dividing
into two daily doses gives 400 mg per dose. Using the concentration of 200 mg per 5 mL, set up
the proportion: 400 mg divided by 200 mg multiplied by 5 mL equals 10 mL per dose.
8. A 50-year-old female presents with acute musculoskeletal back pain. She has a history of
peptic ulcer disease and mild renal impairment. Which nonsteroidal anti-inflammatory
drug profile would be safest to minimize gastrointestinal ulceration risk while considering
her renal status?
A. High-dose ibuprofen with concurrent proton pump inhibitor therapy
B. Nonselective nonsteroidal anti-inflammatory drug combined with misoprostol
C. Selective cyclooxygenase-2 inhibitor with concurrent proton pump inhibitor therapy
D. High-dose naproxen monotherapy without gastroprotection
Selective cyclooxygenase-2 inhibitors significantly reduce the incidence of gastroduodenal
ulcers compared to nonselective nonsteroidal anti-inflammatory drugs. Adding a proton pump
inhibitor provides maximal gastrointestinal protection, which is critical given her history of
peptic ulcer disease. Nonselective agents and naproxen carry higher gastrointestinal risks even
with co-therapy.
9. A patient with chronic stable angina is started on a medication that reduces myocardial
oxygen demand by decreasing heart rate and contractility through beta-1 receptor
blockade. Which clinical finding requires immediate notification of the provider or
withholding of the dose?
A. Blood pressure of 130/80 mmHg
B. Heart rate of 52 beats per minute
C. Respiratory rate of 16 breaths per minute
D. Mild peripheral edema of the ankles
Beta-blockers exert negative chronotropic effects, and a heart rate below 60 beats per minute
indicates bradycardia, which necessitates holding the medication and notifying the provider to
prevent symptomatic bradycardia or heart block. A blood pressure of 130/80 mmHg is stable,
respiratory rate is normal, and mild peripheral edema is not an acute contraindication for
beta-blocker administration.
QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED
ANSWERS PLUS RATIONALES | GUARANTEED PASS | LATEST
EXAM UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE
TEST| DOWNLOAD INSTANT PDF
1. A 68-year-old male with a history of heart failure and chronic kidney disease presents
for medication review. His current regimen includes lisinopril, furosemide, and
spironolactone. Laboratory results reveal a serum potassium level of 5.8 mEq/L and a
serum creatinine increase of 30% from baseline. Which of the following is the most
appropriate initial pharmacological adjustment?
A. Discontinue spironolactone and monitor potassium and renal function within one week
B. Add a thiazide diuretic to enhance potassium excretion
C. Increase the lisinopril dosage to maximize renal protection
D. Double the furosemide dose to correct hyperkalemia immediately
Spironolactone is a potassium-sparing diuretic that, when combined with an ACE inhibitor
like lisinopril in the setting of chronic kidney disease, significantly increases the risk of severe
hyperkalemia and acute kidney injury. Discontinuing spironolactone directly addresses the
hyperkalemia and rising creatinine. Adding a thiazide does not sufficiently mitigate severe
hyperkalemia in this context, increasing lisinopril would worsen both hyperkalemia and renal
function, and doubling furosemide without addressing the offending agent is inappropriate
and risks volume depletion.
2. A nurse practitioner is prescribing a new medication for a 45-year-old female diagnosed
with major depressive disorder who also has a history of controlled angle-closure
glaucoma. Which of the following antidepressant classes should be avoided due to its
anticholinergic properties?
A. Selective serotonin reuptake inhibitors
B. Serotonin-norepinephrine reuptake inhibitors
C. Tricyclic antidepressants
D. Atypical antidepressants such as bupropion
Tricyclic antidepressants possess potent anticholinergic activity, which can induce mydriasis
and precipitate an acute attack of angle-closure glaucoma. Selective serotonin reuptake
,inhibitors and serotonin-norepinephrine reuptake inhibitors have a much lower
anticholinergic profile, and bupropion does not carry the same degree of mydriatic risk,
making tricyclic antidepressants the primary class to avoid.
3. A 55-year-old patient with type 2 diabetes mellitus and stage 3 chronic kidney disease is
evaluated for glycemic control. Current HbA1c is 8.2%. The provider decides to add an
agent that provides cardiovascular and renal protection independent of glycemic control.
Which medication class is the most appropriate choice?
A. Sulfonylureas
B. Sodium-glucose cotransporter-2 inhibitors
C. Dipeptidyl peptidase-4 inhibitors
D. Meglitinides
Sodium-glucose cotransporter-2 inhibitors have demonstrated robust renal and cardiovascular
protective effects in patients with chronic kidney disease and heart failure, independent of
their glucose-lowering efficacy. Sulfonylureas carry a high risk of hypoglycemia and lack
organ protection, dipeptidyl peptidase-4 inhibitors are weight-neutral and lack significant
renal/cardiovascular protective benefits, and meglitinides are short-acting secretagogues with
no organ-protective data.
4. A 32-year-old pregnant patient at 28 weeks gestation presents with persistent asthma
symptoms requiring daily controller therapy. Which of the following inhaled
corticosteroids is considered the preferred first-line controller agent with the most
established safety profile in pregnancy?
A. Fluticasone
B. Budesonide
C. Beclomethasone
D. Mometasone
Budesonide is classified as a Pregnancy Category B medication and is supported by the most
extensive human safety data demonstrating safety during pregnancy. While other inhaled
corticosteroids are used, budesonide remains the preferred agent in clinical guidelines for
managing asthma during gestation.
5. An advanced practice registered nurse is managing a patient initiated on warfarin
therapy for deep vein thrombosis. The patient is concurrently prescribed a medication
known to induce cytochrome P450 3A4 and 2C9 enzymes. What is the expected impact on
the patient's International Normalized Ratio?
,A. The International Normalized Ratio will decrease, requiring an increase in warfarin
dosage
B. The International Normalized Ratio will increase, requiring a decrease in warfarin dosage
C. The International Normalized Ratio will remain unchanged due to rapid compensatory
mechanisms
D. The International Normalized Ratio will fluctuate wildly, necessitating immediate
discontinuation of warfarin
Induction of cytochrome P450 enzymes increases the hepatic metabolism and clearance of
warfarin, leading to lower plasma concentrations and a subsequent decrease in the
International Normalized Ratio, which places the patient at risk for thrombotic events unless
the warfarin dose is increased. Inhibition of these enzymes would increase the International
Normalized Ratio and bleeding risk.
6. A 60-year-old male with hypertension and benign prostatic hyperplasia is prescribed a
medication that relaxes smooth muscle in the bladder neck and prostate capsule, while also
lowering blood pressure via alpha-1 blockade. Which drug is most likely prescribed?
A. Metoprolol
B. Terazosin
C. Lisinopril
D. Hydrochlorothiazide
Terazosin is an alpha-1 adrenergic receptor antagonist that relaxes smooth muscle in the
bladder neck and prostate, improving urinary flow in benign prostatic hyperplasia, while also
causing peripheral vasodilation to lower blood pressure. Metoprolol is a beta-blocker,
lisinopril is an ACE inhibitor, and hydrochlorothiazide is a thiazide diuretic, none of which
specifically target prostatic smooth muscle alpha receptors.
7. A pediatric patient weighing 20 kg is prescribed an antibiotic with a recommended
dosage of 40 mg/kg/day divided into two daily doses. The available suspension is 200 mg/5
mL. How many milliliters should the nurse practitioner instruct the parent to administer
per dose?
A. 2.5 mL
B. 5.0 mL
C. 7.5 mL
, D. 10.0 mL
Calculating the total daily dose: 20 kg multiplied by 40 mg/kg/day equals 800 mg/day. Dividing
into two daily doses gives 400 mg per dose. Using the concentration of 200 mg per 5 mL, set up
the proportion: 400 mg divided by 200 mg multiplied by 5 mL equals 10 mL per dose.
8. A 50-year-old female presents with acute musculoskeletal back pain. She has a history of
peptic ulcer disease and mild renal impairment. Which nonsteroidal anti-inflammatory
drug profile would be safest to minimize gastrointestinal ulceration risk while considering
her renal status?
A. High-dose ibuprofen with concurrent proton pump inhibitor therapy
B. Nonselective nonsteroidal anti-inflammatory drug combined with misoprostol
C. Selective cyclooxygenase-2 inhibitor with concurrent proton pump inhibitor therapy
D. High-dose naproxen monotherapy without gastroprotection
Selective cyclooxygenase-2 inhibitors significantly reduce the incidence of gastroduodenal
ulcers compared to nonselective nonsteroidal anti-inflammatory drugs. Adding a proton pump
inhibitor provides maximal gastrointestinal protection, which is critical given her history of
peptic ulcer disease. Nonselective agents and naproxen carry higher gastrointestinal risks even
with co-therapy.
9. A patient with chronic stable angina is started on a medication that reduces myocardial
oxygen demand by decreasing heart rate and contractility through beta-1 receptor
blockade. Which clinical finding requires immediate notification of the provider or
withholding of the dose?
A. Blood pressure of 130/80 mmHg
B. Heart rate of 52 beats per minute
C. Respiratory rate of 16 breaths per minute
D. Mild peripheral edema of the ankles
Beta-blockers exert negative chronotropic effects, and a heart rate below 60 beats per minute
indicates bradycardia, which necessitates holding the medication and notifying the provider to
prevent symptomatic bradycardia or heart block. A blood pressure of 130/80 mmHg is stable,
respiratory rate is normal, and mild peripheral edema is not an acute contraindication for
beta-blocker administration.
