NURS 5334 Advanced Pharmacology Final
Exam V2 UTA 2026/2027 – Questions and
Answers (100% Verified)
Question 1. A patient taking warfarin has an INR of 5.8 without active bleeding.
Which action is most appropriate?
A. Administer the next scheduled dose
B. Hold warfarin and evaluate for bleeding
C. Give protamine sulfate immediately
D. Increase the warfarin dose
**Answer: B. Hold warfarin and evaluate for bleeding.
Rationale: An INR of 5.8 represents excessive anticoagulation. In a patient without
active bleeding, warfarin is generally withheld and the patient is assessed for
bleeding and other risk factors. Protamine reverses heparin, not warfarin.
Question 2. A patient with hypertension is prescribed lisinopril. Which laboratory
value should the advanced practice nurse monitor most closely?
A. Serum potassium
B. Serum calcium
C. Hemoglobin
D. Platelet count
**Answer: A. Serum potassium.
Rationale: ACE inhibitors can decrease aldosterone secretion, which may increase
serum potassium. Renal function and potassium should be monitored during
therapy.
Question 3. Which patient would have the greatest risk for a serious adverse effect
from a nonselective NSAID?
,A. A patient with seasonal allergies
B. A patient with chronic kidney disease
C. A patient with hypothyroidism
D. A patient with iron-deficiency anemia
**Answer: B. A patient with chronic kidney disease.
Rationale: NSAIDs can reduce renal prostaglandin synthesis and decrease renal
perfusion, potentially worsening kidney function. Patients with preexisting renal
impairment require particular caution.
Question 4. A patient taking metformin is scheduled for a procedure involving
iodinated contrast. Which consideration is most important?
A. Increase the metformin dose before the procedure
B. Assess renal function and follow appropriate metformin-holding guidance
C. Administer insulin immediately before contrast
D. Substitute warfarin for metformin
**Answer: B. Assess renal function and follow appropriate metformin-holding
guidance.
Rationale: Iodinated contrast can contribute to acute kidney injury in susceptible
patients. Because metformin is renally cleared, renal function and current
contrast-related recommendations should be reviewed to reduce the risk of
metformin-associated lactic acidosis.
Question 5. Which medication is classified as a direct oral anticoagulant?
A. Warfarin
B. Apixaban
C. Heparin
D. Enoxaparin
**Answer: B. Apixaban.
Rationale: Apixaban is a direct factor Xa inhibitor and belongs to the direct oral
anticoagulant class. Warfarin is a vitamin K antagonist, while heparin and
enoxaparin are parenteral anticoagulants.
,Question 6. A patient taking sertraline reports agitation, diaphoresis, tremor,
diarrhea, and hyperreflexia. Which condition should the clinician suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Opioid withdrawal
**Answer: B. Serotonin syndrome.
Rationale: Serotonin syndrome may present with mental-status changes,
autonomic instability, gastrointestinal symptoms, tremor, clonus, and
hyperreflexia. Prompt recognition and removal of serotonergic agents are
important.
Question 7. Which medication is commonly used as an antidote for opioid-
induced respiratory depression?
A. Flumazenil
B. Naloxone
C. Atropine
D. Protamine
**Answer: B. Naloxone.
Rationale: Naloxone is an opioid receptor antagonist that can rapidly reverse
opioid-induced respiratory and central nervous system depression. Patients
require continued monitoring because naloxone may have a shorter duration of
action than some opioids.
Question 8. A patient taking lithium develops coarse tremor, vomiting, diarrhea,
confusion, and worsening coordination. What is the priority?
A. Increase the lithium dose
B. Hold lithium and evaluate for toxicity
C. Administer another serotonergic medication
D. Encourage a low-sodium diet
**Answer: B. Hold lithium and evaluate for toxicity.
, Rationale: Gastrointestinal symptoms, coarse tremor, confusion, and ataxia can
indicate lithium toxicity. Lithium has a narrow therapeutic index, and dehydration,
renal impairment, and sodium changes can increase toxicity risk.
Question 9. Which medication is most appropriate for rapid reversal of severe
benzodiazepine-induced CNS depression in an appropriate monitored setting?
A. Naloxone
B. Flumazenil
C. Vitamin K
D. Acetylcysteine
**Answer: B. Flumazenil.
Rationale: Flumazenil is a benzodiazepine receptor antagonist. However, it must
be used cautiously because it can precipitate withdrawal and seizures, particularly
in chronic benzodiazepine users or mixed overdoses.
Question 10. A patient taking an ACE inhibitor develops swelling of the lips and
tongue. What is the priority action?
A. Reassure the patient that this is expected
B. Continue the medication and recheck the patient in one month
C. Treat the reaction as potentially life-threatening angioedema
D. Administer the next ACE-inhibitor dose
**Answer: C. Treat the reaction as potentially life-threatening angioedema.
Rationale: ACE inhibitors can cause angioedema involving the lips, tongue, face,
and airway. Airway assessment and emergency management are priorities, and the
offending ACE inhibitor should not be continued.
Question 11. Which pharmacokinetic process describes the movement of a
medication from the bloodstream into body tissues?
A. Absorption
B. Distribution
C. Metabolism
D. Excretion
**Answer: B. Distribution.
Exam V2 UTA 2026/2027 – Questions and
Answers (100% Verified)
Question 1. A patient taking warfarin has an INR of 5.8 without active bleeding.
Which action is most appropriate?
A. Administer the next scheduled dose
B. Hold warfarin and evaluate for bleeding
C. Give protamine sulfate immediately
D. Increase the warfarin dose
**Answer: B. Hold warfarin and evaluate for bleeding.
Rationale: An INR of 5.8 represents excessive anticoagulation. In a patient without
active bleeding, warfarin is generally withheld and the patient is assessed for
bleeding and other risk factors. Protamine reverses heparin, not warfarin.
Question 2. A patient with hypertension is prescribed lisinopril. Which laboratory
value should the advanced practice nurse monitor most closely?
A. Serum potassium
B. Serum calcium
C. Hemoglobin
D. Platelet count
**Answer: A. Serum potassium.
Rationale: ACE inhibitors can decrease aldosterone secretion, which may increase
serum potassium. Renal function and potassium should be monitored during
therapy.
Question 3. Which patient would have the greatest risk for a serious adverse effect
from a nonselective NSAID?
,A. A patient with seasonal allergies
B. A patient with chronic kidney disease
C. A patient with hypothyroidism
D. A patient with iron-deficiency anemia
**Answer: B. A patient with chronic kidney disease.
Rationale: NSAIDs can reduce renal prostaglandin synthesis and decrease renal
perfusion, potentially worsening kidney function. Patients with preexisting renal
impairment require particular caution.
Question 4. A patient taking metformin is scheduled for a procedure involving
iodinated contrast. Which consideration is most important?
A. Increase the metformin dose before the procedure
B. Assess renal function and follow appropriate metformin-holding guidance
C. Administer insulin immediately before contrast
D. Substitute warfarin for metformin
**Answer: B. Assess renal function and follow appropriate metformin-holding
guidance.
Rationale: Iodinated contrast can contribute to acute kidney injury in susceptible
patients. Because metformin is renally cleared, renal function and current
contrast-related recommendations should be reviewed to reduce the risk of
metformin-associated lactic acidosis.
Question 5. Which medication is classified as a direct oral anticoagulant?
A. Warfarin
B. Apixaban
C. Heparin
D. Enoxaparin
**Answer: B. Apixaban.
Rationale: Apixaban is a direct factor Xa inhibitor and belongs to the direct oral
anticoagulant class. Warfarin is a vitamin K antagonist, while heparin and
enoxaparin are parenteral anticoagulants.
,Question 6. A patient taking sertraline reports agitation, diaphoresis, tremor,
diarrhea, and hyperreflexia. Which condition should the clinician suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Opioid withdrawal
**Answer: B. Serotonin syndrome.
Rationale: Serotonin syndrome may present with mental-status changes,
autonomic instability, gastrointestinal symptoms, tremor, clonus, and
hyperreflexia. Prompt recognition and removal of serotonergic agents are
important.
Question 7. Which medication is commonly used as an antidote for opioid-
induced respiratory depression?
A. Flumazenil
B. Naloxone
C. Atropine
D. Protamine
**Answer: B. Naloxone.
Rationale: Naloxone is an opioid receptor antagonist that can rapidly reverse
opioid-induced respiratory and central nervous system depression. Patients
require continued monitoring because naloxone may have a shorter duration of
action than some opioids.
Question 8. A patient taking lithium develops coarse tremor, vomiting, diarrhea,
confusion, and worsening coordination. What is the priority?
A. Increase the lithium dose
B. Hold lithium and evaluate for toxicity
C. Administer another serotonergic medication
D. Encourage a low-sodium diet
**Answer: B. Hold lithium and evaluate for toxicity.
, Rationale: Gastrointestinal symptoms, coarse tremor, confusion, and ataxia can
indicate lithium toxicity. Lithium has a narrow therapeutic index, and dehydration,
renal impairment, and sodium changes can increase toxicity risk.
Question 9. Which medication is most appropriate for rapid reversal of severe
benzodiazepine-induced CNS depression in an appropriate monitored setting?
A. Naloxone
B. Flumazenil
C. Vitamin K
D. Acetylcysteine
**Answer: B. Flumazenil.
Rationale: Flumazenil is a benzodiazepine receptor antagonist. However, it must
be used cautiously because it can precipitate withdrawal and seizures, particularly
in chronic benzodiazepine users or mixed overdoses.
Question 10. A patient taking an ACE inhibitor develops swelling of the lips and
tongue. What is the priority action?
A. Reassure the patient that this is expected
B. Continue the medication and recheck the patient in one month
C. Treat the reaction as potentially life-threatening angioedema
D. Administer the next ACE-inhibitor dose
**Answer: C. Treat the reaction as potentially life-threatening angioedema.
Rationale: ACE inhibitors can cause angioedema involving the lips, tongue, face,
and airway. Airway assessment and emergency management are priorities, and the
offending ACE inhibitor should not be continued.
Question 11. Which pharmacokinetic process describes the movement of a
medication from the bloodstream into body tissues?
A. Absorption
B. Distribution
C. Metabolism
D. Excretion
**Answer: B. Distribution.
