Advanced pharmacology for Nursing Practitioner New Exam 2025

Ray has been diagnosed with hypertension and it is determined that an angiotensin-converting enzyme inhibitor is needed. Prior to prescribing this drug, the nurse practitioner (NP) should assess for: - Correct Answer-Decreased renal function Angiotensin-converting enzyme (ACE) inhibitors are the drug of choice in treating hypertension in diabetic patients because they: - Correct Answer-All of the above: Improve insulin sensitivity Improve renal hemodynamics Reduce the production of angiotensin II A potentially life-threatening adverse response to an ACE inhibitor is angioedema. Which of the following statements is true about this adverse response? - Correct Answer-Swelling of the tongue and hoarseness are the most common symptoms. ACE inhibitors are useful in a variety of disorders. Which of the following statements is true about both their usefulness in a particular disorder and the reason for their use? - Correct Answer-Both 1 and 2 are true: 1. They are useful to prevent stable angina because they decrease the thickening of vascular walls due to decreased modified release. 2. They are useful to prevent heart failure because they reduce remodeling of injured myocardial tissues. Despite good blood pressure control, an NP might change a patient's drug from an ACE inhibitor to an angiotensin II receptor blocker (ARB) because the ARB: - Correct Answer-Does not produce a dry, hacking cough While taking an ARB, patients need to avoid certain over-the-counter drugs without irst consulting the provider because: - Correct Answer-Both 1 and 2: 1. Cimetidine is metabolized by the CYP3A4 isoenzymes 2. Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels Laboratory monitoring for patients on ACE inhibitors or ARBs should include: - Correct Answer-Serum creatinine levels with the drug dosage reduced for values greater than 2.5 mg/dL Jacob has hypertension, for which a calcium channel blocker has been prescribed. This drug helps control blood pressure because it: - Correct Answer-Decreases the amount of calcium inside the cell Which of the following adverse effects may occur due to a dihydropyridine-type calcium channel blocker? - Correct Answer-Edema of the hands and feet Patient teaching related to amlodipine includes: - Correct Answer-Avoid grapefruit juice as it affects the metabolism of this drug. Vera, age 70, has isolated systolic hypertension. Calcium channel blocker dosages for her should be: - Correct Answer-Started at about half the usual dosage Larry has heart failure, which is being treated with digoxin because it exhibits: - Correct Answer-Negative inotropism Furosemide is added to a treatment regimen for heart failure that includes digoxin. Monitoring for this combination includes: - Correct Answer-Serum potassium Which of the following create a higher risk for digoxin toxicity? Both the cause and the reason for it must be correct. - Correct Answer-Administration to older adults because of reduced renal function Serum digoxin levels are monitored for potential toxicity. Monitoring should occur: - Correct Answer-Because a reference point is needed to adjust dosage Which of the following is true about procainamide and its dosing schedule? - Correct Answer- Rodrigo has been prescribed procainamide after a myocardial infarction. He is monitored for dyspnea, jugular venous distention, and peripheral edema because they may indicate: - Correct Answer-Onset of congestive heart failure Amiodarone has been prescribed in a patient with a supraventricular dysrhythmia. Patient teaching should include all of the following EXCEPT: - Correct Answer-Take a hot shower or bath if you feel dizzy. The NP orders a thyroid panel for a patient on amiodarone. The patient tells the NP that he does not have thyroid disease and wants to know why the test has been ordered. Which is a correct response? - Correct Answer-Amiodarone inhibits an enzyme that is important in making thyroid hormone and can cause hypothyroidism. Isosorbide dinitrate is prescribed for a patient with chronic stable angina. This drug is administered twice daily, but the schedule is 7 a.m. and 2 p.m. because: - Correct Answer-Nitrate tolerance can develop. Art is a 55-year-old smoker who has been diagnosed with angina and placed on nitrates. He complains of headaches after using his nitrate. An appropriate reply might be: - Correct Answer- In teaching about the use of sublingual nitroglycerine, the patient should be instructed: - Correct Answer-To place one tablet under the tongue if chest pain occurs and allow it to dissolve Donald has been diagnosed with hyperlipidemia. Based on his lipid profile, atorvastatin is prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald should be told to: - Correct Answer-Report muscle weakness or tenderness and dark urine to his provider immediately. Which of the following diagnostic results would NOT indicate a problem related to a reductase inhibitor? - Correct Answer-Increased white blood cell count Because of the pattern of cholesterol synthesis, reductase inhibitors are given - Correct Answer-In the evening in a single daily dose Niaspan, an extended-release form of niacin, was previously prescribed to treat a patient's hypertriglycerides. However, the FDA withdrew its approval of the drug. Which of the following drugs with research efficacy should be substituted? - Correct Answer-1 or 2: 1. Statins 2. Fibrates Niaspan is less likely to cause which side effect that is common to niacin? - Correct Answer-Cutaneous flushing Dulcea has type 2 diabetes and a high triglyceride level. She has been prescribed gemfibrozil to treat her hypertriglyceridemia. A history of which of the following might contraindicate the use of this drug? - Correct Answer-Gallbladder disease Many patients with hyperlipidemia are treated with more than one drug. Combining a fibric acid derivative such as gemfibrozil with which of the following is not recommended? The drug and the reason must both be correct for the answer to be correct. - Correct Answer-Reductase inhibitors, due to an increased risk for rhabdomyolysis Felicity has been prescribed colestipol to treat her hyperlipidemia. Unlike other antilipidemics, this drug: - Correct Answer-Exchanges chloride ions for negatively charged acids in the bowel Because of their site of action, bile acid sequestering resins: - Correct Answer-Should be administered separately from other drugs by at least four hours Colestipol comes in a powdered form. The patient is taught to: - Correct Answer-Mix the powder with four to six ounces of milk or fruit juice The choice of diuretic to use in treating hypertension is based on: - Correct Answer-Level of kidney function with a thiazide diuretic being used for an estimated glomerular filtration rate higher than the mid-40 mL/min range Direct renin inhibitors have the following properties. They: - Correct Answer-"Shut down" the entire RAAS cycle When comparing ACE and ARB medications, which of the following holds true? - Correct Answer-Both contribute to some retention of potassium How is diabetic renal protection affected by ACE medications? Diabetes mellitus patients: - Correct Answer-Have a reduced rate of renal progression, but ACE medications still need to be discontinued when advanced renal issues are present What dermatological issue is linked to Amiodarone use? - Correct Answer-Progressive change of skin tone toward a blue spectrum Commercials on TV for erectile dysfunction (ED) medications warn about mixing them with nitrates. Why? - Correct Answer-Profound hypotension Which formulation of nitrate is appropriate for acute anginal pain? - Correct Answer-Sublingual Which comment by a patient indicates a need for more education concerning his nitrate medication? - Correct Answer-"I keep a tablet on the bedside table in case I awaken with chest pain." Which precautions are shared with family members who will be assisting the patient with application of nitro patches? - Correct Answer-Wear gloves to prevent getting a head ache. What physical assessment is required prior to initiating a new hypertensive patient on an ACE? - Correct Answer-Renal bruits Which drug class is replacing beta blockers as the "go to" post-myocardial infarction (MI) medication? - Correct Answer-ACE inhibitors The overall goal of treating hyperlipidemia is: - Correct Answer-To reduce atherogenesis When considering which cholesterol-lowering drug to prescribe, which factor determines the type and intensity of treatment? - Correct Answer-Coronary artery disease risk level First-line therapy for hyperlipidemia is: - Correct Answer-Lifestyle changes James is a 45-year-old patient with a very high cardiovascular (CV) risk profile, an LDL level of 120, and normal triglycerides. Appropriate first-line therapy for James may include diet counseling, increased physical activity, and: - Correct Answer-A statin Joanne is a 60-year-old patient with an LDL of 132 and a family history of coronary artery disease. She has already tried diet changes (increasing fiber and plant sterols) to lower her LDL but after six months her LDL is slightly higher. The next step in her treatment would be: - Correct Answer-A statin Sharlene is a 65-year-old patient who has been on a lipid-lowering diet and using plant sterol margarine daily for the past three months. Her LDL is 135 mg/dL. An appropriate treatment for her would be: - Correct Answer-Determined by her risk factors Phil is a 54-year-old male with multiple ris