D116 NURS 6800
Advanced Pharmacology
Final Assessments
2025 Versions
(With Solutions)
1. A 65-year-old patient with chronic heart failure is prescribed digoxin.
Which electrolyte imbalance increases the risk of digoxin toxicity?
A) Hyperkalemia
B) Hypernatremia
C) Hypokalemia
D) Hypercalcemia
Answer: C) Hypokalemia
Rationale: Hypokalemia enhances digoxin binding to Na+/K+ ATPase,
increasing toxicity risk. Electrolyte monitoring is essential in patients
on digoxin.
2. A patient starting warfarin therapy is also prescribed amiodarone.
What adjustment should be considered?
A) Increase warfarin dose
B) Decrease warfarin dose
C) Add aspirin to therapy
D) No dose adjustment needed
Answer: B) Decrease warfarin dose
Rationale: Amiodarone inhibits CYP2C9, reducing warfarin
metabolism, increasing bleeding risk. Warfarin dose should be
lowered and INR closely monitored.
3. A 40-year-old patient with epilepsy is started on phenytoin. Which
laboratory test is vital to monitor during therapy?
A) Liver function tests (LFTs)
B) Renal function tests
,C) Serum glucose
D) Thyroid function tests
Answer: A) Liver function tests (LFTs)
Rationale: Phenytoin is metabolized hepatically and can cause liver
toxicity. Regular LFTs help detect hepatotoxicity early.
4. A patient with asthma is prescribed a long-acting beta-2 agonist
(LABA). What is the primary reason for adding an inhaled
corticosteroid?
A) To prevent LABA tolerance
B) To decrease systemic corticosteroid use
C) To reduce inflammation
D) To induce bronchodilation
Answer: C) To reduce inflammation
Rationale: LABAs provide bronchodilation but do not reduce airway
inflammation, which inhaled corticosteroids target, reducing
exacerbation risk.
5. A patient on lithium therapy reports nausea and tremors. Which lab
test is important to assess for toxicity?
A) Serum lithium level
B) Electrolyte panel
C) Complete blood count
D) Renal ultrasound
Answer: A) Serum lithium level
Rationale: Lithium has a narrow therapeutic window; symptoms like
nausea and tremors may indicate toxicity. Monitoring serum levels
guides dosing.
6. A patient with Type 2 diabetes mellitus is started on metformin.
Which adverse effect should the nurse educate the patient about?
A) Weight gain
B) Lactic acidosis
C) Hypoglycemia
D) Hyperkalemia
Answer: B) Lactic acidosis
Rationale: Metformin rarely causes lactic acidosis, especially in
, patients with renal impairment, hence kidney function monitoring is
mandatory.
7. A patient on vancomycin develops a red rash on the upper body
during infusion. What is the most appropriate nursing intervention?
A) Stop the infusion immediately
B) Slow the rate of infusion
C) Administer antihistamines prophylactically
D) Increase infusion rate to finish sooner
Answer: B) Slow the rate of infusion
Rationale: Red man syndrome is due to histamine release from rapid
infusion; slowing the rate reduces symptoms and prevents
progression.
8. A hypertensive patient on ACE inhibitors develops a persistent dry
cough. Which is the best next step?
A) Discontinue ACE inhibitor and start an ARB
B) Add a beta blocker
C) Increase ACE inhibitor dose
D) Reassure patient and continue therapy
Answer: A) Discontinue ACE inhibitor and start an ARB
Rationale: ACE inhibitors can cause cough due to bradykinin buildup;
ARBs do not cause this side effect and are appropriate alternatives.
9. In a patient receiving chemotherapy with cyclophosphamide, what
prophylactic treatment should be included?
A) Antiemetics
B) Nephroprotective agents
C) Corticosteroids
D) Blood glucose monitoring
Answer: A) Antiemetics
Rationale: Cyclophosphamide is highly emetogenic, so administering
antiemetics before chemotherapy improves patient comfort and
compliance.
10. A patient on chronic corticosteroid therapy is scheduled for
surgery. What precaution is necessary?
A) Discontinue corticosteroids immediately
, B) Administer stress dose steroids perioperatively
C) Switch to NSAIDs pre-surgery
D) No change needed
Answer: B) Administer stress dose steroids perioperatively
Rationale: Chronic corticosteroid use suppresses the HPA axis; stress
dosing is necessary to prevent adrenal crisis during surgery.
11. A patient receiving theophylline for bronchospasm shows signs of
nausea and seizures. What serum level likely corresponds with
these symptoms?
A) Below therapeutic range (<10 mcg/mL)
B) Therapeutic range (10-20 mcg/mL)
C) Toxic range (>20 mcg/mL)
D) Normal range (5-15 mcg/mL)
Answer: C) Toxic range (>20 mcg/mL)
Rationale: Theophylline has a narrow therapeutic window. Toxicity
symptoms like nausea and seizures occur with levels above 20
mcg/mL.
12. A pregnant patient requires antibiotic therapy for a urinary tract
infection. Which antibiotic is safest during pregnancy?
A) Tetracycline
B) Ciprofloxacin
C) Nitrofurantoin
D) Trimethoprim-sulfamethoxazole
Answer: C) Nitrofurantoin
Rationale: Nitrofurantoin is generally safe during pregnancy (except
near term), while others listed have fetal toxicity risks.
13. When initiating statin therapy in a patient, what baseline test is
essential?
A) Fasting lipid panel
B) Liver function tests
C) Renal function tests
D) Thyroid function tests
Answer: B) Liver function tests
Rationale: Statins can cause hepatotoxicity; baseline LFTs are needed
Advanced Pharmacology
Final Assessments
2025 Versions
(With Solutions)
1. A 65-year-old patient with chronic heart failure is prescribed digoxin.
Which electrolyte imbalance increases the risk of digoxin toxicity?
A) Hyperkalemia
B) Hypernatremia
C) Hypokalemia
D) Hypercalcemia
Answer: C) Hypokalemia
Rationale: Hypokalemia enhances digoxin binding to Na+/K+ ATPase,
increasing toxicity risk. Electrolyte monitoring is essential in patients
on digoxin.
2. A patient starting warfarin therapy is also prescribed amiodarone.
What adjustment should be considered?
A) Increase warfarin dose
B) Decrease warfarin dose
C) Add aspirin to therapy
D) No dose adjustment needed
Answer: B) Decrease warfarin dose
Rationale: Amiodarone inhibits CYP2C9, reducing warfarin
metabolism, increasing bleeding risk. Warfarin dose should be
lowered and INR closely monitored.
3. A 40-year-old patient with epilepsy is started on phenytoin. Which
laboratory test is vital to monitor during therapy?
A) Liver function tests (LFTs)
B) Renal function tests
,C) Serum glucose
D) Thyroid function tests
Answer: A) Liver function tests (LFTs)
Rationale: Phenytoin is metabolized hepatically and can cause liver
toxicity. Regular LFTs help detect hepatotoxicity early.
4. A patient with asthma is prescribed a long-acting beta-2 agonist
(LABA). What is the primary reason for adding an inhaled
corticosteroid?
A) To prevent LABA tolerance
B) To decrease systemic corticosteroid use
C) To reduce inflammation
D) To induce bronchodilation
Answer: C) To reduce inflammation
Rationale: LABAs provide bronchodilation but do not reduce airway
inflammation, which inhaled corticosteroids target, reducing
exacerbation risk.
5. A patient on lithium therapy reports nausea and tremors. Which lab
test is important to assess for toxicity?
A) Serum lithium level
B) Electrolyte panel
C) Complete blood count
D) Renal ultrasound
Answer: A) Serum lithium level
Rationale: Lithium has a narrow therapeutic window; symptoms like
nausea and tremors may indicate toxicity. Monitoring serum levels
guides dosing.
6. A patient with Type 2 diabetes mellitus is started on metformin.
Which adverse effect should the nurse educate the patient about?
A) Weight gain
B) Lactic acidosis
C) Hypoglycemia
D) Hyperkalemia
Answer: B) Lactic acidosis
Rationale: Metformin rarely causes lactic acidosis, especially in
, patients with renal impairment, hence kidney function monitoring is
mandatory.
7. A patient on vancomycin develops a red rash on the upper body
during infusion. What is the most appropriate nursing intervention?
A) Stop the infusion immediately
B) Slow the rate of infusion
C) Administer antihistamines prophylactically
D) Increase infusion rate to finish sooner
Answer: B) Slow the rate of infusion
Rationale: Red man syndrome is due to histamine release from rapid
infusion; slowing the rate reduces symptoms and prevents
progression.
8. A hypertensive patient on ACE inhibitors develops a persistent dry
cough. Which is the best next step?
A) Discontinue ACE inhibitor and start an ARB
B) Add a beta blocker
C) Increase ACE inhibitor dose
D) Reassure patient and continue therapy
Answer: A) Discontinue ACE inhibitor and start an ARB
Rationale: ACE inhibitors can cause cough due to bradykinin buildup;
ARBs do not cause this side effect and are appropriate alternatives.
9. In a patient receiving chemotherapy with cyclophosphamide, what
prophylactic treatment should be included?
A) Antiemetics
B) Nephroprotective agents
C) Corticosteroids
D) Blood glucose monitoring
Answer: A) Antiemetics
Rationale: Cyclophosphamide is highly emetogenic, so administering
antiemetics before chemotherapy improves patient comfort and
compliance.
10. A patient on chronic corticosteroid therapy is scheduled for
surgery. What precaution is necessary?
A) Discontinue corticosteroids immediately
, B) Administer stress dose steroids perioperatively
C) Switch to NSAIDs pre-surgery
D) No change needed
Answer: B) Administer stress dose steroids perioperatively
Rationale: Chronic corticosteroid use suppresses the HPA axis; stress
dosing is necessary to prevent adrenal crisis during surgery.
11. A patient receiving theophylline for bronchospasm shows signs of
nausea and seizures. What serum level likely corresponds with
these symptoms?
A) Below therapeutic range (<10 mcg/mL)
B) Therapeutic range (10-20 mcg/mL)
C) Toxic range (>20 mcg/mL)
D) Normal range (5-15 mcg/mL)
Answer: C) Toxic range (>20 mcg/mL)
Rationale: Theophylline has a narrow therapeutic window. Toxicity
symptoms like nausea and seizures occur with levels above 20
mcg/mL.
12. A pregnant patient requires antibiotic therapy for a urinary tract
infection. Which antibiotic is safest during pregnancy?
A) Tetracycline
B) Ciprofloxacin
C) Nitrofurantoin
D) Trimethoprim-sulfamethoxazole
Answer: C) Nitrofurantoin
Rationale: Nitrofurantoin is generally safe during pregnancy (except
near term), while others listed have fetal toxicity risks.
13. When initiating statin therapy in a patient, what baseline test is
essential?
A) Fasting lipid panel
B) Liver function tests
C) Renal function tests
D) Thyroid function tests
Answer: B) Liver function tests
Rationale: Statins can cause hepatotoxicity; baseline LFTs are needed
