Page 1 of 165
NSG 5240 Advanced Pharmacology FINAL Exam
ACTUAL QUESTIONS AND ANSWERS LATEST
UPDATE THIS YEAR
NSG 5240 Advanced Pharmacology FINAL Exam. Each question includes a clinical scenario, four answer
options (A-D), and a summarized rationale in italics. The questions cover major drug classes,
pharmacodynamics, pharmacokinetics, special populations, adverse effects, drug interactions, and
clinical decision-making at an advanced practice level.
Question 1
A 68-year-old man with heart failure with reduced ejection fraction (HFrEF) is started on
sacubitril/valsartan. Which laboratory value must be monitored before initiating this therapy?
A) Serum sodium
B) Serum potassium and renal function
C) Liver function tests
D) Hemoglobin A1c
Answer: B
Sacubitril/valsartan can cause hyperkalemia and angioedema; renal function and potassium must be
checked before initiation and during treatment.
, Page 2 of 165
Question 2
A patient with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD) is on
metformin. Which drug class has been shown to reduce major adverse cardiovascular events (MACE)
and is recommended as an add-on?
A) DPP-4 inhibitor
B) SGLT2 inhibitor or GLP-1 receptor agonist
C) Thiazolidinedione
D) Sulfonylurea
Answer: B
*SGLT2 inhibitors (empagliflozin, canagliflozin) and GLP-1 agonists (liraglutide, semaglutide) have CV
outcome trial evidence showing reduction in MACE and heart failure hospitalizations.*
Question 3
A 45-year-old woman with generalized anxiety disorder is prescribed buspirone. She asks how long it will
take to feel the full effect. What is the correct response?
A) 1-2 days
B) 3-5 days
, Page 3 of 165
C) 2-4 weeks
D) Immediate onset
Answer: C
*Buspirone has a delayed onset of action, typically requiring 2-4 weeks of regular dosing for full
anxiolytic effect, unlike benzodiazepines which work immediately.*
Question 4
A patient on warfarin with an INR of 1.2 needs rapid anticoagulation. Which agent is most appropriate
for acute anticoagulation in this setting?
A) Increase warfarin dose
B) Unfractionated heparin or low molecular weight heparin
C) Aspirin
D) Clopidogrel
Answer: B
Heparin (UFH or LMWH) provides immediate anticoagulation via antithrombin III and is used as a bridge
until warfarin reaches therapeutic INR.
, Page 4 of 165
Question 5
A 72-year-old woman with osteoarthritis asks about using topical NSAIDs instead of oral ibuprofen for
knee pain. What is the primary advantage of the topical route?
A) Higher systemic concentration
B) Lower risk of gastrointestinal bleeding and fewer systemic adverse effects
C) Faster onset of action
D) No maximum daily dose
Answer: B
Topical NSAIDs (diclofenac gel) achieve local tissue concentrations with minimal systemic absorption,
significantly reducing GI, renal, and cardiovascular risks compared to oral NSAIDs.
Question 6
A patient with major depressive disorder has failed two SSRIs. The APRN considers switching to
venlafaxine (SNRI). At what daily dose does venlafaxine begin to affect norepinephrine reuptake
significantly?
A) 37.5 mg
B) 75 mg
NSG 5240 Advanced Pharmacology FINAL Exam
ACTUAL QUESTIONS AND ANSWERS LATEST
UPDATE THIS YEAR
NSG 5240 Advanced Pharmacology FINAL Exam. Each question includes a clinical scenario, four answer
options (A-D), and a summarized rationale in italics. The questions cover major drug classes,
pharmacodynamics, pharmacokinetics, special populations, adverse effects, drug interactions, and
clinical decision-making at an advanced practice level.
Question 1
A 68-year-old man with heart failure with reduced ejection fraction (HFrEF) is started on
sacubitril/valsartan. Which laboratory value must be monitored before initiating this therapy?
A) Serum sodium
B) Serum potassium and renal function
C) Liver function tests
D) Hemoglobin A1c
Answer: B
Sacubitril/valsartan can cause hyperkalemia and angioedema; renal function and potassium must be
checked before initiation and during treatment.
, Page 2 of 165
Question 2
A patient with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD) is on
metformin. Which drug class has been shown to reduce major adverse cardiovascular events (MACE)
and is recommended as an add-on?
A) DPP-4 inhibitor
B) SGLT2 inhibitor or GLP-1 receptor agonist
C) Thiazolidinedione
D) Sulfonylurea
Answer: B
*SGLT2 inhibitors (empagliflozin, canagliflozin) and GLP-1 agonists (liraglutide, semaglutide) have CV
outcome trial evidence showing reduction in MACE and heart failure hospitalizations.*
Question 3
A 45-year-old woman with generalized anxiety disorder is prescribed buspirone. She asks how long it will
take to feel the full effect. What is the correct response?
A) 1-2 days
B) 3-5 days
, Page 3 of 165
C) 2-4 weeks
D) Immediate onset
Answer: C
*Buspirone has a delayed onset of action, typically requiring 2-4 weeks of regular dosing for full
anxiolytic effect, unlike benzodiazepines which work immediately.*
Question 4
A patient on warfarin with an INR of 1.2 needs rapid anticoagulation. Which agent is most appropriate
for acute anticoagulation in this setting?
A) Increase warfarin dose
B) Unfractionated heparin or low molecular weight heparin
C) Aspirin
D) Clopidogrel
Answer: B
Heparin (UFH or LMWH) provides immediate anticoagulation via antithrombin III and is used as a bridge
until warfarin reaches therapeutic INR.
, Page 4 of 165
Question 5
A 72-year-old woman with osteoarthritis asks about using topical NSAIDs instead of oral ibuprofen for
knee pain. What is the primary advantage of the topical route?
A) Higher systemic concentration
B) Lower risk of gastrointestinal bleeding and fewer systemic adverse effects
C) Faster onset of action
D) No maximum daily dose
Answer: B
Topical NSAIDs (diclofenac gel) achieve local tissue concentrations with minimal systemic absorption,
significantly reducing GI, renal, and cardiovascular risks compared to oral NSAIDs.
Question 6
A patient with major depressive disorder has failed two SSRIs. The APRN considers switching to
venlafaxine (SNRI). At what daily dose does venlafaxine begin to affect norepinephrine reuptake
significantly?
A) 37.5 mg
B) 75 mg
