NURS 6521N ADVANCED PHARMACOLOGY
COMPREHENSIVE MIDTERM EXAM REVIEW
BOARD-STYLE QUESTIONS WITH ANSWERS,
RATIONALES, AND CLINICAL APPLICATIONS
Question 1
A patient with type 2 diabetes is prescribed metformin. The nurse practitioner
should monitor which laboratory value most closely?
A) Serum creatinine
B) Liver enzymes
C) Hemoglobin A1C
D) Serum potassium
Answer: A) Serum creatinine
Explanation: Metformin is contraindicated in renal impairment due to the risk of
lactic acidosis. Serum creatinine should be monitored regularly to assess renal
function.
Question 2
A patient is prescribed warfarin for atrial fibrillation. Which herbal supplement
should the patient be advised to avoid due to increased bleeding risk?
A) St. John's wort
B) Ginkgo biloba
C) Echinacea
D) Goldenseal
,Answer: B) Ginkgo biloba
Explanation: Ginkgo biloba increases bleeding risk when taken with warfarin due
to its antiplatelet effects. St. John's wort decreases warfarin effectiveness.
Question 3
A 45-year-old female with hypertension is prescribed lisinopril. Which adverse
effect is most concerning and requires immediate discontinuation?
A) Dry cough
B) Angioedema
C) Hyperkalemia
D) Dizziness
Answer: B) Angioedema
Explanation: Angioedema is a life-threatening adverse effect of ACE inhibitors like
lisinopril and requires immediate discontinuation and emergency care.
Question 4
Which of the following affects drug distribution throughout the body?
A) Protein binding
B) Hepatic metabolism
C) Renal excretion
D) Gastric emptying
Answer: A) Protein binding
Explanation: Protein binding affects the amount of free drug available to tissues.
Only unbound (free) drug can distribute to target sites.
Question 5
A Nurse Practitioner documents generic rather than proprietary drug names
because:
A) Generic names are easier to pronounce
,B) There is potential for confusion if proprietary names are used
C) Generic names are required by federal law
D) Proprietary names are less accurate
Answer: B) There is potential for confusion if proprietary names are used
Explanation: Using generic names reduces the risk of medication errors and
miscommunication, as proprietary names can vary between manufacturers.
Question 6
Before administering intravenous nitroglycerin to a patient with chest pain, the
nurse should prioritize which assessment?
A) Heart rate
B) Respiratory rate
C) Blood pressure
D) Oxygen saturation
Answer: C) Blood pressure
Explanation: Nitroglycerin causes vasodilation and can significantly lower blood
pressure. Hypotension is a major risk, so blood pressure must be assessed before
and during infusion.
Question 7
A male patient prescribed an albuterol inhaler for pneumonia should be advised
of which common adverse effect?
A) Throat irritation
B) Tachycardia
C) Sedation
D) Hypertension
Answer: A) Throat irritation
Explanation: Albuterol can cause throat irritation and dry mouth due to local
effects. Tachycardia is also possible but less common with inhaled doses.
, Question 8
A patient with type 1 diabetes undergoing surgery is most likely to achieve
glycemic control with which regimen?
A) Basal insulin twice daily with regular insulin before meals
B) Sliding scale insulin only
C) Oral hypoglycemics only
D) Once-daily long-acting insulin
Answer: A) Basal insulin twice daily with regular insulin before meals
Explanation: This regimen provides basal coverage and prandial insulin, allowing
flexible adjustment during perioperative stress.
Question 9
The APRN's ability to prescribe controlled substances is regulated by:
A) Federal law only
B) State law
C) Hospital policy
D) DEA registration only
Answer: B) State law
Explanation: State laws govern APRN prescribing authority, including controlled
substances. Federal DEA registration is also required but state law determines
scope.
Question 10
To increase the amount of free drug available to body cells for a drug with high
first-pass effect, the prescriber should:
A) Increase the oral dose
B) Administer the drug intravenously
C) Administer with food
D) Use a sustained-release formulation
COMPREHENSIVE MIDTERM EXAM REVIEW
BOARD-STYLE QUESTIONS WITH ANSWERS,
RATIONALES, AND CLINICAL APPLICATIONS
Question 1
A patient with type 2 diabetes is prescribed metformin. The nurse practitioner
should monitor which laboratory value most closely?
A) Serum creatinine
B) Liver enzymes
C) Hemoglobin A1C
D) Serum potassium
Answer: A) Serum creatinine
Explanation: Metformin is contraindicated in renal impairment due to the risk of
lactic acidosis. Serum creatinine should be monitored regularly to assess renal
function.
Question 2
A patient is prescribed warfarin for atrial fibrillation. Which herbal supplement
should the patient be advised to avoid due to increased bleeding risk?
A) St. John's wort
B) Ginkgo biloba
C) Echinacea
D) Goldenseal
,Answer: B) Ginkgo biloba
Explanation: Ginkgo biloba increases bleeding risk when taken with warfarin due
to its antiplatelet effects. St. John's wort decreases warfarin effectiveness.
Question 3
A 45-year-old female with hypertension is prescribed lisinopril. Which adverse
effect is most concerning and requires immediate discontinuation?
A) Dry cough
B) Angioedema
C) Hyperkalemia
D) Dizziness
Answer: B) Angioedema
Explanation: Angioedema is a life-threatening adverse effect of ACE inhibitors like
lisinopril and requires immediate discontinuation and emergency care.
Question 4
Which of the following affects drug distribution throughout the body?
A) Protein binding
B) Hepatic metabolism
C) Renal excretion
D) Gastric emptying
Answer: A) Protein binding
Explanation: Protein binding affects the amount of free drug available to tissues.
Only unbound (free) drug can distribute to target sites.
Question 5
A Nurse Practitioner documents generic rather than proprietary drug names
because:
A) Generic names are easier to pronounce
,B) There is potential for confusion if proprietary names are used
C) Generic names are required by federal law
D) Proprietary names are less accurate
Answer: B) There is potential for confusion if proprietary names are used
Explanation: Using generic names reduces the risk of medication errors and
miscommunication, as proprietary names can vary between manufacturers.
Question 6
Before administering intravenous nitroglycerin to a patient with chest pain, the
nurse should prioritize which assessment?
A) Heart rate
B) Respiratory rate
C) Blood pressure
D) Oxygen saturation
Answer: C) Blood pressure
Explanation: Nitroglycerin causes vasodilation and can significantly lower blood
pressure. Hypotension is a major risk, so blood pressure must be assessed before
and during infusion.
Question 7
A male patient prescribed an albuterol inhaler for pneumonia should be advised
of which common adverse effect?
A) Throat irritation
B) Tachycardia
C) Sedation
D) Hypertension
Answer: A) Throat irritation
Explanation: Albuterol can cause throat irritation and dry mouth due to local
effects. Tachycardia is also possible but less common with inhaled doses.
, Question 8
A patient with type 1 diabetes undergoing surgery is most likely to achieve
glycemic control with which regimen?
A) Basal insulin twice daily with regular insulin before meals
B) Sliding scale insulin only
C) Oral hypoglycemics only
D) Once-daily long-acting insulin
Answer: A) Basal insulin twice daily with regular insulin before meals
Explanation: This regimen provides basal coverage and prandial insulin, allowing
flexible adjustment during perioperative stress.
Question 9
The APRN's ability to prescribe controlled substances is regulated by:
A) Federal law only
B) State law
C) Hospital policy
D) DEA registration only
Answer: B) State law
Explanation: State laws govern APRN prescribing authority, including controlled
substances. Federal DEA registration is also required but state law determines
scope.
Question 10
To increase the amount of free drug available to body cells for a drug with high
first-pass effect, the prescriber should:
A) Increase the oral dose
B) Administer the drug intravenously
C) Administer with food
D) Use a sustained-release formulation
