1
NURS 676 Advanced Pharmacology Midterm Exam 2025–2026 | 150
Clinical Questions & Correct Answers with Rationales | WCU NP
Exam Prep (Guaranteed Pass)
Question 1
A 64-year-old female with a history of hypertension and type 2 diabetes mellitus presents for a
follow-up appointment. Her blood pressure today is 152/96 mmHg despite being on
hydrochlorothiazide 25 mg daily. She reports mild ankle swelling and a persistent dry cough over
the past 3 weeks. Labs show potassium of 4.2 mEq/L, creatinine 1.1 mg/dL, and eGFR 68
mL/min/1.73m². The provider considers changing her medication due to the side effects. Which
of the following is the most appropriate next step in managing her hypertension?
A. Increase hydrochlorothiazide to 50 mg daily
B. Add lisinopril 10 mg daily
C. Discontinue current therapy and start losartan 50 mg daily
D. Add amlodipine 5 mg daily
Correct Answer: C. Discontinue current therapy and start losartan 50 mg daily
, 2
Rationale: The patient's persistent dry cough is a classic adverse effect of ACE inhibitors like
lisinopril. Since she is already experiencing side effects, switching to an ARB such as losartan —
which does not cause cough — is appropriate. Increasing hydrochlorothiazide will not address
the cough and may worsen fluid/electrolyte status. Amlodipine may control BP but not resolve
the cough, and she is already on a diuretic.
Reference: Woo, T. M., & Robinson, M. V. (2020). Pharmacotherapeutics for Advanced
Practice Nurse Prescribers (5th ed.).
Question 2
A 75-year-old male with atrial fibrillation and a past medical history of congestive heart failure is
being initiated on digoxin. His heart rate is 112 bpm, and his BP is 132/76 mmHg. Current
medications include furosemide, lisinopril, and warfarin. Recent labs show potassium 3.1
mEq/L, magnesium 1.4 mg/dL, and creatinine 1.4 mg/dL. The NP reviews his electrolyte and
renal function before prescribing. What is the most significant clinical concern when initiating
digoxin in this patient?
A. Risk of bleeding due to warfarin-digoxin interaction
B. Digoxin toxicity due to renal impairment and hypokalemia
C. Bradycardia from concurrent use with lisinopril
D. Ineffectiveness of digoxin in atrial fibrillation
Correct Answer: B. Digoxin toxicity due to renal impairment and hypokalemia
, 3
Rationale: The patient is at high risk for digoxin toxicity due to decreased renal clearance and
low potassium and magnesium levels, which sensitize the myocardium to digoxin. Warfarin and
digoxin don’t have a significant interaction. Bradycardia is possible, but the greater concern is
toxicity. Digoxin remains useful in controlling ventricular rate in atrial fibrillation.
Reference: Lehne, R. A. (2019). Pharmacology for Nursing Care (10th ed.).
Question 3
A 45-year-old woman is diagnosed with hyperthyroidism and is prescribed methimazole. Three
weeks into treatment, she presents with a sore throat and fever (101.8°F). On exam, her throat
appears erythematous without exudate, and her white blood cell (WBC) count is 1,500/mm³.
What is the most appropriate immediate action?
A. Prescribe amoxicillin-clavulanate and monitor
B. Continue methimazole and add antipyretics
C. Discontinue methimazole and obtain a throat culture
D. Discontinue methimazole and refer for urgent evaluation
Correct Answer: D. Discontinue methimazole and refer for urgent evaluation
Rationale: Agranulocytosis is a rare but life-threatening side effect of methimazole. A sore
throat and fever in this context with a low WBC count strongly suggests agranulocytosis.
Methimazole should be stopped immediately, and urgent evaluation is warranted. Antibiotics or
continued treatment are not appropriate without further workup.
, 4
Reference: Woo & Robinson (2020), Pharmacotherapeutics for Advanced Practice Nurse
Prescribers.
Question 4
A 58-year-old male with a 20-year history of type 2 diabetes mellitus presents with peripheral
neuropathy and poor glycemic control (A1c = 9.2%). His current regimen includes metformin
1000 mg BID and glipizide 10 mg daily. He complains of new burning pain in both feet and
difficulty sleeping. The NP considers adding a medication to manage his neuropathic pain.
Which is the most appropriate choice to address both issues?
A. Add pregabalin 75 mg BID
B. Add duloxetine 30 mg daily
C. Switch to insulin glargine
D. Increase glipizide to 20 mg daily
Correct Answer: B. Add duloxetine 30 mg daily
Rationale: Duloxetine is FDA-approved for diabetic peripheral neuropathy and also improves
glycemic control modestly. Pregabalin helps with pain but does not affect glucose. Insulin may
help glycemic control but does not treat pain. Increasing glipizide may increase risk of
hypoglycemia without improving neuropathic symptoms.
Reference: Woo & Robinson (2020), Pharmacotherapeutics for Advanced Practice Nurse
Prescribers.
NURS 676 Advanced Pharmacology Midterm Exam 2025–2026 | 150
Clinical Questions & Correct Answers with Rationales | WCU NP
Exam Prep (Guaranteed Pass)
Question 1
A 64-year-old female with a history of hypertension and type 2 diabetes mellitus presents for a
follow-up appointment. Her blood pressure today is 152/96 mmHg despite being on
hydrochlorothiazide 25 mg daily. She reports mild ankle swelling and a persistent dry cough over
the past 3 weeks. Labs show potassium of 4.2 mEq/L, creatinine 1.1 mg/dL, and eGFR 68
mL/min/1.73m². The provider considers changing her medication due to the side effects. Which
of the following is the most appropriate next step in managing her hypertension?
A. Increase hydrochlorothiazide to 50 mg daily
B. Add lisinopril 10 mg daily
C. Discontinue current therapy and start losartan 50 mg daily
D. Add amlodipine 5 mg daily
Correct Answer: C. Discontinue current therapy and start losartan 50 mg daily
, 2
Rationale: The patient's persistent dry cough is a classic adverse effect of ACE inhibitors like
lisinopril. Since she is already experiencing side effects, switching to an ARB such as losartan —
which does not cause cough — is appropriate. Increasing hydrochlorothiazide will not address
the cough and may worsen fluid/electrolyte status. Amlodipine may control BP but not resolve
the cough, and she is already on a diuretic.
Reference: Woo, T. M., & Robinson, M. V. (2020). Pharmacotherapeutics for Advanced
Practice Nurse Prescribers (5th ed.).
Question 2
A 75-year-old male with atrial fibrillation and a past medical history of congestive heart failure is
being initiated on digoxin. His heart rate is 112 bpm, and his BP is 132/76 mmHg. Current
medications include furosemide, lisinopril, and warfarin. Recent labs show potassium 3.1
mEq/L, magnesium 1.4 mg/dL, and creatinine 1.4 mg/dL. The NP reviews his electrolyte and
renal function before prescribing. What is the most significant clinical concern when initiating
digoxin in this patient?
A. Risk of bleeding due to warfarin-digoxin interaction
B. Digoxin toxicity due to renal impairment and hypokalemia
C. Bradycardia from concurrent use with lisinopril
D. Ineffectiveness of digoxin in atrial fibrillation
Correct Answer: B. Digoxin toxicity due to renal impairment and hypokalemia
, 3
Rationale: The patient is at high risk for digoxin toxicity due to decreased renal clearance and
low potassium and magnesium levels, which sensitize the myocardium to digoxin. Warfarin and
digoxin don’t have a significant interaction. Bradycardia is possible, but the greater concern is
toxicity. Digoxin remains useful in controlling ventricular rate in atrial fibrillation.
Reference: Lehne, R. A. (2019). Pharmacology for Nursing Care (10th ed.).
Question 3
A 45-year-old woman is diagnosed with hyperthyroidism and is prescribed methimazole. Three
weeks into treatment, she presents with a sore throat and fever (101.8°F). On exam, her throat
appears erythematous without exudate, and her white blood cell (WBC) count is 1,500/mm³.
What is the most appropriate immediate action?
A. Prescribe amoxicillin-clavulanate and monitor
B. Continue methimazole and add antipyretics
C. Discontinue methimazole and obtain a throat culture
D. Discontinue methimazole and refer for urgent evaluation
Correct Answer: D. Discontinue methimazole and refer for urgent evaluation
Rationale: Agranulocytosis is a rare but life-threatening side effect of methimazole. A sore
throat and fever in this context with a low WBC count strongly suggests agranulocytosis.
Methimazole should be stopped immediately, and urgent evaluation is warranted. Antibiotics or
continued treatment are not appropriate without further workup.
, 4
Reference: Woo & Robinson (2020), Pharmacotherapeutics for Advanced Practice Nurse
Prescribers.
Question 4
A 58-year-old male with a 20-year history of type 2 diabetes mellitus presents with peripheral
neuropathy and poor glycemic control (A1c = 9.2%). His current regimen includes metformin
1000 mg BID and glipizide 10 mg daily. He complains of new burning pain in both feet and
difficulty sleeping. The NP considers adding a medication to manage his neuropathic pain.
Which is the most appropriate choice to address both issues?
A. Add pregabalin 75 mg BID
B. Add duloxetine 30 mg daily
C. Switch to insulin glargine
D. Increase glipizide to 20 mg daily
Correct Answer: B. Add duloxetine 30 mg daily
Rationale: Duloxetine is FDA-approved for diabetic peripheral neuropathy and also improves
glycemic control modestly. Pregabalin helps with pain but does not affect glucose. Insulin may
help glycemic control but does not treat pain. Increasing glipizide may increase risk of
hypoglycemia without improving neuropathic symptoms.
Reference: Woo & Robinson (2020), Pharmacotherapeutics for Advanced Practice Nurse
Prescribers.
