Advanced Pharmacology D116 Top quality Exam Review
Guide Questions and Answers 2025/2026
An 88-year-old patient with heart failure has progressed to Stage D and is hospitalized
for the third time in a month. The nurse will expect to discuss which topic with the
patient'sfamily?
A patient has had blood pressures of 150/95 mmHg and 148/90 mmHg on two separate
office visits. The patient reports a blood pressure of 145/92 mm Hg taken in an
ambulatory setting. The patient's diagnostic tests are all normal. The nurse will expect
this patient's provider to order:
a thiazide diuretic.
Feedback: This patient has primary, or essential, hypertension as evidenced by systolic
pressure greater than 140 and diastolic pressure greater than 90, along with normal
tests ruling out another primary cause. Thiazide diuretics are first-line drugs for
hypertension. Beta blockers are effective but are most often used to counter reflex
tachycardia associated with reduced blood pressure caused by therapeutic agents.
Loop diuretics cause greater diuresis than is usually needed and so are not firstline
drugs. This patient should be counseled on lifestyle changes as an adjunct to drug
therapy but should also begin drug therapy because hypertension already exists
A patient with diabetes develops hypertension. The nurse will anticipate administering
which type of medication to treat hypertension in this patient?
ACE inhibitors
Feedback: ACE inhibitors slow the progression of kidney injury in diabetic patients with
renal damage. Beta blockers can mask signs of hypoglycemia and must be used with
caution in diabetics. Direct-acting vasodilators are third-line drugs for chronic
hypertension. Thiazide diuretics promote hyperglycemia.
A patient has been taking digoxin [Lanoxin] 0.25 mg, and furosemide [Lasix] 40 mg,
daily. Upon routine assessment bythe nurse, the patient states, "I see yellow halos
around the lights." The nurse should perform which action based on this assessment?
Check the patient for other symptoms of digitalis toxicity.
Feedback: Yellow halos around lights indicate digoxin toxicity. The use of furosemide
increases the risk of hypokalemia, which in turn potentiates digoxin toxicity. The patient
should also be assessed for headache, nausea, and vomiting, and blood should be
drawn for measurement of the serum digoxin level. The nurse should not withhold the
dose of furosemide until further assessment is done, including measurement of a serum
digoxin level. No evidence indicates that the patient is in worsening heart failure.
Documentation of findings is secondary to further assessment and prevention of digoxin
toxicity.
,A patient tells a nurse that she is thinking about getting pregnant and asks about
nutritional supplements. What will the nurse recommend?
400 to 800 mg of folic acid per day
Feedback: The current recommendation is that all women of childbearing age receive
folic acid supplementation to prevent the development of neural tube defects that can
occur early in pregnancy. Dietary folic acid is not sufficient to provide this amount. Iron
supplements are given when pregnancy occurs and are not necessary before becoming
pregnant. Vitamin B12 supplements are not recommended
Which finding would indicate that terazosin has been effective for a patient with BPH?
Improved urinary hesitation
Feedback: Terazosin is an alpha1-adrenergic antagonist. These medications relax the
smooth muscles of the bladder neck to improve urinary symptoms experienced with
BPH. They do not decrease the size of the prostate. Increased urinary frequency is a
sign of worsening BPH, not improvement.
A patient with stable COPD is prescribed a bronchodilator medication. Which type of
bronchodilator is preferred for this patient?
A long-acting inhaled beta2 agonist
Feedback: LABAs are preferred over SABAs for COPD. Oral beta2 agonists are not
first-line therapy. Although theophylline, a methylxanthine, was once standard therapy in
COPD, it is no longer recommended. It is used only if beta2 agonists are not available
A patient with asthma comes to a clinic for treatment of an asthma exacerbation. The
patient's medication history lists an inhaled glucocorticoid, montelukast [Singulair], and
a SABA as needed via MDI. The NP assesses the patient and notes a respiratory rate of
18 breaths/minute, a heart rate of 96 beats/minute, and an oxygen saturation of 95%.
The nurse Practitionerauscultates mild expiratory wheezes and equal breath sounds
bilaterally. What will the nurse do?
Question the patient about how much albuterol has been used
Feedback: To determine the next course of action, it is important to assess the drugs
given before these symptoms were observed. Patients who continue to wheeze after
using a SABA need systemic glucocorticoids and nebulized albuterol. If a SABA has not
been used, that will be the first intervention. LABAs are not used for exacerbations. If a
patient reports using a SABA without good results, evaluating the MDI technique may
be warranted
Which medication should be used for asthma patients as part of step 1 management?
Short-acting beta2 agonists
, Feedback: Patients needing step 1 management have intermittent, mild symptoms and
can be managed with a SABA as needed. Combination inhaled glucocorticoids/LABAs
are used for step 3 management. Inhaled low-dose glucocorticoids are used for step 2
management. LABAs, along with inhaled glucocorticoids, are used for step 3
management
A patient with persistent, frequent asthma exacerbations asks a nurse about a long-
acting beta2-agonist medication. What will the nurse tell this patient?
LABAs should be combined with an inhaled glucocorticoid.
Feedback: LABAs can increase the risk of asthma-related deaths when used
improperly; this risk is minimized when LABAs are combined with an inhaled
glucocorticoid. LABAs are not safer than SABAs, and they are not used PRN. LABAs
increase the risk of asthma-related deaths.
A patient who takes oral theophylline [Theochron] twice daily for chronic stable asthma
develops an infection and will take ciprofloxacin. The NP should:
Reduce the Theophylliine dose
Feedback: Fluoroquinolone antibiotics increase theophylline levels, so the dose of
theophylline may need to be reduced to prevent theophylline toxicity. Changing
antibiotics, giving the theophylline once daily, and changing to a LABA are not indicated.
A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an
inhaled beta2-adrenergic agonist. Which statement by the patient indicates
understanding of this medication regimen?
“The glucocorticoid is used as prophylaxis to prevent exacerbations.”
Feedback: Inhaled glucocorticoids are used daily to prevent acute attacks. They are not
used PRN. The beta2- adrenergic agonist drugs should not be used daily; they are used
to treat symptoms as needed. They do not suppress mediators of inflammation
A patient who is malnourished has scaling, cracked skin on the arms and face. The
patient is irritable, anxious, and has difficulty sleeping. The patient complains of
soreness of the tongue and mouth. Whenteaching this patient about vitamin therapy for
this disorder, the nurse will tell the patient to report which side effects?
Flushing, dizziness, and nausea
Feedback: This patient shows signs of niacin deficiency. Side effects of niacin
deficiency include flushing, dizziness, and nausea secondary to vasodilation. Abdominal
cramps, diarrhea, migraines, and numbness of extremities are not side effects of niacin
deficiency
A patient with hyperlipidemia has been told by the NP to take extra niacin. The NP will
tell the patient to:
Guide Questions and Answers 2025/2026
An 88-year-old patient with heart failure has progressed to Stage D and is hospitalized
for the third time in a month. The nurse will expect to discuss which topic with the
patient'sfamily?
A patient has had blood pressures of 150/95 mmHg and 148/90 mmHg on two separate
office visits. The patient reports a blood pressure of 145/92 mm Hg taken in an
ambulatory setting. The patient's diagnostic tests are all normal. The nurse will expect
this patient's provider to order:
a thiazide diuretic.
Feedback: This patient has primary, or essential, hypertension as evidenced by systolic
pressure greater than 140 and diastolic pressure greater than 90, along with normal
tests ruling out another primary cause. Thiazide diuretics are first-line drugs for
hypertension. Beta blockers are effective but are most often used to counter reflex
tachycardia associated with reduced blood pressure caused by therapeutic agents.
Loop diuretics cause greater diuresis than is usually needed and so are not firstline
drugs. This patient should be counseled on lifestyle changes as an adjunct to drug
therapy but should also begin drug therapy because hypertension already exists
A patient with diabetes develops hypertension. The nurse will anticipate administering
which type of medication to treat hypertension in this patient?
ACE inhibitors
Feedback: ACE inhibitors slow the progression of kidney injury in diabetic patients with
renal damage. Beta blockers can mask signs of hypoglycemia and must be used with
caution in diabetics. Direct-acting vasodilators are third-line drugs for chronic
hypertension. Thiazide diuretics promote hyperglycemia.
A patient has been taking digoxin [Lanoxin] 0.25 mg, and furosemide [Lasix] 40 mg,
daily. Upon routine assessment bythe nurse, the patient states, "I see yellow halos
around the lights." The nurse should perform which action based on this assessment?
Check the patient for other symptoms of digitalis toxicity.
Feedback: Yellow halos around lights indicate digoxin toxicity. The use of furosemide
increases the risk of hypokalemia, which in turn potentiates digoxin toxicity. The patient
should also be assessed for headache, nausea, and vomiting, and blood should be
drawn for measurement of the serum digoxin level. The nurse should not withhold the
dose of furosemide until further assessment is done, including measurement of a serum
digoxin level. No evidence indicates that the patient is in worsening heart failure.
Documentation of findings is secondary to further assessment and prevention of digoxin
toxicity.
,A patient tells a nurse that she is thinking about getting pregnant and asks about
nutritional supplements. What will the nurse recommend?
400 to 800 mg of folic acid per day
Feedback: The current recommendation is that all women of childbearing age receive
folic acid supplementation to prevent the development of neural tube defects that can
occur early in pregnancy. Dietary folic acid is not sufficient to provide this amount. Iron
supplements are given when pregnancy occurs and are not necessary before becoming
pregnant. Vitamin B12 supplements are not recommended
Which finding would indicate that terazosin has been effective for a patient with BPH?
Improved urinary hesitation
Feedback: Terazosin is an alpha1-adrenergic antagonist. These medications relax the
smooth muscles of the bladder neck to improve urinary symptoms experienced with
BPH. They do not decrease the size of the prostate. Increased urinary frequency is a
sign of worsening BPH, not improvement.
A patient with stable COPD is prescribed a bronchodilator medication. Which type of
bronchodilator is preferred for this patient?
A long-acting inhaled beta2 agonist
Feedback: LABAs are preferred over SABAs for COPD. Oral beta2 agonists are not
first-line therapy. Although theophylline, a methylxanthine, was once standard therapy in
COPD, it is no longer recommended. It is used only if beta2 agonists are not available
A patient with asthma comes to a clinic for treatment of an asthma exacerbation. The
patient's medication history lists an inhaled glucocorticoid, montelukast [Singulair], and
a SABA as needed via MDI. The NP assesses the patient and notes a respiratory rate of
18 breaths/minute, a heart rate of 96 beats/minute, and an oxygen saturation of 95%.
The nurse Practitionerauscultates mild expiratory wheezes and equal breath sounds
bilaterally. What will the nurse do?
Question the patient about how much albuterol has been used
Feedback: To determine the next course of action, it is important to assess the drugs
given before these symptoms were observed. Patients who continue to wheeze after
using a SABA need systemic glucocorticoids and nebulized albuterol. If a SABA has not
been used, that will be the first intervention. LABAs are not used for exacerbations. If a
patient reports using a SABA without good results, evaluating the MDI technique may
be warranted
Which medication should be used for asthma patients as part of step 1 management?
Short-acting beta2 agonists
, Feedback: Patients needing step 1 management have intermittent, mild symptoms and
can be managed with a SABA as needed. Combination inhaled glucocorticoids/LABAs
are used for step 3 management. Inhaled low-dose glucocorticoids are used for step 2
management. LABAs, along with inhaled glucocorticoids, are used for step 3
management
A patient with persistent, frequent asthma exacerbations asks a nurse about a long-
acting beta2-agonist medication. What will the nurse tell this patient?
LABAs should be combined with an inhaled glucocorticoid.
Feedback: LABAs can increase the risk of asthma-related deaths when used
improperly; this risk is minimized when LABAs are combined with an inhaled
glucocorticoid. LABAs are not safer than SABAs, and they are not used PRN. LABAs
increase the risk of asthma-related deaths.
A patient who takes oral theophylline [Theochron] twice daily for chronic stable asthma
develops an infection and will take ciprofloxacin. The NP should:
Reduce the Theophylliine dose
Feedback: Fluoroquinolone antibiotics increase theophylline levels, so the dose of
theophylline may need to be reduced to prevent theophylline toxicity. Changing
antibiotics, giving the theophylline once daily, and changing to a LABA are not indicated.
A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an
inhaled beta2-adrenergic agonist. Which statement by the patient indicates
understanding of this medication regimen?
“The glucocorticoid is used as prophylaxis to prevent exacerbations.”
Feedback: Inhaled glucocorticoids are used daily to prevent acute attacks. They are not
used PRN. The beta2- adrenergic agonist drugs should not be used daily; they are used
to treat symptoms as needed. They do not suppress mediators of inflammation
A patient who is malnourished has scaling, cracked skin on the arms and face. The
patient is irritable, anxious, and has difficulty sleeping. The patient complains of
soreness of the tongue and mouth. Whenteaching this patient about vitamin therapy for
this disorder, the nurse will tell the patient to report which side effects?
Flushing, dizziness, and nausea
Feedback: This patient shows signs of niacin deficiency. Side effects of niacin
deficiency include flushing, dizziness, and nausea secondary to vasodilation. Abdominal
cramps, diarrhea, migraines, and numbness of extremities are not side effects of niacin
deficiency
A patient with hyperlipidemia has been told by the NP to take extra niacin. The NP will
tell the patient to:
