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ADVANCED PHARMACOLOGY FOR NP
EXAM 2 WITH VERIFIED ANSWERS
100% CORRECT 2025/
Ray has been diagnosed with hypertension and it is determined that an angiotensin-converting enzyme inhibitor is needed. Prior to prescribing this drug, the nurse practitioner (NP) should assess for: Decreased renal function Angiotensin-converting enzyme (ACE) inhibitors are the drug of choice in treating hypertension in diabetic patients because they: All of the above: Improve insulin sensitivity Improve renal hemodynamics Reduce the production of angiotensin II A potentially life-threatening adverse response to an ACE inhibitor is angioedema. Which of the following statements is true about this adverse response? Swelling of the tongue and hoarseness are the most common symptoms. ACE inhibitors are useful in a variety of disorders. Which of the following statements is true about both their usefulness in a particular disorder and the reason for their use? Both 1 and 2 are true:
- They are useful to prevent stable angina because they decrease the thickening of vascular
walls due to decreased modified release.
- They are useful to prevent heart failure because they reduce remodeling of injured myocardial tissues. Despite good blood pressure control, an NP might change a patient's drug from an ACE inhibitor to an angiotensin II receptor blocker (ARB) because the ARB: Does not produce a dry, hacking cough While taking an ARB, patients need to avoid certain over-the-counter drugs without irst consulting the provider because: Both 1 and 2:
- Cimetidine is metabolized by the CYP3A4 isoenzymes
- Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels Laboratory monitoring for patients on ACE inhibitors or ARBs should include: Serum creatinine levels with the drug dosage reduced for values greater than 2.5 mg/dL Jacob has hypertension, for which a calcium channel blocker has been prescribed. This drug helps control blood pressure because it: Decreases the amount of calcium inside the cell Which of the following adverse effects may occur due to a dihydropyridine-type calcium channel blocker? Edema of the hands and feet Patient teaching related to amlodipine includes: Avoid grapefruit juice as it affects the metabolism of this drug. Vera, age 70, has isolated systolic hypertension. Calcium channel blocker dosages for her should be: Started at about half the usual dosage
Nitrate tolerance can develop. Art is a 55-year-old smoker who has been diagnosed with angina and placed on nitrates. He complains of headaches after using his nitrate. An appropriate reply might be: In teaching about the use of sublingual nitroglycerine, the patient should be instructed: To place one tablet under the tongue if chest pain occurs and allow it to dissolve Donald has been diagnosed with hyperlipidemia. Based on his lipid profile, atorvastatin is prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald should be told to: Report muscle weakness or tenderness and dark urine to his provider immediately. Which of the following diagnostic results would NOT indicate a problem related to a reductase inhibitor? Increased white blood cell count Because of the pattern of cholesterol synthesis, reductase inhibitors are given In the evening in a single daily dose Niaspan, an extended-release form of niacin, was previously prescribed to treat a patient's hypertriglycerides. However, the FDA withdrew its approval of the drug. Which of the following drugs with research efficacy should be substituted? 1 or 2:
- Statins
- Fibrates Niaspan is less likely to cause which side effect that is common to niacin? Cutaneous flushing
Dulcea has type 2 diabetes and a high triglyceride level. She has been prescribed gemfibrozil to treat her hypertriglyceridemia. A history of which of the following might contraindicate the use of this drug? Gallbladder disease Many patients with hyperlipidemia are treated with more than one drug. Combining a fibric acid derivative such as gemfibrozil with which of the following is not recommended? The drug and the reason must both be correct for the answer to be correct. Reductase inhibitors, due to an increased risk for rhabdomyolysis Felicity has been prescribed colestipol to treat her hyperlipidemia. Unlike other antilipidemics, this drug: Exchanges chloride ions for negatively charged acids in the bowel Because of their site of action, bile acid sequestering resins: Should be administered separately from other drugs by at least four hours Colestipol comes in a powdered form. The patient is taught to: Mix the powder with four to six ounces of milk or fruit juice The choice of diuretic to use in treating hypertension is based on: Level of kidney function with a thiazide diuretic being used for an estimated glomerular filtration rate higher than the mid-40 mL/min range Direct renin inhibitors have the following properties. They: "Shut down" the entire RAAS cycle When comparing ACE and ARB medications, which of the following holds true? Both contribute to some retention of potassium How is diabetic renal protection affected by ACE medications? Diabetes mellitus patients:
When considering which cholesterol-lowering drug to prescribe, which factor determines the type and intensity of treatment? Coronary artery disease risk level First-line therapy for hyperlipidemia is: Lifestyle changes James is a 45-year-old patient with a very high cardiovascular (CV) risk profile, an LDL level of 120, and normal triglycerides. Appropriate first-line therapy for James may include diet counseling, increased physical activity, and: A statin Joanne is a 60-year-old patient with an LDL of 132 and a family history of coronary artery disease. She has already tried diet changes (increasing fiber and plant sterols) to lower her LDL but after six months her LDL is slightly higher. The next step in her treatment would be: A statin Sharlene is a 65-year-old patient who has been on a lipid-lowering diet and using plant sterol margarine daily for the past three months. Her LDL is 135 mg/dL. An appropriate treatment for her would be: Determined by her risk factors Phil is a 54-year-old male with multiple risk factors who has been on a high-dose statin for three months to treat his high LDL level. His LDL is still higher than his goal and his triglycerides are elevated. A reasonable change in therapy would be to: Continue the statin and add in ezetimibe. Jamie is a 34-year-old pregnant woman with familial hyperlipidemia and elevated LDL levels. What is the appropriate treatment for a pregnant woman? Bile acid-binding resins
Han is a 48-year-old diabetic with hyperlipidemia and high triglycerides. His LDL is 112 mg/dL and he has not tolerated statins. He warrants a trial of a: Fibric acid derivative Jose is a 12-year-old overweight child with a total cholesterol of 180 mg/dL and LDL of 125 mg/dL. Along with diet education and recommending increased physical activity, a treatment plan for Jose would include ____________ with a re-evaluation in six months. Sterols Monitoring of a patient who is on a lipid-lowering drug includes: Lipid profile with attention to serum LDL 6 to 8 weeks after starting therapy, then again in six weeks Before starting therapy with a statin, the following baseline laboratory values should be evaluated: Liver function [alanine aminotransferase/aspartate aminotransferase (ALT/AST)] and creatine kinase When starting a patient on a statin, education would include: All of the above:
- If they stop the medication their lipid levels will return to pretreatment levels.
- Medication is a supplement to diet therapy and exercise.
- If they have any muscle aches or pain, they should contact their provider. Omega-3 fatty acids are best used to help treat: High triglycerides When are statins traditionally ordered to be taken? With the evening meal Which of the following patients should not have a statin medication ordered?
Deplete body sodium and reduce fluid volume Because of its action on various body systems, the patient taking a thiazide or loop diuretic may also need to take the following supplement: Potassium All patients with hypertension benefit from diuretic therapy, but those who benefit the most are: African Americans Beta blockers treat hypertension because they: Reduce peripheral resistance Which of the following disease processes could be made worse by taking a nonselective beta blocker? Both might worsen Disease states in addition to hypertension in which beta blockade has a compelling indication include: Myocardial infarction Angiotensin-converting enzyme (ACE) inhibitors treat hypertension because they: All of the above:
- Reduce sodium and water retention
- Decrease vasoconstriction
- Increase vasodilation Based on clinical trials, compelling indications for an ACE inhibitor as treatment for hypertension include: Renal parenchymal disease
An ACE inhibitor and what other class of drug may reduce proteinuria in patients with diabetes better than either drug alone? Nondihydropyridine calcium channel blockers If not chosen as the first drug in hypertension treatment, which drug class should be added as a second step because it will enhance the effects of most other agents? Diuretics Treatment costs are important for patients with hypertension. Which of the following statements about cost is NOT true? Few antihypertensive drugs come in generic formulations. Caffeine, exercise, and smoking should be avoided for at least how many minutes before blood pressure measurement? 30 Blood pressure checks in children: Should be done during every health-care visit after three years of age Lack of adherence to blood pressure management is very common. Reasons for this lack of adherence include: All of the above:
- Lifestyle changes are difficult to achieve and maintain.
- Adverse drug reactions.
- Costs of drugs and monitoring with laboratory tests can be expensive. Lifestyle modifications for patients with early hypertension include: Adopt the dietary approaches to stop hypertension (DASH) diet. Which diuretic agents typically do not need potassium supplementation? Aldosterone inhibitors
Acetaminophen, not to exceed 4 grams per day A patient had a deep vein thrombosis (DVT) and was on heparin and warfarin in the hospital and discharged home on warfarin. She asks her primary care nurse practitioner (NP) why she was getting both medications while in the hospital. The best response is to: Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness. The safest drug to use to treat pregnant women who require anticoagulant therapy is: Heparin The average starting dose of warfarin is 5 mg daily. Higher doses of 7.5 mg daily should be considered in which patients? Overweight or obese patients A patient is traveling to Southeast Asia on vacation and has come into the clinic to review their medications. They are healthy with only mild hypertension that is well controlled. They ask about getting "a shot" to prevent blood clots like their friend did before international travel. The correct response would be to: Explain that they are not at high risk of a blood clot and provide education about how to prevent blood clots while traveling. A 51-year-old male has been told by his PCP to take an aspirin a day. Why would this be recommended? Aspirin has antiplatelet activity and prevents clots that cause strokes A patient has been prescribed aspirin 320 mg per day for their atrial fibrillation. They also take aspirin four or more times a day for arthritis pain. What are the symptoms of aspirin toxicity for which they would need to be evaluated?
Tinnitus Patient education when prescribing clopidogrel includes: Do not take any herbal products without first discussing this with the provider. For patients taking warfarin, international normalized ratios (INRs) are best drawn: In the morning if the patient takes their warfarin at night Patients receiving heparin therapy require monitoring of: Platelets every two to three days for thrombocytopenia that may occur on day four of therapy The routine monitoring recommended for low-molecular-weight heparin is Factor Xa levels if the patient is pregnant When writing a prescription for warfarin it is common to write _________ on the prescription. The brand name of warfarin and "do not substitute" Education of patients who are taking warfarin includes discussing their diet. Instructions include: Avoid foods high in vitamin K. Patients who are being treated with epoetin alfa need to be monitored for the development of: Thrombocytopenia If a patient is taking darbepoetin alfa (Aranesp), their blood counts should be monitored to determine if a dosage adjustment is needed. How soon should this be done after starting the drug? Six weeks if they are a cancer patient A patient is having hip replacement surgery and would like to self-donate blood for the surgery. In addition to being prescribed epogen alfa he should also be prescribed: Iron, to start when the epogen starts
A patient has diarrhea and is wondering if they can take loperamide (Imodium). Loperamide: Slows gastric motility and reduces fluid and electrolyte loss from diarrhea Bismuth subsalicylate (Pepto-Bismol) is a common over-the-counter (OTC) remedy for gastrointestinal complaints. Bismuth subsalicylate: May cause stools to turn reddish color A young adult will be traveling to Mexico with her church group over spring break to build houses. She is concerned she may develop traveler's diarrhea. Advice includes following normal food and water precautions as well as taking: Bismuth subsalicylate before each meal and at bedtime A 15-year-old patient presents to the clinic with a 48-hour history of nausea, vomiting, and some diarrhea. She is unable to keep fluids down and her weight is four pounds less than her last recorded weight. Besides intravenous (IV) fluids, the exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order? Ondansetron (Zofran) A patient presents with complaints of heartburn that is minimally relieved with Tums (calcium carbonate) and is diagnosed as gastroesophageal reflux disease (GERD). An appropriate on- demand therapy would be: Ranitidine (Zantac) twice a day Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for: Iron deficiency anemia, vitamin B12 and calcium deficiency A 72-year-old patient takes omeprazole for their chronic GERD. Chronic long-term omeprazole use places them at increased risk for: Megaloblastic anemia
A 10-year-old patient presents with uncomfortable constipation. Along with diet changes, a laxative is ordered to provide more rapid relief of constipation. An appropriate choice of medication for a 10-year-old child would be: Bisacodyl (Dulcolax) suppository Methylnaltrexone is used to treat constipation in: Patients with opioid-associated constipation An elderly person has been prescribed lactulose for treatment of chronic constipation. Monitoring with long-term treatment would include: Electrolytes, including potassium and chloride Which of the following medications places a patient at increased risk of developing chronic kidney disease? Omeprazole Pernicious anemia is treated with: Vitamin B Premature infants require iron supplementation with: 2 mg/kg per day until age 12 months Breastfed infants should receive iron supplementation of: 1 mg/kg per day An adult female presents to the clinic with menorrhagia. Her hemoglobin is 10.2 and her ferritin is 15 ng/mL. Initial treatment for her anemia is: 325 mg ferrous sulfate tid A 15-month-old male has a screening hemoglobin of 10.4 g/dL. Treatment for anemia in toddlers is:
________ should be monitored when vitamin B12 therapy is started. Serum potassium Anemia due to chronic renal failure is treated with: Epoetin alfa (Epogen) Gastroesophageal reflux disease (GERD) may be aggravated by the following medication that affects lower esophageal sphincter (LES) tone: Estrogen Lifestyle changes are the first step in treatment of GERD. Food or drink that may aggravate GERD include: Caffeine Metoclopramide improves GERD symptoms by: Increasing lower esophageal tone Antacids treat GERD by: Increasing gastric pH A patient with mild GERD is started on _______ first. Histamine-2 receptor antagonists If a patient with symptoms of GERD states that he has been self-treating at home with over-the- counter (OTC) ranitidine daily, the appropriate treatment would be: PPI (omeprazole) for 12 weeks If a patient with GERD who is taking a PPI daily is not improving, the plan of care would be: PPI (omeprazole) twice a day for 4 to 8 weeks
The next step in treatment when a patient has been on PPIs twice daily for 12 weeks and not improving is: Refer the patient for endoscopy. Infants with reflux are initially treated with: Antireflux maneuvers (such as elevating the head of the bed) Long-term use of PPIs may lead to: Hip fractures in at-risk persons An acceptable first-line treatment for peptic ulcer disease with positive Helicobacter pylori ( H. pylori) test is: PPI bid plus clarithromycin plus amoxicillin for 14 days Treatment failure in patients with peptic ulcer disease associated with H. pylori may be because of: Antimicrobial resistance If a patient with H. pylori- positive peptic ulcer disease fails first-line therapy, the next step would be: A PPI b.i.d. plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days After H. pylori treatment is completed, the next step in peptic ulcer disease therapy is: A PPI for 8 to 12 weeks until healing is complete What would be the appropriate treatment for H. pylori in a patient who recently took azithromycin for "bronchitis"? Quadruple therapy with a PPI, bismuth, tetracycline, and metronidazole for 10 to 14 days When given subcutaneously, how long until neutral protamine Hagedorn (NPH) insulin begins to take effect (onset of action) after administration?
