NUR612/NUR612 Final Exam V3 | Advance
Pharmacology Q&A with Rationale |
William Paterson University
1. Which of the following describes the ‘first-pass effect’ in pharmacokinetics?
A. The initial metabolism in the liver of a drug absorbed from the gastrointestinal tract.
B. The rapid excretion of a drug by the kidneys after the first dose.
C. The distribution of a drug to the brain across the blood-brain barrier.
D. The binding of a drug to plasma proteins during its first circulation.
Answer: A
Rationale: The first-pass effect occurs when a drug is metabolized by the liver before it
reaches the systemic circulation. This process significantly reduces the bioavailability of
many oral medications. Consequently, higher oral doses or alternative routes of
administration may be necessary for certain drugs.
2. A patient is prescribed an ACE inhibitor for hypertension. Which side effect should the
nurse practitioner monitor for most closely?
A. Hypokalemia
B. Hypernatremia
C. Tachycardia
D. Dry, non-productive cough
,Answer: D
Rationale: A dry, persistent cough is a common side effect of ACE inhibitors caused by the
accumulation of bradykinin in the lungs. While not usually dangerous, it often leads to
patient non-compliance and may require a switch to an ARB. This effect is specific to ACE
inhibitors and does not occur with most other antihypertensive classes.
3. What is the primary mechanism of action for Metformin in the treatment of Type 2
Diabetes?
A. Stimulating insulin secretion from pancreatic beta cells.
B. Delaying the absorption of carbohydrates in the small intestine.
C. Decreasing hepatic glucose production and improving insulin sensitivity.
D. Increasing glucose excretion through the kidneys.
Answer: C
Rationale: Metformin primarily works by inhibiting gluconeogenesis in the liver and
enhancing peripheral glucose uptake. Unlike sulfonylureas, it does not stimulate insulin
secretion and therefore has a low risk of causing hypoglycemia. It is considered first-line
therapy for most patients with Type 2 Diabetes.
4. A patient on Warfarin therapy has an INR of 7.0 but shows no signs of bleeding. What is the
recommended intervention?
A. Hold Warfarin and consider administering Vitamin K.
B. Administer 10 units of Heparin immediately.
, C. Double the next dose of Warfarin to stabilize levels.
D. Perform an emergency blood transfusion.
Answer: A
Rationale: An INR of 7.0 indicates a high risk of bleeding, and the standard protocol
involves holding the medication to allow the INR to drop. Vitamin K acts as the specific
antagonist to reverse the effects of Warfarin if necessary. The provider must closely
monitor the patient for any signs of internal or external hemorrhage during this period.
5. Which antibiotic class is associated with a risk of tendon rupture, particularly in the Achilles
tendon?
A. Penicillins
B. Cephalosporins
C. Macrolides
D. Fluoroquinolones
Answer: D
Rationale: Fluoroquinolones like Ciprofloxacin and Levofloxacin carry a black box warning
for tendonitis and tendon rupture. This risk is increased in elderly patients, those taking
corticosteroids, or patients with organ transplants. Patients should be advised to stop the
medication and seek medical attention if they experience tendon pain or swelling.
Pharmacology Q&A with Rationale |
William Paterson University
1. Which of the following describes the ‘first-pass effect’ in pharmacokinetics?
A. The initial metabolism in the liver of a drug absorbed from the gastrointestinal tract.
B. The rapid excretion of a drug by the kidneys after the first dose.
C. The distribution of a drug to the brain across the blood-brain barrier.
D. The binding of a drug to plasma proteins during its first circulation.
Answer: A
Rationale: The first-pass effect occurs when a drug is metabolized by the liver before it
reaches the systemic circulation. This process significantly reduces the bioavailability of
many oral medications. Consequently, higher oral doses or alternative routes of
administration may be necessary for certain drugs.
2. A patient is prescribed an ACE inhibitor for hypertension. Which side effect should the
nurse practitioner monitor for most closely?
A. Hypokalemia
B. Hypernatremia
C. Tachycardia
D. Dry, non-productive cough
,Answer: D
Rationale: A dry, persistent cough is a common side effect of ACE inhibitors caused by the
accumulation of bradykinin in the lungs. While not usually dangerous, it often leads to
patient non-compliance and may require a switch to an ARB. This effect is specific to ACE
inhibitors and does not occur with most other antihypertensive classes.
3. What is the primary mechanism of action for Metformin in the treatment of Type 2
Diabetes?
A. Stimulating insulin secretion from pancreatic beta cells.
B. Delaying the absorption of carbohydrates in the small intestine.
C. Decreasing hepatic glucose production and improving insulin sensitivity.
D. Increasing glucose excretion through the kidneys.
Answer: C
Rationale: Metformin primarily works by inhibiting gluconeogenesis in the liver and
enhancing peripheral glucose uptake. Unlike sulfonylureas, it does not stimulate insulin
secretion and therefore has a low risk of causing hypoglycemia. It is considered first-line
therapy for most patients with Type 2 Diabetes.
4. A patient on Warfarin therapy has an INR of 7.0 but shows no signs of bleeding. What is the
recommended intervention?
A. Hold Warfarin and consider administering Vitamin K.
B. Administer 10 units of Heparin immediately.
, C. Double the next dose of Warfarin to stabilize levels.
D. Perform an emergency blood transfusion.
Answer: A
Rationale: An INR of 7.0 indicates a high risk of bleeding, and the standard protocol
involves holding the medication to allow the INR to drop. Vitamin K acts as the specific
antagonist to reverse the effects of Warfarin if necessary. The provider must closely
monitor the patient for any signs of internal or external hemorrhage during this period.
5. Which antibiotic class is associated with a risk of tendon rupture, particularly in the Achilles
tendon?
A. Penicillins
B. Cephalosporins
C. Macrolides
D. Fluoroquinolones
Answer: D
Rationale: Fluoroquinolones like Ciprofloxacin and Levofloxacin carry a black box warning
for tendonitis and tendon rupture. This risk is increased in elderly patients, those taking
corticosteroids, or patients with organ transplants. Patients should be advised to stop the
medication and seek medical attention if they experience tendon pain or swelling.
