NURS 6521N Advanced Pharmacology Midterm Exam - Multiple
Choice Questions with Explanations (Latest Update)
|| Walden University - 198 Questions and Answers Already
Graded A+ Premium Exam Tested And Verified
Subject Area Advanced Pharmacology
Description This midterm exam assesses advanced pharmacological principles including
pharmacokinetics/pharmacodynamics, drug interactions, adverse effects, and
therapeutic decision-making across major drug classes. Emphasis is on
evidence-based prescribing and safety monitoring.
Expected Grade A+
Total Questions 198
Duration 3 hours
Learning Outcomes 1. Analyze pharmacokinetic and pharmacodynamic factors influencing drug
response across populations.
2. Evaluate drug-drug interactions and adverse effects to optimize therapeutic
regimens.
3. Apply current guidelines to select appropriate pharmacotherapy for complex
clinical scenarios.
Accreditation Meets AACN and CCNE standards for graduate nursing pharmacology education.
Page 1
,1. A 45-year-old patient with type 2 diabetes and stage 3 chronic kidney disease
(eGFR 45 mL/min) is prescribed metformin. Which of the following best describes
the primary concern regarding metformin use in this patient?
A. Increased risk of lactic acidosis due to reduced renal clearance of metformin
B. Enhanced hypoglycemic effect requiring dose reduction of insulin
C. Potential for metformin to cause acute kidney injury via tubular toxicity
D. Reduced efficacy of metformin due to impaired drug absorption in uremia
Answer: A. Increased risk of lactic acidosis due to reduced renal clearance of
metformin
Metformin is contraindicated when eGFR <30 mL/min and used with caution when
eGFR 30-45 mL/min due to risk of lactic acidosis from drug accumulation. Renal
impairment reduces clearance, increasing plasma levels. Option B is less specific;
hypoglycemia risk is present but not the primary concern. Option C is incorrect;
metformin does not directly cause AKI. Option D is incorrect; absorption is not
significantly affected.
2. A patient on warfarin for atrial fibrillation is started on amiodarone for rhythm
control. The INR increases from 2.5 to 7.2 within one week. Which mechanism best
explains this interaction?
A. Amiodarone inhibits CYP2C9, decreasing warfarin metabolism
B. Amiodarone displaces warfarin from albumin binding sites
C. Amiodarone enhances warfarin absorption from the gut
D. Amiodarone inhibits vitamin K epoxide reductase synergistically
Answer: A. Amiodarone inhibits CYP2C9, decreasing warfarin metabolism
Amiodarone is a potent inhibitor of CYP2C9, the primary enzyme metabolizing
S-warfarin, leading to increased warfarin levels and INR. Option B is a minor
mechanism but not primary. Option C is incorrect; amiodarone does not affect
absorption. Option D is incorrect; amiodarone does not directly inhibit VKOR.
Page 2
,3. A patient with hypertension and hyperlipidemia is started on atorvastatin. Which
of the following best describes the rationale for monitoring liver function tests
(LFTs) during therapy?
A. Statins commonly cause irreversible hepatotoxicity requiring early detection
B. Elevated transaminases indicate statin-induced muscle injury
C. Baseline and periodic LFTs are recommended to detect rare but serious hepatic reactions
D. LFT monitoring is required to adjust statin dose based on hepatic clearance
Answer: C. Baseline and periodic LFTs are recommended to detect rare but
serious hepatic reactions
Current guidelines recommend baseline LFTs and repeat if symptoms develop, as
statin-induced liver injury is rare but can be serious. Option A overstates risk;
irreversible hepatotoxicity is uncommon. Option B is incorrect; muscle injury is
monitored by CK. Option D is incorrect; dose adjustment is not based on LFTs.
4. A patient with heart failure with reduced ejection fraction (HFrEF) is on
lisinopril, metoprolol succinate, and furosemide. The patient develops hyperkalemia
(K+ 5.8 mEq/L). Which medication is most likely contributing?
A. Lisinopril
B. Metoprolol succinate
C. Furosemide
D. Combination of all three
Answer: A. Lisinopril
ACE inhibitors (lisinopril) reduce aldosterone production, leading to decreased
potassium excretion and hyperkalemia. Metoprolol can cause mild hyperkalemia but
less significant. Furosemide causes hypokalemia. Thus lisinopril is the most likely
culprit.
Page 3
, 5. A patient with generalized anxiety disorder is prescribed buspirone. Which
statement best describes the advantage of buspirone over benzodiazepines?
A. Buspirone has a faster onset of anxiolytic effect
B. Buspirone lacks abuse potential and sedation
C. Buspirone is effective for panic disorder
D. Buspirone can be used as-needed for acute anxiety
Answer: B. Buspirone lacks abuse potential and sedation
Buspirone is non-sedating and has no significant abuse potential, unlike
benzodiazepines. It has a delayed onset (2-4 weeks) and is not effective for acute anxiety
or panic disorder. Options A, C, and D are incorrect.
6. A patient with severe pain from metastatic cancer is being switched from oral
morphine to fentanyl transdermal patch. Which conversion consideration is most
critical?
A. Fentanyl patch provides rapid onset of analgesia within 30 minutes
B. The patient must be opioid-tolerant before starting fentanyl patch
C. Fentanyl patch is equivalent to morphine in a 1:1 ratio
D. The patch should be applied to a hairy area for better absorption
Answer: B. The patient must be opioid-tolerant before starting fentanyl patch
Fentanyl patches are indicated only for opioid-tolerant patients due to risk of
respiratory depression in opioid-naive individuals. Onset is delayed (12-18 hours).
Conversion ratios are not 1:1; fentanyl is ~100 times more potent. The patch should be
applied to non-hairy, intact skin.
7. A patient with a history of peptic ulcer disease requires long-term NSAID therapy
for osteoarthritis. Which prophylactic strategy is most appropriate?
A. Concurrent use of misoprostol or a proton pump inhibitor (PPI)
B. Use of enteric-coated NSAIDs to reduce gastric irritation
C. Addition of an H2 receptor antagonist at bedtime
D. Switching to acetaminophen as a safer alternative
Answer: A. Concurrent use of misoprostol or a proton pump inhibitor (PPI)
Misoprostol or PPIs are recommended to prevent NSAID-induced gastric ulcers in
high-risk patients. Enteric coating does not prevent systemic prostaglandin inhibition.
H2RAs are less effective for ulcer prevention. Acetaminophen is an alternative but not a
prophylactic strategy for NSAID therapy.
Page 4
Choice Questions with Explanations (Latest Update)
|| Walden University - 198 Questions and Answers Already
Graded A+ Premium Exam Tested And Verified
Subject Area Advanced Pharmacology
Description This midterm exam assesses advanced pharmacological principles including
pharmacokinetics/pharmacodynamics, drug interactions, adverse effects, and
therapeutic decision-making across major drug classes. Emphasis is on
evidence-based prescribing and safety monitoring.
Expected Grade A+
Total Questions 198
Duration 3 hours
Learning Outcomes 1. Analyze pharmacokinetic and pharmacodynamic factors influencing drug
response across populations.
2. Evaluate drug-drug interactions and adverse effects to optimize therapeutic
regimens.
3. Apply current guidelines to select appropriate pharmacotherapy for complex
clinical scenarios.
Accreditation Meets AACN and CCNE standards for graduate nursing pharmacology education.
Page 1
,1. A 45-year-old patient with type 2 diabetes and stage 3 chronic kidney disease
(eGFR 45 mL/min) is prescribed metformin. Which of the following best describes
the primary concern regarding metformin use in this patient?
A. Increased risk of lactic acidosis due to reduced renal clearance of metformin
B. Enhanced hypoglycemic effect requiring dose reduction of insulin
C. Potential for metformin to cause acute kidney injury via tubular toxicity
D. Reduced efficacy of metformin due to impaired drug absorption in uremia
Answer: A. Increased risk of lactic acidosis due to reduced renal clearance of
metformin
Metformin is contraindicated when eGFR <30 mL/min and used with caution when
eGFR 30-45 mL/min due to risk of lactic acidosis from drug accumulation. Renal
impairment reduces clearance, increasing plasma levels. Option B is less specific;
hypoglycemia risk is present but not the primary concern. Option C is incorrect;
metformin does not directly cause AKI. Option D is incorrect; absorption is not
significantly affected.
2. A patient on warfarin for atrial fibrillation is started on amiodarone for rhythm
control. The INR increases from 2.5 to 7.2 within one week. Which mechanism best
explains this interaction?
A. Amiodarone inhibits CYP2C9, decreasing warfarin metabolism
B. Amiodarone displaces warfarin from albumin binding sites
C. Amiodarone enhances warfarin absorption from the gut
D. Amiodarone inhibits vitamin K epoxide reductase synergistically
Answer: A. Amiodarone inhibits CYP2C9, decreasing warfarin metabolism
Amiodarone is a potent inhibitor of CYP2C9, the primary enzyme metabolizing
S-warfarin, leading to increased warfarin levels and INR. Option B is a minor
mechanism but not primary. Option C is incorrect; amiodarone does not affect
absorption. Option D is incorrect; amiodarone does not directly inhibit VKOR.
Page 2
,3. A patient with hypertension and hyperlipidemia is started on atorvastatin. Which
of the following best describes the rationale for monitoring liver function tests
(LFTs) during therapy?
A. Statins commonly cause irreversible hepatotoxicity requiring early detection
B. Elevated transaminases indicate statin-induced muscle injury
C. Baseline and periodic LFTs are recommended to detect rare but serious hepatic reactions
D. LFT monitoring is required to adjust statin dose based on hepatic clearance
Answer: C. Baseline and periodic LFTs are recommended to detect rare but
serious hepatic reactions
Current guidelines recommend baseline LFTs and repeat if symptoms develop, as
statin-induced liver injury is rare but can be serious. Option A overstates risk;
irreversible hepatotoxicity is uncommon. Option B is incorrect; muscle injury is
monitored by CK. Option D is incorrect; dose adjustment is not based on LFTs.
4. A patient with heart failure with reduced ejection fraction (HFrEF) is on
lisinopril, metoprolol succinate, and furosemide. The patient develops hyperkalemia
(K+ 5.8 mEq/L). Which medication is most likely contributing?
A. Lisinopril
B. Metoprolol succinate
C. Furosemide
D. Combination of all three
Answer: A. Lisinopril
ACE inhibitors (lisinopril) reduce aldosterone production, leading to decreased
potassium excretion and hyperkalemia. Metoprolol can cause mild hyperkalemia but
less significant. Furosemide causes hypokalemia. Thus lisinopril is the most likely
culprit.
Page 3
, 5. A patient with generalized anxiety disorder is prescribed buspirone. Which
statement best describes the advantage of buspirone over benzodiazepines?
A. Buspirone has a faster onset of anxiolytic effect
B. Buspirone lacks abuse potential and sedation
C. Buspirone is effective for panic disorder
D. Buspirone can be used as-needed for acute anxiety
Answer: B. Buspirone lacks abuse potential and sedation
Buspirone is non-sedating and has no significant abuse potential, unlike
benzodiazepines. It has a delayed onset (2-4 weeks) and is not effective for acute anxiety
or panic disorder. Options A, C, and D are incorrect.
6. A patient with severe pain from metastatic cancer is being switched from oral
morphine to fentanyl transdermal patch. Which conversion consideration is most
critical?
A. Fentanyl patch provides rapid onset of analgesia within 30 minutes
B. The patient must be opioid-tolerant before starting fentanyl patch
C. Fentanyl patch is equivalent to morphine in a 1:1 ratio
D. The patch should be applied to a hairy area for better absorption
Answer: B. The patient must be opioid-tolerant before starting fentanyl patch
Fentanyl patches are indicated only for opioid-tolerant patients due to risk of
respiratory depression in opioid-naive individuals. Onset is delayed (12-18 hours).
Conversion ratios are not 1:1; fentanyl is ~100 times more potent. The patch should be
applied to non-hairy, intact skin.
7. A patient with a history of peptic ulcer disease requires long-term NSAID therapy
for osteoarthritis. Which prophylactic strategy is most appropriate?
A. Concurrent use of misoprostol or a proton pump inhibitor (PPI)
B. Use of enteric-coated NSAIDs to reduce gastric irritation
C. Addition of an H2 receptor antagonist at bedtime
D. Switching to acetaminophen as a safer alternative
Answer: A. Concurrent use of misoprostol or a proton pump inhibitor (PPI)
Misoprostol or PPIs are recommended to prevent NSAID-induced gastric ulcers in
high-risk patients. Enteric coating does not prevent systemic prostaglandin inhibition.
H2RAs are less effective for ulcer prevention. Acetaminophen is an alternative but not a
prophylactic strategy for NSAID therapy.
Page 4
