NURS-6521N Advanced Pharmacology Week 11 Exam Study
Guide 2026-2027 Walden University Nursing Final Exam
Review Questions & Rationales
1) A male patient is considering finasteride (Proscar) for symptomatic BPH. When
counseling the patient, the nurse should include which important risk?
A. Fluid retention and edema
B. Increased risk of high-grade prostate cancer on biopsy
C. Significant orthostatic hypotension
D. Elevated liver enzymes
Correct Answer: B
Rationale: Finasteride (a 5-alpha reductase inhibitor) reduces overall prostate
cancer risk but is associated with a small increased risk of high-grade tumors if
cancer develops. Patients should be informed of this before starting therapy. PSA
levels are also reduced by approximately 50%, which must be considered during
screening.
2) All of the following systemic drugs can interfere with the effectiveness of
combined oral contraceptives except:
A. Rifampin
B. Carbamazepine
,C. Corticosteroids
D. Phenytoin
Correct Answer: C
Rationale: Rifampin, carbamazepine, and phenytoin are strong CYP3A4 inducers
that accelerate metabolism of hormonal contraceptives. Corticosteroids do not
significantly induce CYP enzymes and do not reduce contraceptive efficacy.
3) The first-line antibiotic for a previously healthy adult with community-acquired
pneumonia (no comorbidities, low CURB-65 score) is:
A. High-dose amoxicillin
B. Azithromycin
C. Levofloxacin
D. Doxycycline
Correct Answer: B
Rationale: Per 2024–2026 IDSA/ATS guidelines, macrolides such as azithromycin
remain first-line for healthy outpatients with CAP when atypical coverage is
desired. Doxycycline is an acceptable alternative in areas with high macrolide
resistance.
4) What is the best initial treatment approach for sleep disturbance in an older adult
patient?
A. Zolpidem 5 mg at bedtime
B. Decrease noise and light in the environment
C. Trazodone 50 mg at bedtime
, D. Melatonin 10 mg at bedtime
Correct Answer: B
Rationale: Nonpharmacologic interventions (sleep hygiene) are first-line in older
adults due to high risk of adverse effects from sedatives (falls, cognitive
impairment, delirium). The American Geriatrics Society Beers Criteria strongly
recommends avoiding benzodiazepines and Z-drugs in this population.
5) A patient receiving radioactive iodine (RAI) therapy for hyperthyroidism asks if
her breast milk is safe for her infant. If treatment cannot be postponed, the nurse
should recommend:
A. Continue breastfeeding normally
B. Pump and discard milk for 48 hours
C. Discard breast milk in a biohazard container
D. Switch to formula only after 7 days
Correct Answer: C
Rationale: Radioactive iodine is concentrated in breast milk and poses significant
risk to the infant’s thyroid. Breastfeeding must be discontinued and milk discarded
until radioactivity levels are safe (often several days to weeks depending on dose).
6) A Nurse Practitioner is educating a 50-year-old woman taking methotrexate
(MTX) for breast cancer. The patient should be instructed to avoid which of the
following?
A. Acetaminophen
B. Salicylates (aspirin)
Guide 2026-2027 Walden University Nursing Final Exam
Review Questions & Rationales
1) A male patient is considering finasteride (Proscar) for symptomatic BPH. When
counseling the patient, the nurse should include which important risk?
A. Fluid retention and edema
B. Increased risk of high-grade prostate cancer on biopsy
C. Significant orthostatic hypotension
D. Elevated liver enzymes
Correct Answer: B
Rationale: Finasteride (a 5-alpha reductase inhibitor) reduces overall prostate
cancer risk but is associated with a small increased risk of high-grade tumors if
cancer develops. Patients should be informed of this before starting therapy. PSA
levels are also reduced by approximately 50%, which must be considered during
screening.
2) All of the following systemic drugs can interfere with the effectiveness of
combined oral contraceptives except:
A. Rifampin
B. Carbamazepine
,C. Corticosteroids
D. Phenytoin
Correct Answer: C
Rationale: Rifampin, carbamazepine, and phenytoin are strong CYP3A4 inducers
that accelerate metabolism of hormonal contraceptives. Corticosteroids do not
significantly induce CYP enzymes and do not reduce contraceptive efficacy.
3) The first-line antibiotic for a previously healthy adult with community-acquired
pneumonia (no comorbidities, low CURB-65 score) is:
A. High-dose amoxicillin
B. Azithromycin
C. Levofloxacin
D. Doxycycline
Correct Answer: B
Rationale: Per 2024–2026 IDSA/ATS guidelines, macrolides such as azithromycin
remain first-line for healthy outpatients with CAP when atypical coverage is
desired. Doxycycline is an acceptable alternative in areas with high macrolide
resistance.
4) What is the best initial treatment approach for sleep disturbance in an older adult
patient?
A. Zolpidem 5 mg at bedtime
B. Decrease noise and light in the environment
C. Trazodone 50 mg at bedtime
, D. Melatonin 10 mg at bedtime
Correct Answer: B
Rationale: Nonpharmacologic interventions (sleep hygiene) are first-line in older
adults due to high risk of adverse effects from sedatives (falls, cognitive
impairment, delirium). The American Geriatrics Society Beers Criteria strongly
recommends avoiding benzodiazepines and Z-drugs in this population.
5) A patient receiving radioactive iodine (RAI) therapy for hyperthyroidism asks if
her breast milk is safe for her infant. If treatment cannot be postponed, the nurse
should recommend:
A. Continue breastfeeding normally
B. Pump and discard milk for 48 hours
C. Discard breast milk in a biohazard container
D. Switch to formula only after 7 days
Correct Answer: C
Rationale: Radioactive iodine is concentrated in breast milk and poses significant
risk to the infant’s thyroid. Breastfeeding must be discontinued and milk discarded
until radioactivity levels are safe (often several days to weeks depending on dose).
6) A Nurse Practitioner is educating a 50-year-old woman taking methotrexate
(MTX) for breast cancer. The patient should be instructed to avoid which of the
following?
A. Acetaminophen
B. Salicylates (aspirin)
