NR 567 Exam 4 V2 | NR 567 Advanced
Pharmacology for the AGACNP | Actual
Q&A with Rationale (NR567 Exam 4) |
Chamberlain College of Nursing
1. When prescribing aminoglycosides such as gentamicin, the AGACNP must be aware of
specific toxicities and monitoring requirements. Which of the following are known adverse
effects of this class? (Select all that apply)
A. Ototoxicity
B. Nephrotoxicity
C. Neuromuscular blockade
D. Hepatotoxicity
E. Hypokalemia
F. Stevens-Johnson Syndrome
Answer: ABC
Rationale: Aminoglycosides are associated with serious dose-related toxicities including
damage to the eighth cranial nerve and renal tubular necrosis. Ototoxicity may be
irreversible, while nephrotoxicity is often reversible if caught early through serum creatinine
monitoring. Additionally, these agents can cause neuromuscular blockade, particularly in
patients with myasthenia gravis or those receiving neuromuscular blockers.
,2. A patient receiving doxorubicin for breast cancer is at risk for developing which specific long-
term complication?
A. Pulmonary fibrosis
B. Cardiotoxicity
C. Hemorrhagic cystitis
D. Ototoxicity
Answer: B
Rationale: Doxorubicin belongs to the anthracycline class and is well-known for causing
cumulative dose-related cardiomyopathy. This risk necessitates baseline and periodic
evaluation of the left ventricular ejection fraction via MUGA scans or echocardiograms.
Providers must monitor the total lifetime dose to prevent irreversible heart failure.
3. Which of the following medications is used to reduce the risk of hemorrhagic cystitis in
patients receiving high-dose cyclophosphamide?
A. Leucovorin
B. Dexrazoxane
C. Mesna
D. Filgrastim
Answer: C
, Rationale: Mesna is a chemoprotectant that binds to acrolein, a toxic metabolite of
cyclophosphamide and ifosfamide that irritates the bladder lining. By neutralizing acrolein in
the urine, Mesna effectively prevents hemorrhagic cystitis. Aggressive hydration is also
required alongside Mesna administration to ensure adequate urinary output.
4. A patient on warfarin therapy presents with an INR of 10 and no signs of bleeding. Which of
the following is the most appropriate management?
A. Administer Protamine sulfate intravenously
B. Hold warfarin and administer Vitamin K (Phytonadione) orally
C. Administer Fresh Frozen Plasma (FFP) immediately
D. Continue current warfarin dose and recheck INR in 24 hours
Answer: B
Rationale: For a very high INR without bleeding, the standard approach is to hold warfarin
and provide oral Vitamin K to facilitate the synthesis of clotting factors. Oral Vitamin K is
preferred over subcutaneous or intramuscular routes due to more predictable absorption and
lower risk of anaphylaxis. If life-threatening bleeding were present, IV Vitamin K and
prothrombin complex concentrates would be indicated.
5. Methotrexate toxicity can be mitigated by ‘rescuing’ normal cells with which of the following
agents?
A. Glucarpidase
B. Leucovorin (Folinic Acid)
Pharmacology for the AGACNP | Actual
Q&A with Rationale (NR567 Exam 4) |
Chamberlain College of Nursing
1. When prescribing aminoglycosides such as gentamicin, the AGACNP must be aware of
specific toxicities and monitoring requirements. Which of the following are known adverse
effects of this class? (Select all that apply)
A. Ototoxicity
B. Nephrotoxicity
C. Neuromuscular blockade
D. Hepatotoxicity
E. Hypokalemia
F. Stevens-Johnson Syndrome
Answer: ABC
Rationale: Aminoglycosides are associated with serious dose-related toxicities including
damage to the eighth cranial nerve and renal tubular necrosis. Ototoxicity may be
irreversible, while nephrotoxicity is often reversible if caught early through serum creatinine
monitoring. Additionally, these agents can cause neuromuscular blockade, particularly in
patients with myasthenia gravis or those receiving neuromuscular blockers.
,2. A patient receiving doxorubicin for breast cancer is at risk for developing which specific long-
term complication?
A. Pulmonary fibrosis
B. Cardiotoxicity
C. Hemorrhagic cystitis
D. Ototoxicity
Answer: B
Rationale: Doxorubicin belongs to the anthracycline class and is well-known for causing
cumulative dose-related cardiomyopathy. This risk necessitates baseline and periodic
evaluation of the left ventricular ejection fraction via MUGA scans or echocardiograms.
Providers must monitor the total lifetime dose to prevent irreversible heart failure.
3. Which of the following medications is used to reduce the risk of hemorrhagic cystitis in
patients receiving high-dose cyclophosphamide?
A. Leucovorin
B. Dexrazoxane
C. Mesna
D. Filgrastim
Answer: C
, Rationale: Mesna is a chemoprotectant that binds to acrolein, a toxic metabolite of
cyclophosphamide and ifosfamide that irritates the bladder lining. By neutralizing acrolein in
the urine, Mesna effectively prevents hemorrhagic cystitis. Aggressive hydration is also
required alongside Mesna administration to ensure adequate urinary output.
4. A patient on warfarin therapy presents with an INR of 10 and no signs of bleeding. Which of
the following is the most appropriate management?
A. Administer Protamine sulfate intravenously
B. Hold warfarin and administer Vitamin K (Phytonadione) orally
C. Administer Fresh Frozen Plasma (FFP) immediately
D. Continue current warfarin dose and recheck INR in 24 hours
Answer: B
Rationale: For a very high INR without bleeding, the standard approach is to hold warfarin
and provide oral Vitamin K to facilitate the synthesis of clotting factors. Oral Vitamin K is
preferred over subcutaneous or intramuscular routes due to more predictable absorption and
lower risk of anaphylaxis. If life-threatening bleeding were present, IV Vitamin K and
prothrombin complex concentrates would be indicated.
5. Methotrexate toxicity can be mitigated by ‘rescuing’ normal cells with which of the following
agents?
A. Glucarpidase
B. Leucovorin (Folinic Acid)
