NURS 5334 ADVANCED
PHARMACOLOGY FINAL EXAM
QUESTIONS AND ANSWERS
1. A patient with chronic kidney disease (Stage 4) requires an anticoagulant for atrial
fibrillation. Which of the following is the most appropriate choice considering renal
clearance?
A. Dabigatran
B. Rivaroxaban
C. Edoxaban
D. Warfarin
Answer: D
Conceptual Explanation: Warfarin is primarily metabolized by the liver (CYP450) and is
not significantly cleared by the kidneys, making it safer for advanced CKD compared to
DOACs which have high renal excretion percentages.
2. When prescribing an ACE inhibitor to a patient with diabetes, what is the primary
physiological mechanism that provides nephroprotection?
A. Dilation of the afferent arteriole
,B. Constriction of the efferent arteriole
C. Inhibition of sodium-potassium ATPase
D. Dilation of the efferent arteriole
Answer: D
Conceptual Explanation: ACE inhibitors dilate the efferent arteriole, which decreases
intraglomerular pressure, thereby slowing the progression of diabetic nephropathy.
3. A 65-year-old male is started on Amiodarone for refractory ventricular tachycardia. Which
monitoring parameter is essential due to the drug’s long-term side effect profile?
A. Pulmonary function tests
B. Serial echocardiograms
C. Annual hearing tests
D. Serum calcium levels
Answer: A
Conceptual Explanation: Amiodarone can cause pulmonary toxicity (interstitial lung
disease/fibrosis), necessitating baseline and periodic pulmonary function tests and chest X-
rays.
4. Which mechanism best explains why Methotrexate is effective in treating Rheumatoid
Arthritis?
A. Antagonism of TNF-alpha receptors
, B. Inhibition of dihydrofolate reductase
C. Inhibition of cyclooxygenase-2
D. Activation of adenosine receptors
Answer: B
Conceptual Explanation: Methotrexate is a folate antimetabolite that inhibits
dihydrofolate reductase, leading to inhibition of DNA synthesis and cell proliferation in
immune cells.
5. A patient is diagnosed with Clostridioides difficile infection (CDI). According to current
clinical guidelines, which is the first-line oral treatment for a first episode?
A. Fidaxomicin
B. Ciprofloxacin
C. Metronidazole
D. Doxycycline
Answer: A
Conceptual Explanation: Current IDSA guidelines recommend Fidaxomicin or
Vancomycin as first-line therapy for CDI; Metronidazole is no longer preferred for initial
episodes due to lower efficacy.
PHARMACOLOGY FINAL EXAM
QUESTIONS AND ANSWERS
1. A patient with chronic kidney disease (Stage 4) requires an anticoagulant for atrial
fibrillation. Which of the following is the most appropriate choice considering renal
clearance?
A. Dabigatran
B. Rivaroxaban
C. Edoxaban
D. Warfarin
Answer: D
Conceptual Explanation: Warfarin is primarily metabolized by the liver (CYP450) and is
not significantly cleared by the kidneys, making it safer for advanced CKD compared to
DOACs which have high renal excretion percentages.
2. When prescribing an ACE inhibitor to a patient with diabetes, what is the primary
physiological mechanism that provides nephroprotection?
A. Dilation of the afferent arteriole
,B. Constriction of the efferent arteriole
C. Inhibition of sodium-potassium ATPase
D. Dilation of the efferent arteriole
Answer: D
Conceptual Explanation: ACE inhibitors dilate the efferent arteriole, which decreases
intraglomerular pressure, thereby slowing the progression of diabetic nephropathy.
3. A 65-year-old male is started on Amiodarone for refractory ventricular tachycardia. Which
monitoring parameter is essential due to the drug’s long-term side effect profile?
A. Pulmonary function tests
B. Serial echocardiograms
C. Annual hearing tests
D. Serum calcium levels
Answer: A
Conceptual Explanation: Amiodarone can cause pulmonary toxicity (interstitial lung
disease/fibrosis), necessitating baseline and periodic pulmonary function tests and chest X-
rays.
4. Which mechanism best explains why Methotrexate is effective in treating Rheumatoid
Arthritis?
A. Antagonism of TNF-alpha receptors
, B. Inhibition of dihydrofolate reductase
C. Inhibition of cyclooxygenase-2
D. Activation of adenosine receptors
Answer: B
Conceptual Explanation: Methotrexate is a folate antimetabolite that inhibits
dihydrofolate reductase, leading to inhibition of DNA synthesis and cell proliferation in
immune cells.
5. A patient is diagnosed with Clostridioides difficile infection (CDI). According to current
clinical guidelines, which is the first-line oral treatment for a first episode?
A. Fidaxomicin
B. Ciprofloxacin
C. Metronidazole
D. Doxycycline
Answer: A
Conceptual Explanation: Current IDSA guidelines recommend Fidaxomicin or
Vancomycin as first-line therapy for CDI; Metronidazole is no longer preferred for initial
episodes due to lower efficacy.
