NUR 6011 Exam 3 Actual Exam V1 | NUR 6011 Advance Pharmacology
(NUR6011 Exam 3) | William Paterson University
1. A 65-year-old patient with atrial fibrillation is being started on warfarin. Which of the
following cytochrome P450 enzymes is primarily responsible for the metabolism of the S-
enantiomer of warfarin?
A. CYP2D6
B. CYP3A4
C. CYP2C9
D. CYP1A2
Answer: C
Rationale: The S-enantiomer of warfarin is 3 to 5 times more potent than the R-
enantiomer and is primarily metabolized by the CYP2C9 enzyme. Genetic polymorphisms
in CYP2C9 can significantly affect a patient’s sensitivity to warfarin and their required
maintenance dose. Understanding this metabolic pathway is crucial for predicting potential
drug-drug interactions with inhibitors like amiodarone.
2. Which clinical monitoring parameter is most critical for a patient receiving long-term
amiodarone therapy for ventricular arrhythmias?
A. Pulmonary function tests and thyroid function tests
B. Serum calcium levels every 3 months
C. Daily blood glucose monitoring
D. Weekly complete blood counts
Answer: A
Rationale: Amiodarone is associated with significant organ toxicities, most notably
pulmonary fibrosis and thyroid dysfunction due to its high iodine content. Advanced
practice nurses must monitor baseline and periodic pulmonary function tests and chest X-
rays to detect early interstitial lung disease. Additionally, because amiodarone can cause
both hyperthyroidism and hypothyroidism, thyroid-stimulating hormone (TSH) must be
monitored regularly.
3. A patient with Type 2 Diabetes and a history of heart failure with reduced ejection fraction
(HFrEF) requires intensification of therapy. Which medication class has shown significant
benefit in reducing heart failure hospitalizations?
A. DPP-4 inhibitors
B. SGLT2 inhibitors
,C. Sulfonylureas
D. Thiazolidinediones
Answer: B
Rationale: SGLT2 inhibitors, such as empagliflozin and dapagliflozin, have demonstrated
clear cardiovascular benefits in patients with HFrEF, regardless of diabetes status. These
agents promote osmotic diuresis and natriuresis, which reduces preload and afterload on
the heart. Conversely, thiazolidinediones should be avoided in this population as they can
cause fluid retention and exacerbate heart failure symptoms.
4. A 45-year-old female patient is prescribed lisinopril for hypertension. She develops a dry,
persistent cough. What is the physiological mechanism behind this adverse effect?
A. Increased production of angiotensin II
B. Direct irritation of the bronchial mucosa by the drug
C. Accumulation of bradykinin in the upper airways
D. Activation of the sympathetic nervous system
Answer: C
Rationale: ACE inhibitors prevent the breakdown of bradykinin and substance P, leading
to their accumulation in the respiratory tract. This accumulation triggers the sensory fibers
that produce the characteristic dry, non-productive cough. If the cough becomes
intolerable, the provider should consider switching the patient to an Angiotensin II
Receptor Blocker (ARB), which does not affect bradykinin metabolism.
5. When prescribing an HMG-CoA reductase inhibitor (statin), which of the following baseline
laboratory tests is required according to current guidelines?
A. Creatine kinase (CK) in all patients
B. Serum creatinine and GFR
C. Alanine aminotransferase (ALT)
D. Baseline bone density scan
Answer: C
Rationale: Current guidelines recommend obtaining a baseline ALT level prior to initiating
statin therapy to assess hepatic function. While routine periodic monitoring of LFTs is no
longer mandatory unless symptoms of hepatotoxicity occur, the baseline value is essential
for comparison. Creatine kinase is only recommended at baseline for patients at high risk
for muscle complications or those with a personal history of statin intolerance.
, 6. An elderly patient is being treated for chronic pain with an opioid analgesic. Which side
effect should the clinician anticipate and treat preemptively?
A. Diarrhea
B. Constipation
C. Tachycardia
D. Hypertension
Answer: B
Rationale: Opioid-induced constipation (OIC) is a nearly universal side effect because
tolerance to the mu-opioid receptor effects in the gastrointestinal tract does not develop
over time. Unlike respiratory depression or sedation, which may improve as the patient
adapts to the dose, constipation persists. Clinicians should initiate a bowel regimen,
typically involving a stimulant laxative or an osmotic agent, at the same time the opioid is
started.
7. A patient is prescribed sildenafil for erectile dysfunction. Which medication is absolutely
contraindicated due to the risk of life-threatening hypotension?
A. Amlodipine
B. Isosorbide mononitrate
C. Metoprolol
D. Atorvastatin
Answer: B
Rationale: Sildenafil is a PDE-5 inhibitor that enhances the effects of nitric oxide, leading
to vasodilation. Nitrates, such as isosorbide mononitrate or nitroglycerin, also increase
cyclic GMP levels, and the combination can lead to synergistic vasodilation and profound,
refractory hypotension. Patients must be counseled to wait at least 24 hours (or longer for
tadalafil) after taking a PDE-5 inhibitor before using any nitrate product.
8. In a patient with chronic kidney disease (CKD) and an eGFR of 25 mL/min, which of the
following diabetic medications is contraindicated?
A. Insulin Glargine
B. Linagliptin
C. Metformin
D. Pioglitazone
Answer: C
(NUR6011 Exam 3) | William Paterson University
1. A 65-year-old patient with atrial fibrillation is being started on warfarin. Which of the
following cytochrome P450 enzymes is primarily responsible for the metabolism of the S-
enantiomer of warfarin?
A. CYP2D6
B. CYP3A4
C. CYP2C9
D. CYP1A2
Answer: C
Rationale: The S-enantiomer of warfarin is 3 to 5 times more potent than the R-
enantiomer and is primarily metabolized by the CYP2C9 enzyme. Genetic polymorphisms
in CYP2C9 can significantly affect a patient’s sensitivity to warfarin and their required
maintenance dose. Understanding this metabolic pathway is crucial for predicting potential
drug-drug interactions with inhibitors like amiodarone.
2. Which clinical monitoring parameter is most critical for a patient receiving long-term
amiodarone therapy for ventricular arrhythmias?
A. Pulmonary function tests and thyroid function tests
B. Serum calcium levels every 3 months
C. Daily blood glucose monitoring
D. Weekly complete blood counts
Answer: A
Rationale: Amiodarone is associated with significant organ toxicities, most notably
pulmonary fibrosis and thyroid dysfunction due to its high iodine content. Advanced
practice nurses must monitor baseline and periodic pulmonary function tests and chest X-
rays to detect early interstitial lung disease. Additionally, because amiodarone can cause
both hyperthyroidism and hypothyroidism, thyroid-stimulating hormone (TSH) must be
monitored regularly.
3. A patient with Type 2 Diabetes and a history of heart failure with reduced ejection fraction
(HFrEF) requires intensification of therapy. Which medication class has shown significant
benefit in reducing heart failure hospitalizations?
A. DPP-4 inhibitors
B. SGLT2 inhibitors
,C. Sulfonylureas
D. Thiazolidinediones
Answer: B
Rationale: SGLT2 inhibitors, such as empagliflozin and dapagliflozin, have demonstrated
clear cardiovascular benefits in patients with HFrEF, regardless of diabetes status. These
agents promote osmotic diuresis and natriuresis, which reduces preload and afterload on
the heart. Conversely, thiazolidinediones should be avoided in this population as they can
cause fluid retention and exacerbate heart failure symptoms.
4. A 45-year-old female patient is prescribed lisinopril for hypertension. She develops a dry,
persistent cough. What is the physiological mechanism behind this adverse effect?
A. Increased production of angiotensin II
B. Direct irritation of the bronchial mucosa by the drug
C. Accumulation of bradykinin in the upper airways
D. Activation of the sympathetic nervous system
Answer: C
Rationale: ACE inhibitors prevent the breakdown of bradykinin and substance P, leading
to their accumulation in the respiratory tract. This accumulation triggers the sensory fibers
that produce the characteristic dry, non-productive cough. If the cough becomes
intolerable, the provider should consider switching the patient to an Angiotensin II
Receptor Blocker (ARB), which does not affect bradykinin metabolism.
5. When prescribing an HMG-CoA reductase inhibitor (statin), which of the following baseline
laboratory tests is required according to current guidelines?
A. Creatine kinase (CK) in all patients
B. Serum creatinine and GFR
C. Alanine aminotransferase (ALT)
D. Baseline bone density scan
Answer: C
Rationale: Current guidelines recommend obtaining a baseline ALT level prior to initiating
statin therapy to assess hepatic function. While routine periodic monitoring of LFTs is no
longer mandatory unless symptoms of hepatotoxicity occur, the baseline value is essential
for comparison. Creatine kinase is only recommended at baseline for patients at high risk
for muscle complications or those with a personal history of statin intolerance.
, 6. An elderly patient is being treated for chronic pain with an opioid analgesic. Which side
effect should the clinician anticipate and treat preemptively?
A. Diarrhea
B. Constipation
C. Tachycardia
D. Hypertension
Answer: B
Rationale: Opioid-induced constipation (OIC) is a nearly universal side effect because
tolerance to the mu-opioid receptor effects in the gastrointestinal tract does not develop
over time. Unlike respiratory depression or sedation, which may improve as the patient
adapts to the dose, constipation persists. Clinicians should initiate a bowel regimen,
typically involving a stimulant laxative or an osmotic agent, at the same time the opioid is
started.
7. A patient is prescribed sildenafil for erectile dysfunction. Which medication is absolutely
contraindicated due to the risk of life-threatening hypotension?
A. Amlodipine
B. Isosorbide mononitrate
C. Metoprolol
D. Atorvastatin
Answer: B
Rationale: Sildenafil is a PDE-5 inhibitor that enhances the effects of nitric oxide, leading
to vasodilation. Nitrates, such as isosorbide mononitrate or nitroglycerin, also increase
cyclic GMP levels, and the combination can lead to synergistic vasodilation and profound,
refractory hypotension. Patients must be counseled to wait at least 24 hours (or longer for
tadalafil) after taking a PDE-5 inhibitor before using any nitrate product.
8. In a patient with chronic kidney disease (CKD) and an eGFR of 25 mL/min, which of the
following diabetic medications is contraindicated?
A. Insulin Glargine
B. Linagliptin
C. Metformin
D. Pioglitazone
Answer: C
