NUR 6011 Exam 2 Actual Exam V3 | NUR 6011 Advance Pharmacology
(NUR6011 Exam 2) | William Paterson University
1. A 65-year-old patient with heart failure and a reduced ejection fraction (HFrEF) is currently
taking an ACE inhibitor, a beta-blocker, and a loop diuretic. Which of the following
medications should be added to the regimen to further reduce mortality based on current
clinical guidelines?
A. Nifedipine
B. Hydrochlorothiazide
C. Spironolactone
D. Diltiazem
Answer: C
Rationale: Spironolactone is a mineralocorticoid receptor antagonist (MRA) that has been
shown to reduce mortality in patients with HFrEF. Calcium channel blockers like Nifedipine
and Diltiazem are generally not used for this purpose and can even be harmful in certain
heart failure states. Adding an MRA requires careful monitoring of serum potassium and
renal function to prevent hyperkalemia.
2. A patient is prescribed Amiodarone for the management of ventricular arrhythmias. Which
baseline diagnostic test is essential before starting this therapy due to potential organ
toxicity?
A. Hemoglobin A1c
B. Bone density scan
C. Pulmonary Function Tests
D. Audiometry
Answer: C
Rationale: Amiodarone is associated with significant pulmonary toxicity, including
interstitial lung disease and fibrosis. Therefore, baseline pulmonary function tests (PFTs)
and a chest X-ray are required before initiation. Long-term monitoring also includes
thyroid and liver function tests due to the drug’s high iodine content and hepatic
metabolism.
3. A patient stabilized on Warfarin therapy is diagnosed with a urinary tract infection and
prescribed Sulfamethoxazole/Trimethoprim (Bactrim). What is the expected
pharmacodynamic interaction?
A. The INR will increase, increasing the risk of bleeding.
,B. The INR will remain stable as there is no interaction.
C. The INR will decrease, increasing the risk of thrombosis.
D. Warfarin metabolism will be induced by the antibiotic.
Answer: A
Rationale: Sulfamethoxazole/Trimethoprim inhibits the CYP2C9 enzyme, which is
responsible for the metabolism of S-warfarin, the more potent isomer. This inhibition leads
to decreased clearance of Warfarin and a subsequent rise in the International Normalized
Ratio (INR). Clinicians must proactively reduce the Warfarin dose and monitor the INR
closely when starting this antibiotic.
4. Which mechanism of action describes how SGLT2 inhibitors like Empagliflozin lower blood
glucose in patients with Type 2 Diabetes?
A. Increasing insulin secretion from pancreatic beta cells
B. Slowing gastric emptying and suppressing glucagon
C. Inhibiting glucose reabsorption in the proximal renal tubule
D. Increasing sensitivity of peripheral tissues to insulin
Answer: C
Rationale: SGLT2 inhibitors block the sodium-glucose co-transporter 2 in the kidneys,
leading to glucosuria and lower plasma glucose levels. This mechanism is independent of
insulin and provides additional benefits such as weight loss and blood pressure reduction.
However, it increases the risk of urinary tract infections and genital mycotic infections due
to the high sugar content in the urine.
5. When prescribing Metformin, which laboratory value is the most critical contraindication
to monitor for the risk of lactic acidosis?
A. Alanine aminotransferase (ALT) > 3x normal
B. Serum Potassium > 5.5 mEq/L
C. Glomerular Filtration Rate (eGFR) < 30 mL/min/1.73 m²
D. Platelet count < 100,000/mm³
Answer: C
Rationale: Metformin is renally cleared, and its accumulation significantly increases the
risk of the rare but serious side effect, lactic acidosis. Current guidelines state that
Metformin is contraindicated in patients with an eGFR less than 30 mL/min/1.73 m². For
patients with an eGFR between 30 and 45, the dose should be reduced or initiation should
be avoided.
, 6. A patient with hypertension and a history of asthma requires a beta-blocker for migraine
prophylaxis. Which agent is the safest choice?
A. Propranolol
B. Metoprolol succinate
C. Nadolol
D. Timolol
Answer: B
Rationale: Metoprolol is a cardioselective beta-1 antagonist, meaning it has a higher
affinity for the heart than the beta-2 receptors in the lungs. Propranolol, Nadolol, and
Timolol are non-selective beta-blockers and can cause bronchoconstriction in patients with
asthma. Even with selective agents, high doses can lose selectivity, so cautious monitoring
for respiratory symptoms is necessary.
7. Which of the following is a common side effect of Verapamil that the nurse practitioner
should counsel the patient about?
A. Dry cough
B. Diarrhea
C. Constipation
D. Hyperthyroidism
Answer: C
Rationale: Verapamil is a non-dihydropyridine calcium channel blocker that is well-known
for causing constipation, especially in elderly patients. This occurs because the drug
inhibits calcium-mediated smooth muscle contraction in the gastrointestinal tract. Patients
should be advised to increase fluid and fiber intake to manage this side effect.
8. A patient is starting Levothyroxine for hypothyroidism. How should the patient be
instructed to take this medication to ensure optimal absorption?
A. With a large meal to prevent GI upset
B. In the morning on an empty stomach, 30-60 minutes before food
C. At bedtime with a glass of milk
D. Simultaneously with their calcium and iron supplements
Answer: B
Rationale: Levothyroxine has a narrow therapeutic index and its absorption is easily
disrupted by food and other medications. Taking it on an empty stomach at least 30 to 60
minutes before breakfast maximizes bioavailability. Supplements containing calcium or
(NUR6011 Exam 2) | William Paterson University
1. A 65-year-old patient with heart failure and a reduced ejection fraction (HFrEF) is currently
taking an ACE inhibitor, a beta-blocker, and a loop diuretic. Which of the following
medications should be added to the regimen to further reduce mortality based on current
clinical guidelines?
A. Nifedipine
B. Hydrochlorothiazide
C. Spironolactone
D. Diltiazem
Answer: C
Rationale: Spironolactone is a mineralocorticoid receptor antagonist (MRA) that has been
shown to reduce mortality in patients with HFrEF. Calcium channel blockers like Nifedipine
and Diltiazem are generally not used for this purpose and can even be harmful in certain
heart failure states. Adding an MRA requires careful monitoring of serum potassium and
renal function to prevent hyperkalemia.
2. A patient is prescribed Amiodarone for the management of ventricular arrhythmias. Which
baseline diagnostic test is essential before starting this therapy due to potential organ
toxicity?
A. Hemoglobin A1c
B. Bone density scan
C. Pulmonary Function Tests
D. Audiometry
Answer: C
Rationale: Amiodarone is associated with significant pulmonary toxicity, including
interstitial lung disease and fibrosis. Therefore, baseline pulmonary function tests (PFTs)
and a chest X-ray are required before initiation. Long-term monitoring also includes
thyroid and liver function tests due to the drug’s high iodine content and hepatic
metabolism.
3. A patient stabilized on Warfarin therapy is diagnosed with a urinary tract infection and
prescribed Sulfamethoxazole/Trimethoprim (Bactrim). What is the expected
pharmacodynamic interaction?
A. The INR will increase, increasing the risk of bleeding.
,B. The INR will remain stable as there is no interaction.
C. The INR will decrease, increasing the risk of thrombosis.
D. Warfarin metabolism will be induced by the antibiotic.
Answer: A
Rationale: Sulfamethoxazole/Trimethoprim inhibits the CYP2C9 enzyme, which is
responsible for the metabolism of S-warfarin, the more potent isomer. This inhibition leads
to decreased clearance of Warfarin and a subsequent rise in the International Normalized
Ratio (INR). Clinicians must proactively reduce the Warfarin dose and monitor the INR
closely when starting this antibiotic.
4. Which mechanism of action describes how SGLT2 inhibitors like Empagliflozin lower blood
glucose in patients with Type 2 Diabetes?
A. Increasing insulin secretion from pancreatic beta cells
B. Slowing gastric emptying and suppressing glucagon
C. Inhibiting glucose reabsorption in the proximal renal tubule
D. Increasing sensitivity of peripheral tissues to insulin
Answer: C
Rationale: SGLT2 inhibitors block the sodium-glucose co-transporter 2 in the kidneys,
leading to glucosuria and lower plasma glucose levels. This mechanism is independent of
insulin and provides additional benefits such as weight loss and blood pressure reduction.
However, it increases the risk of urinary tract infections and genital mycotic infections due
to the high sugar content in the urine.
5. When prescribing Metformin, which laboratory value is the most critical contraindication
to monitor for the risk of lactic acidosis?
A. Alanine aminotransferase (ALT) > 3x normal
B. Serum Potassium > 5.5 mEq/L
C. Glomerular Filtration Rate (eGFR) < 30 mL/min/1.73 m²
D. Platelet count < 100,000/mm³
Answer: C
Rationale: Metformin is renally cleared, and its accumulation significantly increases the
risk of the rare but serious side effect, lactic acidosis. Current guidelines state that
Metformin is contraindicated in patients with an eGFR less than 30 mL/min/1.73 m². For
patients with an eGFR between 30 and 45, the dose should be reduced or initiation should
be avoided.
, 6. A patient with hypertension and a history of asthma requires a beta-blocker for migraine
prophylaxis. Which agent is the safest choice?
A. Propranolol
B. Metoprolol succinate
C. Nadolol
D. Timolol
Answer: B
Rationale: Metoprolol is a cardioselective beta-1 antagonist, meaning it has a higher
affinity for the heart than the beta-2 receptors in the lungs. Propranolol, Nadolol, and
Timolol are non-selective beta-blockers and can cause bronchoconstriction in patients with
asthma. Even with selective agents, high doses can lose selectivity, so cautious monitoring
for respiratory symptoms is necessary.
7. Which of the following is a common side effect of Verapamil that the nurse practitioner
should counsel the patient about?
A. Dry cough
B. Diarrhea
C. Constipation
D. Hyperthyroidism
Answer: C
Rationale: Verapamil is a non-dihydropyridine calcium channel blocker that is well-known
for causing constipation, especially in elderly patients. This occurs because the drug
inhibits calcium-mediated smooth muscle contraction in the gastrointestinal tract. Patients
should be advised to increase fluid and fiber intake to manage this side effect.
8. A patient is starting Levothyroxine for hypothyroidism. How should the patient be
instructed to take this medication to ensure optimal absorption?
A. With a large meal to prevent GI upset
B. In the morning on an empty stomach, 30-60 minutes before food
C. At bedtime with a glass of milk
D. Simultaneously with their calcium and iron supplements
Answer: B
Rationale: Levothyroxine has a narrow therapeutic index and its absorption is easily
disrupted by food and other medications. Taking it on an empty stomach at least 30 to 60
minutes before breakfast maximizes bioavailability. Supplements containing calcium or
