NUR 6011 Exam 4 Actual Exam V1 | NUR 6011 Advance Pharmacology
(NUR6011 Exam 4) | William Paterson University
1. A 58-year-old patient with a history of Type 2 Diabetes and stage 3 chronic kidney disease
(eGFR 35 mL/min) requires medication adjustment. Which of the following is the most
appropriate action regarding Metformin therapy?
A. Continue current dosage but monitor serum creatinine monthly.
B. Increase the dose to maximize glycemic control before renal function declines further.
C. Decrease the dose by 50% and monitor renal function closely.
D. Discontinue Metformin due to the high risk of lactic acidosis.
Answer: C
Rationale: Metformin is primarily excreted by the kidneys, and its accumulation increases
the risk of lactic acidosis. Current clinical guidelines suggest that a dosage reduction is
necessary when the eGFR falls between 30 and 45 mL/min. If the eGFR drops below 30
mL/min, the medication must be discontinued entirely to ensure patient safety.
2. When prescribing Levothyroxine for an 80-year-old patient with a history of coronary
artery disease, what is the most appropriate initial dosing strategy?
A. Start with a full replacement dose of 1.6 mcg/kg/day.
B. Use Liothyronine (T3) instead to achieve faster therapeutic results.
C. Initiate therapy at 50 mcg and double the dose every week.
D. Start with a low dose such as 12.5 to 25 mcg daily.
Answer: D
Rationale: In elderly patients or those with underlying cardiac disease, excessive thyroid
hormone can lead to tachycardia, arrhythmias, or myocardial ischemia. Starting at a very
low dose, often referred to as ‘start low and go slow,’ allows the cardiovascular system to
adapt to the metabolic changes. Monitoring of TSH levels every 6 to 8 weeks is essential
during the titration phase to reach the target range safely.
3. A patient is prescribed an Inhaled Corticosteroid (ICS) for the management of persistent
asthma. Which education point is critical to prevent a common local adverse effect?
A. Take the medication only during acute asthma attacks.
B. Check blood glucose levels twice daily.
C. Rinse the mouth and throat with water after each use.
D. Use a rescue inhaler immediately before the ICS.
,Answer: C
Rationale: Inhaled corticosteroids can deposit in the oropharynx, leading to local
immunosuppression and the development of oropharyngeal candidiasis, also known as
thrush. Rinsing the mouth with water and spitting it out after administration helps remove
residual medication from the mucosal surfaces. This simple intervention significantly
reduces the incidence of both thrush and hoarseness associated with ICS use.
4. Which mechanism of action explains why SGLT2 inhibitors like Empagliflozin provide
cardiovascular benefits in patients with heart failure?
A. Direct inhibition of myocardial beta-receptors.
B. Stimulating the release of endogenous insulin to improve myocardial metabolism.
C. Promoting osmotic diuresis and natriuresis by inhibiting glucose reabsorption in the
proximal tubule.
D. Increasing peripheral vascular resistance to maintain blood pressure.
Answer: C
Rationale: SGLT2 inhibitors work in the kidneys to prevent glucose reabsorption, which
leads to glucose and sodium excretion in the urine. This process causes mild diuresis and
natriuresis, which reduces preload and afterload on the heart. These hemodynamic
changes, along with potential metabolic benefits, contribute to the reduction in heart
failure hospitalizations observed in clinical trials.
5. A 36-year-old female who smokes one pack of cigarettes per day is seeking contraception.
Which of the following is contraindicated for this patient?
A. Combined Oral Contraceptives (COCs).
B. Progestin-only pill (Mini-pill).
C. Copper Intrauterine Device (IUD).
D. Medroxyprogesterone acetate injection.
Answer: A
Rationale: Combined Oral Contraceptives contain estrogen, which increases the risk of
thromboembolic events such as stroke and myocardial infarction. This risk is significantly
amplified in women over the age of 35 who smoke. For this specific population, progestin-
only methods or non-hormonal options like the copper IUD are preferred to ensure safety.
6. A patient with hyperthyroidism is pregnant and in her first trimester. Which medication is
preferred for management during this period?
A. Methimazole
B. Radioactive Iodine
, C. Propylthiouracil (PTU)
D. High-dose Aspirin
Answer: C
Rationale: Propylthiouracil (PTU) is the preferred antithyroid drug during the first
trimester of pregnancy because it is less likely to cause congenital malformations like
aplasia cutis compared to Methimazole. After the first trimester, many providers switch the
patient to Methimazole to avoid the potential for PTU-induced hepatotoxicity. This staged
approach balances the risks of teratogenicity and maternal liver damage throughout the
gestational period.
7. Which of the following GLP-1 receptor agonists is currently available in an oral
formulation?
A. Exenatide
B. Liraglutide
C. Semaglutide
D. Dulaglutide
Answer: C
Rationale: Semaglutide is unique among the GLP-1 receptor agonists as it is available in
both injectable and oral (Rybelsus) forms. The oral version utilizes an absorption enhancer
to allow the peptide to cross the gastric mucosa. It must be taken on an empty stomach
with a small sip of water to ensure adequate bioavailability for therapeutic effect.
8. A patient taking Warfarin is prescribed Amiodarone for atrial fibrillation. What adjustment
should the clinician anticipate?
A. Decrease the Warfarin dose by 30% to 50%.
B. Increase the Warfarin dose by 50%.
C. Discontinue Warfarin and start Aspirin.
D. No adjustment is necessary as they work on different pathways.
Answer: A
Rationale: Amiodarone is a potent inhibitor of CYP2C9, the primary enzyme responsible
for the metabolism of the more active S-isomer of Warfarin. When these drugs are
combined, Warfarin levels rise significantly, increasing the risk of bleeding. Clinicians must
preemptively lower the Warfarin dose and monitor the INR frequently until a new steady
state is achieved.
9. What is the primary rationale for using a spacer with a Metered-Dose Inhaler (MDI)?
A. To increase the taste of the medication.
(NUR6011 Exam 4) | William Paterson University
1. A 58-year-old patient with a history of Type 2 Diabetes and stage 3 chronic kidney disease
(eGFR 35 mL/min) requires medication adjustment. Which of the following is the most
appropriate action regarding Metformin therapy?
A. Continue current dosage but monitor serum creatinine monthly.
B. Increase the dose to maximize glycemic control before renal function declines further.
C. Decrease the dose by 50% and monitor renal function closely.
D. Discontinue Metformin due to the high risk of lactic acidosis.
Answer: C
Rationale: Metformin is primarily excreted by the kidneys, and its accumulation increases
the risk of lactic acidosis. Current clinical guidelines suggest that a dosage reduction is
necessary when the eGFR falls between 30 and 45 mL/min. If the eGFR drops below 30
mL/min, the medication must be discontinued entirely to ensure patient safety.
2. When prescribing Levothyroxine for an 80-year-old patient with a history of coronary
artery disease, what is the most appropriate initial dosing strategy?
A. Start with a full replacement dose of 1.6 mcg/kg/day.
B. Use Liothyronine (T3) instead to achieve faster therapeutic results.
C. Initiate therapy at 50 mcg and double the dose every week.
D. Start with a low dose such as 12.5 to 25 mcg daily.
Answer: D
Rationale: In elderly patients or those with underlying cardiac disease, excessive thyroid
hormone can lead to tachycardia, arrhythmias, or myocardial ischemia. Starting at a very
low dose, often referred to as ‘start low and go slow,’ allows the cardiovascular system to
adapt to the metabolic changes. Monitoring of TSH levels every 6 to 8 weeks is essential
during the titration phase to reach the target range safely.
3. A patient is prescribed an Inhaled Corticosteroid (ICS) for the management of persistent
asthma. Which education point is critical to prevent a common local adverse effect?
A. Take the medication only during acute asthma attacks.
B. Check blood glucose levels twice daily.
C. Rinse the mouth and throat with water after each use.
D. Use a rescue inhaler immediately before the ICS.
,Answer: C
Rationale: Inhaled corticosteroids can deposit in the oropharynx, leading to local
immunosuppression and the development of oropharyngeal candidiasis, also known as
thrush. Rinsing the mouth with water and spitting it out after administration helps remove
residual medication from the mucosal surfaces. This simple intervention significantly
reduces the incidence of both thrush and hoarseness associated with ICS use.
4. Which mechanism of action explains why SGLT2 inhibitors like Empagliflozin provide
cardiovascular benefits in patients with heart failure?
A. Direct inhibition of myocardial beta-receptors.
B. Stimulating the release of endogenous insulin to improve myocardial metabolism.
C. Promoting osmotic diuresis and natriuresis by inhibiting glucose reabsorption in the
proximal tubule.
D. Increasing peripheral vascular resistance to maintain blood pressure.
Answer: C
Rationale: SGLT2 inhibitors work in the kidneys to prevent glucose reabsorption, which
leads to glucose and sodium excretion in the urine. This process causes mild diuresis and
natriuresis, which reduces preload and afterload on the heart. These hemodynamic
changes, along with potential metabolic benefits, contribute to the reduction in heart
failure hospitalizations observed in clinical trials.
5. A 36-year-old female who smokes one pack of cigarettes per day is seeking contraception.
Which of the following is contraindicated for this patient?
A. Combined Oral Contraceptives (COCs).
B. Progestin-only pill (Mini-pill).
C. Copper Intrauterine Device (IUD).
D. Medroxyprogesterone acetate injection.
Answer: A
Rationale: Combined Oral Contraceptives contain estrogen, which increases the risk of
thromboembolic events such as stroke and myocardial infarction. This risk is significantly
amplified in women over the age of 35 who smoke. For this specific population, progestin-
only methods or non-hormonal options like the copper IUD are preferred to ensure safety.
6. A patient with hyperthyroidism is pregnant and in her first trimester. Which medication is
preferred for management during this period?
A. Methimazole
B. Radioactive Iodine
, C. Propylthiouracil (PTU)
D. High-dose Aspirin
Answer: C
Rationale: Propylthiouracil (PTU) is the preferred antithyroid drug during the first
trimester of pregnancy because it is less likely to cause congenital malformations like
aplasia cutis compared to Methimazole. After the first trimester, many providers switch the
patient to Methimazole to avoid the potential for PTU-induced hepatotoxicity. This staged
approach balances the risks of teratogenicity and maternal liver damage throughout the
gestational period.
7. Which of the following GLP-1 receptor agonists is currently available in an oral
formulation?
A. Exenatide
B. Liraglutide
C. Semaglutide
D. Dulaglutide
Answer: C
Rationale: Semaglutide is unique among the GLP-1 receptor agonists as it is available in
both injectable and oral (Rybelsus) forms. The oral version utilizes an absorption enhancer
to allow the peptide to cross the gastric mucosa. It must be taken on an empty stomach
with a small sip of water to ensure adequate bioavailability for therapeutic effect.
8. A patient taking Warfarin is prescribed Amiodarone for atrial fibrillation. What adjustment
should the clinician anticipate?
A. Decrease the Warfarin dose by 30% to 50%.
B. Increase the Warfarin dose by 50%.
C. Discontinue Warfarin and start Aspirin.
D. No adjustment is necessary as they work on different pathways.
Answer: A
Rationale: Amiodarone is a potent inhibitor of CYP2C9, the primary enzyme responsible
for the metabolism of the more active S-isomer of Warfarin. When these drugs are
combined, Warfarin levels rise significantly, increasing the risk of bleeding. Clinicians must
preemptively lower the Warfarin dose and monitor the INR frequently until a new steady
state is achieved.
9. What is the primary rationale for using a spacer with a Metered-Dose Inhaler (MDI)?
A. To increase the taste of the medication.
