NUR 6011 Exam 3 Actual Exam V2 | NUR 6011 Advance Pharmacology
(NUR6011 Exam 3) | William Paterson University
1. A 65-year-old patient with chronic kidney disease and hypertension is prescribed an ACE
inhibitor. Which physiological response is most concerning when initiating this therapy in this
specific patient population?
A. Hypokalemia due to increased aldosterone secretion.
B. Decreased renal perfusion pressure leading to a significant rise in serum creatinine.
C. Increased glomerular filtration rate due to afferent arteriole dilation.
D. Peripheral edema caused by increased venous pressure.
Answer: B
Rationale: ACE inhibitors cause dilation of the efferent arteriole, which can lead to a
decrease in intraglomerular pressure and a drop in GFR. While this is often protective in
the long term, a sudden rise in creatinine greater than 30 percent may indicate bilateral
renal artery stenosis. Close monitoring of renal function and potassium levels is mandatory
during the first weeks of therapy.
2. When prescribing Amiodarone for the management of ventricular arrhythmias, the
Advanced Practice Nurse must monitor for which systemic adverse effect due to the drug’s
high iodine content?
A. Acute pancreatitis due to hypertriglyceridemia.
B. Thyroid dysfunction, including both hyperthyroidism and hypothyroidism.
C. Nephrogenic diabetes insipidus.
D. Megaloblastic anemia resulting from folate deficiency.
Answer: B
Rationale: Amiodarone contains a high concentration of iodine and is structurally similar
to thyroxine. This can lead to either drug-induced hypothyroidism or hyperthyroidism by
interfering with thyroid hormone metabolism. Routine monitoring of thyroid-stimulating
hormone (TSH) is essential for patients on long-term amiodarone therapy.
3. A patient with Type 2 Diabetes is scheduled for an elective imaging procedure requiring
intravenous iodinated contrast. Which action should be taken regarding their Metformin
therapy?
A. Increase the dose to prevent hyperglycemia during the procedure.
B. Switch to an oral sulfonylurea immediately to maintain glucose control.
,C. Discontinue Metformin 48 hours before the procedure and resume 48 hours after if renal
function is stable.
D. Continue the medication as usual since there is no interaction with contrast dye.
Answer: C
Rationale: Metformin is primarily excreted by the kidneys and can accumulate if renal
function is impaired by contrast-induced nephropathy. Such accumulation increases the
risk of life-threatening lactic acidosis. It is standard practice to hold Metformin at the time
of or prior to the procedure and re-evaluate renal function before restarting.
4. Which of the following describes the primary mechanism by which Warfarin exerts its
anticoagulant effect?
A. Direct inhibition of thrombin (Factor IIa).
B. Inhibition of the ADP receptor on platelet membranes.
C. Inhibition of the enzyme Vitamin K epoxide reductase, preventing the recycling of
Vitamin K.
D. Activation of antithrombin III, which neutralizes Factor Xa.
Answer: C
Rationale: Warfarin works by interfering with the synthesis of Vitamin K-dependent
clotting factors II, VII, IX, and X. It specifically inhibits the enzyme responsible for
regenerating reduced Vitamin K, which is a necessary cofactor for the carboxylation of
these factors. Because it affects synthesis rather than existing factors, its full effect is not
immediate.
5. A diabetic patient is started on a non-selective beta-blocker for migraine prophylaxis. What
education is most critical for this patient?
A. The drug may mask the adrenergic symptoms of hypoglycemia, such as tremors and
tachycardia.
B. The drug will likely cause a significant increase in daily insulin requirements.
C. Stop the medication immediately if the patient develops a dry, non-productive cough.
D. Take the medication only when a migraine headache is starting to occur.
Answer: A
Rationale: Beta-blockers can mask the autonomic warning signs of hypoglycemia, which
are primarily mediated by epinephrine. This is dangerous for patients with diabetes who
rely on these symptoms to identify low blood sugar levels. Patients should be taught to rely
on other signs like sweating (cholinergic mediated) or to monitor their blood glucose more
frequently.
, 6. Statins are contraindicated in which of the following patient scenarios?
A. A patient with a history of myocardial infarction.
B. A patient with controlled Type 2 Diabetes.
C. A patient who is pregnant or planning to become pregnant.
D. A patient with a BMI over 30 and elevated LDL.
Answer: C
Rationale: Statins are classified as Pregnancy Category X because cholesterol is essential
for fetal development and cell membrane synthesis. Disruption of the cholesterol synthesis
pathway can lead to significant teratogenic effects. Any woman of childbearing age should
be counseled on effective contraception while taking a statin.
7. The FDA has issued a Black Box Warning for fluoroquinolones (e.g., Ciprofloxacin) regarding
which specific risk?
A. Acute liver failure in patients with hepatic impairment.
B. Tendinitis and tendon rupture, especially of the Achilles tendon.
C. Severe dermatological reactions like Stevens-Johnson Syndrome.
D. Permanent hearing loss due to ototoxicity.
Answer: B
Rationale: Fluoroquinolones are associated with an increased risk of tendinitis and tendon
rupture across all ages. The risk is significantly higher in patients over 60 years old, those
taking corticosteroids, and organ transplant recipients. Patients should be advised to stop
the medication and contact their provider if they experience tendon pain or inflammation.
8. Digoxin toxicity is most likely to be precipitated by which of the following electrolyte
imbalances?
A. Hyperkalemia.
B. Hyponatremia.
C. Hypokalemia.
D. Hypocalcemia.
Answer: C
Rationale: Digoxin competes with potassium for binding sites on the Na+/K+ ATPase
pump. When potassium levels are low, there are more available binding sites for digoxin,
which increases its inhibitory effect and risk of toxicity. Monitoring serum potassium is
vital, especially if the patient is also taking potassium-wasting diuretics.
(NUR6011 Exam 3) | William Paterson University
1. A 65-year-old patient with chronic kidney disease and hypertension is prescribed an ACE
inhibitor. Which physiological response is most concerning when initiating this therapy in this
specific patient population?
A. Hypokalemia due to increased aldosterone secretion.
B. Decreased renal perfusion pressure leading to a significant rise in serum creatinine.
C. Increased glomerular filtration rate due to afferent arteriole dilation.
D. Peripheral edema caused by increased venous pressure.
Answer: B
Rationale: ACE inhibitors cause dilation of the efferent arteriole, which can lead to a
decrease in intraglomerular pressure and a drop in GFR. While this is often protective in
the long term, a sudden rise in creatinine greater than 30 percent may indicate bilateral
renal artery stenosis. Close monitoring of renal function and potassium levels is mandatory
during the first weeks of therapy.
2. When prescribing Amiodarone for the management of ventricular arrhythmias, the
Advanced Practice Nurse must monitor for which systemic adverse effect due to the drug’s
high iodine content?
A. Acute pancreatitis due to hypertriglyceridemia.
B. Thyroid dysfunction, including both hyperthyroidism and hypothyroidism.
C. Nephrogenic diabetes insipidus.
D. Megaloblastic anemia resulting from folate deficiency.
Answer: B
Rationale: Amiodarone contains a high concentration of iodine and is structurally similar
to thyroxine. This can lead to either drug-induced hypothyroidism or hyperthyroidism by
interfering with thyroid hormone metabolism. Routine monitoring of thyroid-stimulating
hormone (TSH) is essential for patients on long-term amiodarone therapy.
3. A patient with Type 2 Diabetes is scheduled for an elective imaging procedure requiring
intravenous iodinated contrast. Which action should be taken regarding their Metformin
therapy?
A. Increase the dose to prevent hyperglycemia during the procedure.
B. Switch to an oral sulfonylurea immediately to maintain glucose control.
,C. Discontinue Metformin 48 hours before the procedure and resume 48 hours after if renal
function is stable.
D. Continue the medication as usual since there is no interaction with contrast dye.
Answer: C
Rationale: Metformin is primarily excreted by the kidneys and can accumulate if renal
function is impaired by contrast-induced nephropathy. Such accumulation increases the
risk of life-threatening lactic acidosis. It is standard practice to hold Metformin at the time
of or prior to the procedure and re-evaluate renal function before restarting.
4. Which of the following describes the primary mechanism by which Warfarin exerts its
anticoagulant effect?
A. Direct inhibition of thrombin (Factor IIa).
B. Inhibition of the ADP receptor on platelet membranes.
C. Inhibition of the enzyme Vitamin K epoxide reductase, preventing the recycling of
Vitamin K.
D. Activation of antithrombin III, which neutralizes Factor Xa.
Answer: C
Rationale: Warfarin works by interfering with the synthesis of Vitamin K-dependent
clotting factors II, VII, IX, and X. It specifically inhibits the enzyme responsible for
regenerating reduced Vitamin K, which is a necessary cofactor for the carboxylation of
these factors. Because it affects synthesis rather than existing factors, its full effect is not
immediate.
5. A diabetic patient is started on a non-selective beta-blocker for migraine prophylaxis. What
education is most critical for this patient?
A. The drug may mask the adrenergic symptoms of hypoglycemia, such as tremors and
tachycardia.
B. The drug will likely cause a significant increase in daily insulin requirements.
C. Stop the medication immediately if the patient develops a dry, non-productive cough.
D. Take the medication only when a migraine headache is starting to occur.
Answer: A
Rationale: Beta-blockers can mask the autonomic warning signs of hypoglycemia, which
are primarily mediated by epinephrine. This is dangerous for patients with diabetes who
rely on these symptoms to identify low blood sugar levels. Patients should be taught to rely
on other signs like sweating (cholinergic mediated) or to monitor their blood glucose more
frequently.
, 6. Statins are contraindicated in which of the following patient scenarios?
A. A patient with a history of myocardial infarction.
B. A patient with controlled Type 2 Diabetes.
C. A patient who is pregnant or planning to become pregnant.
D. A patient with a BMI over 30 and elevated LDL.
Answer: C
Rationale: Statins are classified as Pregnancy Category X because cholesterol is essential
for fetal development and cell membrane synthesis. Disruption of the cholesterol synthesis
pathway can lead to significant teratogenic effects. Any woman of childbearing age should
be counseled on effective contraception while taking a statin.
7. The FDA has issued a Black Box Warning for fluoroquinolones (e.g., Ciprofloxacin) regarding
which specific risk?
A. Acute liver failure in patients with hepatic impairment.
B. Tendinitis and tendon rupture, especially of the Achilles tendon.
C. Severe dermatological reactions like Stevens-Johnson Syndrome.
D. Permanent hearing loss due to ototoxicity.
Answer: B
Rationale: Fluoroquinolones are associated with an increased risk of tendinitis and tendon
rupture across all ages. The risk is significantly higher in patients over 60 years old, those
taking corticosteroids, and organ transplant recipients. Patients should be advised to stop
the medication and contact their provider if they experience tendon pain or inflammation.
8. Digoxin toxicity is most likely to be precipitated by which of the following electrolyte
imbalances?
A. Hyperkalemia.
B. Hyponatremia.
C. Hypokalemia.
D. Hypocalcemia.
Answer: C
Rationale: Digoxin competes with potassium for binding sites on the Na+/K+ ATPase
pump. When potassium levels are low, there are more available binding sites for digoxin,
which increases its inhibitory effect and risk of toxicity. Monitoring serum potassium is
vital, especially if the patient is also taking potassium-wasting diuretics.
