NURS 6531 final exam Complete verified
questions and correct Answers 2025_2026
1. Q: A patient with congestive heart failure has peripheral edema and a BNP of 900
pg/mL. Which class of drug is first-line to reduce preload and fluid overload?
A: Loop diuretics (e.g., furosemide).
Rationale: Loop diuretics produce potent natriuresis and diuresis, reducing preload and
relieving congestion in HF.
2. Q: Which antihypertensive is contraindicated in pregnancy due to teratogenicity?
A: ACE inhibitors (e.g., enalapril) and ARBs.
Rationale: ACE inhibitors/ARBs cause fetal renal dysplasia and are teratogenic,
especially in 2nd/3rd trimesters.
3. Q: A patient on warfarin has an INR of 8.2 and no bleeding. What is the immediate
management?
A: Hold warfarin and give low-dose oral vitamin K (phytonadione).
Rationale: For elevated INR without bleeding, vitamin K reverses anticoagulation
gradually; avoid prothrombin complex unless bleeding.
4. Q: Mechanism of action of β-lactam antibiotics?
A: Inhibit bacterial cell wall synthesis by binding penicillin-binding proteins (PBPs).
Rationale: Disrupt peptidoglycan crosslinking, leading to cell lysis—bactericidal for
actively dividing bacteria.
5. Q: Preferred opioid for severe cancer pain in a patient with normal renal function?
A: Morphine or hydromorphone; hydromorphone if concerns about active metabolites.
Rationale: Morphine effective but metabolites accumulate with renal dysfunction;
hydromorphone is alternative.
,6. Q: A patient has acute anaphylaxis: first-line medication and route?
A: Intramuscular epinephrine (0.3–0.5 mg of 1:1000 in adults) into the lateral thigh.
Rationale: Rapid alpha/beta agonism reverses bronchospasm, vasodilation, and
hypotension.
7. Q: Mechanism and an adverse effect of aminoglycosides?
A: Inhibit bacterial 30S ribosomal subunit; nephrotoxicity and ototoxicity.
Rationale: Concentration-dependent killing with renal clearance and accumulation in
inner ear.
8. Q: A hypertensive patient has bradycardia and heart block on ECG. Which
antihypertensive class should be avoided?
A: Non-dihydropyridine calcium channel blockers (verapamil, diltiazem).
Rationale: They decrease AV conduction and can worsen bradycardia/heart block.
9. Q: First-line disease-modifying therapy for acute ischemic stroke within window?
A: IV alteplase (tPA) if within appropriate time window and no contraindications.
Rationale: Fibrinolysis with tPA can dissolve thrombus and improve outcomes when
given timely.
10.Q: Which drug is used to reverse heparin in bleeding?
A: Protamine sulfate.
Rationale: Protamine binds heparin to neutralize its anticoagulant effect.
11.Q: Best class to treat osteoporosis and reduce vertebral fracture risk?
A: Bisphosphonates (e.g., alendronate).
Rationale: Inhibit osteoclast-mediated bone resorption, increasing bone mineral
density.
12.Q: Mechanism of selective serotonin reuptake inhibitors (SSRIs)?
A: Block presynaptic serotonin reuptake transporter, increasing serotonin in synaptic
cleft.
Rationale: Enhances serotonergic neurotransmission; used in depression/anxiety.
13.Q: A patient with type 2 diabetes and renal impairment needs glucose lowering without
hypoglycemia risk. Which class is useful?
A: DPP-4 inhibitors (e.g., sitagliptin) or GLP-1 receptor agonists—dose adjust for renal;
SGLT2s less effective in severe renal impairment.
Rationale: DPP-4 inhibitors are weight neutral with low hypoglycemia risk; renal dosing
needed.
14.Q: Drug of choice for acute bacterial meningitis empiric therapy in adults?
A: Vancomycin plus a third-generation cephalosporin (ceftriaxone or cefotaxime).
Rationale: Broad coverage including resistant Streptococcus pneumoniae and
, Gram-negatives.
15.Q: Which medication causes a disulfiram-like reaction with alcohol?
A: Metronidazole and some cephalosporins (e.g., cefotetan).
Rationale: Inhibits aldehyde dehydrogenase leading to acetaldehyde accumulation
causing flushing, nausea.
16.Q: A patient on digoxin shows nausea, visual changes, and arrhythmias. What is the
antidote?
A: Digoxin-specific antibody fragments (digoxin immune Fab).
Rationale: Antibodies bind circulating digoxin and reverse toxicity.
17.Q: Preferred long-term anticoagulant for a patient with nonvalvular atrial fibrillation who
wants no INR monitoring?
A: Direct oral anticoagulant (DOAC), e.g., apixaban or rivaroxaban.
Rationale: DOACs have predictable effects, no routine INR monitoring, and noninferior
stroke prevention.
18.Q: Mechanism of action of benzodiazepines?
A: Positive allosteric modulators of GABA_A receptors increasing GABA-mediated
chloride influx.
Rationale: Enhance inhibitory neurotransmission producing sedation, anxiolysis,
anticonvulsant effects.
19.Q: A patient with peptic ulcer disease requires H. pylori eradication. Typical triple
therapy?
A: PPI + clarithromycin + amoxicillin (or metronidazole if allergic).
Rationale: Combined acid suppression and antibiotics enhance eradication rates.
20.Q: Drug class used in heart failure with reduced ejection fraction that lowers mortality by
blocking RAAS?
A: ACE inhibitors or ARBs (plus beta-blockers, MRAs).
Rationale: Inhibit maladaptive RAAS activation reducing remodeling and mortality.
21.Q: A patient with asthma has poor control on inhaled corticosteroid alone; next add-on
therapy?
A: Add a long-acting β2-agonist (LABA).
Rationale: Combination ICS + LABA improves symptoms and reduces exacerbations
versus ICS alone.
22.Q: Which antibiotic is teratogenic and should be avoided in pregnancy (bone/teeth
effects)?
A: Tetracyclines (e.g., doxycycline).
questions and correct Answers 2025_2026
1. Q: A patient with congestive heart failure has peripheral edema and a BNP of 900
pg/mL. Which class of drug is first-line to reduce preload and fluid overload?
A: Loop diuretics (e.g., furosemide).
Rationale: Loop diuretics produce potent natriuresis and diuresis, reducing preload and
relieving congestion in HF.
2. Q: Which antihypertensive is contraindicated in pregnancy due to teratogenicity?
A: ACE inhibitors (e.g., enalapril) and ARBs.
Rationale: ACE inhibitors/ARBs cause fetal renal dysplasia and are teratogenic,
especially in 2nd/3rd trimesters.
3. Q: A patient on warfarin has an INR of 8.2 and no bleeding. What is the immediate
management?
A: Hold warfarin and give low-dose oral vitamin K (phytonadione).
Rationale: For elevated INR without bleeding, vitamin K reverses anticoagulation
gradually; avoid prothrombin complex unless bleeding.
4. Q: Mechanism of action of β-lactam antibiotics?
A: Inhibit bacterial cell wall synthesis by binding penicillin-binding proteins (PBPs).
Rationale: Disrupt peptidoglycan crosslinking, leading to cell lysis—bactericidal for
actively dividing bacteria.
5. Q: Preferred opioid for severe cancer pain in a patient with normal renal function?
A: Morphine or hydromorphone; hydromorphone if concerns about active metabolites.
Rationale: Morphine effective but metabolites accumulate with renal dysfunction;
hydromorphone is alternative.
,6. Q: A patient has acute anaphylaxis: first-line medication and route?
A: Intramuscular epinephrine (0.3–0.5 mg of 1:1000 in adults) into the lateral thigh.
Rationale: Rapid alpha/beta agonism reverses bronchospasm, vasodilation, and
hypotension.
7. Q: Mechanism and an adverse effect of aminoglycosides?
A: Inhibit bacterial 30S ribosomal subunit; nephrotoxicity and ototoxicity.
Rationale: Concentration-dependent killing with renal clearance and accumulation in
inner ear.
8. Q: A hypertensive patient has bradycardia and heart block on ECG. Which
antihypertensive class should be avoided?
A: Non-dihydropyridine calcium channel blockers (verapamil, diltiazem).
Rationale: They decrease AV conduction and can worsen bradycardia/heart block.
9. Q: First-line disease-modifying therapy for acute ischemic stroke within window?
A: IV alteplase (tPA) if within appropriate time window and no contraindications.
Rationale: Fibrinolysis with tPA can dissolve thrombus and improve outcomes when
given timely.
10.Q: Which drug is used to reverse heparin in bleeding?
A: Protamine sulfate.
Rationale: Protamine binds heparin to neutralize its anticoagulant effect.
11.Q: Best class to treat osteoporosis and reduce vertebral fracture risk?
A: Bisphosphonates (e.g., alendronate).
Rationale: Inhibit osteoclast-mediated bone resorption, increasing bone mineral
density.
12.Q: Mechanism of selective serotonin reuptake inhibitors (SSRIs)?
A: Block presynaptic serotonin reuptake transporter, increasing serotonin in synaptic
cleft.
Rationale: Enhances serotonergic neurotransmission; used in depression/anxiety.
13.Q: A patient with type 2 diabetes and renal impairment needs glucose lowering without
hypoglycemia risk. Which class is useful?
A: DPP-4 inhibitors (e.g., sitagliptin) or GLP-1 receptor agonists—dose adjust for renal;
SGLT2s less effective in severe renal impairment.
Rationale: DPP-4 inhibitors are weight neutral with low hypoglycemia risk; renal dosing
needed.
14.Q: Drug of choice for acute bacterial meningitis empiric therapy in adults?
A: Vancomycin plus a third-generation cephalosporin (ceftriaxone or cefotaxime).
Rationale: Broad coverage including resistant Streptococcus pneumoniae and
, Gram-negatives.
15.Q: Which medication causes a disulfiram-like reaction with alcohol?
A: Metronidazole and some cephalosporins (e.g., cefotetan).
Rationale: Inhibits aldehyde dehydrogenase leading to acetaldehyde accumulation
causing flushing, nausea.
16.Q: A patient on digoxin shows nausea, visual changes, and arrhythmias. What is the
antidote?
A: Digoxin-specific antibody fragments (digoxin immune Fab).
Rationale: Antibodies bind circulating digoxin and reverse toxicity.
17.Q: Preferred long-term anticoagulant for a patient with nonvalvular atrial fibrillation who
wants no INR monitoring?
A: Direct oral anticoagulant (DOAC), e.g., apixaban or rivaroxaban.
Rationale: DOACs have predictable effects, no routine INR monitoring, and noninferior
stroke prevention.
18.Q: Mechanism of action of benzodiazepines?
A: Positive allosteric modulators of GABA_A receptors increasing GABA-mediated
chloride influx.
Rationale: Enhance inhibitory neurotransmission producing sedation, anxiolysis,
anticonvulsant effects.
19.Q: A patient with peptic ulcer disease requires H. pylori eradication. Typical triple
therapy?
A: PPI + clarithromycin + amoxicillin (or metronidazole if allergic).
Rationale: Combined acid suppression and antibiotics enhance eradication rates.
20.Q: Drug class used in heart failure with reduced ejection fraction that lowers mortality by
blocking RAAS?
A: ACE inhibitors or ARBs (plus beta-blockers, MRAs).
Rationale: Inhibit maladaptive RAAS activation reducing remodeling and mortality.
21.Q: A patient with asthma has poor control on inhaled corticosteroid alone; next add-on
therapy?
A: Add a long-acting β2-agonist (LABA).
Rationale: Combination ICS + LABA improves symptoms and reduces exacerbations
versus ICS alone.
22.Q: Which antibiotic is teratogenic and should be avoided in pregnancy (bone/teeth
effects)?
A: Tetracyclines (e.g., doxycycline).
