NURS 5461/ NURS5461 Final Exam
2026 Exam · 200 Questions · With Rationales
ati. NURS 5461/ NURS5461 Final Exam
Question: 1 of 200
A patient with a history of atrial fibrillation is initiated on warfarin. The patient also takes a medication that
inhibits CYP2C9. How should the warfarin dose be adjusted initially, and what additional monitoring is
A. Increase warfarin dose by 25%; monitor INR weekly.
B. Decrease warfarin dose by 30-50%; monitor INR more frequently.
C. No dose adjustment needed; monitor for bleeding.
D. Switch to a direct oral anticoagulant (DOAC) to avoid interaction.
PREVIOUS CONTINUE
A patient with a history of atrial fibrillation is initiated on warfarin. The patient also takes a
medication that inhibits CYP2C9. How should the warfarin dose be adjusted initially, and
what additional monitoring is warranted?
A. Increase warfarin dose by 25%; monitor INR weekly.
(Correct) B. Decrease warfarin dose by 30-50%; monitor INR more frequently.
C. No dose adjustment needed; monitor for bleeding.
D. Switch to a direct oral anticoagulant (DOAC) to avoid interaction.
Correct Answer: B
CYP2C9 inhibition reduces warfarin metabolism, increasing anticoagulant effect. A 30-50% dose reduction is
recommended, with more frequent INR monitoring (e.g., every 2-3 days) until stable. Option A would increase
risk of supratherapeutic INR. Option C ignores significant interaction. Option D may be considered but is not the
initial step; warfarin can be used with careful dose adjustment.
Page 1 | NURS 5461/ NURS5461 Final Exam 2026
, NURS 5461/ NURS5461 Final Exam
2026 Exam · 200 Questions · With Rationales
ati. NURS 5461/ NURS5461 Final Exam
Question: 2 of 200
A patient with chronic kidney disease (eGFR 25 mL/min/1.73m²) requires treatment for hypertension. Which
antihypertensive agent requires dose adjustment and why?
A. Lisinopril; it is primarily renally excreted and can accumulate.
B. Metoprolol; it undergoes extensive hepatic metabolism.
C. Amlodipine; it has a long half-life and renal impairment reduces clearance.
D. Hydrochlorothiazide; it loses efficacy at low GFR and may cause electrolyte disturbances.
PREVIOUS CONTINUE
A patient with chronic kidney disease (eGFR 25 mL/min/1.73m²) requires treatment for
hypertension. Which antihypertensive agent requires dose adjustment and why?
(Correct) A. Lisinopril; it is primarily renally excreted and can accumulate.
B. Metoprolol; it undergoes extensive hepatic metabolism.
C. Amlodipine; it has a long half-life and renal impairment reduces clearance.
D. Hydrochlorothiazide; it loses efficacy at low GFR and may cause electrolyte disturbances.
Correct Answer: A
Lisinopril is predominantly eliminated unchanged by the kidneys. In advanced CKD, accumulation can cause
hypotension and hyperkalemia; dose reduction is required. Metoprolol is hepatically metabolized and does not
require dose adjustment in CKD. Amlodipine is hepatically metabolized and not significantly affected by renal
impairment. Hydrochlorothiazide is ineffective when GFR <30 mL/min and is not recommended as
monotherapy, but the question asks for dose adjustment due to accumulation, which is more characteristic of
lisinopril.
Page 2 | NURS 5461/ NURS5461 Final Exam 2026
, NURS 5461/ NURS5461 Final Exam
2026 Exam · 200 Questions · With Rationales
ati. NURS 5461/ NURS5461 Final Exam
Question: 3 of 200
A patient on a stable dose of digoxin for heart failure develops acute kidney injury (AKI). What is the most
appropriate next step regarding digoxin therapy?
A. Continue current dose; monitor digoxin level in 1 week.
B. Reduce dose by 50% and check digoxin level immediately.
C. Discontinue digoxin permanently and start a different inotrope.
D. Hold digoxin until renal function returns to baseline.
PREVIOUS CONTINUE
A patient on a stable dose of digoxin for heart failure develops acute kidney injury (AKI).
What is the most appropriate next step regarding digoxin therapy?
A. Continue current dose; monitor digoxin level in 1 week.
(Correct) B. Reduce dose by 50% and check digoxin level immediately.
C. Discontinue digoxin permanently and start a different inotrope.
D. Hold digoxin until renal function returns to baseline.
Correct Answer: B
Digoxin is primarily renally excreted. AKI reduces clearance, increasing risk of toxicity. A 50% dose reduction is
recommended, with prompt serum digoxin level assessment. Option A risks toxicity. Option C is overly
aggressive; digoxin can be resumed at adjusted dose. Option D may be considered but dose reduction with
monitoring is preferred to avoid exacerbating heart failure.
Page 3 | NURS 5461/ NURS5461 Final Exam 2026
, NURS 5461/ NURS5461 Final Exam
2026 Exam · 200 Questions · With Rationales
ati. NURS 5461/ NURS5461 Final Exam
Question: 4 of 200
A patient with type 2 diabetes and eGFR 45 mL/min/1.73m² is being started on metformin. According to
current FDA guidelines, what is the appropriate action?
A. Initiate metformin at full dose; no renal monitoring needed.
B. Start metformin at half the usual dose; monitor renal function every 3 months.
C. Avoid metformin due to contraindication at this eGFR level.
D. Use metformin with caution; reduce dose if eGFR falls below 30.
PREVIOUS CONTINUE
A patient with type 2 diabetes and eGFR 45 mL/min/1.73m² is being started on metformin.
According to current FDA guidelines, what is the appropriate action?
A. Initiate metformin at full dose; no renal monitoring needed.
B. Start metformin at half the usual dose; monitor renal function every 3 months.
C. Avoid metformin due to contraindication at this eGFR level.
(Correct) D. Use metformin with caution; reduce dose if eGFR falls below 30.
Correct Answer: D
Current FDA guidance allows metformin use if eGFR 30 mL/min/1.73m², but dose should be reduced when
eGFR is 30-45. Monitoring renal function every 3-6 months is recommended. Option A is incorrect due to need
for dose adjustment. Option B is too conservative; starting at half dose is not mandated, but the key is to
monitor and reduce if needed. Option C is outdated; metformin is not contraindicated until eGFR <30.
Page 4 | NURS 5461/ NURS5461 Final Exam 2026
2026 Exam · 200 Questions · With Rationales
ati. NURS 5461/ NURS5461 Final Exam
Question: 1 of 200
A patient with a history of atrial fibrillation is initiated on warfarin. The patient also takes a medication that
inhibits CYP2C9. How should the warfarin dose be adjusted initially, and what additional monitoring is
A. Increase warfarin dose by 25%; monitor INR weekly.
B. Decrease warfarin dose by 30-50%; monitor INR more frequently.
C. No dose adjustment needed; monitor for bleeding.
D. Switch to a direct oral anticoagulant (DOAC) to avoid interaction.
PREVIOUS CONTINUE
A patient with a history of atrial fibrillation is initiated on warfarin. The patient also takes a
medication that inhibits CYP2C9. How should the warfarin dose be adjusted initially, and
what additional monitoring is warranted?
A. Increase warfarin dose by 25%; monitor INR weekly.
(Correct) B. Decrease warfarin dose by 30-50%; monitor INR more frequently.
C. No dose adjustment needed; monitor for bleeding.
D. Switch to a direct oral anticoagulant (DOAC) to avoid interaction.
Correct Answer: B
CYP2C9 inhibition reduces warfarin metabolism, increasing anticoagulant effect. A 30-50% dose reduction is
recommended, with more frequent INR monitoring (e.g., every 2-3 days) until stable. Option A would increase
risk of supratherapeutic INR. Option C ignores significant interaction. Option D may be considered but is not the
initial step; warfarin can be used with careful dose adjustment.
Page 1 | NURS 5461/ NURS5461 Final Exam 2026
, NURS 5461/ NURS5461 Final Exam
2026 Exam · 200 Questions · With Rationales
ati. NURS 5461/ NURS5461 Final Exam
Question: 2 of 200
A patient with chronic kidney disease (eGFR 25 mL/min/1.73m²) requires treatment for hypertension. Which
antihypertensive agent requires dose adjustment and why?
A. Lisinopril; it is primarily renally excreted and can accumulate.
B. Metoprolol; it undergoes extensive hepatic metabolism.
C. Amlodipine; it has a long half-life and renal impairment reduces clearance.
D. Hydrochlorothiazide; it loses efficacy at low GFR and may cause electrolyte disturbances.
PREVIOUS CONTINUE
A patient with chronic kidney disease (eGFR 25 mL/min/1.73m²) requires treatment for
hypertension. Which antihypertensive agent requires dose adjustment and why?
(Correct) A. Lisinopril; it is primarily renally excreted and can accumulate.
B. Metoprolol; it undergoes extensive hepatic metabolism.
C. Amlodipine; it has a long half-life and renal impairment reduces clearance.
D. Hydrochlorothiazide; it loses efficacy at low GFR and may cause electrolyte disturbances.
Correct Answer: A
Lisinopril is predominantly eliminated unchanged by the kidneys. In advanced CKD, accumulation can cause
hypotension and hyperkalemia; dose reduction is required. Metoprolol is hepatically metabolized and does not
require dose adjustment in CKD. Amlodipine is hepatically metabolized and not significantly affected by renal
impairment. Hydrochlorothiazide is ineffective when GFR <30 mL/min and is not recommended as
monotherapy, but the question asks for dose adjustment due to accumulation, which is more characteristic of
lisinopril.
Page 2 | NURS 5461/ NURS5461 Final Exam 2026
, NURS 5461/ NURS5461 Final Exam
2026 Exam · 200 Questions · With Rationales
ati. NURS 5461/ NURS5461 Final Exam
Question: 3 of 200
A patient on a stable dose of digoxin for heart failure develops acute kidney injury (AKI). What is the most
appropriate next step regarding digoxin therapy?
A. Continue current dose; monitor digoxin level in 1 week.
B. Reduce dose by 50% and check digoxin level immediately.
C. Discontinue digoxin permanently and start a different inotrope.
D. Hold digoxin until renal function returns to baseline.
PREVIOUS CONTINUE
A patient on a stable dose of digoxin for heart failure develops acute kidney injury (AKI).
What is the most appropriate next step regarding digoxin therapy?
A. Continue current dose; monitor digoxin level in 1 week.
(Correct) B. Reduce dose by 50% and check digoxin level immediately.
C. Discontinue digoxin permanently and start a different inotrope.
D. Hold digoxin until renal function returns to baseline.
Correct Answer: B
Digoxin is primarily renally excreted. AKI reduces clearance, increasing risk of toxicity. A 50% dose reduction is
recommended, with prompt serum digoxin level assessment. Option A risks toxicity. Option C is overly
aggressive; digoxin can be resumed at adjusted dose. Option D may be considered but dose reduction with
monitoring is preferred to avoid exacerbating heart failure.
Page 3 | NURS 5461/ NURS5461 Final Exam 2026
, NURS 5461/ NURS5461 Final Exam
2026 Exam · 200 Questions · With Rationales
ati. NURS 5461/ NURS5461 Final Exam
Question: 4 of 200
A patient with type 2 diabetes and eGFR 45 mL/min/1.73m² is being started on metformin. According to
current FDA guidelines, what is the appropriate action?
A. Initiate metformin at full dose; no renal monitoring needed.
B. Start metformin at half the usual dose; monitor renal function every 3 months.
C. Avoid metformin due to contraindication at this eGFR level.
D. Use metformin with caution; reduce dose if eGFR falls below 30.
PREVIOUS CONTINUE
A patient with type 2 diabetes and eGFR 45 mL/min/1.73m² is being started on metformin.
According to current FDA guidelines, what is the appropriate action?
A. Initiate metformin at full dose; no renal monitoring needed.
B. Start metformin at half the usual dose; monitor renal function every 3 months.
C. Avoid metformin due to contraindication at this eGFR level.
(Correct) D. Use metformin with caution; reduce dose if eGFR falls below 30.
Correct Answer: D
Current FDA guidance allows metformin use if eGFR 30 mL/min/1.73m², but dose should be reduced when
eGFR is 30-45. Monitoring renal function every 3-6 months is recommended. Option A is incorrect due to need
for dose adjustment. Option B is too conservative; starting at half dose is not mandated, but the key is to
monitor and reduce if needed. Option C is outdated; metformin is not contraindicated until eGFR <30.
Page 4 | NURS 5461/ NURS5461 Final Exam 2026
