NURS 6521N Exam 4 V1 | NURS 6521N
Advanced Pharmacology | Actual Q&A
with Rationale (NURS6521N Exam 4) |
Walden University
1. A patient is prescribed levothyroxine for the treatment of hypothyroidism. Which
instruction should the nurse prioritize during patient education?
A. Take the medication on an empty stomach at least 30 to 60 minutes before breakfast.
B. Take the medication with a high-protein dinner to enhance absorption.
C. If a dose is missed, double the next dose to maintain steady-state levels.
D. Expect the full therapeutic effect to occur within 24 to 48 hours.
Answer: A
Rationale: Levothyroxine absorption is best achieved when the stomach is empty, typically
30 to 60 minutes before food intake. Taking it with food or certain minerals can
significantly decrease its bioavailability and effectiveness. Patients must understand that
this is a long-term therapy that requires several weeks to reach a steady state.
2. A diabetic patient is switched from twice-daily NPH insulin to once-daily insulin glargine
(Lantus). What is a unique characteristic of insulin glargine?
A. It has a rapid onset of 15 minutes and is used for mealtime coverage.
B. It provides a steady blood level over 24 hours without a distinct peak.
,C. It is a cloudy suspension that must be rolled before administration.
D. It is the only insulin that can be administered via an intravenous line.
Answer: B
Rationale: Insulin glargine is a long-acting basal insulin designed to provide a continuous
level of insulin for approximately 24 hours. Unlike NPH or regular insulin, it does not have
a pronounced peak, which reduces the risk of hypoglycemia between meals. This
characteristic makes it an ideal choice for maintaining baseline glycemic control in diabetic
patients.
3. A patient who has been taking high-dose prednisone for several months is being prepared
for discharge. What is the most critical instruction regarding this medication?
A. Do not stop taking the medication abruptly; it must be tapered slowly.
B. Stop taking the medication immediately if you develop a fever.
C. Take the medication only on days when you feel joint pain or stiffness.
D. Avoid taking the medication with food to prevent gastric irritation.
Answer: A
Rationale: Prolonged use of exogenous glucocorticoids like prednisone suppresses the
hypothalamic-pituitary-adrenal (HPA) axis and endogenous cortisol production. Abrupt
withdrawal can lead to life-threatening adrenal crisis because the body cannot immediately
resume adequate cortisol synthesis. Tapering the dose allows the adrenal glands to
gradually regain their normal function.
,4. Which laboratory value should the nurse monitor most closely in a patient receiving
metformin (Glucophage) for Type 2 diabetes?
A. Glomerular filtration rate (GFR) and serum creatinine.
B. Serum amylase and lipase levels.
C. Platelet count and international normalized ratio (INR).
D. Serum potassium and sodium levels.
Answer: A
Rationale: Metformin is primarily excreted unchanged by the kidneys, and renal
impairment increases the risk of metformin-associated lactic acidosis. The medication is
contraindicated in patients with significant renal dysfunction, typically defined by a GFR
below 30 mL/min. Monitoring renal function is essential for safe dosing and preventing
toxic accumulations.
5. A patient is prescribed sildenafil (Viagra) for erectile dysfunction. The nurse must warn the
patient that this drug is contraindicated with which other medication?
A. Nitroglycerin for angina.
B. Atorvastatin for hyperlipidemia.
C. Metoprolol for hypertension.
D. Warfarin for atrial fibrillation.
Answer: A
, Rationale: Sildenafil is a PDE5 inhibitor that enhances the vasodilatory effects of nitric
oxide, which can lead to profound hypotension when combined with nitrates. The
combination of sildenafil and nitroglycerin can cause a life-threatening drop in blood
pressure that is difficult to reverse. Patients must be screened for nitrate use before
sildenafil is prescribed.
6. A patient is receiving Propylthiouracil (PTU) for the treatment of Graves’ disease. Which
adverse effect should the nurse instruct the patient to report immediately?
A. A metallic taste in the mouth.
B. Increased appetite and weight gain.
C. Sore throat, fever, or unusual bleeding.
D. Occasional mild constipation.
Answer: C
Rationale: Propylthiouracil (PTU) can cause agranulocytosis, which is a severe reduction
in white blood cell counts that leaves the patient vulnerable to infection. Signs of infection,
such as a sore throat or fever, must be investigated immediately to prevent sepsis. Liver
toxicity is another serious concern with PTU, so jaundice or dark urine should also be
reported.
7. When administering alendronate (Fosamax) for osteoporosis, the nurse ensures the patient
remains upright for at least 30 minutes. What is the rationale for this?
A. To minimize the risk of severe esophageal irritation and ulceration.
Advanced Pharmacology | Actual Q&A
with Rationale (NURS6521N Exam 4) |
Walden University
1. A patient is prescribed levothyroxine for the treatment of hypothyroidism. Which
instruction should the nurse prioritize during patient education?
A. Take the medication on an empty stomach at least 30 to 60 minutes before breakfast.
B. Take the medication with a high-protein dinner to enhance absorption.
C. If a dose is missed, double the next dose to maintain steady-state levels.
D. Expect the full therapeutic effect to occur within 24 to 48 hours.
Answer: A
Rationale: Levothyroxine absorption is best achieved when the stomach is empty, typically
30 to 60 minutes before food intake. Taking it with food or certain minerals can
significantly decrease its bioavailability and effectiveness. Patients must understand that
this is a long-term therapy that requires several weeks to reach a steady state.
2. A diabetic patient is switched from twice-daily NPH insulin to once-daily insulin glargine
(Lantus). What is a unique characteristic of insulin glargine?
A. It has a rapid onset of 15 minutes and is used for mealtime coverage.
B. It provides a steady blood level over 24 hours without a distinct peak.
,C. It is a cloudy suspension that must be rolled before administration.
D. It is the only insulin that can be administered via an intravenous line.
Answer: B
Rationale: Insulin glargine is a long-acting basal insulin designed to provide a continuous
level of insulin for approximately 24 hours. Unlike NPH or regular insulin, it does not have
a pronounced peak, which reduces the risk of hypoglycemia between meals. This
characteristic makes it an ideal choice for maintaining baseline glycemic control in diabetic
patients.
3. A patient who has been taking high-dose prednisone for several months is being prepared
for discharge. What is the most critical instruction regarding this medication?
A. Do not stop taking the medication abruptly; it must be tapered slowly.
B. Stop taking the medication immediately if you develop a fever.
C. Take the medication only on days when you feel joint pain or stiffness.
D. Avoid taking the medication with food to prevent gastric irritation.
Answer: A
Rationale: Prolonged use of exogenous glucocorticoids like prednisone suppresses the
hypothalamic-pituitary-adrenal (HPA) axis and endogenous cortisol production. Abrupt
withdrawal can lead to life-threatening adrenal crisis because the body cannot immediately
resume adequate cortisol synthesis. Tapering the dose allows the adrenal glands to
gradually regain their normal function.
,4. Which laboratory value should the nurse monitor most closely in a patient receiving
metformin (Glucophage) for Type 2 diabetes?
A. Glomerular filtration rate (GFR) and serum creatinine.
B. Serum amylase and lipase levels.
C. Platelet count and international normalized ratio (INR).
D. Serum potassium and sodium levels.
Answer: A
Rationale: Metformin is primarily excreted unchanged by the kidneys, and renal
impairment increases the risk of metformin-associated lactic acidosis. The medication is
contraindicated in patients with significant renal dysfunction, typically defined by a GFR
below 30 mL/min. Monitoring renal function is essential for safe dosing and preventing
toxic accumulations.
5. A patient is prescribed sildenafil (Viagra) for erectile dysfunction. The nurse must warn the
patient that this drug is contraindicated with which other medication?
A. Nitroglycerin for angina.
B. Atorvastatin for hyperlipidemia.
C. Metoprolol for hypertension.
D. Warfarin for atrial fibrillation.
Answer: A
, Rationale: Sildenafil is a PDE5 inhibitor that enhances the vasodilatory effects of nitric
oxide, which can lead to profound hypotension when combined with nitrates. The
combination of sildenafil and nitroglycerin can cause a life-threatening drop in blood
pressure that is difficult to reverse. Patients must be screened for nitrate use before
sildenafil is prescribed.
6. A patient is receiving Propylthiouracil (PTU) for the treatment of Graves’ disease. Which
adverse effect should the nurse instruct the patient to report immediately?
A. A metallic taste in the mouth.
B. Increased appetite and weight gain.
C. Sore throat, fever, or unusual bleeding.
D. Occasional mild constipation.
Answer: C
Rationale: Propylthiouracil (PTU) can cause agranulocytosis, which is a severe reduction
in white blood cell counts that leaves the patient vulnerable to infection. Signs of infection,
such as a sore throat or fever, must be investigated immediately to prevent sepsis. Liver
toxicity is another serious concern with PTU, so jaundice or dark urine should also be
reported.
7. When administering alendronate (Fosamax) for osteoporosis, the nurse ensures the patient
remains upright for at least 30 minutes. What is the rationale for this?
A. To minimize the risk of severe esophageal irritation and ulceration.
