NURS 6521N Exam 4 V3 | NURS 6521N
Advanced Pharmacology | Actual Q&A
with Rationale (NURS6521N Exam 4) |
Walden University
1. A 45-year-old female patient with Type 2 Diabetes is prescribed Metformin (Glucophage).
Which laboratory value would necessitate the immediate discontinuation of this medication?
A. Serum creatinine of 1.8 mg/dL
B. Fast blood glucose of 140 mg/dL
C. Hemoglobin A1c of 7.2%
D. Total cholesterol of 210 mg/dL
Answer: A
Rationale: Metformin is primarily excreted by the kidneys and can accumulate in patients
with renal impairment, significantly increasing the risk of lactic acidosis. A serum
creatinine level above 1.5 mg/dL in men or 1.4 mg/dL in women is traditionally considered
a contraindication for its use. The provider must monitor renal function closely and pause
the drug if the estimated glomerular filtration rate (eGFR) falls below 30 mL/min/1.73m².
2. When educating a patient newly diagnosed with Hypothyroidism regarding Levothyroxine
(Synthroid) administration, which instruction is most appropriate?
A. Take the medication with a high-calcium breakfast to enhance absorption.
,B. Take the medication only when feeling symptomatic of fatigue or cold intolerance.
C. Take the medication at bedtime with a full glass of milk.
D. Take the medication on an empty stomach, 30 to 60 minutes before breakfast.
Answer: D
Rationale: Levothyroxine absorption is significantly decreased when taken with food,
especially those containing calcium, iron, or fiber. For optimal and consistent
bioavailability, it should be taken in the morning on an empty stomach with water. Patients
should wait at least 30 to 60 minutes before consuming any food or other medications to
ensure therapeutic levels are maintained.
3. A 68-year-old patient is receiving Metoclopramide (Reglan) for Diabetic Gastroparesis. The
nurse practitioner should prioritize monitoring for which serious adverse effect?
A. Hypertension
B. Tachycardia
C. Hypoglycemia
D. Tardive Dyskinesia
Answer: D
Rationale: Metoclopramide is a dopamine antagonist that crosses the blood-brain barrier
and can cause extrapyramidal symptoms, including irreversible tardive dyskinesia. This
risk is particularly high in elderly patients and those treated for durations exceeding 12
,weeks. The clinician must educate the patient to report any involuntary movements of the
face, tongue, or limbs immediately.
4. A patient with Type 1 Diabetes plans to begin a rigorous exercise program. What
adjustment is generally recommended regarding their insulin regimen?
A. Increase the dose of basal insulin by 20% on exercise days.
B. Inject insulin directly into the primary muscle group being exercised.
C. Omit the insulin dose entirely on days when exercise is performed.
D. Decrease the insulin dose or consume extra carbohydrates before exercise.
Answer: D
Rationale: Exercise increases glucose uptake by muscle cells via insulin-independent
pathways, which can lead to hypoglycemia if insulin doses are not adjusted. Patients are
typically advised to reduce the bolus insulin dose prior to exercise or consume a
carbohydrate-rich snack. Monitoring blood glucose before, during, and after exercise is
critical to prevent late-onset hypoglycemia.
5. Which medication is considered the gold standard for treating a patient with a
documented Myxedema Coma?
A. Oral Propylthiouracil (PTU)
B. Oral Radioactive Iodine
C. Subcutaneous Methimazole
, D. Intravenous Levothyroxine (T4)
Answer: D
Rationale: Myxedema coma is a life-threatening complication of severe hypothyroidism
requiring rapid thyroid hormone replacement. Intravenous administration of
Levothyroxine is preferred over the oral route because the patient’s gastrointestinal
absorption may be compromised. Supportive care, including glucocorticoids and
respiratory support, is also essential during the acute management phase.
6. A patient is prescribed Omeprazole (Prilosec) for GERD. Long-term use of Proton Pump
Inhibitors (PPIs) has been associated with which nutritional deficiency?
A. Vitamin C
B. Vitamin B12
C. Vitamin A
D. Folic Acid
Answer: B
Rationale: PPIs suppress gastric acid production, which is necessary for the cleavage of
Vitamin B12 from dietary proteins and its subsequent absorption. Chronic acid
suppression can lead to malabsorption and deficiency over several years of use. Clinicians
should periodically monitor B12 levels or consider supplementation in patients on long-
term PPI therapy.
Advanced Pharmacology | Actual Q&A
with Rationale (NURS6521N Exam 4) |
Walden University
1. A 45-year-old female patient with Type 2 Diabetes is prescribed Metformin (Glucophage).
Which laboratory value would necessitate the immediate discontinuation of this medication?
A. Serum creatinine of 1.8 mg/dL
B. Fast blood glucose of 140 mg/dL
C. Hemoglobin A1c of 7.2%
D. Total cholesterol of 210 mg/dL
Answer: A
Rationale: Metformin is primarily excreted by the kidneys and can accumulate in patients
with renal impairment, significantly increasing the risk of lactic acidosis. A serum
creatinine level above 1.5 mg/dL in men or 1.4 mg/dL in women is traditionally considered
a contraindication for its use. The provider must monitor renal function closely and pause
the drug if the estimated glomerular filtration rate (eGFR) falls below 30 mL/min/1.73m².
2. When educating a patient newly diagnosed with Hypothyroidism regarding Levothyroxine
(Synthroid) administration, which instruction is most appropriate?
A. Take the medication with a high-calcium breakfast to enhance absorption.
,B. Take the medication only when feeling symptomatic of fatigue or cold intolerance.
C. Take the medication at bedtime with a full glass of milk.
D. Take the medication on an empty stomach, 30 to 60 minutes before breakfast.
Answer: D
Rationale: Levothyroxine absorption is significantly decreased when taken with food,
especially those containing calcium, iron, or fiber. For optimal and consistent
bioavailability, it should be taken in the morning on an empty stomach with water. Patients
should wait at least 30 to 60 minutes before consuming any food or other medications to
ensure therapeutic levels are maintained.
3. A 68-year-old patient is receiving Metoclopramide (Reglan) for Diabetic Gastroparesis. The
nurse practitioner should prioritize monitoring for which serious adverse effect?
A. Hypertension
B. Tachycardia
C. Hypoglycemia
D. Tardive Dyskinesia
Answer: D
Rationale: Metoclopramide is a dopamine antagonist that crosses the blood-brain barrier
and can cause extrapyramidal symptoms, including irreversible tardive dyskinesia. This
risk is particularly high in elderly patients and those treated for durations exceeding 12
,weeks. The clinician must educate the patient to report any involuntary movements of the
face, tongue, or limbs immediately.
4. A patient with Type 1 Diabetes plans to begin a rigorous exercise program. What
adjustment is generally recommended regarding their insulin regimen?
A. Increase the dose of basal insulin by 20% on exercise days.
B. Inject insulin directly into the primary muscle group being exercised.
C. Omit the insulin dose entirely on days when exercise is performed.
D. Decrease the insulin dose or consume extra carbohydrates before exercise.
Answer: D
Rationale: Exercise increases glucose uptake by muscle cells via insulin-independent
pathways, which can lead to hypoglycemia if insulin doses are not adjusted. Patients are
typically advised to reduce the bolus insulin dose prior to exercise or consume a
carbohydrate-rich snack. Monitoring blood glucose before, during, and after exercise is
critical to prevent late-onset hypoglycemia.
5. Which medication is considered the gold standard for treating a patient with a
documented Myxedema Coma?
A. Oral Propylthiouracil (PTU)
B. Oral Radioactive Iodine
C. Subcutaneous Methimazole
, D. Intravenous Levothyroxine (T4)
Answer: D
Rationale: Myxedema coma is a life-threatening complication of severe hypothyroidism
requiring rapid thyroid hormone replacement. Intravenous administration of
Levothyroxine is preferred over the oral route because the patient’s gastrointestinal
absorption may be compromised. Supportive care, including glucocorticoids and
respiratory support, is also essential during the acute management phase.
6. A patient is prescribed Omeprazole (Prilosec) for GERD. Long-term use of Proton Pump
Inhibitors (PPIs) has been associated with which nutritional deficiency?
A. Vitamin C
B. Vitamin B12
C. Vitamin A
D. Folic Acid
Answer: B
Rationale: PPIs suppress gastric acid production, which is necessary for the cleavage of
Vitamin B12 from dietary proteins and its subsequent absorption. Chronic acid
suppression can lead to malabsorption and deficiency over several years of use. Clinicians
should periodically monitor B12 levels or consider supplementation in patients on long-
term PPI therapy.
