NURS 6521 Advanced Pharmacology Final Exam Test Bank Q&As
with Verified Answers & Rationales (Walden University Winter
Quarter V3)
Question 1
A 67-year-old female patient with a history of chronic kidney disease
(CKD) Stage 3b is diagnosed with an acute urinary tract infection.
, The nurse practitioner notes a creatinine clearance (CrCl) of 32
mL/min. Which of the following antimicrobial agents should be
completely avoided due to lack of efficacy and increased risk of toxic
systemic accumulation?
A) Amoxicillin
B) Nitrofurantoin
C) Ciprofloxacin
D) Cephalexin
Verified Answer: B) Nitrofurantoin
Explanation: Nitrofurantoin requires adequate renal function to
achieve therapeutic concentrations in the urine. When the
creatinine clearance falls below 30 to 40 mL/min, the drug cannot
effectively concentrate in the urinary tract, leading to clinical
failure of the treatment. Furthermore, decreased renal clearance
causes systemic drug accumulation, significantly raising the risk of
severe peripheral neuropathy and pulmonary fibrosis in geriatric
populations.
Question 2
, A 42-year-old male with a history of mechanical heart valve
replacement is taking long-term warfarin therapy. He presents to the
clinic presenting with a 3-day history of acute gouty arthritis. Which
of the following analgesics is the safest option to prescribe without
significantly altering his International Normalized Ratio (INR) or
increasing GI bleed risk?
A) Ibuprofen
B) High-dose Aspirin
C) Acetaminophen (short-term, low-dose)
D) Celecoxib
Verified Answer: C) Acetaminophen (short-term, low-dose)
Explanation: NSAIDs like ibuprofen, high-dose aspirin, and
celecoxib displace warfarin from plasma protein binding sites,
inhibit platelets, and erode gastric mucosa, dramatically elevating
bleeding hazards without necessarily altering the INR. Short-term,
low-dose acetaminophen (less than 2 grams per day) is the safest
choice, though monitoring is still required if used for prolonged
periods because high doses can inhibit warfarin metabolism.
Question 3
, An emergency department patient presents with a severe exacerbation
of asthma. The clinical team administers high-dose inhaled albuterol
via a nebulizer every 20 minutes. Which of the following metabolic
and electrolyte abnormalities must the clinician monitor for closely?
A) Hyperkalemia
B) Hypokalemia
C) Hypercalcemia
D) Hyponatremia
Verified Answer: B) Hypokalemia
Explanation: Beta-2 adrenergic receptor agonists like albuterol
stimulate the sodium-potassium adenosine triphosphatase (Na+/K+
ATPase) pump. This action drives extracellular potassium ions into
the intracellular compartment, which can cause a rapid, dangerous
drop in serum potassium levels (hypokalemia), leading to cardiac
dysrhythmias.
Question 4
A patient who is an ultra-rapid metabolizer of the CYP2D6 enzyme
system is prescribed codeine for post-operative dental pain. What is
the primary clinical consequence the nurse practitioner expects this
with Verified Answers & Rationales (Walden University Winter
Quarter V3)
Question 1
A 67-year-old female patient with a history of chronic kidney disease
(CKD) Stage 3b is diagnosed with an acute urinary tract infection.
, The nurse practitioner notes a creatinine clearance (CrCl) of 32
mL/min. Which of the following antimicrobial agents should be
completely avoided due to lack of efficacy and increased risk of toxic
systemic accumulation?
A) Amoxicillin
B) Nitrofurantoin
C) Ciprofloxacin
D) Cephalexin
Verified Answer: B) Nitrofurantoin
Explanation: Nitrofurantoin requires adequate renal function to
achieve therapeutic concentrations in the urine. When the
creatinine clearance falls below 30 to 40 mL/min, the drug cannot
effectively concentrate in the urinary tract, leading to clinical
failure of the treatment. Furthermore, decreased renal clearance
causes systemic drug accumulation, significantly raising the risk of
severe peripheral neuropathy and pulmonary fibrosis in geriatric
populations.
Question 2
, A 42-year-old male with a history of mechanical heart valve
replacement is taking long-term warfarin therapy. He presents to the
clinic presenting with a 3-day history of acute gouty arthritis. Which
of the following analgesics is the safest option to prescribe without
significantly altering his International Normalized Ratio (INR) or
increasing GI bleed risk?
A) Ibuprofen
B) High-dose Aspirin
C) Acetaminophen (short-term, low-dose)
D) Celecoxib
Verified Answer: C) Acetaminophen (short-term, low-dose)
Explanation: NSAIDs like ibuprofen, high-dose aspirin, and
celecoxib displace warfarin from plasma protein binding sites,
inhibit platelets, and erode gastric mucosa, dramatically elevating
bleeding hazards without necessarily altering the INR. Short-term,
low-dose acetaminophen (less than 2 grams per day) is the safest
choice, though monitoring is still required if used for prolonged
periods because high doses can inhibit warfarin metabolism.
Question 3
, An emergency department patient presents with a severe exacerbation
of asthma. The clinical team administers high-dose inhaled albuterol
via a nebulizer every 20 minutes. Which of the following metabolic
and electrolyte abnormalities must the clinician monitor for closely?
A) Hyperkalemia
B) Hypokalemia
C) Hypercalcemia
D) Hyponatremia
Verified Answer: B) Hypokalemia
Explanation: Beta-2 adrenergic receptor agonists like albuterol
stimulate the sodium-potassium adenosine triphosphatase (Na+/K+
ATPase) pump. This action drives extracellular potassium ions into
the intracellular compartment, which can cause a rapid, dangerous
drop in serum potassium levels (hypokalemia), leading to cardiac
dysrhythmias.
Question 4
A patient who is an ultra-rapid metabolizer of the CYP2D6 enzyme
system is prescribed codeine for post-operative dental pain. What is
the primary clinical consequence the nurse practitioner expects this
