NURS 6512 Exam 2 V1 | NURS 6512 Advanced Pharmacology | Actual
Q&A with Rationale (NURS 6512 Exam 2) | Walden
1. Mr. Henderson, a 62-year-old African American male, presents for a follow-up of stage 2
hypertension. His current blood pressure is 158/94 mmHg despite two months of lifestyle
modifications. According to current JNC 8 and ACC/AHA guidelines, which of the following is
the most appropriate initial pharmacologic therapy for this patient?
A. Amlodipine 5 mg daily
B. Lisinopril 10 mg daily
C. Metoprolol Succinate 25 mg daily
D. Losartan 50 mg daily
Answer: A
Rationale: For African American patients without chronic kidney disease, initial
antihypertensive therapy should include a thiazide-type diuretic or a calcium channel
blocker (CCB). Amlodipine is a dihydropyridine CCB that is highly effective in this
population compared to ACE inhibitors or ARBs. Beta-blockers like metoprolol are no
longer recommended as first-line therapy for uncomplicated hypertension unless a
compelling indication like heart failure is present.
2. A 45-year-old female patient with a history of heart failure with reduced ejection fraction
(HFrEF) is being started on Spironolactone. Which laboratory parameter must the nurse
practitioner monitor most closely within the first week of initiating this therapy?
A. Serum Sodium
B. Serum Calcium
C. Blood Urea Nitrogen (BUN)
D. Serum Potassium
Answer: D
Rationale: Spironolactone is a potassium-sparing diuretic and aldosterone antagonist that
can lead to life-threatening hyperkalemia, especially in patients also taking ACE inhibitors.
The nurse practitioner must monitor serum potassium levels and renal function at baseline
and within one week of initiation or dose increase. Patients should be educated to avoid
high-potassium foods and salt substitutes containing potassium chloride.
,3. Mrs. Thompson, a 55-year-old woman, is diagnosed with Type 2 Diabetes Mellitus. Her
baseline HbA1c is 8.2%. She has a history of mild heart failure and a BMI of 32. Which
medication is the preferred first-line agent according to the American Diabetes Association
(ADA) guidelines, provided there are no contraindications?
A. Glipizide
B. Pioglitazone
C. Sitagliptin
D. Metformin
Answer: D
Rationale: Metformin is the first-line pharmacologic treatment for Type 2 Diabetes
Mellitus due to its efficacy, low cost, and weight-neutral or weight-loss benefits. It works
primarily by decreasing hepatic glucose production and improving insulin sensitivity.
Unless a patient has a significant renal impairment (eGFR < 30 mL/min), Metformin
remains the gold standard initial therapy.
4. A 68-year-old male is prescribed Warfarin (Coumadin) for stroke prevention due to atrial
fibrillation. He is currently taking Amiodarone for rhythm control. How should the nurse
practitioner adjust the Warfarin dosing strategy when initiating Amiodarone?
A. Increase the Warfarin dose by 25%
B. Decrease the Warfarin dose by 25% to 50%
C. Maintain the current Warfarin dose and monitor INR monthly
D. Discontinue Warfarin and switch to Dabigatran
Answer: B
Rationale: Amiodarone is a potent inhibitor of the CYP2C9 enzyme, which is responsible
for the metabolism of the more active S-isomer of Warfarin. This interaction significantly
increases Warfarin serum levels and the risk of bleeding. The standard of care is to
empirically reduce the Warfarin dose by approximately 30-50% and monitor the INR
closely until a new steady state is achieved.
5. A 30-year-old female patient with persistent asthma uses an Albuterol inhaler as needed.
She reports using her rescue inhaler 4 to 5 times per week and waking up twice a month due
to shortness of breath. Which of the following is the most appropriate next step in her
pharmacotherapy?
A. Add a Long-Acting Beta Agonist (LABA)
B. Add a Low-Dose Inhaled Corticosteroid (ICS)
C. Increase the frequency of Albuterol use
D. Start Theophylline
, Answer: B
Rationale: The patient’s asthma is classified as ‘mild persistent’ because she uses her
rescue inhaler more than twice a week but not daily. According to GINA guidelines, the
first-line maintenance therapy for persistent asthma is a low-dose inhaled corticosteroid
(ICS) to reduce airway inflammation. LABAs should never be used as monotherapy in
asthma due to the increased risk of asthma-related death.
6. Mr. Rodriguez is a 50-year-old male with a history of hyperlipidemia currently taking
Simvastatin 40 mg daily. He presents with new-onset muscle pain and dark urine. Which lab
test is the priority to evaluate for potential statin-induced rhabdomyolysis?
A. Alanine Aminotransferase (ALT)
B. Creatine Kinase (CK)
C. Serum Bilirubin
D. Alkaline Phosphatase
Answer: B
Rationale: Creatine Kinase (CK) levels are elevated when there is significant muscle injury,
such as rhabdomyolysis, which is a rare but serious side effect of statin therapy. Dark urine
in this context often indicates myoglobinuria, which can lead to acute renal failure. The
nurse practitioner must immediately stop the statin and assess CK and renal function.
7. A 72-year-old patient with chronic obstructive pulmonary disease (COPD) is being
prescribed Tiotropium (Spiriva). What is the primary mechanism of action for this
medication?
A. Stimulation of beta-2 adrenergic receptors
B. Inhibition of muscarinic M3 receptors in the airway
C. Stabilization of mast cell membranes
D. Inhibition of phosphodiesterase-4
Answer: B
Rationale: Tiotropium is a Long-Acting Muscarinic Antagonist (LAMA) that works by
blocking the M3 muscarinic receptors on smooth muscle cells in the bronchi. This prevents
acetylcholine-induced bronchoconstriction, leading to prolonged bronchodilation. It is a
cornerstone therapy in the long-term maintenance of COPD symptoms.
8. A 28-year-old female patient is diagnosed with hypothyroidism and started on
Levothyroxine 50 mcg daily. Which instruction is most critical for ensuring optimal absorption
of this medication?
A. Take the medication with a high-fiber breakfast
B. Take the medication on an empty stomach, 30-60 minutes before breakfast
Q&A with Rationale (NURS 6512 Exam 2) | Walden
1. Mr. Henderson, a 62-year-old African American male, presents for a follow-up of stage 2
hypertension. His current blood pressure is 158/94 mmHg despite two months of lifestyle
modifications. According to current JNC 8 and ACC/AHA guidelines, which of the following is
the most appropriate initial pharmacologic therapy for this patient?
A. Amlodipine 5 mg daily
B. Lisinopril 10 mg daily
C. Metoprolol Succinate 25 mg daily
D. Losartan 50 mg daily
Answer: A
Rationale: For African American patients without chronic kidney disease, initial
antihypertensive therapy should include a thiazide-type diuretic or a calcium channel
blocker (CCB). Amlodipine is a dihydropyridine CCB that is highly effective in this
population compared to ACE inhibitors or ARBs. Beta-blockers like metoprolol are no
longer recommended as first-line therapy for uncomplicated hypertension unless a
compelling indication like heart failure is present.
2. A 45-year-old female patient with a history of heart failure with reduced ejection fraction
(HFrEF) is being started on Spironolactone. Which laboratory parameter must the nurse
practitioner monitor most closely within the first week of initiating this therapy?
A. Serum Sodium
B. Serum Calcium
C. Blood Urea Nitrogen (BUN)
D. Serum Potassium
Answer: D
Rationale: Spironolactone is a potassium-sparing diuretic and aldosterone antagonist that
can lead to life-threatening hyperkalemia, especially in patients also taking ACE inhibitors.
The nurse practitioner must monitor serum potassium levels and renal function at baseline
and within one week of initiation or dose increase. Patients should be educated to avoid
high-potassium foods and salt substitutes containing potassium chloride.
,3. Mrs. Thompson, a 55-year-old woman, is diagnosed with Type 2 Diabetes Mellitus. Her
baseline HbA1c is 8.2%. She has a history of mild heart failure and a BMI of 32. Which
medication is the preferred first-line agent according to the American Diabetes Association
(ADA) guidelines, provided there are no contraindications?
A. Glipizide
B. Pioglitazone
C. Sitagliptin
D. Metformin
Answer: D
Rationale: Metformin is the first-line pharmacologic treatment for Type 2 Diabetes
Mellitus due to its efficacy, low cost, and weight-neutral or weight-loss benefits. It works
primarily by decreasing hepatic glucose production and improving insulin sensitivity.
Unless a patient has a significant renal impairment (eGFR < 30 mL/min), Metformin
remains the gold standard initial therapy.
4. A 68-year-old male is prescribed Warfarin (Coumadin) for stroke prevention due to atrial
fibrillation. He is currently taking Amiodarone for rhythm control. How should the nurse
practitioner adjust the Warfarin dosing strategy when initiating Amiodarone?
A. Increase the Warfarin dose by 25%
B. Decrease the Warfarin dose by 25% to 50%
C. Maintain the current Warfarin dose and monitor INR monthly
D. Discontinue Warfarin and switch to Dabigatran
Answer: B
Rationale: Amiodarone is a potent inhibitor of the CYP2C9 enzyme, which is responsible
for the metabolism of the more active S-isomer of Warfarin. This interaction significantly
increases Warfarin serum levels and the risk of bleeding. The standard of care is to
empirically reduce the Warfarin dose by approximately 30-50% and monitor the INR
closely until a new steady state is achieved.
5. A 30-year-old female patient with persistent asthma uses an Albuterol inhaler as needed.
She reports using her rescue inhaler 4 to 5 times per week and waking up twice a month due
to shortness of breath. Which of the following is the most appropriate next step in her
pharmacotherapy?
A. Add a Long-Acting Beta Agonist (LABA)
B. Add a Low-Dose Inhaled Corticosteroid (ICS)
C. Increase the frequency of Albuterol use
D. Start Theophylline
, Answer: B
Rationale: The patient’s asthma is classified as ‘mild persistent’ because she uses her
rescue inhaler more than twice a week but not daily. According to GINA guidelines, the
first-line maintenance therapy for persistent asthma is a low-dose inhaled corticosteroid
(ICS) to reduce airway inflammation. LABAs should never be used as monotherapy in
asthma due to the increased risk of asthma-related death.
6. Mr. Rodriguez is a 50-year-old male with a history of hyperlipidemia currently taking
Simvastatin 40 mg daily. He presents with new-onset muscle pain and dark urine. Which lab
test is the priority to evaluate for potential statin-induced rhabdomyolysis?
A. Alanine Aminotransferase (ALT)
B. Creatine Kinase (CK)
C. Serum Bilirubin
D. Alkaline Phosphatase
Answer: B
Rationale: Creatine Kinase (CK) levels are elevated when there is significant muscle injury,
such as rhabdomyolysis, which is a rare but serious side effect of statin therapy. Dark urine
in this context often indicates myoglobinuria, which can lead to acute renal failure. The
nurse practitioner must immediately stop the statin and assess CK and renal function.
7. A 72-year-old patient with chronic obstructive pulmonary disease (COPD) is being
prescribed Tiotropium (Spiriva). What is the primary mechanism of action for this
medication?
A. Stimulation of beta-2 adrenergic receptors
B. Inhibition of muscarinic M3 receptors in the airway
C. Stabilization of mast cell membranes
D. Inhibition of phosphodiesterase-4
Answer: B
Rationale: Tiotropium is a Long-Acting Muscarinic Antagonist (LAMA) that works by
blocking the M3 muscarinic receptors on smooth muscle cells in the bronchi. This prevents
acetylcholine-induced bronchoconstriction, leading to prolonged bronchodilation. It is a
cornerstone therapy in the long-term maintenance of COPD symptoms.
8. A 28-year-old female patient is diagnosed with hypothyroidism and started on
Levothyroxine 50 mcg daily. Which instruction is most critical for ensuring optimal absorption
of this medication?
A. Take the medication with a high-fiber breakfast
B. Take the medication on an empty stomach, 30-60 minutes before breakfast
