NUR 6011 Final Exam Actual Exam V1 | NUR 6011 Advance
Pharmacology (NUR6011 Final Exam) | William Paterson University
1. A 68-year-old patient with Stage 3 Chronic Kidney Disease (CKD) requires an antibiotic for a
complicated urinary tract infection. When prescribing a drug that is primarily excreted
renally, which pharmacokinetic principle must the NP consider most critically?
A. Increasing the loading dose to achieve steady state faster
B. Decreasing the dosing interval to maintain peak concentrations
C. Switching to a highly protein-bound drug to avoid filtration
D. Adjusting the dose based on estimated Glomerular Filtration Rate (eGFR)
Answer: D
Rationale: In patients with CKD, renal clearance is significantly reduced, necessitating
dosage adjustments to avoid drug accumulation and toxicity. The eGFR is the most reliable
clinical marker for determining the degree of renal impairment and calculating appropriate
drug doses. Failure to adjust for eGFR can lead to adverse effects such as nephrotoxicity or
systemic overdose.
2. Which statement best describes the mechanism of action of Sacubitril in the combination
drug Sacubitril/Valsartan (Entresto) for heart failure?
A. It blocks the AT1 receptor to prevent vasoconstriction
B. It inhibits the ACE enzyme to reduce Angiotensin II levels
C. It inhibits neprilysin, increasing levels of natriuretic peptides
D. It acts as a direct renin inhibitor to decrease systemic vascular resistance
Answer: C
Rationale: Sacubitril is a neprilysin inhibitor that prevents the breakdown of endogenous
natriuretic peptides, leading to increased vasodilation and natriuresis. This mechanism
works synergistically with Valsartan, which blocks the effects of Angiotensin II at the
receptor level. Together, they provide superior outcomes in heart failure patients
compared to ACE inhibitors alone.
3. A patient with a history of heart failure and a reduced ejection fraction (HFrEF) is currently
taking an ACE inhibitor. The NP plans to switch the patient to an Angiotensin Receptor-
Neprilysin Inhibitor (ARNI). What is the mandatory washout period required?
A. 12 hours
B. 24 hours
,C. 36 hours
D. 48 hours
Answer: C
Rationale: A 36-hour washout period is required when switching from an ACE inhibitor to
an ARNI to minimize the risk of angioedema. This delay ensures that the ACE enzyme
activity returns toward baseline before neprilysin inhibition begins. Overlapping these
mechanisms significantly increases bradykinin levels, which is a primary driver of life-
threatening airway swelling.
4. When prescribing Amiodarone for atrial fibrillation, which of the following baseline and
periodic monitoring parameters is essential due to the drug’s unique pharmacokinetic
profile?
A. Blood urea nitrogen (BUN) and creatinine
B. Complete blood count and serum electrolytes
C. Pulmonary function tests and thyroid stimulating hormone (TSH)
D. Urine microalbumin and uric acid levels
Answer: C
Rationale: Amiodarone contains iodine and has a high affinity for fatty tissues, leading to
potential toxicities in the lungs and thyroid gland. Pulmonary fibrosis is a rare but lethal
side effect that requires baseline and annual chest X-rays or PFTs. Additionally, because of
its iodine content, it can cause both hypo- and hyperthyroidism, necessitating regular TSH
monitoring.
5. A 45-year-old male with Type 2 Diabetes and a history of myocardial infarction is being
started on an SGLT2 inhibitor. Which clinical benefit is most associated with this class of
medication in this specific patient population?
A. Reduced risk of hospitalization for heart failure and cardiovascular death
B. Significant weight gain to improve metabolic reserves
C. Rapid increase in insulin sensitivity through hepatic glucose suppression
D. Prevention of vitamin B12 deficiency associated with long-term metformin use
Answer: A
Rationale: SGLT2 inhibitors have demonstrated significant cardiovascular benefits,
particularly in reducing heart failure hospitalizations and cardiovascular mortality. These
drugs work by inhibiting glucose reabsorption in the proximal tubule, leading to glucosuria
and mild diuresis. They are now considered foundational therapy for patients with
diabetes and established cardiovascular disease.
, 6. Which pharmacokinetic change is typically observed in geriatric patients that increases the
risk of toxicity for lipid-soluble drugs like diazepam?
A. Increased total body water
B. Decreased percentage of body fat
C. Increased hepatic blood flow
D. Increased percentage of body fat
Answer: D
Rationale: Aging is associated with an increase in the percentage of body fat and a
decrease in total body water and lean muscle mass. Lipid-soluble drugs like diazepam have
an increased volume of distribution in elderly patients because they sequester in fat stores.
This leads to a prolonged half-life and an increased risk of cumulative toxicity and
prolonged sedation.
7. A patient is prescribed Warfarin for a mechanical heart valve. They are now starting a
course of Sulfamethoxazole/Trimethoprim (Bactrim) for a UTI. What is the expected drug-
drug interaction?
A. Bactrim induces Warfarin metabolism, decreasing the INR and risk of clotting
B. Bactrim inhibits Warfarin metabolism, increasing the INR and risk of bleeding
C. Bactrim decreases the absorption of Warfarin in the GI tract
D. There is no significant interaction between these two medications
Answer: B
Rationale: Bactrim is a potent inhibitor of the CYP2C9 enzyme, which is the primary
pathway for the metabolism of the more active S-isomer of Warfarin. Inhibiting this
enzyme leads to significantly higher concentrations of Warfarin in the blood, causing the
INR to spike. Prescribers must closely monitor the INR and typically proactively reduce the
Warfarin dose during the antibiotic course.
8. When initiating a statin for a patient with hyperlipidemia, which laboratory value must be
assessed baseline according to current guidelines?
A. Creatinine kinase (CK)
B. Alkaline phosphatase (ALP)
C. Lactate dehydrogenase (LDH)
D. Alanine aminotransferase (ALT)
E. Correct Answer: B
Answer: D
Pharmacology (NUR6011 Final Exam) | William Paterson University
1. A 68-year-old patient with Stage 3 Chronic Kidney Disease (CKD) requires an antibiotic for a
complicated urinary tract infection. When prescribing a drug that is primarily excreted
renally, which pharmacokinetic principle must the NP consider most critically?
A. Increasing the loading dose to achieve steady state faster
B. Decreasing the dosing interval to maintain peak concentrations
C. Switching to a highly protein-bound drug to avoid filtration
D. Adjusting the dose based on estimated Glomerular Filtration Rate (eGFR)
Answer: D
Rationale: In patients with CKD, renal clearance is significantly reduced, necessitating
dosage adjustments to avoid drug accumulation and toxicity. The eGFR is the most reliable
clinical marker for determining the degree of renal impairment and calculating appropriate
drug doses. Failure to adjust for eGFR can lead to adverse effects such as nephrotoxicity or
systemic overdose.
2. Which statement best describes the mechanism of action of Sacubitril in the combination
drug Sacubitril/Valsartan (Entresto) for heart failure?
A. It blocks the AT1 receptor to prevent vasoconstriction
B. It inhibits the ACE enzyme to reduce Angiotensin II levels
C. It inhibits neprilysin, increasing levels of natriuretic peptides
D. It acts as a direct renin inhibitor to decrease systemic vascular resistance
Answer: C
Rationale: Sacubitril is a neprilysin inhibitor that prevents the breakdown of endogenous
natriuretic peptides, leading to increased vasodilation and natriuresis. This mechanism
works synergistically with Valsartan, which blocks the effects of Angiotensin II at the
receptor level. Together, they provide superior outcomes in heart failure patients
compared to ACE inhibitors alone.
3. A patient with a history of heart failure and a reduced ejection fraction (HFrEF) is currently
taking an ACE inhibitor. The NP plans to switch the patient to an Angiotensin Receptor-
Neprilysin Inhibitor (ARNI). What is the mandatory washout period required?
A. 12 hours
B. 24 hours
,C. 36 hours
D. 48 hours
Answer: C
Rationale: A 36-hour washout period is required when switching from an ACE inhibitor to
an ARNI to minimize the risk of angioedema. This delay ensures that the ACE enzyme
activity returns toward baseline before neprilysin inhibition begins. Overlapping these
mechanisms significantly increases bradykinin levels, which is a primary driver of life-
threatening airway swelling.
4. When prescribing Amiodarone for atrial fibrillation, which of the following baseline and
periodic monitoring parameters is essential due to the drug’s unique pharmacokinetic
profile?
A. Blood urea nitrogen (BUN) and creatinine
B. Complete blood count and serum electrolytes
C. Pulmonary function tests and thyroid stimulating hormone (TSH)
D. Urine microalbumin and uric acid levels
Answer: C
Rationale: Amiodarone contains iodine and has a high affinity for fatty tissues, leading to
potential toxicities in the lungs and thyroid gland. Pulmonary fibrosis is a rare but lethal
side effect that requires baseline and annual chest X-rays or PFTs. Additionally, because of
its iodine content, it can cause both hypo- and hyperthyroidism, necessitating regular TSH
monitoring.
5. A 45-year-old male with Type 2 Diabetes and a history of myocardial infarction is being
started on an SGLT2 inhibitor. Which clinical benefit is most associated with this class of
medication in this specific patient population?
A. Reduced risk of hospitalization for heart failure and cardiovascular death
B. Significant weight gain to improve metabolic reserves
C. Rapid increase in insulin sensitivity through hepatic glucose suppression
D. Prevention of vitamin B12 deficiency associated with long-term metformin use
Answer: A
Rationale: SGLT2 inhibitors have demonstrated significant cardiovascular benefits,
particularly in reducing heart failure hospitalizations and cardiovascular mortality. These
drugs work by inhibiting glucose reabsorption in the proximal tubule, leading to glucosuria
and mild diuresis. They are now considered foundational therapy for patients with
diabetes and established cardiovascular disease.
, 6. Which pharmacokinetic change is typically observed in geriatric patients that increases the
risk of toxicity for lipid-soluble drugs like diazepam?
A. Increased total body water
B. Decreased percentage of body fat
C. Increased hepatic blood flow
D. Increased percentage of body fat
Answer: D
Rationale: Aging is associated with an increase in the percentage of body fat and a
decrease in total body water and lean muscle mass. Lipid-soluble drugs like diazepam have
an increased volume of distribution in elderly patients because they sequester in fat stores.
This leads to a prolonged half-life and an increased risk of cumulative toxicity and
prolonged sedation.
7. A patient is prescribed Warfarin for a mechanical heart valve. They are now starting a
course of Sulfamethoxazole/Trimethoprim (Bactrim) for a UTI. What is the expected drug-
drug interaction?
A. Bactrim induces Warfarin metabolism, decreasing the INR and risk of clotting
B. Bactrim inhibits Warfarin metabolism, increasing the INR and risk of bleeding
C. Bactrim decreases the absorption of Warfarin in the GI tract
D. There is no significant interaction between these two medications
Answer: B
Rationale: Bactrim is a potent inhibitor of the CYP2C9 enzyme, which is the primary
pathway for the metabolism of the more active S-isomer of Warfarin. Inhibiting this
enzyme leads to significantly higher concentrations of Warfarin in the blood, causing the
INR to spike. Prescribers must closely monitor the INR and typically proactively reduce the
Warfarin dose during the antibiotic course.
8. When initiating a statin for a patient with hyperlipidemia, which laboratory value must be
assessed baseline according to current guidelines?
A. Creatinine kinase (CK)
B. Alkaline phosphatase (ALP)
C. Lactate dehydrogenase (LDH)
D. Alanine aminotransferase (ALT)
E. Correct Answer: B
Answer: D
