NUR 6011 Exam 4 Actual Exam V3 | NUR 6011 Advance Pharmacology
(NUR6011 Exam 4) | William Paterson University
1. A 45-year-old male with a history of hypertension is diagnosed with mild persistent
asthma. Which of the following is the most appropriate first-line maintenance therapy
according to current GINA guidelines?
A. Albuterol PRN only
B. Salmeterol monotherapy
C. Theophylline daily
D. Low-dose inhaled corticosteroid (ICS) plus formoterol PRN
Answer: D
Rationale: Current GINA guidelines no longer recommend SABA monotherapy for adults
as it increases the risk of exacerbations. Low-dose ICS-formoterol is the preferred reliever
and maintenance therapy for mild asthma. This approach addresses both the underlying
inflammation and the need for symptom relief simultaneously.
2. When transitioning a patient from a Selective Serotonin Reuptake Inhibitor (SSRI) to a
Monoamine Oxidase Inhibitor (MAOI), what is the required washout period for most SSRIs?
A. 48 hours
B. 1 week
C. 2 weeks
D. 5 weeks
Answer: C
Rationale: For most SSRIs, a minimum washout period of 2 weeks is necessary to prevent
serotonin syndrome. Fluoxetine is the exception, requiring a 5-week washout due to its
exceptionally long half-life. Failure to observe these periods can lead to life-threatening
autonomic instability and neuromuscular hyperreactivity.
3. A patient taking Lithium for Bipolar Disorder presents with tremor, ataxia, and confusion.
Which medication, if recently added, most likely contributed to Lithium toxicity?
A. Ibuprofen
B. Acetaminophen
C. Aspirin
D. Amoxicillin
,Answer: A
Rationale: NSAIDs like ibuprofen reduce renal blood flow and inhibit the synthesis of
prostaglandins, leading to decreased lithium clearance. This interaction can rapidly elevate
lithium levels into the toxic range. Patients should be advised to use acetaminophen as a
safer analgesic alternative while on lithium therapy.
4. Which mechanism of action describes the effect of Tiotropium in the management of
Chronic Obstructive Pulmonary Disease (COPD)?
A. Beta-2 adrenergic agonist
B. Leukotriene receptor antagonist
C. Long-acting muscarinic antagonist
D. Phosphodiesterase-4 inhibitor
Answer: C
Rationale: Tiotropium is a long-acting muscarinic antagonist (LAMA) that works by
blocking M3 receptors on smooth muscle. This leads to bronchodilation by inhibiting the
bronchoconstrictive effects of acetylcholine. It is a cornerstone of maintenance therapy to
reduce COPD exacerbations and improve lung function.
5. A patient is being started on Phenytoin for seizure control. The clinician knows that
Phenytoin follows which type of pharmacokinetics?
A. First-order kinetics at all doses
B. Zero-order (Michaelis-Menten) kinetics at therapeutic doses
C. Incomplete absorption in the GI tract
D. Rapid renal excretion without metabolism
Answer: B
Rationale: Phenytoin exhibits saturation kinetics, meaning that once metabolic enzymes
are saturated, small dose increases lead to disproportionately large increases in serum
levels. This makes the drug difficult to manage and necessitates frequent blood level
monitoring. Understanding this relationship is critical for preventing toxicity and ensuring
therapeutic efficacy.
6. Which of the following adverse effects is most commonly associated with the use of
Atypical Antipsychotics like Olanzapine?
A. Agranulocytosis
B. Acute dystonia
C. Metabolic syndrome and weight gain
, D. Hyperthyroidism
Answer: C
Rationale: Second-generation or atypical antipsychotics are strongly linked to metabolic
side effects including significant weight gain, dyslipidemia, and insulin resistance.
Monitoring of waist circumference, blood glucose, and lipid profiles is a mandatory
component of clinical care. While they have a lower risk of EPS compared to first-
generation drugs, the metabolic burden remains a primary concern.
7. A 32-year-old female patient with a history of migraines is seeking a prescription for
Sumatriptan. Which comorbidity would be a contraindication for this medication?
A. Hypothyroidism
B. Type 2 Diabetes
C. Asthma
D. Ischemic Heart Disease
Answer: D
Rationale: Triptans are 5-HT1B/1D agonists that cause vasoconstriction of cranial vessels
but can also affect coronary arteries. They are contraindicated in patients with ischemic
heart disease, Prinzmetal angina, or uncontrolled hypertension due to the risk of
myocardial infarction. A thorough cardiovascular screening is essential before initiating
triptan therapy.
8. A patient with depression and a history of smoking cessation attempts is considering
Bupropion. Which condition would make Bupropion an inappropriate choice?
A. Sexual dysfunction
B. Seizure disorder
C. Hypersomnia
D. Obesity
Answer: B
Rationale: Bupropion lowers the seizure threshold and is strictly contraindicated in
patients with epilepsy or a history of seizures. It is also contraindicated in patients with
eating disorders like anorexia or bulimia due to electrolyte imbalances increasing seizure
risk. Despite these risks, it is often favored for patients concerned about weight gain or
sexual dysfunction associated with SSRIs.
9. What is the primary rationale for combining Carbidopa with Levodopa in the treatment of
Parkinson’s Disease?
A. To inhibit the peripheral conversion of levodopa to dopamine
(NUR6011 Exam 4) | William Paterson University
1. A 45-year-old male with a history of hypertension is diagnosed with mild persistent
asthma. Which of the following is the most appropriate first-line maintenance therapy
according to current GINA guidelines?
A. Albuterol PRN only
B. Salmeterol monotherapy
C. Theophylline daily
D. Low-dose inhaled corticosteroid (ICS) plus formoterol PRN
Answer: D
Rationale: Current GINA guidelines no longer recommend SABA monotherapy for adults
as it increases the risk of exacerbations. Low-dose ICS-formoterol is the preferred reliever
and maintenance therapy for mild asthma. This approach addresses both the underlying
inflammation and the need for symptom relief simultaneously.
2. When transitioning a patient from a Selective Serotonin Reuptake Inhibitor (SSRI) to a
Monoamine Oxidase Inhibitor (MAOI), what is the required washout period for most SSRIs?
A. 48 hours
B. 1 week
C. 2 weeks
D. 5 weeks
Answer: C
Rationale: For most SSRIs, a minimum washout period of 2 weeks is necessary to prevent
serotonin syndrome. Fluoxetine is the exception, requiring a 5-week washout due to its
exceptionally long half-life. Failure to observe these periods can lead to life-threatening
autonomic instability and neuromuscular hyperreactivity.
3. A patient taking Lithium for Bipolar Disorder presents with tremor, ataxia, and confusion.
Which medication, if recently added, most likely contributed to Lithium toxicity?
A. Ibuprofen
B. Acetaminophen
C. Aspirin
D. Amoxicillin
,Answer: A
Rationale: NSAIDs like ibuprofen reduce renal blood flow and inhibit the synthesis of
prostaglandins, leading to decreased lithium clearance. This interaction can rapidly elevate
lithium levels into the toxic range. Patients should be advised to use acetaminophen as a
safer analgesic alternative while on lithium therapy.
4. Which mechanism of action describes the effect of Tiotropium in the management of
Chronic Obstructive Pulmonary Disease (COPD)?
A. Beta-2 adrenergic agonist
B. Leukotriene receptor antagonist
C. Long-acting muscarinic antagonist
D. Phosphodiesterase-4 inhibitor
Answer: C
Rationale: Tiotropium is a long-acting muscarinic antagonist (LAMA) that works by
blocking M3 receptors on smooth muscle. This leads to bronchodilation by inhibiting the
bronchoconstrictive effects of acetylcholine. It is a cornerstone of maintenance therapy to
reduce COPD exacerbations and improve lung function.
5. A patient is being started on Phenytoin for seizure control. The clinician knows that
Phenytoin follows which type of pharmacokinetics?
A. First-order kinetics at all doses
B. Zero-order (Michaelis-Menten) kinetics at therapeutic doses
C. Incomplete absorption in the GI tract
D. Rapid renal excretion without metabolism
Answer: B
Rationale: Phenytoin exhibits saturation kinetics, meaning that once metabolic enzymes
are saturated, small dose increases lead to disproportionately large increases in serum
levels. This makes the drug difficult to manage and necessitates frequent blood level
monitoring. Understanding this relationship is critical for preventing toxicity and ensuring
therapeutic efficacy.
6. Which of the following adverse effects is most commonly associated with the use of
Atypical Antipsychotics like Olanzapine?
A. Agranulocytosis
B. Acute dystonia
C. Metabolic syndrome and weight gain
, D. Hyperthyroidism
Answer: C
Rationale: Second-generation or atypical antipsychotics are strongly linked to metabolic
side effects including significant weight gain, dyslipidemia, and insulin resistance.
Monitoring of waist circumference, blood glucose, and lipid profiles is a mandatory
component of clinical care. While they have a lower risk of EPS compared to first-
generation drugs, the metabolic burden remains a primary concern.
7. A 32-year-old female patient with a history of migraines is seeking a prescription for
Sumatriptan. Which comorbidity would be a contraindication for this medication?
A. Hypothyroidism
B. Type 2 Diabetes
C. Asthma
D. Ischemic Heart Disease
Answer: D
Rationale: Triptans are 5-HT1B/1D agonists that cause vasoconstriction of cranial vessels
but can also affect coronary arteries. They are contraindicated in patients with ischemic
heart disease, Prinzmetal angina, or uncontrolled hypertension due to the risk of
myocardial infarction. A thorough cardiovascular screening is essential before initiating
triptan therapy.
8. A patient with depression and a history of smoking cessation attempts is considering
Bupropion. Which condition would make Bupropion an inappropriate choice?
A. Sexual dysfunction
B. Seizure disorder
C. Hypersomnia
D. Obesity
Answer: B
Rationale: Bupropion lowers the seizure threshold and is strictly contraindicated in
patients with epilepsy or a history of seizures. It is also contraindicated in patients with
eating disorders like anorexia or bulimia due to electrolyte imbalances increasing seizure
risk. Despite these risks, it is often favored for patients concerned about weight gain or
sexual dysfunction associated with SSRIs.
9. What is the primary rationale for combining Carbidopa with Levodopa in the treatment of
Parkinson’s Disease?
A. To inhibit the peripheral conversion of levodopa to dopamine
