NUR 6011 Exam 3 Actual Exam V3 | NUR 6011 Advance Pharmacology
(NUR6011 Exam 3) | William Paterson University
1. A 55-year-old patient with Type 2 Diabetes presents with an estimated Glomerular
Filtration Rate (eGFR) of 25 mL/min/1.73m2. Which of the following is the most appropriate
action regarding their Metformin therapy?
A. Discontinue Metformin immediately
B. Maintain the current dose and monitor creatinine every 3 months
C. Reduce the dose by 50%
D. Switch to a Sulfonylurea without dose adjustment
Answer: A
Rationale: Metformin is strictly contraindicated in patients with an eGFR less than 30
mL/min/1.73m2. The primary concern is the increased risk of lactic acidosis, which is a
rare but potentially fatal metabolic complication. The provider must evaluate alternative
glucose-lowering therapies that are safer for advanced renal impairment.
2. When prescribing Levothyroxine for a patient with newly diagnosed primary
hypothyroidism, which counseling point is most critical for ensuring drug absorption?
A. Take the medication on an empty stomach, 30 to 60 minutes before breakfast
B. Take the medication with a full glass of milk to prevent GI upset
C. Take the medication immediately after the largest meal of the day
D. Take the medication concurrently with iron or calcium supplements
Answer: A
Rationale: Levothyroxine absorption is significantly reduced when taken with food,
especially fiber, coffee, or calcium-containing products. Optimal absorption occurs when
the stomach is empty, typically 30 to 60 minutes before the first meal of the day. Consistent
timing is essential to maintain stable TSH levels and therapeutic efficacy.
3. A patient taking Lithium for Bipolar Disorder is started on a Thiazide diuretic for
hypertension. Which outcome should the Advanced Practice Nurse anticipate?
A. Decreased Lithium levels due to increased renal clearance
B. Increased risk of hypokalemia leading to Lithium resistance
C. No significant change in Lithium levels
D. Increased Lithium levels due to decreased renal clearance
,Answer: D
Rationale: Thiazide diuretics cause sodium depletion, which leads the kidneys to
compensate by increasing the reabsorption of both sodium and lithium. This mechanism
can result in toxic levels of lithium in the bloodstream even at previously stable doses.
Frequent monitoring of lithium levels and renal function is mandatory when adding a
diuretic to the regimen.
4. A patient initiated on Valproic acid (Depakote) requires baseline and periodic laboratory
monitoring. Which of the following is the most important to monitor to prevent serious
adverse effects?
A. Serum Potassium and Calcium
B. Pulmonary Function Tests
C. Serum Creatinine and BUN
D. Liver Function Tests and Platelet Count
Answer: D
Rationale: Valproic acid carries black box warnings for hepatotoxicity and pancreatitis.
Additionally, it can cause dose-related thrombocytopenia, necessitating regular monitoring
of the complete blood count. Clinicians must educate patients to report symptoms such as
abdominal pain, jaundice, or unusual bruising immediately.
5. A patient with a history of atrial fibrillation is taking Warfarin. They are prescribed a course
of Trimethoprim-Sulfamethoxazole (Bactrim) for a urinary tract infection. What is the
expected effect on the International Normalized Ratio (INR)?
A. The INR will decrease, raising the risk of thrombosis
B. The INR will increase, raising the risk of bleeding
C. The INR will remain stable as Bactrim does not interact with Warfarin
D. The INR will fluctuate unpredictably due to the infection itself
Answer: B
Rationale: Bactrim inhibits the CYP2C9 enzyme, which is the primary pathway for the
metabolism of S-warfarin, the more potent isomer. This interaction significantly increases
the anticoagulant effect, leading to a dangerous rise in INR. Providers should consider dose
reduction of warfarin or alternative antibiotics and perform frequent INR monitoring
during the course.
6. Which of the following classes of anti-diabetic medications is associated with a risk of
euglycemic diabetic ketoacidosis (DKA)?
A. GLP-1 Receptor Agonists
B. DPP-4 Inhibitors
, C. SGLT2 Inhibitors
D. Thiazolidinediones
Answer: C
Rationale: SGLT2 inhibitors like Canagliflozin can cause DKA even when blood glucose
levels are near normal (less than 250 mg/dL). This occurs because the drug promotes
glucose excretion while metabolic stressors trigger ketone production. Patients should be
taught to recognize symptoms like nausea, vomiting, and abdominal pain regardless of
their glucose readings.
7. A patient presents with symptoms of Serotonin Syndrome, including hyperthermia,
agitation, and hyperreflexia. Which medication combination is most likely to cause this
condition?
A. Fluoxetine and Lorazepam
B. Sertraline and Phenelzine
C. Venlafaxine and Gabapentin
D. Amitriptyline and Hydrochlorothiazide
Answer: B
Rationale: Serotonin Syndrome results from excessive serotonergic activity, often due to
the combination of an SSRI (like Sertraline) and an MAOI (like Phenelzine). These two
classes should never be used together and require a washout period when switching
between them. The management involves immediate discontinuation of the offending
agents and supportive care.
8. A patient starting Clozapine (Clozaril) for treatment-resistant schizophrenia must be
registered in the REMS program. What is the primary reason for this mandatory monitoring?
A. Risk of severe hepatotoxicity
B. Risk of Stevens-Johnson Syndrome
C. Risk of severe QTc prolongation
D. Risk of severe neutropenia (agranulocytosis)
Answer: D
Rationale: Clozapine is associated with a high risk of life-threatening agranulocytosis,
which is a severe drop in the absolute neutrophil count (ANC). The REMS program
mandates regular blood draws to ensure the ANC remains within a safe range before the
drug can be dispensed. This safety protocol has significantly reduced the mortality
associated with Clozapine therapy.
(NUR6011 Exam 3) | William Paterson University
1. A 55-year-old patient with Type 2 Diabetes presents with an estimated Glomerular
Filtration Rate (eGFR) of 25 mL/min/1.73m2. Which of the following is the most appropriate
action regarding their Metformin therapy?
A. Discontinue Metformin immediately
B. Maintain the current dose and monitor creatinine every 3 months
C. Reduce the dose by 50%
D. Switch to a Sulfonylurea without dose adjustment
Answer: A
Rationale: Metformin is strictly contraindicated in patients with an eGFR less than 30
mL/min/1.73m2. The primary concern is the increased risk of lactic acidosis, which is a
rare but potentially fatal metabolic complication. The provider must evaluate alternative
glucose-lowering therapies that are safer for advanced renal impairment.
2. When prescribing Levothyroxine for a patient with newly diagnosed primary
hypothyroidism, which counseling point is most critical for ensuring drug absorption?
A. Take the medication on an empty stomach, 30 to 60 minutes before breakfast
B. Take the medication with a full glass of milk to prevent GI upset
C. Take the medication immediately after the largest meal of the day
D. Take the medication concurrently with iron or calcium supplements
Answer: A
Rationale: Levothyroxine absorption is significantly reduced when taken with food,
especially fiber, coffee, or calcium-containing products. Optimal absorption occurs when
the stomach is empty, typically 30 to 60 minutes before the first meal of the day. Consistent
timing is essential to maintain stable TSH levels and therapeutic efficacy.
3. A patient taking Lithium for Bipolar Disorder is started on a Thiazide diuretic for
hypertension. Which outcome should the Advanced Practice Nurse anticipate?
A. Decreased Lithium levels due to increased renal clearance
B. Increased risk of hypokalemia leading to Lithium resistance
C. No significant change in Lithium levels
D. Increased Lithium levels due to decreased renal clearance
,Answer: D
Rationale: Thiazide diuretics cause sodium depletion, which leads the kidneys to
compensate by increasing the reabsorption of both sodium and lithium. This mechanism
can result in toxic levels of lithium in the bloodstream even at previously stable doses.
Frequent monitoring of lithium levels and renal function is mandatory when adding a
diuretic to the regimen.
4. A patient initiated on Valproic acid (Depakote) requires baseline and periodic laboratory
monitoring. Which of the following is the most important to monitor to prevent serious
adverse effects?
A. Serum Potassium and Calcium
B. Pulmonary Function Tests
C. Serum Creatinine and BUN
D. Liver Function Tests and Platelet Count
Answer: D
Rationale: Valproic acid carries black box warnings for hepatotoxicity and pancreatitis.
Additionally, it can cause dose-related thrombocytopenia, necessitating regular monitoring
of the complete blood count. Clinicians must educate patients to report symptoms such as
abdominal pain, jaundice, or unusual bruising immediately.
5. A patient with a history of atrial fibrillation is taking Warfarin. They are prescribed a course
of Trimethoprim-Sulfamethoxazole (Bactrim) for a urinary tract infection. What is the
expected effect on the International Normalized Ratio (INR)?
A. The INR will decrease, raising the risk of thrombosis
B. The INR will increase, raising the risk of bleeding
C. The INR will remain stable as Bactrim does not interact with Warfarin
D. The INR will fluctuate unpredictably due to the infection itself
Answer: B
Rationale: Bactrim inhibits the CYP2C9 enzyme, which is the primary pathway for the
metabolism of S-warfarin, the more potent isomer. This interaction significantly increases
the anticoagulant effect, leading to a dangerous rise in INR. Providers should consider dose
reduction of warfarin or alternative antibiotics and perform frequent INR monitoring
during the course.
6. Which of the following classes of anti-diabetic medications is associated with a risk of
euglycemic diabetic ketoacidosis (DKA)?
A. GLP-1 Receptor Agonists
B. DPP-4 Inhibitors
, C. SGLT2 Inhibitors
D. Thiazolidinediones
Answer: C
Rationale: SGLT2 inhibitors like Canagliflozin can cause DKA even when blood glucose
levels are near normal (less than 250 mg/dL). This occurs because the drug promotes
glucose excretion while metabolic stressors trigger ketone production. Patients should be
taught to recognize symptoms like nausea, vomiting, and abdominal pain regardless of
their glucose readings.
7. A patient presents with symptoms of Serotonin Syndrome, including hyperthermia,
agitation, and hyperreflexia. Which medication combination is most likely to cause this
condition?
A. Fluoxetine and Lorazepam
B. Sertraline and Phenelzine
C. Venlafaxine and Gabapentin
D. Amitriptyline and Hydrochlorothiazide
Answer: B
Rationale: Serotonin Syndrome results from excessive serotonergic activity, often due to
the combination of an SSRI (like Sertraline) and an MAOI (like Phenelzine). These two
classes should never be used together and require a washout period when switching
between them. The management involves immediate discontinuation of the offending
agents and supportive care.
8. A patient starting Clozapine (Clozaril) for treatment-resistant schizophrenia must be
registered in the REMS program. What is the primary reason for this mandatory monitoring?
A. Risk of severe hepatotoxicity
B. Risk of Stevens-Johnson Syndrome
C. Risk of severe QTc prolongation
D. Risk of severe neutropenia (agranulocytosis)
Answer: D
Rationale: Clozapine is associated with a high risk of life-threatening agranulocytosis,
which is a severe drop in the absolute neutrophil count (ANC). The REMS program
mandates regular blood draws to ensure the ANC remains within a safe range before the
drug can be dispensed. This safety protocol has significantly reduced the mortality
associated with Clozapine therapy.
