NUR 6011 Exam 2 Actual Exam V1 | NUR 6011 Advance Pharmacology
(NUR6011 Exam 2) | William Paterson University
1. A 65-year-old patient with Heart Failure with Reduced Ejection Fraction (HFrEF) is currently
taking Lisinopril. The provider decides to transition the patient to Sacubitril/Valsartan
(Entresto). Which of the following is the most critical prescribing action required during this
transition?
A. Discontinue Lisinopril and wait 36 hours before starting Entresto.
B. Initiate the first dose of Entresto 12 hours after the last dose of Lisinopril.
C. Double the dose of Lisinopril for 3 days before switching to Entresto.
D. Start Entresto immediately at a low dose while tapering Lisinopril over one week.
Answer: A
Rationale: A mandatory 36-hour washout period is required when switching from an ACE
inhibitor to an ARNI to minimize the risk of angioedema. This is because both ACE
inhibitors and neprilysin inhibitors inhibit the breakdown of bradykinin. Concurrent use or
inadequate washout periods can lead to life-threatening airway swelling due to excessive
bradykinin accumulation.
2. A patient is prescribed Amiodarone for the management of ventricular arrhythmias. Which
of the following baseline and periodic monitoring parameters is most essential due to the
drug’s pharmacokinetic profile and potential for systemic toxicity?
A. Daily weights and orthostatic blood pressure checks.
B. Serum calcium and magnesium levels every 2 weeks.
C. Pulmonary function tests and chest X-rays.
D. Complete blood counts (CBC) with differential every month.
Answer: C
Rationale: Amiodarone is known to cause pulmonary toxicity, which can manifest as
interstitial pneumonitis or pulmonary fibrosis. Because of its long half-life and tendency to
accumulate in tissues, monitoring pulmonary function is critical for early detection of life-
threatening adverse effects. Additionally, thyroid function and liver enzymes must be
monitored regularly due to the high iodine content and hepatic metabolism of the drug.
3. When prescribing a HMG-CoA reductase inhibitor (statin), which patient-reported
symptom would most likely necessitate the measurement of serum creatine kinase (CK)
levels?
A. Occasional dry cough and nasal congestion.
,B. Mild dyspepsia and constipation.
C. Unexplained muscle pain, tenderness, or weakness.
D. Increased frequency of urination and thirst.
Answer: C
Rationale: Statins can cause myopathy, which is characterized by muscle pain and elevated
creatine kinase levels. If left untreated, this can progress to rhabdomyolysis, a severe
condition involving muscle breakdown and potential renal failure. Checking CK levels helps
the clinician differentiate between mild myalgia and significant muscle injury that requires
drug discontinuation.
4. A patient with Type 2 Diabetes and established Atherosclerotic Cardiovascular Disease
(ASCVD) requires an additional agent to achieve glycemic control. Which class of medication
is currently recommended for its proven cardiovascular mortality benefits?
A. Sulfonylureas such as Glimepiride.
B. DPP-4 inhibitors such as Sitagliptin.
C. Thiazolidinediones such as Pioglitazone.
D. SGLT2 inhibitors such as Empagliflozin.
Answer: D
Rationale: SGLT2 inhibitors like Empagliflozin have demonstrated significant reduction in
cardiovascular death and heart failure hospitalizations in clinical trials. They work by
inhibiting glucose reabsorption in the proximal tubule of the kidney, leading to glycosuria.
This class is now prioritized in guidelines for patients with T2DM and high cardiovascular
risk regardless of baseline HbA1c.
5. A 45-year-old female is diagnosed with hyperthyroidism and is prescribed Propylthiouracil
(PTU). The nurse practitioner should educate the patient to report which sign of a rare but
serious adverse effect immediately?
A. Dry skin and cold intolerance.
B. Increased appetite and weight gain.
C. Dark urine and yellowing of the sclera.
D. Mild hair thinning and brittle nails.
Answer: C
Rationale: Propylthiouracil (PTU) carries a black box warning for severe liver injury and
acute liver failure. Signs such as dark urine, jaundice (yellowing of eyes/skin), and
abdominal pain indicate potential hepatotoxicity. Patients must be educated to report these
, symptoms immediately as the condition can be fatal and requires urgent medical
intervention.
6. Which statement best describes the pharmacodynamics of Warfarin regarding its onset of
action?
A. It inhibits the synthesis of clotting factors immediately upon ingestion.
B. It requires several days to achieve therapeutic effect because it does not affect existing
clotting factors.
C. It directly inhibits thrombin (Factor IIa) to produce a rapid anticoagulant effect.
D. Its effect is dependent on the rapid clearance of Vitamin K from the diet.
Answer: B
Rationale: Warfarin acts by inhibiting the enzyme Vitamin K epoxide reductase, which
prevents the synthesis of new clotting factors II, VII, IX, and X. It has no effect on factors
that are already circulating in the plasma. Therefore, the clinical anticoagulant effect is
delayed until the pre-existing factors are naturally depleted, which usually takes 3 to 5
days.
7. An 80-year-old patient is prescribed a new medication that is highly protein-bound. The
patient has a low serum albumin level. What is the most likely pharmacological consequence
of this scenario?
A. The therapeutic effect will be significantly decreased.
B. The drug will be cleared more slowly by the kidneys.
C. The free (active) fraction of the drug will increase, raising the risk of toxicity.
D. The drug’s volume of distribution will decrease.
Answer: C
Rationale: Albumin is the primary protein that binds drugs in the bloodstream; only the
‘free’ or unbound drug is pharmacologically active. In patients with hypoalbuminemia,
there are fewer binding sites available, leading to a higher concentration of free drug. This
increases the intensity of the drug’s effect and the likelihood of adverse reactions even at
standard doses.
8. A patient with asthma is not well-controlled on a Low-Dose Inhaled Corticosteroid (ICS)
alone. According to GINA guidelines, what is the preferred next step in therapy for an adult
patient?
A. Add an oral corticosteroid to be taken daily.
B. Switch to a Long-Acting Beta Agonist (LABA) monotherapy.
C. Add a Long-Acting Beta Agonist (LABA) to the low-dose ICS.
(NUR6011 Exam 2) | William Paterson University
1. A 65-year-old patient with Heart Failure with Reduced Ejection Fraction (HFrEF) is currently
taking Lisinopril. The provider decides to transition the patient to Sacubitril/Valsartan
(Entresto). Which of the following is the most critical prescribing action required during this
transition?
A. Discontinue Lisinopril and wait 36 hours before starting Entresto.
B. Initiate the first dose of Entresto 12 hours after the last dose of Lisinopril.
C. Double the dose of Lisinopril for 3 days before switching to Entresto.
D. Start Entresto immediately at a low dose while tapering Lisinopril over one week.
Answer: A
Rationale: A mandatory 36-hour washout period is required when switching from an ACE
inhibitor to an ARNI to minimize the risk of angioedema. This is because both ACE
inhibitors and neprilysin inhibitors inhibit the breakdown of bradykinin. Concurrent use or
inadequate washout periods can lead to life-threatening airway swelling due to excessive
bradykinin accumulation.
2. A patient is prescribed Amiodarone for the management of ventricular arrhythmias. Which
of the following baseline and periodic monitoring parameters is most essential due to the
drug’s pharmacokinetic profile and potential for systemic toxicity?
A. Daily weights and orthostatic blood pressure checks.
B. Serum calcium and magnesium levels every 2 weeks.
C. Pulmonary function tests and chest X-rays.
D. Complete blood counts (CBC) with differential every month.
Answer: C
Rationale: Amiodarone is known to cause pulmonary toxicity, which can manifest as
interstitial pneumonitis or pulmonary fibrosis. Because of its long half-life and tendency to
accumulate in tissues, monitoring pulmonary function is critical for early detection of life-
threatening adverse effects. Additionally, thyroid function and liver enzymes must be
monitored regularly due to the high iodine content and hepatic metabolism of the drug.
3. When prescribing a HMG-CoA reductase inhibitor (statin), which patient-reported
symptom would most likely necessitate the measurement of serum creatine kinase (CK)
levels?
A. Occasional dry cough and nasal congestion.
,B. Mild dyspepsia and constipation.
C. Unexplained muscle pain, tenderness, or weakness.
D. Increased frequency of urination and thirst.
Answer: C
Rationale: Statins can cause myopathy, which is characterized by muscle pain and elevated
creatine kinase levels. If left untreated, this can progress to rhabdomyolysis, a severe
condition involving muscle breakdown and potential renal failure. Checking CK levels helps
the clinician differentiate between mild myalgia and significant muscle injury that requires
drug discontinuation.
4. A patient with Type 2 Diabetes and established Atherosclerotic Cardiovascular Disease
(ASCVD) requires an additional agent to achieve glycemic control. Which class of medication
is currently recommended for its proven cardiovascular mortality benefits?
A. Sulfonylureas such as Glimepiride.
B. DPP-4 inhibitors such as Sitagliptin.
C. Thiazolidinediones such as Pioglitazone.
D. SGLT2 inhibitors such as Empagliflozin.
Answer: D
Rationale: SGLT2 inhibitors like Empagliflozin have demonstrated significant reduction in
cardiovascular death and heart failure hospitalizations in clinical trials. They work by
inhibiting glucose reabsorption in the proximal tubule of the kidney, leading to glycosuria.
This class is now prioritized in guidelines for patients with T2DM and high cardiovascular
risk regardless of baseline HbA1c.
5. A 45-year-old female is diagnosed with hyperthyroidism and is prescribed Propylthiouracil
(PTU). The nurse practitioner should educate the patient to report which sign of a rare but
serious adverse effect immediately?
A. Dry skin and cold intolerance.
B. Increased appetite and weight gain.
C. Dark urine and yellowing of the sclera.
D. Mild hair thinning and brittle nails.
Answer: C
Rationale: Propylthiouracil (PTU) carries a black box warning for severe liver injury and
acute liver failure. Signs such as dark urine, jaundice (yellowing of eyes/skin), and
abdominal pain indicate potential hepatotoxicity. Patients must be educated to report these
, symptoms immediately as the condition can be fatal and requires urgent medical
intervention.
6. Which statement best describes the pharmacodynamics of Warfarin regarding its onset of
action?
A. It inhibits the synthesis of clotting factors immediately upon ingestion.
B. It requires several days to achieve therapeutic effect because it does not affect existing
clotting factors.
C. It directly inhibits thrombin (Factor IIa) to produce a rapid anticoagulant effect.
D. Its effect is dependent on the rapid clearance of Vitamin K from the diet.
Answer: B
Rationale: Warfarin acts by inhibiting the enzyme Vitamin K epoxide reductase, which
prevents the synthesis of new clotting factors II, VII, IX, and X. It has no effect on factors
that are already circulating in the plasma. Therefore, the clinical anticoagulant effect is
delayed until the pre-existing factors are naturally depleted, which usually takes 3 to 5
days.
7. An 80-year-old patient is prescribed a new medication that is highly protein-bound. The
patient has a low serum albumin level. What is the most likely pharmacological consequence
of this scenario?
A. The therapeutic effect will be significantly decreased.
B. The drug will be cleared more slowly by the kidneys.
C. The free (active) fraction of the drug will increase, raising the risk of toxicity.
D. The drug’s volume of distribution will decrease.
Answer: C
Rationale: Albumin is the primary protein that binds drugs in the bloodstream; only the
‘free’ or unbound drug is pharmacologically active. In patients with hypoalbuminemia,
there are fewer binding sites available, leading to a higher concentration of free drug. This
increases the intensity of the drug’s effect and the likelihood of adverse reactions even at
standard doses.
8. A patient with asthma is not well-controlled on a Low-Dose Inhaled Corticosteroid (ICS)
alone. According to GINA guidelines, what is the preferred next step in therapy for an adult
patient?
A. Add an oral corticosteroid to be taken daily.
B. Switch to a Long-Acting Beta Agonist (LABA) monotherapy.
C. Add a Long-Acting Beta Agonist (LABA) to the low-dose ICS.
