Pharmacology NURS 251 Final Exam Portage learning Questions
and Answer - Professor Stepp - 90 Questions and Answers
Already Graded A+ Premium Exam Tested And Verified
Subject Area Pharmacology for Nursing
Description This final exam assesses advanced understanding of pharmacodynamics,
pharmacokinetics, drug interactions, adverse effects, and therapeutic management
across major drug classes. Emphasis is on clinical application, evidence-based
practice, and safety monitoring in diverse patient populations.
Expected Grade A+
Total Questions 90
Duration 3 hours
Learning Outcomes 1. Analyze mechanisms of action and therapeutic uses of major drug classes.
2. Evaluate adverse drug reactions and drug-drug interactions using
pharmacokinetic and pharmacodynamic principles.
3. Apply clinical decision-making to medication management in complex
scenarios.
4. Interpret laboratory and diagnostic data to guide pharmacotherapy.
Accreditation This exam conforms to the rigor and standards of accredited US university
nursing pharmacology courses (e.g., AACN Essentials).
Page 1
,1. A patient on long-term warfarin therapy is prescribed a course of metronidazole
for a pelvic infection. The nurse anticipates that the INR will:
A. Decrease due to induction of CYP2C9 by metronidazole.
B. Increase due to inhibition of warfarin metabolism by metronidazole.
C. Remain unchanged because metronidazole does not affect the coagulation cascade.
D. Increase due to displacement of warfarin from albumin by metronidazole.
Answer: B. Increase due to inhibition of warfarin metabolism by metronidazole.
Metronidazole is a potent inhibitor of CYP2C9, the primary enzyme responsible for
metabolizing the S-enantiomer of warfarin. Inhibition leads to increased warfarin levels
and INR. Option A is incorrect because metronidazole inhibits, not induces. Option C
ignores the metabolic interaction. Option D is plausible but the primary mechanism is
metabolic inhibition, not protein displacement.
2. Which of the following best explains why a patient with chronic kidney disease
(eGFR 25 mL/min) is at increased risk of nephrotoxicity when receiving intravenous
vancomycin?
A. Vancomycin undergoes extensive hepatic metabolism, leading to accumulation of toxic
metabolites.
B. Reduced renal clearance prolongs vancomycin half-life, increasing exposure and risk of
acute kidney injury.
C. Vancomycin binds to renal tubular cells and directly causes glomerular sclerosis.
D. Impaired renal function reduces vancomycin volume of distribution, increasing peak
serum concentrations.
Answer: B. Reduced renal clearance prolongs vancomycin half-life, increasing
exposure and risk of acute kidney injury.
Vancomycin is primarily eliminated unchanged by glomerular filtration. In CKD,
clearance is reduced, half-life is prolonged, and area under the curve (AUC) increases,
raising nephrotoxicity risk. Option A is false; vancomycin is not hepatically
metabolized. Option C describes a mechanism not established for vancomycin. Option
D is incorrect; volume of distribution is not significantly altered in CKD.
Page 2
,3. A patient receiving a continuous infusion of propofol for sedation in the ICU
develops green urine, hypotension, and metabolic acidosis. Which adverse effect
should the nurse suspect?
A. Propofol infusion syndrome
B. Serotonin syndrome
C. Malignant hyperthermia
D. Neuroleptic malignant syndrome
Answer: A. Propofol infusion syndrome
Propofol infusion syndrome is a rare but life-threatening complication characterized by
metabolic acidosis, rhabdomyolysis, hyperkalemia, hepatomegaly, renal failure, and
green urine. It is associated with high doses and prolonged infusions. Serotonin
syndrome (B) would involve hyperthermia, clonus, and agitation. Malignant
hyperthermia (C) presents with hyperthermia and rigidity. Neuroleptic malignant
syndrome (D) includes rigidity, fever, and autonomic instability.
4. A patient with type 2 diabetes and severe insulin resistance is started on
pioglitazone. The nurse should monitor for which potential adverse effect that is
unique to this class?
A. Lactic acidosis
B. Pancreatitis
C. Bone fractures in women
D. Acute hepatitis
Answer: C. Bone fractures in women
Pioglitazone, a thiazolidinedione, is associated with an increased risk of bone fractures
in women, likely due to effects on osteoblast differentiation. Lactic acidosis (A) is
associated with metformin, not pioglitazone. Pancreatitis (B) is more common with
GLP-1 agonists. Acute hepatitis (D) is rare but reported; however, bone fractures are a
class-specific concern.
Page 3
, 5. A patient with atrial fibrillation is being rate-controlled with metoprolol. Which of
the following concurrent findings would warrant immediate discontinuation of
metoprolol?
A. Heart rate of 58 beats per minute
B. PR interval of 0.24 seconds on ECG
C. Wheezing and peak expiratory flow rate 40% of predicted
D. Blood pressure 100/60 mm Hg
Answer: C. Wheezing and peak expiratory flow rate 40% of predicted
Metoprolol is a beta-blocker and can exacerbate bronchospasm in patients with
reactive airway disease. Wheezing with significantly reduced PEFR indicates
bronchospasm, requiring drug discontinuation. A heart rate of 58 (A) is acceptable if
asymptomatic. PR prolongation (B) is a known effect but not an immediate stop sign.
Blood pressure 100/60 (D) is often tolerated.
6. A patient on lithium carbonate for bipolar disorder is admitted with confusion,
tremors, and ataxia. Labs: serum lithium 2.8 mEq/L, sodium 132 mEq/L. Which
intervention is most appropriate?
A. Administer furosemide to enhance lithium excretion
B. Discontinue lithium and start hemodialysis
C. Restrict sodium intake to correct hyponatremia
D. Administer sodium polystyrene sulfonate to bind lithium
Answer: B. Discontinue lithium and start hemodialysis
Severe lithium toxicity (>2.5 mEq/L) with neurological symptoms requires immediate
discontinuation and hemodialysis to rapidly remove lithium. Furosemide (A) can
worsen hyponatremia and increase lithium reabsorption. Sodium restriction (C) would
exacerbate hyponatremia and increase lithium reabsorption. Sodium polystyrene
sulfonate (D) is not effective for lithium.
Page 4
and Answer - Professor Stepp - 90 Questions and Answers
Already Graded A+ Premium Exam Tested And Verified
Subject Area Pharmacology for Nursing
Description This final exam assesses advanced understanding of pharmacodynamics,
pharmacokinetics, drug interactions, adverse effects, and therapeutic management
across major drug classes. Emphasis is on clinical application, evidence-based
practice, and safety monitoring in diverse patient populations.
Expected Grade A+
Total Questions 90
Duration 3 hours
Learning Outcomes 1. Analyze mechanisms of action and therapeutic uses of major drug classes.
2. Evaluate adverse drug reactions and drug-drug interactions using
pharmacokinetic and pharmacodynamic principles.
3. Apply clinical decision-making to medication management in complex
scenarios.
4. Interpret laboratory and diagnostic data to guide pharmacotherapy.
Accreditation This exam conforms to the rigor and standards of accredited US university
nursing pharmacology courses (e.g., AACN Essentials).
Page 1
,1. A patient on long-term warfarin therapy is prescribed a course of metronidazole
for a pelvic infection. The nurse anticipates that the INR will:
A. Decrease due to induction of CYP2C9 by metronidazole.
B. Increase due to inhibition of warfarin metabolism by metronidazole.
C. Remain unchanged because metronidazole does not affect the coagulation cascade.
D. Increase due to displacement of warfarin from albumin by metronidazole.
Answer: B. Increase due to inhibition of warfarin metabolism by metronidazole.
Metronidazole is a potent inhibitor of CYP2C9, the primary enzyme responsible for
metabolizing the S-enantiomer of warfarin. Inhibition leads to increased warfarin levels
and INR. Option A is incorrect because metronidazole inhibits, not induces. Option C
ignores the metabolic interaction. Option D is plausible but the primary mechanism is
metabolic inhibition, not protein displacement.
2. Which of the following best explains why a patient with chronic kidney disease
(eGFR 25 mL/min) is at increased risk of nephrotoxicity when receiving intravenous
vancomycin?
A. Vancomycin undergoes extensive hepatic metabolism, leading to accumulation of toxic
metabolites.
B. Reduced renal clearance prolongs vancomycin half-life, increasing exposure and risk of
acute kidney injury.
C. Vancomycin binds to renal tubular cells and directly causes glomerular sclerosis.
D. Impaired renal function reduces vancomycin volume of distribution, increasing peak
serum concentrations.
Answer: B. Reduced renal clearance prolongs vancomycin half-life, increasing
exposure and risk of acute kidney injury.
Vancomycin is primarily eliminated unchanged by glomerular filtration. In CKD,
clearance is reduced, half-life is prolonged, and area under the curve (AUC) increases,
raising nephrotoxicity risk. Option A is false; vancomycin is not hepatically
metabolized. Option C describes a mechanism not established for vancomycin. Option
D is incorrect; volume of distribution is not significantly altered in CKD.
Page 2
,3. A patient receiving a continuous infusion of propofol for sedation in the ICU
develops green urine, hypotension, and metabolic acidosis. Which adverse effect
should the nurse suspect?
A. Propofol infusion syndrome
B. Serotonin syndrome
C. Malignant hyperthermia
D. Neuroleptic malignant syndrome
Answer: A. Propofol infusion syndrome
Propofol infusion syndrome is a rare but life-threatening complication characterized by
metabolic acidosis, rhabdomyolysis, hyperkalemia, hepatomegaly, renal failure, and
green urine. It is associated with high doses and prolonged infusions. Serotonin
syndrome (B) would involve hyperthermia, clonus, and agitation. Malignant
hyperthermia (C) presents with hyperthermia and rigidity. Neuroleptic malignant
syndrome (D) includes rigidity, fever, and autonomic instability.
4. A patient with type 2 diabetes and severe insulin resistance is started on
pioglitazone. The nurse should monitor for which potential adverse effect that is
unique to this class?
A. Lactic acidosis
B. Pancreatitis
C. Bone fractures in women
D. Acute hepatitis
Answer: C. Bone fractures in women
Pioglitazone, a thiazolidinedione, is associated with an increased risk of bone fractures
in women, likely due to effects on osteoblast differentiation. Lactic acidosis (A) is
associated with metformin, not pioglitazone. Pancreatitis (B) is more common with
GLP-1 agonists. Acute hepatitis (D) is rare but reported; however, bone fractures are a
class-specific concern.
Page 3
, 5. A patient with atrial fibrillation is being rate-controlled with metoprolol. Which of
the following concurrent findings would warrant immediate discontinuation of
metoprolol?
A. Heart rate of 58 beats per minute
B. PR interval of 0.24 seconds on ECG
C. Wheezing and peak expiratory flow rate 40% of predicted
D. Blood pressure 100/60 mm Hg
Answer: C. Wheezing and peak expiratory flow rate 40% of predicted
Metoprolol is a beta-blocker and can exacerbate bronchospasm in patients with
reactive airway disease. Wheezing with significantly reduced PEFR indicates
bronchospasm, requiring drug discontinuation. A heart rate of 58 (A) is acceptable if
asymptomatic. PR prolongation (B) is a known effect but not an immediate stop sign.
Blood pressure 100/60 (D) is often tolerated.
6. A patient on lithium carbonate for bipolar disorder is admitted with confusion,
tremors, and ataxia. Labs: serum lithium 2.8 mEq/L, sodium 132 mEq/L. Which
intervention is most appropriate?
A. Administer furosemide to enhance lithium excretion
B. Discontinue lithium and start hemodialysis
C. Restrict sodium intake to correct hyponatremia
D. Administer sodium polystyrene sulfonate to bind lithium
Answer: B. Discontinue lithium and start hemodialysis
Severe lithium toxicity (>2.5 mEq/L) with neurological symptoms requires immediate
discontinuation and hemodialysis to rapidly remove lithium. Furosemide (A) can
worsen hyponatremia and increase lithium reabsorption. Sodium restriction (C) would
exacerbate hyponatremia and increase lithium reabsorption. Sodium polystyrene
sulfonate (D) is not effective for lithium.
Page 4
