NSG 6001 – Advanced Pharmacology
Week 3 Quiz: Principles of Pharmacotherapeutics & Clinical
Decision-Making
[Graduate Nursing Program | Current Curriculum Standards | 100%
Verified Coverage]
Q1: A 72-year-old male with newly diagnosed hypertension and stage 3 chronic kidney
disease (eGFR 45 mL/min/1.73m²) requires antihypertensive therapy. Which medication
class provides both blood pressure control and renoprotective effects through reduction
of intraglomerular pressure?
A. Thiazide diuretics
B. Calcium channel blockers (dihydropyridine)
C. ACE inhibitors
D. Alpha-1 blockers
Correct Answer: C
Rationale: [CORRECT] C: ACE inhibitors reduce efferent arteriolar tone in the glomerulus,
decreasing intraglomerular pressure and proteinuria, providing renoprotection
independent of blood pressure lowering. This is a compelling indication per JNC-8 and
KDIGO guidelines for CKD with albuminuria. A: Thiazides lose efficacy when eGFR <30
and lack specific renoprotective mechanisms. B: Dihydropyridine CCBs dilate afferent
arterioles, potentially increasing glomerular pressure without RAAS blockade. D:
Alpha-blockers reduce peripheral vascular resistance but do not affect glomerular
hemodynamics.
,Q2: A 45-year-old female with bipolar disorder is prescribed lithium carbonate. Which
laboratory monitoring is required at baseline and periodically during treatment?
A. Liver function tests and lipid panel
B. Thyroid function tests and serum creatinine/eGFR
C. Complete blood count and iron studies
D. Cardiac troponin and BNP
Correct Answer: B
Rationale: [CORRECT] B: Lithium causes dose-dependent nephrogenic diabetes
insipidus (nephrotoxicity) and hypothyroidism by inhibiting thyroid hormone release and
conversion. Baseline and periodic monitoring of TSH, creatinine, and eGFR are
essential. A: Lithium does not significantly affect liver enzymes or lipids. C: Hematologic
effects are minimal. D: No direct cardiac toxicity requiring troponin/BNP monitoring.
Q3: A patient prescribed warfarin for atrial fibrillation presents with an INR of 5.2
without bleeding. Which intervention is most appropriate?
A. Administer vitamin K 10 mg IV immediately
B. Hold warfarin and recheck INR in 24-48 hours
C. Administer fresh frozen plasma
D. Reduce warfarin dose by 50% and continue
Correct Answer: B
, Rationale: [CORRECT] B: Per CHEST guidelines, INR 4.5-10 without bleeding: hold
warfarin and monitor. Vitamin K (A) reserved for INR >10 or serious bleeding. FFP (C) for
active bleeding or pre-procedure reversal. Continuing reduced dose (D) inappropriate
with supratherapeutic INR.
Q4: Which antidepressant class is associated with the highest risk of serotonin
syndrome when combined with tramadol?
A. Tricyclic antidepressants (TCAs)
B. Selective serotonin reuptake inhibitors (SSRIs)
C. Monoamine oxidase inhibitors (MAOIs)
D. Both B and C
Correct Answer: D
Rationale: [CORRECT] D: Tramadol has weak SNRI activity and increases serotonin
availability. Both SSRIs and MAOIs significantly increase serotonin syndrome risk when
combined; MAOIs represent absolute contraindication. A: TCAs have moderate
serotonin reuptake inhibition but lower risk than SSRIs/MAOIs. Serotonin syndrome
characterized by mental status changes, autonomic instability, and neuromuscular
abnormalities.
Q5: A 68-year-old female with osteoporosis is prescribed alendronate. Which counseling
point is essential to prevent esophageal injury?
A. Take with food and antacids to reduce gastric irritation
B. Take first thing in the morning with 8 oz water, remain upright 30 minutes
Week 3 Quiz: Principles of Pharmacotherapeutics & Clinical
Decision-Making
[Graduate Nursing Program | Current Curriculum Standards | 100%
Verified Coverage]
Q1: A 72-year-old male with newly diagnosed hypertension and stage 3 chronic kidney
disease (eGFR 45 mL/min/1.73m²) requires antihypertensive therapy. Which medication
class provides both blood pressure control and renoprotective effects through reduction
of intraglomerular pressure?
A. Thiazide diuretics
B. Calcium channel blockers (dihydropyridine)
C. ACE inhibitors
D. Alpha-1 blockers
Correct Answer: C
Rationale: [CORRECT] C: ACE inhibitors reduce efferent arteriolar tone in the glomerulus,
decreasing intraglomerular pressure and proteinuria, providing renoprotection
independent of blood pressure lowering. This is a compelling indication per JNC-8 and
KDIGO guidelines for CKD with albuminuria. A: Thiazides lose efficacy when eGFR <30
and lack specific renoprotective mechanisms. B: Dihydropyridine CCBs dilate afferent
arterioles, potentially increasing glomerular pressure without RAAS blockade. D:
Alpha-blockers reduce peripheral vascular resistance but do not affect glomerular
hemodynamics.
,Q2: A 45-year-old female with bipolar disorder is prescribed lithium carbonate. Which
laboratory monitoring is required at baseline and periodically during treatment?
A. Liver function tests and lipid panel
B. Thyroid function tests and serum creatinine/eGFR
C. Complete blood count and iron studies
D. Cardiac troponin and BNP
Correct Answer: B
Rationale: [CORRECT] B: Lithium causes dose-dependent nephrogenic diabetes
insipidus (nephrotoxicity) and hypothyroidism by inhibiting thyroid hormone release and
conversion. Baseline and periodic monitoring of TSH, creatinine, and eGFR are
essential. A: Lithium does not significantly affect liver enzymes or lipids. C: Hematologic
effects are minimal. D: No direct cardiac toxicity requiring troponin/BNP monitoring.
Q3: A patient prescribed warfarin for atrial fibrillation presents with an INR of 5.2
without bleeding. Which intervention is most appropriate?
A. Administer vitamin K 10 mg IV immediately
B. Hold warfarin and recheck INR in 24-48 hours
C. Administer fresh frozen plasma
D. Reduce warfarin dose by 50% and continue
Correct Answer: B
, Rationale: [CORRECT] B: Per CHEST guidelines, INR 4.5-10 without bleeding: hold
warfarin and monitor. Vitamin K (A) reserved for INR >10 or serious bleeding. FFP (C) for
active bleeding or pre-procedure reversal. Continuing reduced dose (D) inappropriate
with supratherapeutic INR.
Q4: Which antidepressant class is associated with the highest risk of serotonin
syndrome when combined with tramadol?
A. Tricyclic antidepressants (TCAs)
B. Selective serotonin reuptake inhibitors (SSRIs)
C. Monoamine oxidase inhibitors (MAOIs)
D. Both B and C
Correct Answer: D
Rationale: [CORRECT] D: Tramadol has weak SNRI activity and increases serotonin
availability. Both SSRIs and MAOIs significantly increase serotonin syndrome risk when
combined; MAOIs represent absolute contraindication. A: TCAs have moderate
serotonin reuptake inhibition but lower risk than SSRIs/MAOIs. Serotonin syndrome
characterized by mental status changes, autonomic instability, and neuromuscular
abnormalities.
Q5: A 68-year-old female with osteoporosis is prescribed alendronate. Which counseling
point is essential to prevent esophageal injury?
A. Take with food and antacids to reduce gastric irritation
B. Take first thing in the morning with 8 oz water, remain upright 30 minutes
