NURS 6521N Final Exam V3 | NURS 6521N
Advanced Pharmacology | Actual Q&A
with Rationale (NURS6521N Final Exam) |
Walden University
1. An elderly patient with chronic kidney disease is prescribed a new medication that is
primarily excreted by the kidneys. What pharmacokinetic change should the nurse
practitioner anticipate?
A. Decreased drug clearance and increased half-life
B. Increased rate of drug metabolism
C. Reduced drug absorption in the GI tract
D. Increased volume of distribution
Answer: A
Rationale: In patients with renal impairment, the ability of the kidneys to filter and excrete
drugs is significantly reduced. This leads to a longer duration of the drug in the systemic
circulation, necessitating dosage adjustments to prevent toxicity. Monitoring creatinine
clearance is a vital step for ensuring safe pharmacological management in this population.
2. A patient is being treated with warfarin for atrial fibrillation. Which laboratory value is the
primary indicator of the medication’s therapeutic effectiveness and safety?
A. International Normalized Ratio (INR)
,B. Platelet count
C. Activated partial thromboplastin time (aPTT)
D. Bleeding time
Answer: A
Rationale: Warfarin monitoring relies on the INR to ensure the patient remains within the
narrow therapeutic window required to prevent clotting without causing hemorrhage. The
target range typically falls between 2.0 and 3.0 for most indications like atrial fibrillation.
Frequent adjustments and consistent dietary vitamin K intake are necessary to maintain
stable levels.
3. When prescribing an ACE inhibitor such as lisinopril, which electrolyte abnormality must
the clinician monitor for?
A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypocalcemia
Answer: C
Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II, which
subsequently reduces the secretion of aldosterone. Since aldosterone is responsible for
excreting potassium and retaining sodium, its reduction leads to potassium retention.
, Patients should be cautioned against using salt substitutes that contain potassium chloride
while on this therapy.
4. A 45-year-old male patient with type 2 diabetes is prescribed metformin. Which condition
is a contraindication for this medication due to the risk of lactic acidosis?
A. Hypertension
B. Hyperlipidemia
C. Mild obesity
D. Severe renal impairment (eGFR < 30 mL/min)
Answer: D
Rationale: Metformin is predominantly excreted unchanged by the kidneys, and impaired
renal function can lead to drug accumulation. High levels of metformin increase the risk of
lactic acidosis, a rare but potentially fatal metabolic complication. Practitioners must assess
renal function at baseline and periodically thereafter to ensure safe use.
5. A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) for
depression presents with agitation, tremors, and hyperreflexia. What should the clinician
suspect?
A. Major depressive episode recurrence
B. Serotonin syndrome
C. Anticholinergic toxicity
Advanced Pharmacology | Actual Q&A
with Rationale (NURS6521N Final Exam) |
Walden University
1. An elderly patient with chronic kidney disease is prescribed a new medication that is
primarily excreted by the kidneys. What pharmacokinetic change should the nurse
practitioner anticipate?
A. Decreased drug clearance and increased half-life
B. Increased rate of drug metabolism
C. Reduced drug absorption in the GI tract
D. Increased volume of distribution
Answer: A
Rationale: In patients with renal impairment, the ability of the kidneys to filter and excrete
drugs is significantly reduced. This leads to a longer duration of the drug in the systemic
circulation, necessitating dosage adjustments to prevent toxicity. Monitoring creatinine
clearance is a vital step for ensuring safe pharmacological management in this population.
2. A patient is being treated with warfarin for atrial fibrillation. Which laboratory value is the
primary indicator of the medication’s therapeutic effectiveness and safety?
A. International Normalized Ratio (INR)
,B. Platelet count
C. Activated partial thromboplastin time (aPTT)
D. Bleeding time
Answer: A
Rationale: Warfarin monitoring relies on the INR to ensure the patient remains within the
narrow therapeutic window required to prevent clotting without causing hemorrhage. The
target range typically falls between 2.0 and 3.0 for most indications like atrial fibrillation.
Frequent adjustments and consistent dietary vitamin K intake are necessary to maintain
stable levels.
3. When prescribing an ACE inhibitor such as lisinopril, which electrolyte abnormality must
the clinician monitor for?
A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypocalcemia
Answer: C
Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II, which
subsequently reduces the secretion of aldosterone. Since aldosterone is responsible for
excreting potassium and retaining sodium, its reduction leads to potassium retention.
, Patients should be cautioned against using salt substitutes that contain potassium chloride
while on this therapy.
4. A 45-year-old male patient with type 2 diabetes is prescribed metformin. Which condition
is a contraindication for this medication due to the risk of lactic acidosis?
A. Hypertension
B. Hyperlipidemia
C. Mild obesity
D. Severe renal impairment (eGFR < 30 mL/min)
Answer: D
Rationale: Metformin is predominantly excreted unchanged by the kidneys, and impaired
renal function can lead to drug accumulation. High levels of metformin increase the risk of
lactic acidosis, a rare but potentially fatal metabolic complication. Practitioners must assess
renal function at baseline and periodically thereafter to ensure safe use.
5. A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) for
depression presents with agitation, tremors, and hyperreflexia. What should the clinician
suspect?
A. Major depressive episode recurrence
B. Serotonin syndrome
C. Anticholinergic toxicity
