NURS-6521N FINAL EXAM PHARM (Latest 2026/2027) 100%
Correct Study Guide, Download to Score A
Walden University | Advanced Pharmacology | NURS-6521N
Section 1: Comprehensive Pharmacotherapy Review
Q1: A 68-year-old male with a history of hypertension, type 2 diabetes, and heart failure
presents with shortness of breath and peripheral edema. Current medications include
lisinopril, metformin, and furosemide. His BP is 142/88 mmHg, HR 88 bpm, and
creatinine 1.8 mg/dL. The provider plans to add spironolactone. Which laboratory
parameter requires the most frequent monitoring after initiation?
A. Fasting blood glucose levels
B. Serum potassium levels
C. Liver function tests
D. Complete blood count
Correct Answer: B
,Rationale: Spironolactone is a potassium-sparing diuretic that antagonizes aldosterone
receptors, causing potassium retention. In patients with heart failure and renal
impairment (creatinine 1.8 mg/dL), the risk of hyperkalemia is significantly elevated.
The combination with ACE inhibitors (lisinopril) further increases this risk as ACE
inhibitors reduce aldosterone secretion. While glucose monitoring is important in
diabetic patients, spironolactone has minimal impact on glycemic control. Liver function
tests and CBC are not primary concerns with spironolactone therapy. Clinical pearl:
Monitor potassium within 1 week of initiation and periodically thereafter, especially
when creatinine >1.5 mg/dL or when combined with ACE inhibitors/ARBs.
Q2: A 45-year-old female with a history of migraines is prescribed sumatriptan. She calls
the clinic reporting chest tightness and pressure occurring 30 minutes after taking the
medication. What is the priority nursing action?
A. Advise her to take a second dose to achieve better migraine relief
B. Instruct her to take ibuprofen for the chest discomfort
C. Advise immediate discontinuation and emergency department evaluation
D. Reassure her that this is a common, benign side effect
Correct Answer: C
Rationale: Sumatriptan is a 5-HT1B/1D receptor agonist that causes vasoconstriction,
including coronary vasoconstriction. Chest tightness/pressure may indicate coronary
,vasospasm or myocardial ischemia. This is a serious adverse effect requiring
immediate discontinuation and emergency evaluation to rule out myocardial infarction.
The triptan class carries a Black Box Warning for cardiovascular events. Option A is
dangerous as it would worsen vasoconstriction. Option B delays critical care. Option D
is unsafe reassurance. Clinical pearl: Screen all patients for cardiovascular risk factors
before prescribing triptans; contraindicated in coronary artery disease, uncontrolled
hypertension, and peripheral vascular disease.
Q3: A 32-year-old pregnant patient at 28 weeks gestation presents with
community-acquired pneumonia. She has no drug allergies. Which antibiotic is the
safest and most appropriate choice?
A. Doxycycline
B. Levofloxacin
C. Azithromycin
D. Trimethoprim-sulfamethoxazole
Correct Answer: C
Rationale: Azithromycin (Category B) is the safest choice for pregnant patients with
community-acquired pneumonia. It has excellent safety data in pregnancy and covers
atypical pathogens. Doxycycline (Category D) causes fetal bone and teeth discoloration
and is contraindicated after 16 weeks gestation. Fluoroquinolones (Category C) carry
, risks of cartilage damage in developing fetuses and are avoided in pregnancy.
Trimethoprim-sulfamethoxazole (Category C/D) is teratogenic in the first trimester
(neural tube defects) and contraindicated near term (kernicterus risk). Clinical pearl:
Penicillins, cephalosporins, and macrolides (except erythromycin estolate) are preferred
in pregnancy; always verify pregnancy category and gestational age.
Q4: A 58-year-old patient with atrial fibrillation is started on warfarin therapy. The nurse
is providing discharge education. Which statement by the patient indicates
understanding of dietary considerations?
A. "I should avoid all green vegetables completely"
B. "I need to maintain consistent vitamin K intake rather than avoid it"
C. "I can eat whatever I want as long as I take my medication daily"
D. "I should double my dose if I eat a large salad"
Correct Answer: B
Rationale: Warfarin inhibits vitamin K-dependent clotting factors (II, VII, IX, X). The key to
dietary management is consistency, not elimination. Sudden increases in vitamin K
intake decrease INR; sudden decreases increase INR. Patients should maintain
consistent consumption of vitamin K-rich foods (leafy greens) rather than avoiding them
entirely or varying intake dramatically. Option A is incorrect and nutritionally harmful.
Option C ignores the drug-food interaction. Option D is dangerous and could cause
Correct Study Guide, Download to Score A
Walden University | Advanced Pharmacology | NURS-6521N
Section 1: Comprehensive Pharmacotherapy Review
Q1: A 68-year-old male with a history of hypertension, type 2 diabetes, and heart failure
presents with shortness of breath and peripheral edema. Current medications include
lisinopril, metformin, and furosemide. His BP is 142/88 mmHg, HR 88 bpm, and
creatinine 1.8 mg/dL. The provider plans to add spironolactone. Which laboratory
parameter requires the most frequent monitoring after initiation?
A. Fasting blood glucose levels
B. Serum potassium levels
C. Liver function tests
D. Complete blood count
Correct Answer: B
,Rationale: Spironolactone is a potassium-sparing diuretic that antagonizes aldosterone
receptors, causing potassium retention. In patients with heart failure and renal
impairment (creatinine 1.8 mg/dL), the risk of hyperkalemia is significantly elevated.
The combination with ACE inhibitors (lisinopril) further increases this risk as ACE
inhibitors reduce aldosterone secretion. While glucose monitoring is important in
diabetic patients, spironolactone has minimal impact on glycemic control. Liver function
tests and CBC are not primary concerns with spironolactone therapy. Clinical pearl:
Monitor potassium within 1 week of initiation and periodically thereafter, especially
when creatinine >1.5 mg/dL or when combined with ACE inhibitors/ARBs.
Q2: A 45-year-old female with a history of migraines is prescribed sumatriptan. She calls
the clinic reporting chest tightness and pressure occurring 30 minutes after taking the
medication. What is the priority nursing action?
A. Advise her to take a second dose to achieve better migraine relief
B. Instruct her to take ibuprofen for the chest discomfort
C. Advise immediate discontinuation and emergency department evaluation
D. Reassure her that this is a common, benign side effect
Correct Answer: C
Rationale: Sumatriptan is a 5-HT1B/1D receptor agonist that causes vasoconstriction,
including coronary vasoconstriction. Chest tightness/pressure may indicate coronary
,vasospasm or myocardial ischemia. This is a serious adverse effect requiring
immediate discontinuation and emergency evaluation to rule out myocardial infarction.
The triptan class carries a Black Box Warning for cardiovascular events. Option A is
dangerous as it would worsen vasoconstriction. Option B delays critical care. Option D
is unsafe reassurance. Clinical pearl: Screen all patients for cardiovascular risk factors
before prescribing triptans; contraindicated in coronary artery disease, uncontrolled
hypertension, and peripheral vascular disease.
Q3: A 32-year-old pregnant patient at 28 weeks gestation presents with
community-acquired pneumonia. She has no drug allergies. Which antibiotic is the
safest and most appropriate choice?
A. Doxycycline
B. Levofloxacin
C. Azithromycin
D. Trimethoprim-sulfamethoxazole
Correct Answer: C
Rationale: Azithromycin (Category B) is the safest choice for pregnant patients with
community-acquired pneumonia. It has excellent safety data in pregnancy and covers
atypical pathogens. Doxycycline (Category D) causes fetal bone and teeth discoloration
and is contraindicated after 16 weeks gestation. Fluoroquinolones (Category C) carry
, risks of cartilage damage in developing fetuses and are avoided in pregnancy.
Trimethoprim-sulfamethoxazole (Category C/D) is teratogenic in the first trimester
(neural tube defects) and contraindicated near term (kernicterus risk). Clinical pearl:
Penicillins, cephalosporins, and macrolides (except erythromycin estolate) are preferred
in pregnancy; always verify pregnancy category and gestational age.
Q4: A 58-year-old patient with atrial fibrillation is started on warfarin therapy. The nurse
is providing discharge education. Which statement by the patient indicates
understanding of dietary considerations?
A. "I should avoid all green vegetables completely"
B. "I need to maintain consistent vitamin K intake rather than avoid it"
C. "I can eat whatever I want as long as I take my medication daily"
D. "I should double my dose if I eat a large salad"
Correct Answer: B
Rationale: Warfarin inhibits vitamin K-dependent clotting factors (II, VII, IX, X). The key to
dietary management is consistency, not elimination. Sudden increases in vitamin K
intake decrease INR; sudden decreases increase INR. Patients should maintain
consistent consumption of vitamin K-rich foods (leafy greens) rather than avoiding them
entirely or varying intake dramatically. Option A is incorrect and nutritionally harmful.
Option C ignores the drug-food interaction. Option D is dangerous and could cause
