NURS 615 Advanced Pharmacology Practice Exam
Question 1
A 58-year-old male with type 2 diabetes mellitus and an eGFR of 45
mL/min/1.73m² is prescribed metformin 1000 mg twice daily. Which
monitoring parameter is most critical within the first 3 months of therapy?
A. Hemoglobin A1c
B. Vitamin B12 levels
C. Serum creatinine and eGFR
D. Liver function tests
Correct Answer: C
Rationale: Metformin is contraindicated when eGFR falls below 30
mL/min/1.73m² and requires dose reduction when eGFR is 30-45. Given this
patient's borderline renal function (Stage 3a CKD), renal monitoring is
paramount to prevent lactic acidosis. While A1c monitoring (A) is important
for efficacy, it is not the most immediate safety concern. Vitamin B12
deficiency (B) develops over years, not months. Metformin is not hepatotoxic
(D).
Question 2
A 72-year-old female with atrial fibrillation (CHADS₂-VASc score 4) and
severe mitral stenosis is started on warfarin. Her genotype reveals
CYP2C9*3/*3 and VKORC1 -1639A/A. What is the most appropriate initial
dosing strategy?
A. Standard 5 mg daily with INR check in 1 week
B. 2-3 mg daily with INR check in 3-5 days
C. 10 mg loading dose for 2 days, then 5 mg
D. Bridge with enoxaparin until therapeutic INR achieved
Correct Answer: B
Rationale: This patient is a CYP2C9 poor metabolizer with VKORC1
, sensitivity, predicting significantly reduced warfarin clearance and increased
bleeding risk. The FDA-approved warfarin pharmacogenomic algorithm
recommends substantially reduced initial doses (2-3 mg) with earlier INR
monitoring (3-5 days). Standard dosing (A) risks hemorrhage. Loading doses
(C) are contraindicated with this genotype. Bridging (D) is unnecessary for
non-valvular AF but is indicated here due to severe mitral stenosis—however,
the question focuses on warfarin dosing strategy, not bridging necessity.
Question 3
A 34-year-old pregnant patient (28 weeks gestation) develops a lower
urinary tract infection with E. coli sensitive to ampicillin, nitrofurantoin, and
ciprofloxacin. Which antibiotic is contraindicated?
A. Ampicillin 500 mg TID × 7 days
B. Nitrofurantoin 100 mg BID × 5 days
C. Ciprofloxacin 250 mg BID × 3 days
D. All are safe in pregnancy
Correct Answer: C
Rationale: Fluoroquinolones (ciprofloxacin) are FDA Pregnancy Category C
and contraindicated in pregnancy due to cartilage damage and arthropathy
in animal studies. Ampicillin (A) is safe (Category B). Nitrofurantoin (B) is
generally safe in second and third trimesters (Category B), though
contraindicated at term (38-42 weeks) due to risk of hemolytic anemia in
G6PD-deficient neonates. At 28 weeks, it remains an appropriate choice.
Question 4
A 45-year-old male with HFrEF (EF 35%), hypertension, and type 2 DM is
prescribed lisinopril, metoprolol succinate, and spironolactone. He presents
with new-onset gynecomastia and hyperkalemia (K+ 5.8 mEq/L). Which
medication interaction most likely contributed?
Question 1
A 58-year-old male with type 2 diabetes mellitus and an eGFR of 45
mL/min/1.73m² is prescribed metformin 1000 mg twice daily. Which
monitoring parameter is most critical within the first 3 months of therapy?
A. Hemoglobin A1c
B. Vitamin B12 levels
C. Serum creatinine and eGFR
D. Liver function tests
Correct Answer: C
Rationale: Metformin is contraindicated when eGFR falls below 30
mL/min/1.73m² and requires dose reduction when eGFR is 30-45. Given this
patient's borderline renal function (Stage 3a CKD), renal monitoring is
paramount to prevent lactic acidosis. While A1c monitoring (A) is important
for efficacy, it is not the most immediate safety concern. Vitamin B12
deficiency (B) develops over years, not months. Metformin is not hepatotoxic
(D).
Question 2
A 72-year-old female with atrial fibrillation (CHADS₂-VASc score 4) and
severe mitral stenosis is started on warfarin. Her genotype reveals
CYP2C9*3/*3 and VKORC1 -1639A/A. What is the most appropriate initial
dosing strategy?
A. Standard 5 mg daily with INR check in 1 week
B. 2-3 mg daily with INR check in 3-5 days
C. 10 mg loading dose for 2 days, then 5 mg
D. Bridge with enoxaparin until therapeutic INR achieved
Correct Answer: B
Rationale: This patient is a CYP2C9 poor metabolizer with VKORC1
, sensitivity, predicting significantly reduced warfarin clearance and increased
bleeding risk. The FDA-approved warfarin pharmacogenomic algorithm
recommends substantially reduced initial doses (2-3 mg) with earlier INR
monitoring (3-5 days). Standard dosing (A) risks hemorrhage. Loading doses
(C) are contraindicated with this genotype. Bridging (D) is unnecessary for
non-valvular AF but is indicated here due to severe mitral stenosis—however,
the question focuses on warfarin dosing strategy, not bridging necessity.
Question 3
A 34-year-old pregnant patient (28 weeks gestation) develops a lower
urinary tract infection with E. coli sensitive to ampicillin, nitrofurantoin, and
ciprofloxacin. Which antibiotic is contraindicated?
A. Ampicillin 500 mg TID × 7 days
B. Nitrofurantoin 100 mg BID × 5 days
C. Ciprofloxacin 250 mg BID × 3 days
D. All are safe in pregnancy
Correct Answer: C
Rationale: Fluoroquinolones (ciprofloxacin) are FDA Pregnancy Category C
and contraindicated in pregnancy due to cartilage damage and arthropathy
in animal studies. Ampicillin (A) is safe (Category B). Nitrofurantoin (B) is
generally safe in second and third trimesters (Category B), though
contraindicated at term (38-42 weeks) due to risk of hemolytic anemia in
G6PD-deficient neonates. At 28 weeks, it remains an appropriate choice.
Question 4
A 45-year-old male with HFrEF (EF 35%), hypertension, and type 2 DM is
prescribed lisinopril, metoprolol succinate, and spironolactone. He presents
with new-onset gynecomastia and hyperkalemia (K+ 5.8 mEq/L). Which
medication interaction most likely contributed?
