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2025 - 2026 MSN 611 ADVANCED
PHARMACOLOGY FINAL EXAM |REAL
150Qs&As|GRADED A+
A 65-year-old man presents to the office with increased frequency, urgency, nocturia, and hesitancy in micturition for the past week. He also complains of pain in ejaculation. He has no flank pain, dysuria, hematuria, or fever. He is in a monogamous relationship and uses condoms regularly. His temperature is 98.6 F (37 C), pulse rate is 77 beats/ minute, respiration is 14 breaths/minute, and blood pressure is 130/80 mmhg. There is no costovertebral angle tenderness or suprapubic tenderness, and external genitalia examination is normal. Digital rectal examination shows normal sphincter tone and reflexes with slightly enlarged and tender prostate. Urinalysis shows many wbcs with no rbcs or casts. Urine culture grows E. Coli. Serum prostate-specific antigen is 8ng/ml (reference range of less than 3.5 ng/ml). Which of the following drug class can be used to treat the patient's condition? Fluroquinolone A 41-year-old G5P4004 at 38 weeks, 0 days pregnant presents for late prenatal testing. She is found to have igm-positive antibodies for HSV-2. The patient desires to deliver vaginally. Which of the following statements is correct regarding the treatment of choice for this patient's condition? It is generally safe in pregnancy A 25-year-old woman presents to the clinician with complaints of frequent burning micturition and suprapubic discomfort from the past two days. The patient is sexually active and has no significant past medical history. Urinalysis reveals the presence of leukocyte esterase and a high level of nitrites. The
clinician prescribes her a combination antibiotic that inhibits two steps in the bacterial biosynthesis of tetrahydrofolate. Which of the following is a contraindication to the use of this medication? Pregnancy A 35-year-old woman comes to the office for pain and burning during urination for the past few days. She denies fever, abdominal or flank pain, bloody urine, or passing any stones while urinating. She has a medical history of gastroesophageal reflux disease, diabetes mellitus type 2, and hyperlipidemia. She takes over-the- counter antacids, pantoprazole, metformin, and atorvastatin. She is para 2 with both normal vaginal delivery and her last menstrual period was three weeks ago. She uses oral contraceptive pills for contraception. Her temperature is 37.2 C, her pulse is 70 beats/min, her respiratory rate is 12 breaths/min, and her blood pressure is 130/80 mmhg. On examination, she denies suprapubic pain or costovertebral angle tenderness. Urinalysis reveals white blood cells of 20-25/hpf and red blood cells of 5-10/hpf with no casts. Urinary nitrites and leukocyte esterase are positive, and glucose and ketone are absent. White blood cell count is 7800/mm3. Serum creatinine is 1.1 mg/dl and blood urea nitrogen is 17 mg/dl. Urine culture grows Escherichia coli. The patient is started on a drug that inhibits an enzyme required in bacterial DNA replication. The patient is counseled about adherence and the adverse effect of this drug. About which of her other medications should she be counseled? Antacid A 27-year-old male with a past medical history of tuberculosis presents to the outpatient clinic with complaints of diarrhea and crampy abdominal pain. The patient was diagnosed with tuberculosis 16 weeks ago and is currently on treatment with isoniazid and rifampicin. Complete blood count shows an elevated
A 65-year-old female comes to the clinician with pain behind her left heel for a day. The pain is aggravated by dorsiflexion of the feet. She denies stiffness, weakness, numbness, tingling, or redness of her feet and toes. She has diabetes managed with Insulin and osteoarthritis of the knee managed with painkillers. She was recently treated for an episode of urinary tract infection. She eats a balanced diet and walks for 30 minutes every day. Her vital signs are normal. On examination, there is no warmth, redness, or swelling on her feet, but there is tenderness 3 centimeters above the posterior calcaneus on the left side. Bilateral motor strength, reflexes, and sensation are normal. Which of the following is the most likely cause of the condition? Use of prescription medication A 54-year-old female with no significant past medical history presents with a 6- month history of recurring "cold sores on my mouth." On exam, there are several vesicular lesions on her lips. A 5% concentration of the antiviral ointment is administered. Regarding this antiviral ointment, it is important to teach the patient which one of the following? Lesions may occur again at a later date despite treatment A 25-year-old sexually active female comes to the clinician with complaints of frequent urination, burning micturition, and mild supra-pubic pain for two days. She gives no history of fever, nausea, flank pain, or vomiting. After an appropriate workup, the clinician prescribes her a medication taken up by bacterial intracellular nitroreductases to produce the active form of the drug to treat her condition. Which of the following is a well-known severe adverse effect of the drug most likely given in this case?
Pulmonary toxicity A 25-year-old female patient comes to you for urinary discomfort and frequency. Urine culture shows that her infection is susceptible to sulfamethoxazole/trimethoprim. What is the benefit of using these drugs together? The drugs inhibit sequential steps of the folate synthesis pathway A 45-year-old woman develops pruritis, erythematous rash on the face and neck, and hypotension during initial intravenous antimicrobial treatment. Which of the following most likely caused this patients presentation? Vancomycin A 41-year-old woman is involved in a serious skiing accident, requiring surgery for a fractured femur. Postoperatively she develops methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Infusion of a synthetic oxazolidinone antimicrobial drug is initiated. Which of the following is one of the most common adverse effects of this drug? Headache An 8-month-old boy presents with a new onset of fever, urinary hesitancy, and frequency for three days. This is his second episode of similar complaints in the same month. He has a history of recurrent urinary tract infections since his birth. He has a 4-year-old sibling who is healthy. He has normal growth and development and achieved his milestones on time. The urine culture of
A 55-year-old man presents with septicemia after recovering from a motorcycle accident in the hospital. The clinician suspects that the septicemia is caused by methicillin-resistant Staphylococcus aureus (MRSA). Which of the following would provide the best antibiotic coverage for this patient? Vancomycin A 17-year-old patient presents to the clinic after experiencing significant dysphagia and retrosternal heartburn. He was recently prescribed medication to treat a genital chlamydial infection. Which of the following medications could have caused this patient's presenting symptoms while treating the genital chlamydial infection? Doxycycline A 1 2 - month old presents to his pediatrician for a well-child visit. The exam is mostly normal, except the pediatrician notes significantly discolored teeth. The mother insists that she only allows her child to drink milk and water. Upon further questioning, the mother reveals she was on medication for acne before she knew she was pregnant. What medication was she most likely given? Doxycycline A 66-year-old man with a history of follicular non-Hodgkins lymphoma is being treated with anthracycline therapy, interferon adjuvant therapy, and supportive pain medications. Over the course of his treatment, this patient develops suicidal
ideation. Which of the following medications is most likely responsible for this patient’s symptoms? Interferon-alpha 2b A 65-year-old man underwent surgery for basal cell carcinoma of the helical rim of the ear. Margins were clear on frozen sections. Due to the size of the defect, an advancement flap was performed. What signs or symptoms are associated with the Black Box Warning of the antibiotic that would be most appropriate for the patient to receive postoperatively? Pain in the achilles tendon A 5-year-old boy is brought to the clinic by his parents because of a worsening cough and thick yellow-green nasal discharge for the past 2 weeks. The patient has no chronic medical conditions, and he is not taking any medication. His immunization is up to date. Vital signs show temperature 39.2 C, blood pressure 120/80 mmhg, pulse 92/min, and respiratory rate 20/min. On examination, nasal turbinates are swollen and erythematous, and there is a thick purulent discharge from the nares; lungs are clear on auscultation. Amoxicillin-clavulanate is prescribed, which results in the complete resolution of symptoms in two days. Which of the following is the most likely organism responsible for this patient's initial presentation? Moraxella catarrhalis A 23-year-old female was recently prescribed fluconazole and "other antibiotics she forgets" after getting a local infection in Mississippi. After receiving
Maculopapular rash A 17-year-old male patient comes to the clinic. He has been experiencing a headache, facial pain, runny nose, and nasal congestion. His blood pressure is 110/70 mmhg, heart rate is 100 beats/min, and temperature is 37.5 C (99.5 F). A culture has been taken, which shows a Gram-negative coccobacillus rod. Which of the following drug treatments is first-line for this patient’s condition? Amoxicillin A 25-year-old female marathon runner presents to the urgent care for urinary urgency and polyuria. She states that her symptoms started three days ago and have persisted despite trying to stay hydrated and drinking a lot of cranberry juice. Her past medical history is significant for Achilles tendinopathy, which she attributed to a running injury last year. The physical examination is unremarkable and vital signs are within normal limits. Urinalysis demonstrates pyuria and positive leukocyte esterase. The decision to start a fluoroquinolone is discussed with the patient, and she agrees to treatment. Which of the following side effects is of significant concern in this patient? Tendonitis A 55-year-old man presents with two days of progressive shortness of breath and cough productive of copious yellow sputum without fever or chills. The patient's medical history is significant for hypertension, type 2 diabetes mellitus, and chronic obstructive pulmonary disease (COPD). He currently smokes one pack of cigarettes daily. He states that his COPD has generally been well-controlled with tiotropium. Other medications include lisinopril, amlodipine, metformin, and rosuvastatin. His blood pressure is 152/100 mmhg, pulse 100 beats per minute, respiratory rate 22 breaths per minute, pulse oximetry 95% on room air, and
temperature 97.2 F (36.2 C). He can answer questions fully and speak in complete sentences. Lung auscultation demonstrates bilateral rhonchi, a chest radiograph is unremarkable, and the forced expiratory volume (FEV1) is 65% of predicted. The clinician considers prescribing azithromycin. What is the most appropriate evaluation before prescribing azithromycin for this patient? Local antibiogram A client visits a provider with complaints of vaginal discharge and itching. After evaluation of the vagina and the discharge, bacterial vaginosis is diagnosed, and metronidazole is added for 7 days. What is the most important instruction to be given to this client? Abstain from alcohol A 17-year-old male with an abscess of the leg secondary to methcillin-resistant Staphylococcus aureus. H was started on intravenous vancomycin. Several minutes into the infusion, the patient developed a pruritic rash on his face and neck. His blood pressure decreases from 120/80 mmhg to 90/60 mmhg. The patient has most likely developed which of the following? Vancomycin flushing syndrome A 25-year-old male comes to the outpatient department for regular follow-up. His medical conditions include gastroesophageal reflux disease and Tourette syndrome, for which he takes famotidine and clonidine. He complains about a recent worsening of his tics that has been causing him emotional distress. The practitioner decides to stop his current medication and try a new drug to treat the patient's tics. Which of the following should concern the practitioner when discontinuing his current medication?
A 65-year-old male patient with hypertension, heart failure with preserved ejection fraction, diabetes mellitus, chronic kidney disease, and cirrhosis presents to the clinic for follow-up. His last visit was three months ago. During the last visit, amlodipine (10 mg daily) was prescribed due to elevated blood pressure in the clinic. His other medications include aspirin, lisinopril, atorvastatin, furosemide, insulin, and multivitamins. The patient noticed a blurring of vision while changing position for the last month. He also had a fall last week but did not have any major injuries. His symptoms are concerning for orthostatic hypotension. What would be the best next intervention? Stop amlodipine A 65-year-old man visits his primary care provider for a routine checkup. On examination, his blood pressure is 159/88 mmhg. This is confirmed on repeat ambulatory blood pressure monitoring at home over the following seven days. A once-daily amlodipine regime is prescribed. When counseling the patient about this medication, which of the following statements best describes possible ankle edema? Ankle edema occurs in approximately 10% of patients taking amlodipine 10mg once daily A 65-year-old man presents with his son to the clinician with complaints of orthopnea, dyspnea on climbing a few steps, vomiting, diarrhea, and visual changes. The patient also complains of urinary incontinence and cannot recall his
daily prescribed medications. Physical examination shows a raised jugular venous pressure, expiratory wheezing, and a significant S3 heart sound. An EKG is performed that shows decreased QT interval, prolongation of the PR interval, and T wave inversion/flattening. Increased levels of which of the following drugs is the likely cause for the patient's findings? Digoxin A 55-year-old African American woman with a history of hypertension and heart failure with reduced ejection presents to her cardiologist's office for follow up. She is already taking lisinopril, carvedilol, aspirin, high-dose spironolactone, and isosorbide dinitrate-hydralazine. Which of the following complications is most likely to occur in this patient? Hyperkalemia A 50-year-old male with a history of congestive heart failure with reduced ejection fraction, coronary artery disease, hypertension, dyslipidemia, CKD stage III presented to the physician's clinic with complaints of decreased hearing in both ears for last 4 weeks. Patient denies any history of ear infection, trauma to the ear or head, ear fullness, nausea, headache or tinnitus. The patient also mentions that 2 months ago the patient was admitted with septic shock secondary to UTI and was treated with broad-spectrum antibiotics including gentamicin and cefepime. Current home medications are aspirin 81 mg/day, metoprolol 50 mg twice a day, atorvastatin 40 mg/day, lisinopril 10 mg/day, furosemide 40 mg twice a day. Patient report no change in heart failure medications since last 6 months. Which of the following is the most likely cause of hearing impairment?
to prevent premature stent thrombosis. What is the mechanism of action of the second agent? Inhibit ADP receptors on the platelets A 65-year-old woman presents to the healthcare provider for an evaluation. The patient had been placed on digoxin for atrial fibrillation. Which of the following drugs, if given, can significantly increase the levels of digoxin in the patient's serum? Amiodorone A 65-year-old woman visits her primary care provider for her annual checkup. The nurse measures her blood pressure, which is 152/89 mmhg. She has no history of high blood pressure, diabetes, or dyslipidemia. The provider decides to start the patient on amlodipine besylate, 5 mg once daily. How should the patient be counseled about the mechanism of action of this medication? "Amlodipine will widen blood vessels by blocking calcium from going into the cells and make it easier for blood to flow through and reduce blood pressure." A 74-year-old man with a past medical history of atrial fibrillation, dyslipidemia, diabetes mellitus, gout, and sick sinus syndrome is admitted to the telemetry unit after a syncopal event. His vitals upon presentation are blood pressure of 100/
mmhg and heart rate of 75 beats per minute. Diltiazem therapy is being considered. Which of the following is the strongest contraindication for diltiazem therapy in this patient? Sick sinus syndrome A 65-year-old man presents to the emergency department with chest pain and diaphoresis for the past one and a half-hour that developed while he was doing work in his garage. Over the past few months, he has had two similar episodes occurring after physical exertion, each lasting for 10 to 15 minutes. The patient has a past medical history of diabetes mellitus, hypertension, and gastroesophageal reflux disease, for which he takes famotidine, amlodipine, and metformin. Vital signs show blood pressure of 138/92 mmhg, pulse 110/min, and temperature 98.6 F (37 C). On physical examination, the patient is in acute distress and marked diaphoresis is noted. He is given a chewable drug as part of standard protocol. What role does this drug play in the management of the patient’s acute condition? Antiplatelet coagulation A 67-year-old man presents to the emergency department with bradycardia with a heart rate of 44 beats per minute and blood pressure of 100/60 mmhg. Which of the following medication should be held to ensure his heart rate rises? Diltiazem
Enhances the action of antithrombin III A 65-year-old female patient is undergoing cardiac surgery. In the operating room, the patient has been successfully anticoagulated during cardiopulmonary bypass. The drug that has been used directly binds to antithrombin 3, leading to a conformation change that inhibits thrombus formation. After cardiopulmonary bypass is discontinued, the anticoagulation needs to be reversed. What medication is appropriate for this purpose? Protamine sulfate A 56-year-old female with a history of coronary artery disease (CAD), asthma, and Chronic Obstructive Pulmonary Disease (COPD) presents with chief complaints of lower extremity swelling and shortness of breath. She denies any abdominal pain, nausea, vomiting, or dysuria. Her symptoms have progressed for the last three months. She complains of the inability to lie down and uses four pillows at night. She drinks alcohol occasionally and smokes one pack per day. Past medical history is significant for hypertension controlled with diet and exercise. In the emergency department, vitals revealed blood pressure of 102/ mmhg, heart rate of 71 per minute, respirations of 19 per minute, temperature 98.9 F, and oxygen saturation of 94% on 2 L. Cardiac auscultation is significant for pansystolic murmur in left fifth intercostal space half-inch lateral to the midclavicular line. Jugular venous distention along with bilateral lower extremity pitting edema is noted. Which of the following medications has been proven to have a mortality benefit for the disease process causing this patient's symptoms? Lisinopril
A 40-year-old male presents to the clinic with complaints of dry, hacking, and nonproductive cough for one week. He denies any fever, chest pain, or shortness of breath. The patient states that the cough has been progressing and does not have any postural or diurnal variation. Because of this severe cough, he has not been sleeping well. He experiences abdominal pain due to severe coughing. He has tried several over-the-counter cough medications with minimal improvement in his symptoms. His medical history is significant for type 2 diabetes mellitus and hypertension. He is on metformin, lisinopril, baby aspirin, and some over-the- counter vitamins. On examination, the heart rate is 82 bpm, respiratory rate of 16/min, and blood pressure is 130/80 mmhg. Lung auscultation is clear. S1 and S2 are well heard without any murmurs on cardiac auscultation. The patient does not have any history of sinus infection. Which of the following is the appropriate next step in managing this patient? Replace lisinopril with lostartan A 72-year-old male with a past medical history of hypothyroidism and hyperlipidemia presents with acute onset weakness to his right upper and lower extremities and slurring of his speech. His symptoms all began about 2.5 hours ago. He takes no blood thinners and had no inciting trauma or events. His vitals show a blood pressure of 170/100 mmhg with a heart rate of 86 bpm and a respiratory rate of 15 breaths per minute. His physical examination shows significant slurring of speech and 3/5 strength in the upper and lower extremities on the right. He is sent for computed tomography (CT) scan for concern of an ischemic stroke, which reveals no active bleeding. His point of care glucose shows 30 mg/dl, his platelet count is 200,000 per microliter and an INR of 1.1. Which of the following excludes him from consideration of alteplase at this time?
