Clinical Nurse Specialist Advanced Pharmacology 2

Question 1

A patient is receiving vancomycin for MRSA bacteremia. The pharmacy calls to report a vancomycin AUC/MIC of 350 mg·h/L (target 400-600 mg·h/L). What pharmacokinetic action should the CNS recommend?

Accepted Answer

Increase the vancomycin dose or frequency to achieve target AUC/MIC ratio for optimal MRSA killing

Answer

AUC/MIC of 350 is below the target of 400-600 mg·h/L — dose optimization is required for adequate bactericidal activity against MRSA while monitoring for nephrotoxicity.

Question 2

A patient with type 2 diabetes and eGFR 35 mL/min is on metformin 1000 mg twice daily. Which pharmacological recommendation is appropriate?

Accepted Answer

Reduce metformin dose (maximum 1000 mg/day total) and monitor renal function every 3 months given eGFR 30-45 range

Answer

FDA guidance: metformin is contraindicated at eGFR <30; at eGFR 30-45, use with caution at reduced doses with frequent renal monitoring — maximum 1000 mg/day total.

Question 3

A patient develops acute ST-elevation MI (STEMI) and receives thrombolytic therapy with alteplase. Which pharmacological mechanism distinguishes alteplase from streptokinase?

Accepted Answer

Alteplase is a recombinant tissue plasminogen activator (tPA) that is fibrin-selective, while streptokinase is a non-selective bacterial protein that causes systemic fibrinolysis

Answer

Alteplase (tPA) is fibrin-selective — it activates plasminogen preferentially at the clot surface; streptokinase causes systemic (non-selective) fibrinolysis with greater systemic bleeding risk.

Question 4

A patient is receiving heparin infusion post-cardioversion. New labs show: platelets 80,000/uL (down from 240,000/uL 5 days ago), positive PF4/heparin ELISA. The 4T score is 7. What is the most appropriate pharmacological action?

Accepted Answer

Immediately discontinue heparin and initiate a non-heparin anticoagulant (argatroban or fondaparinux)

Answer

4T score 7 = high probability HIT; immediate heparin cessation and initiation of a non-heparin anticoagulant is essential — continued heparin causes catastrophic thrombosis.

Question 5

A CNS is reviewing the pharmacological management of a patient with COPD exacerbation requiring bronchodilator therapy. Which statement about ipratropium and albuterol combination therapy is most accurate?

Accepted Answer

The combination provides additive bronchodilation — ipratropium blocks muscarinic receptors, albuterol activates beta-2 receptors — through complementary mechanisms

Answer

Ipratropium (anticholinergic) and albuterol (beta-2 agonist) have complementary mechanisms — both cause bronchodilation through different pathways, providing additive benefit in COPD exacerbation.

Clinical Nurse Specialist Practice Test

Clinical Nurse Specialist Practice Test

Clinical Nurse Specialist Advanced Pharmacology 2