Here is the reformatted activity containing all 15 clinical and pharmaceutical multiple-choice questions, followed by a complete Answer Key table at the end.

Multiple Choice Activity

Question 01: Anticoagulation Post-Valve Replacement

M.A. is a 61-year-old female (height 163 cm, weight 78 kg) with a history of significant primary mitral regurgitation. Her echocardiogram reveals significant leaflet flaring that is not amendable to mitral valve repair. She also has a history of hypertension, dyslipidemia, and gout. Her medications include Enalapril 10 mg orally daily, hydrochlorothiazide 25 mg orally daily, atorvastatin 40 mg orally daily, and allopurinol 300 mg orally daily. Her heart rate is 68 beats/minute and blood pressure is 128/74 mm Hg. Her CrCl is 68 mL/minute. She is scheduled to undergo valve replacement surgery and will receive a mechanical mitral valve. You are discussing the oral anticoagulant postoperative plan with M.A.’s team, Which is the optimal regimen for preventing thrombosis?

  • [✓] Adjusted-dose warfarin to an INR goal of 2.5–3.5 plus aspirin 81 mg orally daily. (CORRECT)

  • [ ] Adjusted-dose warfarin to an INR goal of 2.0–3.0 plus aspirin 81 mg orally daily.

  • [ ] Adjusted-dose warfarin to an INR goal of 2.0–3.0.

  • [ ] Adjusted-dose warfarin to an INR goal of 2.5–3.5.

Question 02: Severe Hyperkalemia Management

A 55-year-old man with diabetes and kidney disease has hyperkalemia. His laboratory values include potassium (K+) 7.2 mEq/L, calcium (Ca2+) 9 mg/dL, albumin 3.5 g/dL, and blood glucose 302 mg/dL. His electrocardiogram (ECG) is abnormal, with peaked T waves. What is the best recommendation for initial treatment?

  • [ ] Regular insulin 10 units intravenously plus 50 g of dextrose intravenously.

  • [✓] 10% calcium gluconate 10 mL intravenously. (CORRECT)

  • [ ] Sodium polystyrene sulfonate (Kayexalate) 15 g orally.

  • [ ] Sodium bicarbonate 50 mEq intravenously over 5 minutes.

Question 03: Vancomycin AUC Pharmacokinetics in Sepsis

S.H. is a 35-year-old man (height 190 cm, weight 85 kg) admitted to the medical ICU because of sepsis caused by hospital-acquired pneumonia. He is empirically treated with intermittent vancomycin, piperacillin/ tazobactam, and ciprofloxacin. His laboratory values are as follows: SCr 1 mg/dL, BUN 12 mg/dL, and WBC 18 × 10³ cells/mm³. S.H. is given a diagnosis of methicillin-resistant Staphylococcus aureus hospital-acquired pneumonia. On day 10 of vancomycin therapy, his vancomycin area under the curve (AUC) is 700 mg x h/L. His previous vancomycin AUC was 425 mg x h/L on the same dosing regimen. Which most likely explains what transpired?

  • [✓] Augmented renal excretion returned to normal. (CORRECT)

  • [ ] Vd increased to larger than normal.

  • [ ] Tissue penetration decreased to below normal.

  • [ ] Liver blood flow returned to normal.

Question 04: Colistin Dosing in Continuous Renal Replacement Therapy (CRRT)

A 60 years old female patient a case of septic shock and AKI and will start on CRRT, the patient will be started on colistin injection based on her cultures results , what is your recommendation regarding the colistin dose:

  • [✓] LD of colistin needs no adjustment (CORRECT)

  • [ ] Colistin is contraindicated in CRRT

  • [ ] Omit the LD of colistin

  • [ ] LD needs to e decreased by 50 %

Question 05: Medication Reconciliation Steps

Medication reconciliation is a process to prevent medication errors and includes which of the following steps?

  • [ ] Providing the admission medication list to patients at discharge

  • [ ] Determining the list of medications from the last hospital stay

  • [ ] Making clinical decisions only on the past list

  • [✓] Finalizing and communicating the reconciled list to the patient and clinicians (CORRECT)

Question 06: Evidence-Based Analysis of Albumin Meta-Analysis

A systematic review evaluated the effect of albumin for fluid resuscitation. A meta-analysis that evaluated the effect of albumin use compared with normal saline on 28-day mortality reported a combined OR of 0.45 (95% CI, 0.3–0.75) for the treatment of hypovolemic shock caused by trauma. For the treatment of septic shock, albumin compared with normal saline resulted in a combined OR of 1.1 (95% CI, 0.98–1.21) when evaluating 28-day mortality. Which best represents the findings of the review?

  • [ ] Albumin increased mortality in trauma but did not affect survival in the treatment of septic shock.

  • [✓] Albumin increased survival in trauma but did not affect survival in the treatment of septic shock. (CORRECT)

  • [ ] Albumin did not affect survival in the treatment of hypovolemic shock caused by trauma but improved survival in the treatment of septic shock.

  • [ ] Albumin did not affect survival in the treatment of hypovolemic shock caused by trauma or septic shock.

Question 07: Statistical Interpretation of Odds Ratio and Confidence Intervals

A case-control study is conducted to determine whether statin therapy is associated with an increased risk of developing new-onset diabetes mellitus. The study reports an odds ratio (OR) for developing new-onset diabetes mellitus with statin therapy to be 1.2 with a 95% confidence interval (CI) of 0.95–1.6. Which of the following best describes the study findings?

  • [ ] Statin therapy increases the risk of diabetes by 20%, and the result is statistically significant.

  • [ ] Statin therapy increases the risk of diabetes by 120%.

  • [✓] Statin therapy is not significantly associated with the development of diabetes. (CORRECT)

  • [ ] Statin therapy significantly reduces the risk of diabetes.

Question 08: Antimicrobial Stewardship Implementation

You are a clinical pharmacist and a member of the hospital’s antimicrobial stewardship committee. Internal audit data show that surgeons frequently continue prophylactic antibiotics for 48 hours after clean orthopedic procedures, Which of the following actions BEST reflects an advocacy-based approach to address this issue?

  • [ ] Send an email reminder to all surgeons stating that prolonged prophylaxis is inappropriate.

  • [✓] Develop and implement an evidence-based institutional surgical prophylaxis guideline in collaboration with surgical leadership, present outcome data, and incorporate order sets into the electronic health record to standardize practice. (CORRECT)

  • [ ] Report noncompliant surgeons to hospital administration for corrective action.

  • [ ] Remove access to postoperative antibiotic orders for surgical staff without prior approval from pharmacy.

Question 09: Renal Dose Adjustment Interventions

A 58-year-old male patient with chronic kidney disease (CrCl 25 mL/min) is admitted with a urinary tract infection. The physician orders ciprofloxacin 500 mg orally every 12 hours. Upon review, you identify that the current dosing regimen requires adjustment for renal impairment. As the clinical pharmacist, which of the following actions is MOST appropriate?

  • [ ] Contact the physician to recommend a renal-adjusted dose of ciprofloxacin 500 mg orally every 48 hours and document the recommendation in the patient’s medical record.

  • [✓] Contact the physician to recommend a renal-adjusted dose of ciprofloxacin 500 mg orally once daily and document the recommendation in the patient’s medical record. (CORRECT)

  • [ ] Cancel the prescription and select an alternative antibiotic without consulting the physician.

  • [ ] None of the above actions are appropriate.

Question 10: Antibiotic Classification Guidelines (JFDA / WHO AWaRe)

Based on the Jordan Food and Drug Administration (JFDA) information related to antibiotic classification and monitoring and WHO AWaRe classification ,one of the following statement is false regarding Reserve group of antibiotics:

  • [ ] They are considered last resort options and should be used sparingly.

  • [✓] Tigecycline and meropenem are examples of antibiotics in this group (CORRECT)

  • [ ] Daptomycin and Telavancin are examples of antibiotics in this group

  • [ ] They are vital for treating severe infections caused by multidrug resistant bacteria

Question 11: Heparin Toxicity Reversal

A male (weight 125 kg) is admitted for the treatment of a DVT with a PE. He is administered a 10,000-unit bolus of UFH and initiated on an infusion of 2000 units/hour. Twelve hours into the infusion, he begins to vomit blood. Which is the most appropriate protamine dose for this patient?

  • [ ] 100 mg.

  • [ ] 50 mg. 

  • [✓ ] 22.5 mg. (CORRECT)

  • [ ] 11.25 mg.

Question 12: Dabigatran Reversal Strategy

H.W. was initiated on dabigatran and, 3 months later, is involved in a motor vehicle accident resulting in an intracranial hemorrhage. Which is the most appropriate reversal strategy for H.W.?

  • [ ] Protamine.

  • [ ] Fresh frozen plasma (FFP).

  • [ ] Andexanet alfa

  • [✓] Idarucizumab (CORRECT)

Question 13: Pharmaceutical Alligation Compounding

How much of 10% solution is needed to prepare 100 mL of 6% solution using 2% solution?

  • [✓] 50 ml (CORRECT)

  • [ ] 30 ml

  • [ ] 70 ml

  • [ ] 100 ml

Question 14: Pharmacokinetic Elimination Kinetics

A drug given as an IV bolus produces serum concentrations of 10 mg/L when measured 4 hours after the dose and 5 mg/L when measured 10 hours after the dose. The half-life of the drug can be calculated as

  • [ ] 2 hours

  • [ ] 5 hours

  • [✓] 6 hours (CORRECT)

  • [ ] 15 hours

Question 15: Nonlinear Pharmacokinetics

Phenytoin displays saturable Michaelis–Menten kinetics. If the dose is increased, the serum concentration is predicted to be _____ than expected with linear kinetics.

  • [ ] Proportionally higher

  • [✓] Disproportionally higher (CORRECT)

  • [ ] Proportionally lower

  • [ ] Disproportionally lower

Last modified: Sunday, 18 October 2026, 6:56 AM