NR 566 FINAL EXAM 2026/2027
ADVANCED PHARMACOLOGY FOR
THE CARE OF THE FAMILY
QUESTIONS AND VERIFIED ANSWERS
WITH RATIONALES GRADED A+
LATEST
1. A 32-year-old woman presents with bacterial sinusitis. She has a history of
anaphylaxis to penicillin. Which antibiotic is safest to prescribe?
A. Amoxicillin
B. Azithromycin
C. Cefuroxime
D. Amoxicillin-clavulanate
Answer: B. Azithromycin
Rationale: Patients with severe penicillin allergy should avoid all beta-lactams.
Azithromycin, a macrolide, is safe and effective for bacterial sinusitis.
2. A patient taking warfarin is started on amiodarone. What is the most important
action by the nurse practitioner?
A. Discontinue warfarin
B. Monitor INR closely
C. Increase warfarin dose
D. Monitor potassium levels
Answer: B. Monitor INR closely
Rationale: Amiodarone inhibits warfarin metabolism, increasing bleeding risk.
INR should be monitored and warfarin dose adjusted accordingly.
,3. A 28-year-old patient is prescribed isotretinoin for severe acne. What patient
teaching is most critical?
A. Take with dairy
B. Avoid sun exposure
C. Use two forms of contraception
D. Increase dietary vitamin A
Answer: C. Use two forms of contraception
Rationale: Isotretinoin is highly teratogenic; strict contraceptive measures are
required to prevent pregnancy.
4. A patient with asthma reports using albuterol inhaler 6 times per day. What is
the best next step?
A. Increase albuterol dose
B. Add inhaled corticosteroid
C. Switch to levalbuterol
D. Stop albuterol
Answer: B. Add inhaled corticosteroid
Rationale: Frequent rescue inhaler use indicates poorly controlled asthma. Long-
term control with corticosteroids is indicated.
5. A 45-year-old patient with chronic heart failure is prescribed spironolactone.
Which laboratory value requires immediate attention?
A. Sodium 138 mEq/L
B. Potassium 5.8 mEq/L
C. Creatinine 0.9 mg/dL
D. Hemoglobin 14 g/dL
Answer: B. Potassium 5.8 mEq/L
Rationale: Spironolactone is potassium-sparing; hyperkalemia >5.5 mEq/L is
dangerous and requires adjustment or discontinuation.
,6. A 60-year-old patient with type 2 diabetes has an HbA1c of 9.2%. Which
medication adjustment is most appropriate?
A. Increase metformin dose
B. Start insulin therapy
C. Add glipizide
D. Discontinue metformin
Answer: B. Start insulin therapy
Rationale: HbA1c >9% indicates poor glycemic control; insulin initiation is
indicated for rapid control and prevention of complications.
7. Which class of drugs is contraindicated in pregnancy due to teratogenic effects?
A. Beta-blockers
B. ACE inhibitors
C. Calcium channel blockers
D. H2 receptor blockers
Answer: B. ACE inhibitors
Rationale: ACE inhibitors can cause fetal renal dysgenesis and are contraindicated
in pregnancy, especially in the second and third trimesters.
8. A patient with chronic kidney disease develops pruritus. Which medication class
should be avoided?
A. Antihistamines
B. Phosphate binders
C. Erythropoiesis-stimulating agents
D. Opioid agonists
Answer: D. Opioid agonists
Rationale: Opioids may worsen pruritus in CKD due to accumulation and
histamine release; non-opioid management is preferred.
, 9. A 55-year-old patient with hyperlipidemia is prescribed atorvastatin. Which
monitoring is essential?
A. TSH
B. Liver function tests
C. Serum potassium
D. Creatinine kinase only if symptomatic
Answer: B. Liver function tests
Rationale: Statins can cause hepatotoxicity; LFTs should be monitored before and
during therapy.
10. A patient taking lithium presents with nausea, tremor, and confusion. What is
the priority action?
A. Increase fluid intake
B. Hold lithium and check serum level
C. Administer antiemetic
D. Continue therapy at same dose
Answer: B. Hold lithium and check serum level
Rationale: These are signs of lithium toxicity. Serum levels must be checked, and
treatment adjusted promptly.
11. Which drug is first-line therapy for type 2 diabetes and has cardiovascular
benefit?
A. Metformin
B. Glipizide
C. Pioglitazone
D. Sitagliptin
Answer: A. Metformin
Rationale: Metformin improves glycemic control and has evidence for
cardiovascular benefit in type 2 diabetes.
ADVANCED PHARMACOLOGY FOR
THE CARE OF THE FAMILY
QUESTIONS AND VERIFIED ANSWERS
WITH RATIONALES GRADED A+
LATEST
1. A 32-year-old woman presents with bacterial sinusitis. She has a history of
anaphylaxis to penicillin. Which antibiotic is safest to prescribe?
A. Amoxicillin
B. Azithromycin
C. Cefuroxime
D. Amoxicillin-clavulanate
Answer: B. Azithromycin
Rationale: Patients with severe penicillin allergy should avoid all beta-lactams.
Azithromycin, a macrolide, is safe and effective for bacterial sinusitis.
2. A patient taking warfarin is started on amiodarone. What is the most important
action by the nurse practitioner?
A. Discontinue warfarin
B. Monitor INR closely
C. Increase warfarin dose
D. Monitor potassium levels
Answer: B. Monitor INR closely
Rationale: Amiodarone inhibits warfarin metabolism, increasing bleeding risk.
INR should be monitored and warfarin dose adjusted accordingly.
,3. A 28-year-old patient is prescribed isotretinoin for severe acne. What patient
teaching is most critical?
A. Take with dairy
B. Avoid sun exposure
C. Use two forms of contraception
D. Increase dietary vitamin A
Answer: C. Use two forms of contraception
Rationale: Isotretinoin is highly teratogenic; strict contraceptive measures are
required to prevent pregnancy.
4. A patient with asthma reports using albuterol inhaler 6 times per day. What is
the best next step?
A. Increase albuterol dose
B. Add inhaled corticosteroid
C. Switch to levalbuterol
D. Stop albuterol
Answer: B. Add inhaled corticosteroid
Rationale: Frequent rescue inhaler use indicates poorly controlled asthma. Long-
term control with corticosteroids is indicated.
5. A 45-year-old patient with chronic heart failure is prescribed spironolactone.
Which laboratory value requires immediate attention?
A. Sodium 138 mEq/L
B. Potassium 5.8 mEq/L
C. Creatinine 0.9 mg/dL
D. Hemoglobin 14 g/dL
Answer: B. Potassium 5.8 mEq/L
Rationale: Spironolactone is potassium-sparing; hyperkalemia >5.5 mEq/L is
dangerous and requires adjustment or discontinuation.
,6. A 60-year-old patient with type 2 diabetes has an HbA1c of 9.2%. Which
medication adjustment is most appropriate?
A. Increase metformin dose
B. Start insulin therapy
C. Add glipizide
D. Discontinue metformin
Answer: B. Start insulin therapy
Rationale: HbA1c >9% indicates poor glycemic control; insulin initiation is
indicated for rapid control and prevention of complications.
7. Which class of drugs is contraindicated in pregnancy due to teratogenic effects?
A. Beta-blockers
B. ACE inhibitors
C. Calcium channel blockers
D. H2 receptor blockers
Answer: B. ACE inhibitors
Rationale: ACE inhibitors can cause fetal renal dysgenesis and are contraindicated
in pregnancy, especially in the second and third trimesters.
8. A patient with chronic kidney disease develops pruritus. Which medication class
should be avoided?
A. Antihistamines
B. Phosphate binders
C. Erythropoiesis-stimulating agents
D. Opioid agonists
Answer: D. Opioid agonists
Rationale: Opioids may worsen pruritus in CKD due to accumulation and
histamine release; non-opioid management is preferred.
, 9. A 55-year-old patient with hyperlipidemia is prescribed atorvastatin. Which
monitoring is essential?
A. TSH
B. Liver function tests
C. Serum potassium
D. Creatinine kinase only if symptomatic
Answer: B. Liver function tests
Rationale: Statins can cause hepatotoxicity; LFTs should be monitored before and
during therapy.
10. A patient taking lithium presents with nausea, tremor, and confusion. What is
the priority action?
A. Increase fluid intake
B. Hold lithium and check serum level
C. Administer antiemetic
D. Continue therapy at same dose
Answer: B. Hold lithium and check serum level
Rationale: These are signs of lithium toxicity. Serum levels must be checked, and
treatment adjusted promptly.
11. Which drug is first-line therapy for type 2 diabetes and has cardiovascular
benefit?
A. Metformin
B. Glipizide
C. Pioglitazone
D. Sitagliptin
Answer: A. Metformin
Rationale: Metformin improves glycemic control and has evidence for
cardiovascular benefit in type 2 diabetes.
