NR 566 Final Exam Q&A (2025/2026)
Advanced Pharmacology | Chamberlain University
1. A patient with type 2 diabetes and chronic kidney disease
(eGFR 35 mL/min) is prescribed metformin. What is the most
appropriate action?
A. Start metformin at a reduced dose
B. Prescribe metformin with a sulfonylurea
C. Hold metformin and consider alternative therapy
D. Start metformin with a GLP-1 agonist
✅ Answer: C. Hold metformin and consider alternative therapy
*Expert Rationale: Metformin is contraindicated in patients with eGFR <45
mL/min due to risk of lactic acidosis. Alternative agents such as SGLT2 inhibitors or
GLP-1 agonists may be considered.*
2. A patient with heart failure with reduced ejection fraction
(HFrEF) is started on sacubitril/valsartan. What laboratory
monitoring is essential?
A. Liver function tests
B. Serum potassium and renal function
C. CBC with differential
D. Hemoglobin A1c
✅ Answer: B. Serum potassium and renal function
Expert Rationale: Sacubitril/valsartan can cause hyperkalemia and worsening
renal function. Monitoring electrolytes and creatinine is required, especially after
initiation or dose adjustment.
, 3. A 72-year-old male with insomnia is prescribed zolpidem 10
mg nightly. Which statement is most concerning?
A. "I take it right before I get into bed."
B. "I often wake up without remembering the middle of the night."
C. "I take it with a small glass of grapefruit juice."
D. "I only take it when I know I have 7–8 hours to sleep."
✅ Answer: C. "I take it with a small glass of grapefruit juice."
Expert Rationale: Grapefruit juice inhibits CYP3A4, increasing zolpidem levels and
risk of toxicity, especially in older adults. Zolpidem should be used at lower doses (5
mg) in the elderly.
4. A patient on warfarin with an INR of 3.8 is scheduled for a
tooth extraction. What is the appropriate management?
A. Hold warfarin for 5 days and bridge with enoxaparin
B. Continue warfarin; INR is therapeutic
C. Administer vitamin K 10 mg PO
D. Hold warfarin for 24–48 hours and check INR before procedure
✅ Answer: D. Hold warfarin for 24–48 hours and check INR before procedure
Expert Rationale: For minor dental procedures, warfarin may be briefly held. INR
should be within a safe range (typically <1.5–2.0) to minimize bleeding risk while
maintaining thromboembolic protection.
5. Which antidepressant is most appropriate for a patient with
chronic neuropathic pain and depression?
A. Bupropion
B. Duloxetine
C. Escitalopram
D. Mirtazapine
Advanced Pharmacology | Chamberlain University
1. A patient with type 2 diabetes and chronic kidney disease
(eGFR 35 mL/min) is prescribed metformin. What is the most
appropriate action?
A. Start metformin at a reduced dose
B. Prescribe metformin with a sulfonylurea
C. Hold metformin and consider alternative therapy
D. Start metformin with a GLP-1 agonist
✅ Answer: C. Hold metformin and consider alternative therapy
*Expert Rationale: Metformin is contraindicated in patients with eGFR <45
mL/min due to risk of lactic acidosis. Alternative agents such as SGLT2 inhibitors or
GLP-1 agonists may be considered.*
2. A patient with heart failure with reduced ejection fraction
(HFrEF) is started on sacubitril/valsartan. What laboratory
monitoring is essential?
A. Liver function tests
B. Serum potassium and renal function
C. CBC with differential
D. Hemoglobin A1c
✅ Answer: B. Serum potassium and renal function
Expert Rationale: Sacubitril/valsartan can cause hyperkalemia and worsening
renal function. Monitoring electrolytes and creatinine is required, especially after
initiation or dose adjustment.
, 3. A 72-year-old male with insomnia is prescribed zolpidem 10
mg nightly. Which statement is most concerning?
A. "I take it right before I get into bed."
B. "I often wake up without remembering the middle of the night."
C. "I take it with a small glass of grapefruit juice."
D. "I only take it when I know I have 7–8 hours to sleep."
✅ Answer: C. "I take it with a small glass of grapefruit juice."
Expert Rationale: Grapefruit juice inhibits CYP3A4, increasing zolpidem levels and
risk of toxicity, especially in older adults. Zolpidem should be used at lower doses (5
mg) in the elderly.
4. A patient on warfarin with an INR of 3.8 is scheduled for a
tooth extraction. What is the appropriate management?
A. Hold warfarin for 5 days and bridge with enoxaparin
B. Continue warfarin; INR is therapeutic
C. Administer vitamin K 10 mg PO
D. Hold warfarin for 24–48 hours and check INR before procedure
✅ Answer: D. Hold warfarin for 24–48 hours and check INR before procedure
Expert Rationale: For minor dental procedures, warfarin may be briefly held. INR
should be within a safe range (typically <1.5–2.0) to minimize bleeding risk while
maintaining thromboembolic protection.
5. Which antidepressant is most appropriate for a patient with
chronic neuropathic pain and depression?
A. Bupropion
B. Duloxetine
C. Escitalopram
D. Mirtazapine
