NR 565 Exam 3: Advanced Pharmacology Fundamentals V1
Updated and Latest Questions and Correct Answers with
Rationale
1. Which of the following instructions should a nurse practitioner provide to a patient
starting levothyroxine for hypothyroidism?
A. Take the medication with a high-fiber breakfast.
B. Take the medication only when feeling symptomatic of fatigue.
C. Take the medication right before bedtime with a glass of milk.
D. Take the medication on an empty stomach, 30 to 60 minutes before breakfast.
Ans: D
Rationale: Levothyroxine absorption is highly sensitive to the presence of food and other medications.
To ensure consistent absorption, it should be taken on an empty stomach in the morning. Patients are
advised to wait at least 30 to 60 minutes before consuming food or coffee. Calcium and iron supplements
must be spaced several hours apart from this medication. Consistency is key to maintaining stable
thyroid-stimulating hormone levels in the blood. Abruptly stopping the medication can lead to a return of
hypothyroid symptoms or even myxedema coma.
,2. A patient with Type 2 Diabetes is prescribed Metformin. Which laboratory value is a
contraindication for this drug?
A. HbA1c of 8.5%
B. Estimated Glomerular Filtration Rate (eGFR) less than 30 mL/min/1.73m²
C. Serum Potassium of 4.2 mEq/L
D. LDL cholesterol of 130 mg/dL
Ans: B
Rationale: Metformin is primarily excreted by the kidneys and can accumulate in renal impairment. An
eGFR below 30 is a strict contraindication due to the risk of lactic acidosis. Lactic acidosis is a rare but
potentially fatal metabolic complication associated with metformin. Providers should monitor renal
function at least annually for all patients on this therapy. If a patient is undergoing a procedure with
iodinated contrast, metformin must be temporarily held. Dose adjustments are often necessary when the
eGFR falls between 30 and 45.
3. Which type of insulin provides a basal coverage and has no peak effect?
A. Insulin Lispro
B. Insulin Glargine
C. NPH Insulin
D. Regular Insulin
Ans: B
,Rationale: Insulin glargine is a long-acting analog designed to provide a steady level of insulin. It lacks a
distinct peak, which significantly reduces the risk of nocturnal hypoglycemia. This insulin is typically
administered once daily at the same time every day. It should never be mixed in the same syringe with
other types of insulin. Because it provides basal coverage, it does not cover mealtime glucose spikes. It
works by forming microprecipitates in the subcutaneous tissue that release slowly over 24 hours.
4. A pregnant woman in her first trimester requires treatment for hyperthyroidism. Which
medication is preferred?
A. Propylthiouracil (PTU)
B. Methimazole
C. Radioactive Iodine
D. Levothyroxine
Ans: A
Rationale: Propylthiouracil is the preferred antithyroid drug during the first trimester of pregnancy.
Methimazole is associated with a higher risk of fetal abnormalities like aplasia cutis. PTU works by
inhibiting the synthesis of thyroid hormones and peripheral conversion of T4 to T3. After the first
trimester, many clinicians switch the patient back to methimazole. This switch occurs because PTU
carries a higher risk of severe maternal hepatotoxicity. Monitoring liver function tests and thyroid levels
is essential throughout the pregnancy period.
, 5. Which of the following is a major contraindication for the use of combined oral
contraceptives (COCs)?
A. Age 25 and nulliparous
B. Dysmenorrhea
C. Controlled hypothyroidism
D. History of deep vein thrombosis (DVT)
Ans: D
Rationale: Combined oral contraceptives contain estrogen, which increases the risk of blood clots. A
history of DVT or pulmonary embolism is an absolute contraindication for their use. Estrogen can
promote the synthesis of clotting factors in the liver. For these patients, progestin-only options or non-
hormonal methods are much safer alternatives. Smoking while over the age of 35 also significantly
increases the risk of stroke. Providers must screen all patients for cardiovascular risk factors before
prescribing hormonal birth control.
6. A patient taking alendronate for osteoporosis should be instructed to:
A. Lie down for 30 minutes after taking the pill.
B. Take the medication with orange juice to increase absorption.
C. Remain upright for at least 30 minutes after administration.
D. Take the medication immediately after a large meal.
Ans: C
Updated and Latest Questions and Correct Answers with
Rationale
1. Which of the following instructions should a nurse practitioner provide to a patient
starting levothyroxine for hypothyroidism?
A. Take the medication with a high-fiber breakfast.
B. Take the medication only when feeling symptomatic of fatigue.
C. Take the medication right before bedtime with a glass of milk.
D. Take the medication on an empty stomach, 30 to 60 minutes before breakfast.
Ans: D
Rationale: Levothyroxine absorption is highly sensitive to the presence of food and other medications.
To ensure consistent absorption, it should be taken on an empty stomach in the morning. Patients are
advised to wait at least 30 to 60 minutes before consuming food or coffee. Calcium and iron supplements
must be spaced several hours apart from this medication. Consistency is key to maintaining stable
thyroid-stimulating hormone levels in the blood. Abruptly stopping the medication can lead to a return of
hypothyroid symptoms or even myxedema coma.
,2. A patient with Type 2 Diabetes is prescribed Metformin. Which laboratory value is a
contraindication for this drug?
A. HbA1c of 8.5%
B. Estimated Glomerular Filtration Rate (eGFR) less than 30 mL/min/1.73m²
C. Serum Potassium of 4.2 mEq/L
D. LDL cholesterol of 130 mg/dL
Ans: B
Rationale: Metformin is primarily excreted by the kidneys and can accumulate in renal impairment. An
eGFR below 30 is a strict contraindication due to the risk of lactic acidosis. Lactic acidosis is a rare but
potentially fatal metabolic complication associated with metformin. Providers should monitor renal
function at least annually for all patients on this therapy. If a patient is undergoing a procedure with
iodinated contrast, metformin must be temporarily held. Dose adjustments are often necessary when the
eGFR falls between 30 and 45.
3. Which type of insulin provides a basal coverage and has no peak effect?
A. Insulin Lispro
B. Insulin Glargine
C. NPH Insulin
D. Regular Insulin
Ans: B
,Rationale: Insulin glargine is a long-acting analog designed to provide a steady level of insulin. It lacks a
distinct peak, which significantly reduces the risk of nocturnal hypoglycemia. This insulin is typically
administered once daily at the same time every day. It should never be mixed in the same syringe with
other types of insulin. Because it provides basal coverage, it does not cover mealtime glucose spikes. It
works by forming microprecipitates in the subcutaneous tissue that release slowly over 24 hours.
4. A pregnant woman in her first trimester requires treatment for hyperthyroidism. Which
medication is preferred?
A. Propylthiouracil (PTU)
B. Methimazole
C. Radioactive Iodine
D. Levothyroxine
Ans: A
Rationale: Propylthiouracil is the preferred antithyroid drug during the first trimester of pregnancy.
Methimazole is associated with a higher risk of fetal abnormalities like aplasia cutis. PTU works by
inhibiting the synthesis of thyroid hormones and peripheral conversion of T4 to T3. After the first
trimester, many clinicians switch the patient back to methimazole. This switch occurs because PTU
carries a higher risk of severe maternal hepatotoxicity. Monitoring liver function tests and thyroid levels
is essential throughout the pregnancy period.
, 5. Which of the following is a major contraindication for the use of combined oral
contraceptives (COCs)?
A. Age 25 and nulliparous
B. Dysmenorrhea
C. Controlled hypothyroidism
D. History of deep vein thrombosis (DVT)
Ans: D
Rationale: Combined oral contraceptives contain estrogen, which increases the risk of blood clots. A
history of DVT or pulmonary embolism is an absolute contraindication for their use. Estrogen can
promote the synthesis of clotting factors in the liver. For these patients, progestin-only options or non-
hormonal methods are much safer alternatives. Smoking while over the age of 35 also significantly
increases the risk of stroke. Providers must screen all patients for cardiovascular risk factors before
prescribing hormonal birth control.
6. A patient taking alendronate for osteoporosis should be instructed to:
A. Lie down for 30 minutes after taking the pill.
B. Take the medication with orange juice to increase absorption.
C. Remain upright for at least 30 minutes after administration.
D. Take the medication immediately after a large meal.
Ans: C
