NR 566 FINAL EXAM 2 LATEST VERSIONS 2026 | Advanced
Pharmacology for Care of Family | 200+ Questions &
Answers | A Grade | Pass Guaranteed - A+ Graded
VERSION A
Section 1: Foundational Pharmacology Principles (10 Questions)
Q1: A 72-year-old patient is prescribed diphenhydramine 25 mg at bedtime for insomnia.
She also has hypertension, constipation, and early cognitive decline. According to the
Beers criteria, what is the primary concern with this prescription?
A. It is safe in the elderly when used for sleep
B. It should be avoided due to anticholinergic properties and risk of confusion,
constipation, and falls
C. It is preferred over zolpidem in patients over 65
D. The dose should be reduced to 12.5 mg due to renal clearance
Correct Answer: B
Rationale: For the NR 566 final exam (Version A), remember that first-generation
antihistamines like diphenhydramine carry strong anticholinergic activity and are on the
Beers list as potentially inappropriate in older adults due to increased risks of confusion,
urinary retention, constipation, and falls. A common final exam trap is thinking OTC
,means safe for everyone—Beers criteria specifically flag these agents in the geriatric
population.
Q2: A patient taking warfarin for atrial fibrillation is started on amiodarone for rhythm
control. What is the expected effect on the INR, and what is the mechanism?
A. INR will decrease because amiodarone induces CYP2C9
B. INR will increase because amiodarone inhibits CYP2C9 and CYP3A4
C. INR will remain unchanged because amiodarone does not affect warfarin
metabolism
D. INR will decrease because amiodarone increases vitamin K absorption
Correct Answer: B
Rationale: The best choice is that INR will increase because amiodarone inhibits both
CYP2C9 and CYP3A4. That's correct because in family practice, amiodarone is a potent
inhibitor of the enzymes that metabolize both S-warfarin (CYP2C9) and R-warfarin
(CYP3A4), leading to significant INR elevation and bleeding risk. You should reduce the
warfarin dose by 30–50% when starting amiodarone and monitor INR closely.
Q3: A 4-year-old child weighing 18 kg needs amoxicillin at 45 mg/kg/day divided BID for
otitis media. What is the appropriate dose per administration?
A. 200 mg per dose
B. 405 mg per dose
C. 810 mg per dose
,D. 225 mg per dose
Correct Answer: B
Rationale: For the NR 566 final exam (Version A), remember that 45 mg/kg/day divided
BID means 22.5 mg/kg per dose. For an 18 kg child, that's 405 mg per dose. A common
final exam trap is giving the daily total as one dose or dividing the daily dose by four
instead of two—always check whether the problem asks for daily total or per-dose
amount.
Q4: A patient with depression is found to be a CYP2D6 poor metabolizer. Which
antidepressant would be most likely to reach toxic levels in this patient due to impaired
metabolism?
A. Sertraline
B. Escitalopram
C. Fluoxetine or paroxetine
D. Mirtazapine
Correct Answer: C
Rationale: The best choice is fluoxetine or paroxetine. That's correct because both are
potent CYP2D6 inhibitors, and in poor metabolizers, their levels accumulate
significantly, increasing risks of side effects like serotonin syndrome, QT prolongation,
or excessive activation. Sertraline and escitalopram are less affected by CYP2D6 status,
and mirtazapine is metabolized by multiple pathways.
, Q5: A pregnant patient at 12 weeks gestation needs treatment for a bacterial infection.
Which medication carries an FDA pregnancy category D risk and should be avoided if
alternatives exist?
A. Amoxicillin
B. Azithromycin
C. Lisinopril
D. Metformin
Correct Answer: C
Rationale: For the NR 566 final exam (Version A), remember that ACE inhibitors like
lisinopril are pregnancy category D (and essentially contraindicated, especially in the
second and third trimesters) due to fetal renal agenesis, oligohydramnios, and skull
hypoplasia. A common trap is thinking all antihypertensives are equally dangerous in
pregnancy—know that labetalol, nifedipine, and methyldopa are preferred, while ACE
inhibitors and ARBs are avoided.
Q6: A 68-year-old patient with cirrhosis is prescribed lorazepam 1 mg at bedtime for
anxiety. Why is this preferred over diazepam in hepatic impairment?
A. Lorazepam is metabolized via glucuronidation rather than oxidation in the liver
B. Lorazepam does not cross the blood-brain barrier
C. Diazepam is renally cleared and accumulates in liver disease
D. Lorazepam has no active metabolites but is primarily oxidized by CYP3A4
Correct Answer: A
Pharmacology for Care of Family | 200+ Questions &
Answers | A Grade | Pass Guaranteed - A+ Graded
VERSION A
Section 1: Foundational Pharmacology Principles (10 Questions)
Q1: A 72-year-old patient is prescribed diphenhydramine 25 mg at bedtime for insomnia.
She also has hypertension, constipation, and early cognitive decline. According to the
Beers criteria, what is the primary concern with this prescription?
A. It is safe in the elderly when used for sleep
B. It should be avoided due to anticholinergic properties and risk of confusion,
constipation, and falls
C. It is preferred over zolpidem in patients over 65
D. The dose should be reduced to 12.5 mg due to renal clearance
Correct Answer: B
Rationale: For the NR 566 final exam (Version A), remember that first-generation
antihistamines like diphenhydramine carry strong anticholinergic activity and are on the
Beers list as potentially inappropriate in older adults due to increased risks of confusion,
urinary retention, constipation, and falls. A common final exam trap is thinking OTC
,means safe for everyone—Beers criteria specifically flag these agents in the geriatric
population.
Q2: A patient taking warfarin for atrial fibrillation is started on amiodarone for rhythm
control. What is the expected effect on the INR, and what is the mechanism?
A. INR will decrease because amiodarone induces CYP2C9
B. INR will increase because amiodarone inhibits CYP2C9 and CYP3A4
C. INR will remain unchanged because amiodarone does not affect warfarin
metabolism
D. INR will decrease because amiodarone increases vitamin K absorption
Correct Answer: B
Rationale: The best choice is that INR will increase because amiodarone inhibits both
CYP2C9 and CYP3A4. That's correct because in family practice, amiodarone is a potent
inhibitor of the enzymes that metabolize both S-warfarin (CYP2C9) and R-warfarin
(CYP3A4), leading to significant INR elevation and bleeding risk. You should reduce the
warfarin dose by 30–50% when starting amiodarone and monitor INR closely.
Q3: A 4-year-old child weighing 18 kg needs amoxicillin at 45 mg/kg/day divided BID for
otitis media. What is the appropriate dose per administration?
A. 200 mg per dose
B. 405 mg per dose
C. 810 mg per dose
,D. 225 mg per dose
Correct Answer: B
Rationale: For the NR 566 final exam (Version A), remember that 45 mg/kg/day divided
BID means 22.5 mg/kg per dose. For an 18 kg child, that's 405 mg per dose. A common
final exam trap is giving the daily total as one dose or dividing the daily dose by four
instead of two—always check whether the problem asks for daily total or per-dose
amount.
Q4: A patient with depression is found to be a CYP2D6 poor metabolizer. Which
antidepressant would be most likely to reach toxic levels in this patient due to impaired
metabolism?
A. Sertraline
B. Escitalopram
C. Fluoxetine or paroxetine
D. Mirtazapine
Correct Answer: C
Rationale: The best choice is fluoxetine or paroxetine. That's correct because both are
potent CYP2D6 inhibitors, and in poor metabolizers, their levels accumulate
significantly, increasing risks of side effects like serotonin syndrome, QT prolongation,
or excessive activation. Sertraline and escitalopram are less affected by CYP2D6 status,
and mirtazapine is metabolized by multiple pathways.
, Q5: A pregnant patient at 12 weeks gestation needs treatment for a bacterial infection.
Which medication carries an FDA pregnancy category D risk and should be avoided if
alternatives exist?
A. Amoxicillin
B. Azithromycin
C. Lisinopril
D. Metformin
Correct Answer: C
Rationale: For the NR 566 final exam (Version A), remember that ACE inhibitors like
lisinopril are pregnancy category D (and essentially contraindicated, especially in the
second and third trimesters) due to fetal renal agenesis, oligohydramnios, and skull
hypoplasia. A common trap is thinking all antihypertensives are equally dangerous in
pregnancy—know that labetalol, nifedipine, and methyldopa are preferred, while ACE
inhibitors and ARBs are avoided.
Q6: A 68-year-old patient with cirrhosis is prescribed lorazepam 1 mg at bedtime for
anxiety. Why is this preferred over diazepam in hepatic impairment?
A. Lorazepam is metabolized via glucuronidation rather than oxidation in the liver
B. Lorazepam does not cross the blood-brain barrier
C. Diazepam is renally cleared and accumulates in liver disease
D. Lorazepam has no active metabolites but is primarily oxidized by CYP3A4
Correct Answer: A
