NR566 | NR566 Advanced Pharmacology for Care
of the Family Exam 2 Version 3 | Questions with
Correct Answers and Expert Explanation for Each
Question | Chamberlain
1. A 45-year-old patient with Type 2 Diabetes has an eGFR of 28 mL/min/1.73 m2.
Which of the following is the most appropriate action regarding their Metformin
therapy?
A. Decrease the dose by 50%
B. Continue the current dose and monitor closely
C. Switch to a Sulfonylurea
D. Discontinue Metformin immediately
Correct Answer: D
Expert Explanation: Metformin is contraindicated in patients with an eGFR less
than 30 mL/min/1.73 m2 due to the increased risk of lactic acidosis. Lactic acidosis
is a rare but serious metabolic complication that can occur when the drug
accumulates. The provider must assess renal function at least annually and before
initiating therapy.
,2. When prescribing Levothyroxine for a 70-year-old patient with newly diagnosed
hypothyroidism and a history of coronary artery disease, what is the recommended
starting dose?
A. 12.5 to 25 mcg/day
B. 1.6 mcg/kg/day
C. 50 to 75 mcg/day
D. 100 mcg/day
Correct Answer: A
Expert Explanation: In elderly patients or those with underlying cardiovascular
disease, the motto is to ‘start low and go slow.’ A starting dose of 12.5 to 25 mcg/day
helps prevent exacerbation of cardiac conditions like angina or arrhythmias. Doses
are typically titrated every 6 to 8 weeks based on TSH levels.
3. A patient using an Inhaled Corticosteroid (ICS) for asthma reports white patches on
the tongue and throat. What should the nurse practitioner advise?
A. Discontinue the inhaler immediately
B. Rinse the mouth with water and spit after each use
C. Increase the dose to treat the inflammation
D. Switch to a Long-Acting Beta Agonist (LABA) monotherapy
,Correct Answer: B
Expert Explanation: Oropharyngeal candidiasis, or thrush, is a common side effect
of inhaled corticosteroids when the medication deposits in the mouth. Patients
should be taught to use a spacer and rinse their mouth after administration to
minimize local deposition. This complication is manageable and does not usually
require cessation of the life-saving asthma medication.
4. Which of the following is a Black Box Warning associated with the use of Long-
Acting Beta Agonists (LABA) as monotherapy in asthma patients?
A. Increased risk of asthma-related death
B. Acute renal failure
C. Hepatotoxicity
D. Steven-Johnson Syndrome
Correct Answer: A
Expert Explanation: LABAs must never be used alone for the treatment of asthma
because they do not address underlying inflammation and have been linked to an
increased risk of asthma-related death. They should always be used in combination
with an inhaled corticosteroid. In contrast, LABAs can be used as monotherapy in
patients with COPD.
, 5. Which medication is the first-line treatment for a patient with Type 2 Diabetes and
established Atherosclerotic Cardiovascular Disease (ASCVD)?
A. Glyburide
B. Pioglitazone
C. GLP-1 Receptor Agonist with proven benefit
D. Sitagliptin
Correct Answer: C
Expert Explanation: Current ADA guidelines recommend GLP-1 receptor agonists
or SGLT2 inhibitors with proven cardiovascular benefit for patients with ASCVD.
These medications have shown a reduction in major adverse cardiovascular events
(MACE). They are often prioritized regardless of the current A1C or metformin use
in this specific population.
6. A patient is prescribed Alendronate for osteoporosis. Which instruction is vital for
preventing esophageal irritation?
A. Take the medication with a full glass of juice
B. Lie down for 30 minutes after taking the pill
C. Remain upright for at least 30 minutes after taking the medication
D. Take the medication at bedtime
of the Family Exam 2 Version 3 | Questions with
Correct Answers and Expert Explanation for Each
Question | Chamberlain
1. A 45-year-old patient with Type 2 Diabetes has an eGFR of 28 mL/min/1.73 m2.
Which of the following is the most appropriate action regarding their Metformin
therapy?
A. Decrease the dose by 50%
B. Continue the current dose and monitor closely
C. Switch to a Sulfonylurea
D. Discontinue Metformin immediately
Correct Answer: D
Expert Explanation: Metformin is contraindicated in patients with an eGFR less
than 30 mL/min/1.73 m2 due to the increased risk of lactic acidosis. Lactic acidosis
is a rare but serious metabolic complication that can occur when the drug
accumulates. The provider must assess renal function at least annually and before
initiating therapy.
,2. When prescribing Levothyroxine for a 70-year-old patient with newly diagnosed
hypothyroidism and a history of coronary artery disease, what is the recommended
starting dose?
A. 12.5 to 25 mcg/day
B. 1.6 mcg/kg/day
C. 50 to 75 mcg/day
D. 100 mcg/day
Correct Answer: A
Expert Explanation: In elderly patients or those with underlying cardiovascular
disease, the motto is to ‘start low and go slow.’ A starting dose of 12.5 to 25 mcg/day
helps prevent exacerbation of cardiac conditions like angina or arrhythmias. Doses
are typically titrated every 6 to 8 weeks based on TSH levels.
3. A patient using an Inhaled Corticosteroid (ICS) for asthma reports white patches on
the tongue and throat. What should the nurse practitioner advise?
A. Discontinue the inhaler immediately
B. Rinse the mouth with water and spit after each use
C. Increase the dose to treat the inflammation
D. Switch to a Long-Acting Beta Agonist (LABA) monotherapy
,Correct Answer: B
Expert Explanation: Oropharyngeal candidiasis, or thrush, is a common side effect
of inhaled corticosteroids when the medication deposits in the mouth. Patients
should be taught to use a spacer and rinse their mouth after administration to
minimize local deposition. This complication is manageable and does not usually
require cessation of the life-saving asthma medication.
4. Which of the following is a Black Box Warning associated with the use of Long-
Acting Beta Agonists (LABA) as monotherapy in asthma patients?
A. Increased risk of asthma-related death
B. Acute renal failure
C. Hepatotoxicity
D. Steven-Johnson Syndrome
Correct Answer: A
Expert Explanation: LABAs must never be used alone for the treatment of asthma
because they do not address underlying inflammation and have been linked to an
increased risk of asthma-related death. They should always be used in combination
with an inhaled corticosteroid. In contrast, LABAs can be used as monotherapy in
patients with COPD.
, 5. Which medication is the first-line treatment for a patient with Type 2 Diabetes and
established Atherosclerotic Cardiovascular Disease (ASCVD)?
A. Glyburide
B. Pioglitazone
C. GLP-1 Receptor Agonist with proven benefit
D. Sitagliptin
Correct Answer: C
Expert Explanation: Current ADA guidelines recommend GLP-1 receptor agonists
or SGLT2 inhibitors with proven cardiovascular benefit for patients with ASCVD.
These medications have shown a reduction in major adverse cardiovascular events
(MACE). They are often prioritized regardless of the current A1C or metformin use
in this specific population.
6. A patient is prescribed Alendronate for osteoporosis. Which instruction is vital for
preventing esophageal irritation?
A. Take the medication with a full glass of juice
B. Lie down for 30 minutes after taking the pill
C. Remain upright for at least 30 minutes after taking the medication
D. Take the medication at bedtime
