NR566 | NR566 Advanced Pharmacology for Care
of the Family Wk 6 Midterm v3 | Questions with
Correct Answers and Expert Explanation for Each
Question | Chamberlain
1. When prescribing a medication that undergoes significant first-pass metabolism,
which route of administration should the NP prioritize to ensure bioavailability?
A. Oral administration
B. Sublingual administration
C. Intravenous administration
D. Rectal administration
Correct Answer: C
Expert Explanation: Intravenous administration bypasses the first-pass
metabolism entirely by delivering the drug directly into the systemic circulation.
This ensures that 100% of the drug is bioavailable for the patient compared to oral
routes where the liver may deactivate a portion. The NP must consider this when
transitioning a patient from IV to oral medications to maintain therapeutic levels.
2. An NP is reviewing a patient’s medication list and notes the patient is taking a
CYP450 enzyme inhibitor. What is the most likely consequence if a prodrug is added?
A. Decreased therapeutic effect of the prodrug
,B. Increased therapeutic effect of the prodrug
C. Increased risk of drug-drug toxicity
D. Rapid excretion of the prodrug
Correct Answer: A
Expert Explanation: Prodrugs require enzymatic conversion by the liver, often via
CYP450 enzymes, to become pharmacologically active. If an inhibitor is present, the
conversion process is slowed, leading to lower levels of the active drug in the
bloodstream. Consequently, the patient will experience a decreased therapeutic
effect or even failure of treatment.
3. A 55-year-old patient with hypertension and a history of asthma requires a new
antihypertensive. Which of the following should the NP avoid?
A. Lisinopril
B. Propranolol
C. Amlodipine
D. Hydrochlorothiazide
Correct Answer: B
Expert Explanation: Propranolol is a non-selective beta-blocker that antagonizes
both Beta-1 and Beta-2 receptors. Blocking Beta-2 receptors in the lungs can lead to
,bronchoconstriction, which is dangerous for patients with asthma or COPD.
Selective beta-blockers like metoprolol are preferred if a beta-blocker is strictly
necessary for this population.
4. Which laboratory value is most critical for the NP to monitor in a patient newly
started on Lisinopril for hypertension?
A. Liver enzymes (ALT/AST)
B. Blood glucose
C. Platelet count
D. Serum Potassium
Correct Answer: D
Expert Explanation: ACE inhibitors like Lisinopril decrease the secretion of
aldosterone, which can lead to the retention of potassium. Hyperkalemia is a
common and potentially life-threatening side effect that requires routine
monitoring of electrolytes. The NP should also advise the patient to avoid
potassium-rich salt substitutes while on this medication.
5. A patient complains of a persistent, dry, non-productive cough after starting an ACE
inhibitor. What is the physiological mechanism behind this side effect?
A. Increase in pulmonary capillary pressure
B. Accumulation of bradykinin in the respiratory tract
, C. Direct irritation of the bronchial mucosa
D. Release of histamine from mast cells
Correct Answer: B
Expert Explanation: ACE inhibitors block the breakdown of bradykinin, leading to
its accumulation in the lungs. This substance sensitizes sensory neurons, resulting
in the characteristic dry cough often seen in up to 20% of patients. Switching the
patient to an ARB is typically the next step as ARBs do not affect bradykinin levels.
6. A patient with heart failure is prescribed Digoxin. The NP understands that which
electrolyte imbalance significantly increases the risk of Digoxin toxicity?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hyponatremia
Correct Answer: B
Expert Explanation: Digoxin competes with potassium for binding sites on the
Sodium-Potassium ATPase pump. When potassium levels are low (hypokalemia),
more Digoxin can bind, leading to increased drug effects and toxicity. NP’s must
of the Family Wk 6 Midterm v3 | Questions with
Correct Answers and Expert Explanation for Each
Question | Chamberlain
1. When prescribing a medication that undergoes significant first-pass metabolism,
which route of administration should the NP prioritize to ensure bioavailability?
A. Oral administration
B. Sublingual administration
C. Intravenous administration
D. Rectal administration
Correct Answer: C
Expert Explanation: Intravenous administration bypasses the first-pass
metabolism entirely by delivering the drug directly into the systemic circulation.
This ensures that 100% of the drug is bioavailable for the patient compared to oral
routes where the liver may deactivate a portion. The NP must consider this when
transitioning a patient from IV to oral medications to maintain therapeutic levels.
2. An NP is reviewing a patient’s medication list and notes the patient is taking a
CYP450 enzyme inhibitor. What is the most likely consequence if a prodrug is added?
A. Decreased therapeutic effect of the prodrug
,B. Increased therapeutic effect of the prodrug
C. Increased risk of drug-drug toxicity
D. Rapid excretion of the prodrug
Correct Answer: A
Expert Explanation: Prodrugs require enzymatic conversion by the liver, often via
CYP450 enzymes, to become pharmacologically active. If an inhibitor is present, the
conversion process is slowed, leading to lower levels of the active drug in the
bloodstream. Consequently, the patient will experience a decreased therapeutic
effect or even failure of treatment.
3. A 55-year-old patient with hypertension and a history of asthma requires a new
antihypertensive. Which of the following should the NP avoid?
A. Lisinopril
B. Propranolol
C. Amlodipine
D. Hydrochlorothiazide
Correct Answer: B
Expert Explanation: Propranolol is a non-selective beta-blocker that antagonizes
both Beta-1 and Beta-2 receptors. Blocking Beta-2 receptors in the lungs can lead to
,bronchoconstriction, which is dangerous for patients with asthma or COPD.
Selective beta-blockers like metoprolol are preferred if a beta-blocker is strictly
necessary for this population.
4. Which laboratory value is most critical for the NP to monitor in a patient newly
started on Lisinopril for hypertension?
A. Liver enzymes (ALT/AST)
B. Blood glucose
C. Platelet count
D. Serum Potassium
Correct Answer: D
Expert Explanation: ACE inhibitors like Lisinopril decrease the secretion of
aldosterone, which can lead to the retention of potassium. Hyperkalemia is a
common and potentially life-threatening side effect that requires routine
monitoring of electrolytes. The NP should also advise the patient to avoid
potassium-rich salt substitutes while on this medication.
5. A patient complains of a persistent, dry, non-productive cough after starting an ACE
inhibitor. What is the physiological mechanism behind this side effect?
A. Increase in pulmonary capillary pressure
B. Accumulation of bradykinin in the respiratory tract
, C. Direct irritation of the bronchial mucosa
D. Release of histamine from mast cells
Correct Answer: B
Expert Explanation: ACE inhibitors block the breakdown of bradykinin, leading to
its accumulation in the lungs. This substance sensitizes sensory neurons, resulting
in the characteristic dry cough often seen in up to 20% of patients. Switching the
patient to an ARB is typically the next step as ARBs do not affect bradykinin levels.
6. A patient with heart failure is prescribed Digoxin. The NP understands that which
electrolyte imbalance significantly increases the risk of Digoxin toxicity?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hyponatremia
Correct Answer: B
Expert Explanation: Digoxin competes with potassium for binding sites on the
Sodium-Potassium ATPase pump. When potassium levels are low (hypokalemia),
more Digoxin can bind, leading to increased drug effects and toxicity. NP’s must
