NR 567 Advanced Pharmacology for the Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) Exam with Questions and Verified Solutions

It covers key domains which include: Polypharmacy & Medication Management, Regulatory, Legal & Ethical Considerations, Acute Care & Emergency Pharmacology, Evidence-Based Prescribing & Clinical Decision-Making and Adverse Drug Reactions & Interactions. Mrs. A is a 76 year old woman admitted from long term care with suspected urosepsis. She has a history of dementia, chronic kidney disease (baseline creatinine 2.0 mg/dL), and hypertension. Initial vitals show hypotension (BP 82/51 mmHg) and tachycardia (HR 122 bpm). After fluid resuscitation with 30 mL/kg NS, she remains hypotensive. Which vasopressor should be initiated first line to support her mean arterial pressure (MAP) in septic shock? a. Norepinephrine b. Vasopressin c. Dopamine d. Phenylephrine Correct Answer : a. Norepinephrine Rationale: Norepinephrine is the first line vasopressor in septic shock because it predominantly increases vascular tone (α 1 agonism) with minimal tachyarrhythmia risk, improving MAP and organ perfusion. Vasopressin can be added if needed but is not first line. Dopamine is not recommended routinely due to higher arrhythmia risk, especially in older adults with cardiac risk. Phenylephrine lacks the desired effect on cardiac output and is generally reserved for specific refractory cases. A 62 year old man with type 2 diabetes and sepsis from bacterial pneumonia has been started on broad spectrum antibiotics. His clinicians want to choose an agent that covers MRSA and Pseudomonas. Which of the following antibiotic regimens is most appropriate empiric therapy? a. Vancomycin + Piperacillin tazobactam b. Ceftriaxone monotherapy c. Doxycycline + Metronidazole d. Amoxicillin clavulanate + Azithromycin Correct Answer : b. Ceftriaxone monotherapy Rationale: While vancomycin plus piperacillin tazobactam covers MRSA and Pseudomonas, in many community acquired pneumonia sepsis scenarios without risk factors for resistant organisms, high dose ceftriaxone plus a macrolide or respiratory fluoroquinolone is recommended and offers broad coverage with less toxicity. Doxycycline/metronidazole and amoxicillin clavulanate/azithromycin do not provide reliable Pseudomonas or MRSA coverage. Empiric therapy must be tailored to suspected source and local antibiograms; broadest agents are not always appropriate first choice.