NRNP 6568 / NURS 6568 EXAM Actual Exam 2026/2027
– Complete Questions and Answers with Detailed
Rationales – Pass Guaranteed - A+ Graded
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SECTION 1: ADVANCED PHARMACOLOGY FOR NURSE PRACTITIONERS Q1 – Q10
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Question 1 of 50
A 62-year-old patient with type 2 diabetes mellitus and chronic kidney disease stage 3b
presents for a medication review. The patient is currently taking metformin 1000 mg
twice daily, lisinopril 20 mg daily, and atorvastatin 40 mg daily. The most recent eGFR is
38 mL/min/1.73 m². The nurse practitioner should:
A. Continue metformin at the current dose because it is renally cleared and well
tolerated
B. Discontinue metformin and consider an alternative agent such as a DPP-4 inhibitor or
SGLT2 inhibitor
C. Reduce the metformin dose to 500 mg twice daily and monitor renal function monthly
D. Add insulin therapy immediately because oral agents are contraindicated in CKD
stage 3b
Correct Answer: B
Rationale: Metformin is contraindicated when eGFR falls below 30 mL/min/1.73 m² and
should be used with caution when eGFR is between 30 and 45, so discontinuation and
switching to an alternative such as a DPP-4 inhibitor or SGLT2 inhibitor is the safest
approach. Continuing at full dose or reducing the dose still exposes the patient to lactic
,acidosis risk as renal function declines. Insulin is not immediately necessary when
other oral options remain viable.
Question 2 of 50
A 45-year-old patient with major depressive disorder has been taking sertraline 100 mg
daily for 8 weeks with partial response. The patient reports improved sleep and appetite
but persistent anhedonia and low energy. The nurse practitioner should:
A. Increase sertraline to 150 mg daily and reassess in 4 weeks
B. Augment with bupropion XL 150 mg daily to address residual symptoms
C. Discontinue sertraline and switch to venlafaxine XR 75 mg daily
D. Add a benzodiazepine for short-term mood stabilization
Correct Answer: B
Rationale: Augmentation with bupropion is an evidence-based strategy for partial
response to SSRIs, particularly when residual symptoms include low energy and
anhedonia, because bupropion enhances dopaminergic and noradrenergic activity.
Increasing sertraline may help but does not target the specific neurotransmitter deficits
underlying these residual symptoms. Switching to venlafaxine is reasonable but more
disruptive than augmentation, and benzodiazepines do not treat depression.
Question 3 of 50
A 58-year-old patient with atrial fibrillation and a CHA2DS2-VASc score of 4 is started on
apixaban 5 mg twice daily. The patient also takes omeprazole 20 mg daily for
gastroesophageal reflux disease. The nurse practitioner should:
A. Reduce apixaban to 2.5 mg twice daily because omeprazole increases apixaban
levels
B. Continue both medications at current doses because omeprazole does not
significantly interact with apixaban
C. Switch the patient to warfarin because proton pump inhibitors interfere with all direct
oral anticoagulants
,D. Discontinue omeprazole and substitute ranitidine to avoid the interaction
Correct Answer: B
Rationale: Omeprazole is metabolized by CYP2C19 and does not significantly affect
apixaban, which is metabolized primarily by CYP3A4, so no dose adjustment is needed.
Reducing apixaban would under-anticoagulate the patient, and warfarin is not required
solely because of omeprazole use. Ranitidine has been withdrawn from the market due
to safety concerns and is not a suitable substitute.
Question 4 of 50
A 35-year-old patient with generalized anxiety disorder has been taking buspirone 10 mg
twice daily for 3 weeks with minimal improvement. The patient asks if the dose can be
increased. The nurse practitioner should:
A. Increase the dose to 15 mg twice daily because buspirone has a linear
dose-response relationship
B. Explain that buspirone requires 4 to 6 weeks for full therapeutic effect and maintain
the current dose
C. Discontinue buspirone and switch to a benzodiazepine for faster symptom relief
D. Add hydroxyzine 25 mg three times daily as an adjunct for immediate anxiety control
Correct Answer: B
Rationale: Buspirone requires 4 to 6 weeks to achieve full therapeutic effect, so
maintaining the current dose and reassessing later is appropriate before making
changes. Increasing the dose prematurely may cause side effects without additional
benefit, and benzodiazepines carry dependence and sedation risks that make them
second-line for chronic anxiety. Hydroxyzine is sedating and not a standard adjunct for
GAD.
Question 5 of 50
, A 70-year-old patient with heart failure with reduced ejection fraction is taking lisinopril
20 mg daily, carvedilol 25 mg twice daily, and furosemide 40 mg daily. The potassium is
5.2 mEq/L and creatinine is 1.8 mg/dL. The nurse practitioner should:
A. Discontinue lisinopril because hyperkalemia and elevated creatinine indicate ACE
inhibitor toxicity
B. Reduce lisinopril to 10 mg daily, restrict dietary potassium, and recheck labs in 1
week
C. Add spironolactone 25 mg daily because the patient meets criteria for
mineralocorticoid receptor antagonist therapy
D. Increase furosemide to 80 mg daily to promote potassium wasting through the
kidneys
Correct Answer: B
Rationale: Mild hyperkalemia and creatinine elevation in a patient on ACE inhibitor
therapy often respond to dose reduction, dietary potassium restriction, and close
monitoring rather than complete discontinuation. Abruptly stopping lisinopril could
worsen heart failure, and adding spironolactone would further increase potassium.
Increasing furosemide is not indicated unless there is volume overload, and aggressive
diuresis can worsen renal function.
Question 6 of 50
A 28-year-old patient with bipolar I disorder in a euthymic phase has been taking lithium
900 mg daily with a level of 0.8 mEq/L. The patient plans to become pregnant and asks
about medication safety. The nurse practitioner should:
A. Discontinue lithium immediately because it is absolutely contraindicated in
pregnancy
B. Continue lithium through conception and the first trimester because the risk of
relapse outweighs teratogenic risk
C. Taper lithium gradually, coordinate with obstetrics, and discuss the risk of Ebstein
anomaly in the first trimester
D. Switch to valproic acid because it has a safer pregnancy profile than lithium
– Complete Questions and Answers with Detailed
Rationales – Pass Guaranteed - A+ Graded
══════════════════════════════════════
SECTION 1: ADVANCED PHARMACOLOGY FOR NURSE PRACTITIONERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 62-year-old patient with type 2 diabetes mellitus and chronic kidney disease stage 3b
presents for a medication review. The patient is currently taking metformin 1000 mg
twice daily, lisinopril 20 mg daily, and atorvastatin 40 mg daily. The most recent eGFR is
38 mL/min/1.73 m². The nurse practitioner should:
A. Continue metformin at the current dose because it is renally cleared and well
tolerated
B. Discontinue metformin and consider an alternative agent such as a DPP-4 inhibitor or
SGLT2 inhibitor
C. Reduce the metformin dose to 500 mg twice daily and monitor renal function monthly
D. Add insulin therapy immediately because oral agents are contraindicated in CKD
stage 3b
Correct Answer: B
Rationale: Metformin is contraindicated when eGFR falls below 30 mL/min/1.73 m² and
should be used with caution when eGFR is between 30 and 45, so discontinuation and
switching to an alternative such as a DPP-4 inhibitor or SGLT2 inhibitor is the safest
approach. Continuing at full dose or reducing the dose still exposes the patient to lactic
,acidosis risk as renal function declines. Insulin is not immediately necessary when
other oral options remain viable.
Question 2 of 50
A 45-year-old patient with major depressive disorder has been taking sertraline 100 mg
daily for 8 weeks with partial response. The patient reports improved sleep and appetite
but persistent anhedonia and low energy. The nurse practitioner should:
A. Increase sertraline to 150 mg daily and reassess in 4 weeks
B. Augment with bupropion XL 150 mg daily to address residual symptoms
C. Discontinue sertraline and switch to venlafaxine XR 75 mg daily
D. Add a benzodiazepine for short-term mood stabilization
Correct Answer: B
Rationale: Augmentation with bupropion is an evidence-based strategy for partial
response to SSRIs, particularly when residual symptoms include low energy and
anhedonia, because bupropion enhances dopaminergic and noradrenergic activity.
Increasing sertraline may help but does not target the specific neurotransmitter deficits
underlying these residual symptoms. Switching to venlafaxine is reasonable but more
disruptive than augmentation, and benzodiazepines do not treat depression.
Question 3 of 50
A 58-year-old patient with atrial fibrillation and a CHA2DS2-VASc score of 4 is started on
apixaban 5 mg twice daily. The patient also takes omeprazole 20 mg daily for
gastroesophageal reflux disease. The nurse practitioner should:
A. Reduce apixaban to 2.5 mg twice daily because omeprazole increases apixaban
levels
B. Continue both medications at current doses because omeprazole does not
significantly interact with apixaban
C. Switch the patient to warfarin because proton pump inhibitors interfere with all direct
oral anticoagulants
,D. Discontinue omeprazole and substitute ranitidine to avoid the interaction
Correct Answer: B
Rationale: Omeprazole is metabolized by CYP2C19 and does not significantly affect
apixaban, which is metabolized primarily by CYP3A4, so no dose adjustment is needed.
Reducing apixaban would under-anticoagulate the patient, and warfarin is not required
solely because of omeprazole use. Ranitidine has been withdrawn from the market due
to safety concerns and is not a suitable substitute.
Question 4 of 50
A 35-year-old patient with generalized anxiety disorder has been taking buspirone 10 mg
twice daily for 3 weeks with minimal improvement. The patient asks if the dose can be
increased. The nurse practitioner should:
A. Increase the dose to 15 mg twice daily because buspirone has a linear
dose-response relationship
B. Explain that buspirone requires 4 to 6 weeks for full therapeutic effect and maintain
the current dose
C. Discontinue buspirone and switch to a benzodiazepine for faster symptom relief
D. Add hydroxyzine 25 mg three times daily as an adjunct for immediate anxiety control
Correct Answer: B
Rationale: Buspirone requires 4 to 6 weeks to achieve full therapeutic effect, so
maintaining the current dose and reassessing later is appropriate before making
changes. Increasing the dose prematurely may cause side effects without additional
benefit, and benzodiazepines carry dependence and sedation risks that make them
second-line for chronic anxiety. Hydroxyzine is sedating and not a standard adjunct for
GAD.
Question 5 of 50
, A 70-year-old patient with heart failure with reduced ejection fraction is taking lisinopril
20 mg daily, carvedilol 25 mg twice daily, and furosemide 40 mg daily. The potassium is
5.2 mEq/L and creatinine is 1.8 mg/dL. The nurse practitioner should:
A. Discontinue lisinopril because hyperkalemia and elevated creatinine indicate ACE
inhibitor toxicity
B. Reduce lisinopril to 10 mg daily, restrict dietary potassium, and recheck labs in 1
week
C. Add spironolactone 25 mg daily because the patient meets criteria for
mineralocorticoid receptor antagonist therapy
D. Increase furosemide to 80 mg daily to promote potassium wasting through the
kidneys
Correct Answer: B
Rationale: Mild hyperkalemia and creatinine elevation in a patient on ACE inhibitor
therapy often respond to dose reduction, dietary potassium restriction, and close
monitoring rather than complete discontinuation. Abruptly stopping lisinopril could
worsen heart failure, and adding spironolactone would further increase potassium.
Increasing furosemide is not indicated unless there is volume overload, and aggressive
diuresis can worsen renal function.
Question 6 of 50
A 28-year-old patient with bipolar I disorder in a euthymic phase has been taking lithium
900 mg daily with a level of 0.8 mEq/L. The patient plans to become pregnant and asks
about medication safety. The nurse practitioner should:
A. Discontinue lithium immediately because it is absolutely contraindicated in
pregnancy
B. Continue lithium through conception and the first trimester because the risk of
relapse outweighs teratogenic risk
C. Taper lithium gradually, coordinate with obstetrics, and discuss the risk of Ebstein
anomaly in the first trimester
D. Switch to valproic acid because it has a safer pregnancy profile than lithium
