NR 566 ADVANCED PHARMACOLOGY FOR CARE OF THE FAMILY
NR 566 Advanced Pharmacology for Care of the Family – Midterm
Exam Study Guide Complete Question Bank (Questions 1–220)
with Verified Answers and Detailed Rationales Chamberlain
University – 2025/2026 Update
Question 1: A patient with chronic kidney disease (eGFR 25 mL/min) is prescribed a medication that is
80% renally excreted. What adjustment is most appropriate?
A. Increase the dose by 50%
B. Decrease the dose or extend the dosing interval
C. No adjustment is needed
D. Administer the medication intravenously instead of orally
☑ Correct Answer: B. Decrease the dose or extend the dosing interval
Rationale: For medications primarily eliminated by the kidneys, dose reduction or extended dosing
intervals are necessary in patients with reduced eGFR to prevent drug accumulation and toxicity. The
degree of adjustment depends on the eGFR and drug characteristics .
Question 2: A patient is prescribed a drug that is a CYP3A4 inhibitor. Which medication would the
nurse expect to have increased levels when co-administered?
A. Simvastatin (Zocor)
B. Acetaminophen (Tylenol)
C. Metformin (Glucophage)
D. Lisinopril (Prinivil)
☑ Correct Answer: A. Simvastatin (Zocor)
Rationale: Simvastatin is a substrate of CYP3A4. When co-administered with a CYP3A4 inhibitor,
simvastatin levels increase, raising the risk of myopathy and rhabdomyolysis .
, NR 566 ADVANCED PHARMACOLOGY FOR CARE OF THE FAMILY
Question 3: What BMI range classifies a patient as overweight?
☑ Correct Answer: 25–29.9
Rationale: Per CDC and WHO guidelines, overweight is defined as a BMI between 25 and 29.9 kg/m².
Obesity is BMI ≥30 .
Question 4: What is the DEA schedule for Phentermine?
☑ Correct Answer: Schedule IV
Rationale: Phentermine, Diethylpropion, and Lorcaserin are Schedule IV controlled substances due to
their potential for abuse and dependence .
Question 5: A patient with type 2 diabetes and heart failure would benefit most from which
antihyperglycemic class?
☑ Correct Answer: SGLT2 inhibitors (empagliflozin, dapagliflozin) or GLP-1 receptor agonists
Rationale: Both SGLT2 inhibitors and GLP-1 receptor agonists have demonstrated cardiovascular
benefits, including reduced heart failure hospitalizations, in patients with type 2 diabetes and
established cardiovascular disease .
Question 6: What lab should be checked prior to starting metformin?
☑ Correct Answer: eGFR (renal function)
Rationale: Metformin is contraindicated in patients with eGFR <30 mL/min and requires dose
adjustment for eGFR 30-45 mL/min due to the risk of lactic acidosis. Annual monitoring of renal function
is recommended .
Question 7: Contraindications for cephalosporins include:
, NR 566 ADVANCED PHARMACOLOGY FOR CARE OF THE FAMILY
☑ Correct Answer: History of allergic reactions to cephalosporins or severe reaction to penicillin
Rationale: Cross-reactivity between penicillins and cephalosporins occurs in approximately 1-3% of
patients with confirmed penicillin allergy. Caution is warranted, especially with first-generation
cephalosporins .
Question 8: What adverse effect should be monitored with sulfonamides?
☑ Correct Answer: CBC, CD4 count (if HIV positive), and signs of blood dyscrasias
Rationale: Sulfonamides can cause hematologic reactions including leukopenia, thrombocytopenia, and
agranulocytosis. Monitoring is especially important in immunocompromised patients .
Question 9: Why are statins recommended to be taken in the evening?
☑ Correct Answer: Cholesterol synthesis is highest during the night and early morning
Rationale: The biosynthesis of cholesterol follows a normal circadian rhythm, with peak synthesis
occurring overnight. Evening administration allows medication levels to be highest during this peak
synthetic period .
Question 10: What is one thing to watch for with cephalosporin use?
☑ Correct Answer: Clostridioides difficile infection
Rationale: Cephalosporins, particularly broad-spectrum agents, are associated with an increased risk of
C. diff infection due to disruption of normal gut flora .
SECTION 1: CARDIOVASCULAR PHARMACOLOGY (Questions 11-40)
Question 11: Which calcium channel blocker is associated with the greatest risk of peripheral edema?
A) Diltiazem
B) Verapamil
, NR 566 ADVANCED PHARMACOLOGY FOR CARE OF THE FAMILY
C) Amlodipine
D) Clevidipine
☑ Correct Answer: C) Amlodipine
Rationale: Amlodipine is a dihydropyridine calcium channel blocker that causes significant vasodilation,
leading to a higher incidence of peripheral edema compared to non-dihydropyridines (diltiazem,
verapamil). The edema is usually dose-dependent, benign, and may improve with concurrent ACE
inhibitor therapy but often does not respond to diuretics .
Question 12: Which statin is least likely to interact with other CYP450-metabolized drugs?
☑ Correct Answer: Pravastatin
Rationale: Pravastatin is not significantly metabolized by CYP450 enzymes and is therefore less likely to
interact with CYP3A4 inhibitors or inducers. This makes it a safer choice for patients taking multiple
medications. Rosuvastatin also has minimal CYP metabolism .
Question 13: A patient taking warfarin asks about dietary restrictions. What should the NP teach
regarding vitamin K intake?
☑ Correct Answer: Maintain consistent intake of vitamin K-containing foods; avoid sudden large
changes
Rationale: Vitamin K is an antagonist to warfarin's anticoagulant effect. Patients should maintain
consistent intake of vitamin K-containing foods (green leafy vegetables) to avoid INR fluctuations.
Sudden changes in intake (large increases decrease INR, large decreases increase INR) can lead to
clotting or bleeding. The goal is consistency, not elimination .
Question 14: A patient with hypertension is started on lisinopril and develops a dry, persistent cough.
What is the most appropriate next step?
A) Continue lisinopril and add a cough suppressant
B) Switch to an ARB (losartan)
NR 566 Advanced Pharmacology for Care of the Family – Midterm
Exam Study Guide Complete Question Bank (Questions 1–220)
with Verified Answers and Detailed Rationales Chamberlain
University – 2025/2026 Update
Question 1: A patient with chronic kidney disease (eGFR 25 mL/min) is prescribed a medication that is
80% renally excreted. What adjustment is most appropriate?
A. Increase the dose by 50%
B. Decrease the dose or extend the dosing interval
C. No adjustment is needed
D. Administer the medication intravenously instead of orally
☑ Correct Answer: B. Decrease the dose or extend the dosing interval
Rationale: For medications primarily eliminated by the kidneys, dose reduction or extended dosing
intervals are necessary in patients with reduced eGFR to prevent drug accumulation and toxicity. The
degree of adjustment depends on the eGFR and drug characteristics .
Question 2: A patient is prescribed a drug that is a CYP3A4 inhibitor. Which medication would the
nurse expect to have increased levels when co-administered?
A. Simvastatin (Zocor)
B. Acetaminophen (Tylenol)
C. Metformin (Glucophage)
D. Lisinopril (Prinivil)
☑ Correct Answer: A. Simvastatin (Zocor)
Rationale: Simvastatin is a substrate of CYP3A4. When co-administered with a CYP3A4 inhibitor,
simvastatin levels increase, raising the risk of myopathy and rhabdomyolysis .
, NR 566 ADVANCED PHARMACOLOGY FOR CARE OF THE FAMILY
Question 3: What BMI range classifies a patient as overweight?
☑ Correct Answer: 25–29.9
Rationale: Per CDC and WHO guidelines, overweight is defined as a BMI between 25 and 29.9 kg/m².
Obesity is BMI ≥30 .
Question 4: What is the DEA schedule for Phentermine?
☑ Correct Answer: Schedule IV
Rationale: Phentermine, Diethylpropion, and Lorcaserin are Schedule IV controlled substances due to
their potential for abuse and dependence .
Question 5: A patient with type 2 diabetes and heart failure would benefit most from which
antihyperglycemic class?
☑ Correct Answer: SGLT2 inhibitors (empagliflozin, dapagliflozin) or GLP-1 receptor agonists
Rationale: Both SGLT2 inhibitors and GLP-1 receptor agonists have demonstrated cardiovascular
benefits, including reduced heart failure hospitalizations, in patients with type 2 diabetes and
established cardiovascular disease .
Question 6: What lab should be checked prior to starting metformin?
☑ Correct Answer: eGFR (renal function)
Rationale: Metformin is contraindicated in patients with eGFR <30 mL/min and requires dose
adjustment for eGFR 30-45 mL/min due to the risk of lactic acidosis. Annual monitoring of renal function
is recommended .
Question 7: Contraindications for cephalosporins include:
, NR 566 ADVANCED PHARMACOLOGY FOR CARE OF THE FAMILY
☑ Correct Answer: History of allergic reactions to cephalosporins or severe reaction to penicillin
Rationale: Cross-reactivity between penicillins and cephalosporins occurs in approximately 1-3% of
patients with confirmed penicillin allergy. Caution is warranted, especially with first-generation
cephalosporins .
Question 8: What adverse effect should be monitored with sulfonamides?
☑ Correct Answer: CBC, CD4 count (if HIV positive), and signs of blood dyscrasias
Rationale: Sulfonamides can cause hematologic reactions including leukopenia, thrombocytopenia, and
agranulocytosis. Monitoring is especially important in immunocompromised patients .
Question 9: Why are statins recommended to be taken in the evening?
☑ Correct Answer: Cholesterol synthesis is highest during the night and early morning
Rationale: The biosynthesis of cholesterol follows a normal circadian rhythm, with peak synthesis
occurring overnight. Evening administration allows medication levels to be highest during this peak
synthetic period .
Question 10: What is one thing to watch for with cephalosporin use?
☑ Correct Answer: Clostridioides difficile infection
Rationale: Cephalosporins, particularly broad-spectrum agents, are associated with an increased risk of
C. diff infection due to disruption of normal gut flora .
SECTION 1: CARDIOVASCULAR PHARMACOLOGY (Questions 11-40)
Question 11: Which calcium channel blocker is associated with the greatest risk of peripheral edema?
A) Diltiazem
B) Verapamil
, NR 566 ADVANCED PHARMACOLOGY FOR CARE OF THE FAMILY
C) Amlodipine
D) Clevidipine
☑ Correct Answer: C) Amlodipine
Rationale: Amlodipine is a dihydropyridine calcium channel blocker that causes significant vasodilation,
leading to a higher incidence of peripheral edema compared to non-dihydropyridines (diltiazem,
verapamil). The edema is usually dose-dependent, benign, and may improve with concurrent ACE
inhibitor therapy but often does not respond to diuretics .
Question 12: Which statin is least likely to interact with other CYP450-metabolized drugs?
☑ Correct Answer: Pravastatin
Rationale: Pravastatin is not significantly metabolized by CYP450 enzymes and is therefore less likely to
interact with CYP3A4 inhibitors or inducers. This makes it a safer choice for patients taking multiple
medications. Rosuvastatin also has minimal CYP metabolism .
Question 13: A patient taking warfarin asks about dietary restrictions. What should the NP teach
regarding vitamin K intake?
☑ Correct Answer: Maintain consistent intake of vitamin K-containing foods; avoid sudden large
changes
Rationale: Vitamin K is an antagonist to warfarin's anticoagulant effect. Patients should maintain
consistent intake of vitamin K-containing foods (green leafy vegetables) to avoid INR fluctuations.
Sudden changes in intake (large increases decrease INR, large decreases increase INR) can lead to
clotting or bleeding. The goal is consistency, not elimination .
Question 14: A patient with hypertension is started on lisinopril and develops a dry, persistent cough.
What is the most appropriate next step?
A) Continue lisinopril and add a cough suppressant
B) Switch to an ARB (losartan)
