NR566 MIDTERM EXAM REVIEW 2026/2027 | Advanced
Pharmacology Care of the Family | Questions & Verified
Answers | Chamberlain University | Pass Guaranteed - A+
Graded
Section 1: Pharmacokinetics/Pharmacodynamics in Special Populations (Q1-12)
Q1. A 72-year-old client with heart failure is prescribed digoxin 0.25 mg daily. The nurse
practitioner reviews the Beers Criteria 2026. Which recommendation applies to this
prescription?
A. Digoxin 0.25 mg is the preferred dose in all elderly patients
B. Avoid digoxin doses >0.125 mg/day in elderly due to decreased renal clearance and
increased toxicity risk
C. Digoxin is safe at any dose if the patient has normal liver function
D. Elderly patients require higher digoxin doses due to increased metabolism
Correct Answer: B. Avoid digoxin doses >0.125 mg/day in elderly due to decreased renal
clearance and increased toxicity risk [CORRECT]
Rationale: The Beers Criteria recommend avoiding digoxin doses >0.125 mg/day in
older adults because age-related decline in renal clearance increases the risk of toxicity
(nausea, visual changes, bradycardia); therapeutic levels are 0.5-0.8 ng/mL. Higher
doses and hepatic function are irrelevant to digoxin dosing.
Q2. A 28-year-old pregnant client at 16 weeks gestation requires treatment for a urinary
tract infection. Which antibiotic is safest per current PLR labeling?
A. Ciprofloxacin
B. Nitrofurantoin
C. Doxycycline
D. Trimethoprim-sulfamethoxazole
Correct Answer: B. Nitrofurantoin [CORRECT]
,Rationale: Nitrofurantoin is generally considered safe in pregnancy (second and third
trimesters) for UTI treatment; fluoroquinolones (ciprofloxacin) cause cartilage damage,
doxycycline affects fetal bone and teeth, and trimethoprim is a folate antagonist
contraindicated in first trimester. PLR labeling replaced old pregnancy categories with
risk summaries.
Q3. A breastfeeding mother requires antibiotic therapy for mastitis. Which antibiotic has
an L1 (safest) lactation risk category and is appropriate for this client?
A. Ciprofloxacin
B. Dicloxacillin
C. Doxycycline
D. Metronidazole
Correct Answer: B. Dicloxacillin [CORRECT]
Rationale: Dicloxacillin and cephalexin are L1 (safest) for breastfeeding and first-line for
mastitis; ciprofloxacin is L3 (probably compatible), doxycycline is L2 but less preferred,
and metronidazole is L2-L3. L1 medications have been taken by large numbers of
breastfeeding mothers without observed increase in adverse effects.
Q4. A 4-year-old child weighing 18 kg requires amoxicillin for otitis media. The dose is
80 mg/kg/day divided BID. What is the correct dose per administration?
A. 360 mg
B. 720 mg
C. 1,440 mg
D. 1,800 mg
Correct Answer: B. 720 mg [CORRECT]
Rationale: Total daily dose = 80 mg/kg × 18 kg = 1,440 mg/day; divided BID = 1,440 ÷ 2 =
720 mg per dose. Errors include using total daily dose as a single dose (1,440 mg) or
miscalculating weight-based dosing.
Q5. An 82-year-old client is prescribed lorazepam 2 mg TID for anxiety. Per the Beers
Criteria 2026, which concern is most significant?
A. Lorazepam is the preferred benzodiazepine for all elderly patients
,B. Benzodiazepines increase fall risk, cognitive impairment, and dependence in older
adults and should be avoided
C. Lorazepam has no drug interactions in the elderly
D. The dose is too low for effective anxiety treatment in geriatric patients
Correct Answer: B. Benzodiazepines increase fall risk, cognitive impairment, and
dependence in older adults and should be avoided [CORRECT]
Rationale: The Beers Criteria classify benzodiazepines as potentially inappropriate in
older adults due to increased risk of falls, fractures, cognitive impairment, and
dependence; buspirone or SSRIs are preferred for chronic anxiety. Dose escalation is not
the solution.
Q6. A pediatric client requires a medication with hepatic metabolism. Which
developmental factor most affects drug clearance in a 6-month-old infant?
A. Hepatic enzyme systems are fully mature at birth
B. Hepatic enzyme systems (CYP450) are immature in infants, leading to decreased
metabolism and prolonged drug half-life
C. Infants have increased hepatic blood flow, increasing clearance
D. Hepatic metabolism is not relevant in pediatric dosing
Correct Answer: B. Hepatic enzyme systems (CYP450) are immature in infants, leading
to decreased metabolism and prolonged drug half-life [CORRECT]
Rationale: CYP450 enzyme systems are immature in infants (especially neonates),
resulting in decreased hepatic metabolism, prolonged half-lives, and increased toxicity
risk for hepatically cleared drugs. Enzyme maturation occurs over the first 1-2 years of
life.
Q7. A 78-year-old client is prescribed metformin for type 2 diabetes. Which age-related
pharmacokinetic change increases the risk of metformin accumulation and lactic
acidosis?
A. Increased hepatic metabolism
B. Decreased renal clearance (eGFR <30 mL/min contraindicates metformin)
C. Decreased volume of distribution
D. Increased gastric acid secretion
, Correct Answer: B. Decreased renal clearance (eGFR <30 mL/min contraindicates
metformin) [CORRECT]
Rationale: Metformin is renally excreted unchanged; age-related decline in GFR
increases accumulation risk and lactic acidosis. Metformin is contraindicated if eGFR
<30 mL/min and should be used with caution if 30-45 mL/min. Hepatic metabolism and
gastric acid are irrelevant.
Q8. A pregnant client at 8 weeks gestation requires treatment for hypertension. Which
antihypertensive is contraindicated due to fetal renal toxicity and oligohydramnios?
A. Labetalol
B. Nifedipine
C. Lisinopril
D. Methyldopa
Correct Answer: C. Lisinopril [CORRECT]
Rationale: ACE inhibitors (lisinopril) are contraindicated in pregnancy (especially second
and third trimesters) due to fetal renal tubular dysplasia, oligohydramnios, and skull
hypoplasia. Labetalol, nifedipine, and methyldopa are preferred agents for pregnancy
hypertension.
Q9. A nurse practitioner is prescribing for a breastfeeding mother with postpartum
depression. Which antidepressant is preferred due to low infant exposure and safety
data?
A. Fluoxetine
B. Sertraline
C. Bupropion
D. Venlafaxine
Correct Answer: B. Sertraline [CORRECT]
Rationale: Sertraline is the preferred SSRI in breastfeeding due to low relative infant
dose (RID <1%), minimal infant serum levels, and extensive safety data; fluoxetine has a
long half-life and higher infant exposure, bupropion has limited lactation data, and
venlafaxine has higher RID.
Pharmacology Care of the Family | Questions & Verified
Answers | Chamberlain University | Pass Guaranteed - A+
Graded
Section 1: Pharmacokinetics/Pharmacodynamics in Special Populations (Q1-12)
Q1. A 72-year-old client with heart failure is prescribed digoxin 0.25 mg daily. The nurse
practitioner reviews the Beers Criteria 2026. Which recommendation applies to this
prescription?
A. Digoxin 0.25 mg is the preferred dose in all elderly patients
B. Avoid digoxin doses >0.125 mg/day in elderly due to decreased renal clearance and
increased toxicity risk
C. Digoxin is safe at any dose if the patient has normal liver function
D. Elderly patients require higher digoxin doses due to increased metabolism
Correct Answer: B. Avoid digoxin doses >0.125 mg/day in elderly due to decreased renal
clearance and increased toxicity risk [CORRECT]
Rationale: The Beers Criteria recommend avoiding digoxin doses >0.125 mg/day in
older adults because age-related decline in renal clearance increases the risk of toxicity
(nausea, visual changes, bradycardia); therapeutic levels are 0.5-0.8 ng/mL. Higher
doses and hepatic function are irrelevant to digoxin dosing.
Q2. A 28-year-old pregnant client at 16 weeks gestation requires treatment for a urinary
tract infection. Which antibiotic is safest per current PLR labeling?
A. Ciprofloxacin
B. Nitrofurantoin
C. Doxycycline
D. Trimethoprim-sulfamethoxazole
Correct Answer: B. Nitrofurantoin [CORRECT]
,Rationale: Nitrofurantoin is generally considered safe in pregnancy (second and third
trimesters) for UTI treatment; fluoroquinolones (ciprofloxacin) cause cartilage damage,
doxycycline affects fetal bone and teeth, and trimethoprim is a folate antagonist
contraindicated in first trimester. PLR labeling replaced old pregnancy categories with
risk summaries.
Q3. A breastfeeding mother requires antibiotic therapy for mastitis. Which antibiotic has
an L1 (safest) lactation risk category and is appropriate for this client?
A. Ciprofloxacin
B. Dicloxacillin
C. Doxycycline
D. Metronidazole
Correct Answer: B. Dicloxacillin [CORRECT]
Rationale: Dicloxacillin and cephalexin are L1 (safest) for breastfeeding and first-line for
mastitis; ciprofloxacin is L3 (probably compatible), doxycycline is L2 but less preferred,
and metronidazole is L2-L3. L1 medications have been taken by large numbers of
breastfeeding mothers without observed increase in adverse effects.
Q4. A 4-year-old child weighing 18 kg requires amoxicillin for otitis media. The dose is
80 mg/kg/day divided BID. What is the correct dose per administration?
A. 360 mg
B. 720 mg
C. 1,440 mg
D. 1,800 mg
Correct Answer: B. 720 mg [CORRECT]
Rationale: Total daily dose = 80 mg/kg × 18 kg = 1,440 mg/day; divided BID = 1,440 ÷ 2 =
720 mg per dose. Errors include using total daily dose as a single dose (1,440 mg) or
miscalculating weight-based dosing.
Q5. An 82-year-old client is prescribed lorazepam 2 mg TID for anxiety. Per the Beers
Criteria 2026, which concern is most significant?
A. Lorazepam is the preferred benzodiazepine for all elderly patients
,B. Benzodiazepines increase fall risk, cognitive impairment, and dependence in older
adults and should be avoided
C. Lorazepam has no drug interactions in the elderly
D. The dose is too low for effective anxiety treatment in geriatric patients
Correct Answer: B. Benzodiazepines increase fall risk, cognitive impairment, and
dependence in older adults and should be avoided [CORRECT]
Rationale: The Beers Criteria classify benzodiazepines as potentially inappropriate in
older adults due to increased risk of falls, fractures, cognitive impairment, and
dependence; buspirone or SSRIs are preferred for chronic anxiety. Dose escalation is not
the solution.
Q6. A pediatric client requires a medication with hepatic metabolism. Which
developmental factor most affects drug clearance in a 6-month-old infant?
A. Hepatic enzyme systems are fully mature at birth
B. Hepatic enzyme systems (CYP450) are immature in infants, leading to decreased
metabolism and prolonged drug half-life
C. Infants have increased hepatic blood flow, increasing clearance
D. Hepatic metabolism is not relevant in pediatric dosing
Correct Answer: B. Hepatic enzyme systems (CYP450) are immature in infants, leading
to decreased metabolism and prolonged drug half-life [CORRECT]
Rationale: CYP450 enzyme systems are immature in infants (especially neonates),
resulting in decreased hepatic metabolism, prolonged half-lives, and increased toxicity
risk for hepatically cleared drugs. Enzyme maturation occurs over the first 1-2 years of
life.
Q7. A 78-year-old client is prescribed metformin for type 2 diabetes. Which age-related
pharmacokinetic change increases the risk of metformin accumulation and lactic
acidosis?
A. Increased hepatic metabolism
B. Decreased renal clearance (eGFR <30 mL/min contraindicates metformin)
C. Decreased volume of distribution
D. Increased gastric acid secretion
, Correct Answer: B. Decreased renal clearance (eGFR <30 mL/min contraindicates
metformin) [CORRECT]
Rationale: Metformin is renally excreted unchanged; age-related decline in GFR
increases accumulation risk and lactic acidosis. Metformin is contraindicated if eGFR
<30 mL/min and should be used with caution if 30-45 mL/min. Hepatic metabolism and
gastric acid are irrelevant.
Q8. A pregnant client at 8 weeks gestation requires treatment for hypertension. Which
antihypertensive is contraindicated due to fetal renal toxicity and oligohydramnios?
A. Labetalol
B. Nifedipine
C. Lisinopril
D. Methyldopa
Correct Answer: C. Lisinopril [CORRECT]
Rationale: ACE inhibitors (lisinopril) are contraindicated in pregnancy (especially second
and third trimesters) due to fetal renal tubular dysplasia, oligohydramnios, and skull
hypoplasia. Labetalol, nifedipine, and methyldopa are preferred agents for pregnancy
hypertension.
Q9. A nurse practitioner is prescribing for a breastfeeding mother with postpartum
depression. Which antidepressant is preferred due to low infant exposure and safety
data?
A. Fluoxetine
B. Sertraline
C. Bupropion
D. Venlafaxine
Correct Answer: B. Sertraline [CORRECT]
Rationale: Sertraline is the preferred SSRI in breastfeeding due to low relative infant
dose (RID <1%), minimal infant serum levels, and extensive safety data; fluoxetine has a
long half-life and higher infant exposure, bupropion has limited lactation data, and
venlafaxine has higher RID.
