NR 566 MIDTERM/NR566 ADVANCED PHARMACOLOGY FOR CARE OF THE
FAMILY MIDTERM EXAM NEWEST 2025 ACTUAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+
A 68-year-old male with a history of hypertension and Type 2 Diabetes Mellitus is prescribed
lisinopril. The Family Nurse Practitioner (FNP) understands that this patient is at increased risk
for which adverse effect due to the medication and his comorbidities?
A) Hypokalemia
B) Hypernatremia
C) Hyperkalemia
D) Hypoglycemia
E) Weight gain
Correct Answer: C) Hyperkalemia
Rationale: ACE inhibitors like lisinopril can cause hyperkalemia by inhibiting aldosterone
secretion, leading to reduced potassium excretion. This risk is further increased in patients
with Type 2 Diabetes Mellitus (which can cause hyporeninemic hypoaldosteronism) and
renal insufficiency (common with diabetes and age).
Question 2
A 35-year-old pregnant female (G2P1, 12 weeks gestation) with new-onset hypertension (BP
150/95 mmHg) requires pharmacologic treatment. Which antihypertensive medication class is
contraindicated in pregnancy?
A) Alpha-adrenergic blockers
B) Beta-adrenergic blockers
C) Angiotensin-converting enzyme (ACE) inhibitors
D) Calcium channel blockers
E) Hydralazine
,Correct Answer: C) Angiotensin-converting enzyme (ACE) inhibitors
Rationale: ACE inhibitors are contraindicated in the second and third trimesters of
pregnancy due to their teratogenic effects, which can cause severe fetal renal damage,
oligohydramnios, and other anomalies. Labetalol, nifedipine, and methyldopa are
commonly used for hypertension in pregnancy.
Question 3
A 72-year-old female with chronic heart failure (ejection fraction 30%) and atrial fibrillation is
taking furosemide, metoprolol, digoxin, and warfarin. She presents with nausea, vomiting,
yellow-green halos around lights, and an apical pulse of 48 bpm. Her serum potassium is 3.0
mEq/L. The FNP suspects:
A) Metoprolol overdose
B) Furosemide-induced dehydration
C) Digoxin toxicity
D) Warfarin-induced bleeding
E) Hypokalemia alone
Correct Answer: C) Digoxin toxicity
Rationale: The patient exhibits classic signs and symptoms of digoxin toxicity, including
gastrointestinal (nausea, vomiting), visual (halos), and cardiac (bradycardia, dysrhythmias)
manifestations. Hypokalemia (3.0 mEq/L) further predisposes to digoxin toxicity because
potassium competes with digoxin for binding sites on the Na+/K+-ATPase pump.
Furosemide can cause hypokalemia, contributing to the toxicity.
Question 4
A 4-year-old child with asthma is prescribed a new inhaled corticosteroid (e.g., fluticasone). The
,FNP provides education to the parents regarding the most important adverse effect prevention
strategy. Which instruction is crucial?
A) "Have your child use this inhaler only when short of breath."
B) "Make sure your child rinses their mouth with water after each use."
C) "This medication will provide immediate relief during an asthma attack."
D) "It's okay to stop this medication once your child's symptoms improve."
E) "Give this medication just before exercise."
Correct Answer: B) "Make sure your child rinses their mouth with water after each use."
Rationale: Inhaled corticosteroids can deposit in the oropharynx, suppressing local
immune defenses and increasing the risk of oral candidiasis (thrush). Rinsing the mouth
with water (and spitting it out) after each dose helps remove residual medication and
significantly reduces this risk. The other options are incorrect uses or understandings of
inhaled corticosteroids.
Question 5
A 58-year-old male with a history of Type 2 Diabetes Mellitus has an HbA1c of 9.5% despite
being on maximal metformin therapy. The FNP considers adding a second-line agent. Which
medication class is known to reduce cardiovascular events in patients with established
cardiovascular disease, in addition to lowering glucose?
A) Sulfonylureas (e.g., glipizide)
B) Thiazolidinediones (e.g., pioglitazone)
C) DPP-4 inhibitors (e.g., sitagliptin)
D) SGLT2 inhibitors (e.g., empagliflozin)
E) Alpha-glucosidase inhibitors (e.g., acarbose)
, Correct Answer: D) SGLT2 inhibitors (e.g., empagliflozin)
Rationale: SGLT2 inhibitors (e.g., empagliflozin, canagliflozin, dapagliflozin) have
demonstrated significant cardiovascular benefit (reduced cardiovascular mortality and
heart failure hospitalizations) in patients with Type 2 Diabetes Mellitus and established
cardiovascular disease, or those at high risk, independent of their glucose-lowering effects.
Question 6
A 70-year-old male with a history of hypertension and Type 2 Diabetes Mellitus is prescribed an
ACE inhibitor. He develops a persistent, dry, non-productive cough. He denies other symptoms.
The FNP should consider:
A) Adding an antitussive medication.
B) Switching to an angiotensin receptor blocker (ARB).
C) Increasing the dose of the ACE inhibitor.
D) Prescribing an antibiotic.
E) Ordering a chest X-ray.
Correct Answer: B) Switching to an angiotensin receptor blocker (ARB).
Rationale: The dry, non-productive cough is a common adverse effect of ACE inhibitors,
attributed to the accumulation of bradykinin. If the cough is bothersome, switching to an
Angiotensin Receptor Blocker (ARB) is the most appropriate action, as ARBs do not affect
bradykinin metabolism and typically do not cause this cough.
Question 7
A 28-year-old female is prescribed oral amoxicillin for bacterial sinusitis. The FNP should advise
the patient to complete the entire course of antibiotics even if symptoms improve, primarily to
prevent which outcome?
FAMILY MIDTERM EXAM NEWEST 2025 ACTUAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+
A 68-year-old male with a history of hypertension and Type 2 Diabetes Mellitus is prescribed
lisinopril. The Family Nurse Practitioner (FNP) understands that this patient is at increased risk
for which adverse effect due to the medication and his comorbidities?
A) Hypokalemia
B) Hypernatremia
C) Hyperkalemia
D) Hypoglycemia
E) Weight gain
Correct Answer: C) Hyperkalemia
Rationale: ACE inhibitors like lisinopril can cause hyperkalemia by inhibiting aldosterone
secretion, leading to reduced potassium excretion. This risk is further increased in patients
with Type 2 Diabetes Mellitus (which can cause hyporeninemic hypoaldosteronism) and
renal insufficiency (common with diabetes and age).
Question 2
A 35-year-old pregnant female (G2P1, 12 weeks gestation) with new-onset hypertension (BP
150/95 mmHg) requires pharmacologic treatment. Which antihypertensive medication class is
contraindicated in pregnancy?
A) Alpha-adrenergic blockers
B) Beta-adrenergic blockers
C) Angiotensin-converting enzyme (ACE) inhibitors
D) Calcium channel blockers
E) Hydralazine
,Correct Answer: C) Angiotensin-converting enzyme (ACE) inhibitors
Rationale: ACE inhibitors are contraindicated in the second and third trimesters of
pregnancy due to their teratogenic effects, which can cause severe fetal renal damage,
oligohydramnios, and other anomalies. Labetalol, nifedipine, and methyldopa are
commonly used for hypertension in pregnancy.
Question 3
A 72-year-old female with chronic heart failure (ejection fraction 30%) and atrial fibrillation is
taking furosemide, metoprolol, digoxin, and warfarin. She presents with nausea, vomiting,
yellow-green halos around lights, and an apical pulse of 48 bpm. Her serum potassium is 3.0
mEq/L. The FNP suspects:
A) Metoprolol overdose
B) Furosemide-induced dehydration
C) Digoxin toxicity
D) Warfarin-induced bleeding
E) Hypokalemia alone
Correct Answer: C) Digoxin toxicity
Rationale: The patient exhibits classic signs and symptoms of digoxin toxicity, including
gastrointestinal (nausea, vomiting), visual (halos), and cardiac (bradycardia, dysrhythmias)
manifestations. Hypokalemia (3.0 mEq/L) further predisposes to digoxin toxicity because
potassium competes with digoxin for binding sites on the Na+/K+-ATPase pump.
Furosemide can cause hypokalemia, contributing to the toxicity.
Question 4
A 4-year-old child with asthma is prescribed a new inhaled corticosteroid (e.g., fluticasone). The
,FNP provides education to the parents regarding the most important adverse effect prevention
strategy. Which instruction is crucial?
A) "Have your child use this inhaler only when short of breath."
B) "Make sure your child rinses their mouth with water after each use."
C) "This medication will provide immediate relief during an asthma attack."
D) "It's okay to stop this medication once your child's symptoms improve."
E) "Give this medication just before exercise."
Correct Answer: B) "Make sure your child rinses their mouth with water after each use."
Rationale: Inhaled corticosteroids can deposit in the oropharynx, suppressing local
immune defenses and increasing the risk of oral candidiasis (thrush). Rinsing the mouth
with water (and spitting it out) after each dose helps remove residual medication and
significantly reduces this risk. The other options are incorrect uses or understandings of
inhaled corticosteroids.
Question 5
A 58-year-old male with a history of Type 2 Diabetes Mellitus has an HbA1c of 9.5% despite
being on maximal metformin therapy. The FNP considers adding a second-line agent. Which
medication class is known to reduce cardiovascular events in patients with established
cardiovascular disease, in addition to lowering glucose?
A) Sulfonylureas (e.g., glipizide)
B) Thiazolidinediones (e.g., pioglitazone)
C) DPP-4 inhibitors (e.g., sitagliptin)
D) SGLT2 inhibitors (e.g., empagliflozin)
E) Alpha-glucosidase inhibitors (e.g., acarbose)
, Correct Answer: D) SGLT2 inhibitors (e.g., empagliflozin)
Rationale: SGLT2 inhibitors (e.g., empagliflozin, canagliflozin, dapagliflozin) have
demonstrated significant cardiovascular benefit (reduced cardiovascular mortality and
heart failure hospitalizations) in patients with Type 2 Diabetes Mellitus and established
cardiovascular disease, or those at high risk, independent of their glucose-lowering effects.
Question 6
A 70-year-old male with a history of hypertension and Type 2 Diabetes Mellitus is prescribed an
ACE inhibitor. He develops a persistent, dry, non-productive cough. He denies other symptoms.
The FNP should consider:
A) Adding an antitussive medication.
B) Switching to an angiotensin receptor blocker (ARB).
C) Increasing the dose of the ACE inhibitor.
D) Prescribing an antibiotic.
E) Ordering a chest X-ray.
Correct Answer: B) Switching to an angiotensin receptor blocker (ARB).
Rationale: The dry, non-productive cough is a common adverse effect of ACE inhibitors,
attributed to the accumulation of bradykinin. If the cough is bothersome, switching to an
Angiotensin Receptor Blocker (ARB) is the most appropriate action, as ARBs do not affect
bradykinin metabolism and typically do not cause this cough.
Question 7
A 28-year-old female is prescribed oral amoxicillin for bacterial sinusitis. The FNP should advise
the patient to complete the entire course of antibiotics even if symptoms improve, primarily to
prevent which outcome?
