NRNP 6565 Week 8: Advanced
Practice Nursing Comprehensive
Examination QUESTIONS AND
ANSWERS WITH RATIONALES/
GRADED A+/2026 UPDATE
/100%CORRECT
Section 1: Pharmacology & Medication Management (Questions 1-15)
1. When prescribing Schedule II through V controlled substances, which
schedule of drugs has the least potential for abuse?
• A) Schedule II
• B) Schedule III
• C) Schedule IV
• D) Schedule V
o Rationale: The Controlled Substances Act classifies drugs into five
schedules based on abuse potential. Schedule V has the lowest
potential for abuse and dependence, often containing limited
quantities of certain narcotics (e.g., cough preparations with codeine) .
2. A patient on amitriptyline (Elavil) for neuropathic pain reports urine
retention and dry mouth. What is the most appropriate action?
• A) Discontinue amitriptyline and begin ibuprofen.
• B) Refer to physical therapy.
• C) Start methocarbamol (Robaxin).
• D) Discontinue amitriptyline and begin gabapentin (Neurontin).
, o Rationale: Amitriptyline is a tricyclic antidepressant (TCA) with
significant anticholinergic side effects (dry mouth, constipation,
urinary retention). Gabapentin is a first-line agent for neuropathic pain
that lacks these specific anticholinergic effects .
3. St. John's wort will usually interact with all the following medications
EXCEPT:
• A) Celecoxib (Celebrex)
• B) Paroxetine (Paxil)
• C) Amitriptyline (Elavil)
• D) Proton Pump Inhibitors (PPIs)
o Rationale: St. John's wort is a potent inducer of the CYP450 enzyme
system (specifically CYP3A4), leading to reduced efficacy of many
drugs like SSRIs, TCAs, and anticoagulants. It does not have a
significant interaction with PPIs compared to the others listed .
4. A 17-year-old male with rheumatoid arthritis treated with an NSAID and
omeprazole (Prilosec) complains of headache, abdominal pain, and gas. These
symptoms are most likely:
• A) Related to the underlying condition.
• B) The result of the NSAID.
• C) Associated with the omeprazole.
• D) Caused by viral gastroenteritis.
o Rationale: While NSAIDs cause gastritis, the addition of omeprazole
is intended to prevent that. Common side effects of omeprazole
include headache, abdominal pain, nausea, and flatulence .
5. The most common side effect of oral ribavirin used in the treatment of
hepatitis C is:
• A) Weight loss.
• B) Depression.
• C) Hypothyroidism.
, • D) Hemolytic anemia.
o Rationale: Ribavirin causes a dose-dependent hemolytic anemia.
Patients require close monitoring of hemoglobin levels during
treatment .
6. A patient with a history of heart failure with reduced ejection fraction
(HFrEF, 25%) is admitted with dyspnea. BNP is 1200 pg/mL. JVP is 8 cm,
lungs are clear, and there is no peripheral edema. The most likely
hemodynamic profile is:
• A) Warm and dry
• B) Warm and wet
• C) Cold and dry
• D) Cold and wet
o Rationale: The Stevenson classification helps guide therapy. "Cold"
refers to low cardiac output (symptoms of dyspnea/fatigue). "Dry"
refers to no evidence of volume overload (clear lungs, no edema).
This patient requires inotropic support rather than diuresis .
7. A patient with diabetic ketoacidosis (DKA) has initial labs: glucose 450
mg/dL, pH 7.15, serum K+ 5.8 mEq/L. After initiating an insulin drip, the
serum K+ drops to 3.2 mEq/L. The best explanation is:
• A) Insulin causes an intracellular shift of potassium.
• B) The initial hyperkalemia was spurious due to acidosis.
• C) Potassium was lost in osmotic diuresis.
• D) All of the above.
o Rationale: Acidosis pushes K+ out of cells (causing pseudo-
hyperkalemia), but total body K+ is low due to osmotic diuresis.
Insulin drives K+ back into cells, revealing the underlying
hypokalemia .
8. A 55-year-old male with alcoholic cirrhosis presents with hematemesis,
tachycardia, and hypotension. After securing IV access and starting fluids, the
next priority intervention is:
Practice Nursing Comprehensive
Examination QUESTIONS AND
ANSWERS WITH RATIONALES/
GRADED A+/2026 UPDATE
/100%CORRECT
Section 1: Pharmacology & Medication Management (Questions 1-15)
1. When prescribing Schedule II through V controlled substances, which
schedule of drugs has the least potential for abuse?
• A) Schedule II
• B) Schedule III
• C) Schedule IV
• D) Schedule V
o Rationale: The Controlled Substances Act classifies drugs into five
schedules based on abuse potential. Schedule V has the lowest
potential for abuse and dependence, often containing limited
quantities of certain narcotics (e.g., cough preparations with codeine) .
2. A patient on amitriptyline (Elavil) for neuropathic pain reports urine
retention and dry mouth. What is the most appropriate action?
• A) Discontinue amitriptyline and begin ibuprofen.
• B) Refer to physical therapy.
• C) Start methocarbamol (Robaxin).
• D) Discontinue amitriptyline and begin gabapentin (Neurontin).
, o Rationale: Amitriptyline is a tricyclic antidepressant (TCA) with
significant anticholinergic side effects (dry mouth, constipation,
urinary retention). Gabapentin is a first-line agent for neuropathic pain
that lacks these specific anticholinergic effects .
3. St. John's wort will usually interact with all the following medications
EXCEPT:
• A) Celecoxib (Celebrex)
• B) Paroxetine (Paxil)
• C) Amitriptyline (Elavil)
• D) Proton Pump Inhibitors (PPIs)
o Rationale: St. John's wort is a potent inducer of the CYP450 enzyme
system (specifically CYP3A4), leading to reduced efficacy of many
drugs like SSRIs, TCAs, and anticoagulants. It does not have a
significant interaction with PPIs compared to the others listed .
4. A 17-year-old male with rheumatoid arthritis treated with an NSAID and
omeprazole (Prilosec) complains of headache, abdominal pain, and gas. These
symptoms are most likely:
• A) Related to the underlying condition.
• B) The result of the NSAID.
• C) Associated with the omeprazole.
• D) Caused by viral gastroenteritis.
o Rationale: While NSAIDs cause gastritis, the addition of omeprazole
is intended to prevent that. Common side effects of omeprazole
include headache, abdominal pain, nausea, and flatulence .
5. The most common side effect of oral ribavirin used in the treatment of
hepatitis C is:
• A) Weight loss.
• B) Depression.
• C) Hypothyroidism.
, • D) Hemolytic anemia.
o Rationale: Ribavirin causes a dose-dependent hemolytic anemia.
Patients require close monitoring of hemoglobin levels during
treatment .
6. A patient with a history of heart failure with reduced ejection fraction
(HFrEF, 25%) is admitted with dyspnea. BNP is 1200 pg/mL. JVP is 8 cm,
lungs are clear, and there is no peripheral edema. The most likely
hemodynamic profile is:
• A) Warm and dry
• B) Warm and wet
• C) Cold and dry
• D) Cold and wet
o Rationale: The Stevenson classification helps guide therapy. "Cold"
refers to low cardiac output (symptoms of dyspnea/fatigue). "Dry"
refers to no evidence of volume overload (clear lungs, no edema).
This patient requires inotropic support rather than diuresis .
7. A patient with diabetic ketoacidosis (DKA) has initial labs: glucose 450
mg/dL, pH 7.15, serum K+ 5.8 mEq/L. After initiating an insulin drip, the
serum K+ drops to 3.2 mEq/L. The best explanation is:
• A) Insulin causes an intracellular shift of potassium.
• B) The initial hyperkalemia was spurious due to acidosis.
• C) Potassium was lost in osmotic diuresis.
• D) All of the above.
o Rationale: Acidosis pushes K+ out of cells (causing pseudo-
hyperkalemia), but total body K+ is low due to osmotic diuresis.
Insulin drives K+ back into cells, revealing the underlying
hypokalemia .
8. A 55-year-old male with alcoholic cirrhosis presents with hematemesis,
tachycardia, and hypotension. After securing IV access and starting fluids, the
next priority intervention is:
