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NR565 / NR 565 Advanced Pharmacology
Care of the Fundamentals Midterm
Exam | Chamberlain University
(2026/2027) | Verified Questions &
Answers with Rationales
Exam Structure:
Subject: Advanced Pharmacology (NR565)
Source: NR565 / NR 565 Advanced Pharmacology Care of the Fundamentals – Midterm
Exam Review (Chamberlain)
Format: Multiple Choice & Open-Ended Q&A
1. Which schedule drugs can APRNs prescribe?
Correct Answer: Schedule II – V
Rationale:
1. APRN prescriptive authority varies by state, but most allow schedules II-
V.
2. Schedule I drugs (heroin, LSD, marijuana federally) have no accepted
medical use and cannot be prescribed.
3. Some states restrict schedule II prescribing (e.g., no refills, specific
documentation).
4. APRNs must register with the DEA to prescribe controlled substances.
2. Who determines and regulates prescriptive authority?
Correct Answer: Nurse practitioner scope of practice is determined by
state practice and licensure laws.
Rationale:
1. Each state’s Nurse Practice Act defines APRN scope.
2. State Boards of Nursing, Medicine, or Pharmacy may regulate prescriptive
authority.
, 2|Page
3. Federal government regulates drug scheduling but not prescriptive
authority.
4. Some states require collaborative agreements or physician supervision.
3. How does limited prescriptive authority impact patients within the
healthcare system?
Correct Answer: Limited authority creates problems for the patient. The
patient is not able to get the care they need.
Rationale:
1. Delays in care when APRN must wait for physician co-signature.
2. Increased healthcare costs due to unnecessary office visits.
3. Barriers to timely pain management or medication refills.
4. Reduced access in rural or underserved areas where APRNs are primary
providers.
4. What are the key responsibilities of prescribing?
Correct Answer:
1. Be prudent and deliberate in your decision-making process.
2. Have a documented provider-patient relationship.
3. Do not prescribe for family, friends, or yourself.
4. Document a thorough history and physical examination.
5. Include discussions of risk factors, side effects, and therapy options.
6. Have a documented plan for drug monitoring or titration.
Rationale:
1. Prudent prescribing minimizes errors and adverse events.
2. A documented relationship is legally required for prescribing.
3. Prescribing for self or family lacks objectivity and is ethically problematic.
4. Thorough documentation protects both patient and provider.
5. What are the pharmacokinetic and pharmacodynamic
considerations for older adults?
Correct Answer: Drug accumulation secondary to reduced renal function;
polypharmacy (≥5 medications daily); greater severity of illness; presence
of comorbidities; use of drugs with low therapeutic index (e.g., digoxin);
increased individual variation due to altered pharmacokinetics; inadequate
supervision of long-term therapy; poor patient adherence.
, 3|Page
Rationale:
1. Reduced renal function decreases drug excretion, increasing toxicity risk.
2. Polypharmacy increases drug-drug interactions.
3. Low therapeutic index drugs require close monitoring.
4. Comorbidities alter drug response and increase adverse event risk.
6. What are the Beers Criteria?
Correct Answer: Potentially Inappropriate Medication (PIM) use in older
adults; PIM use due to medication-disease or medication-syndrome
interactions; medications to be used cautiously; clinically significant drug
interactions to avoid; medications to avoid or adjust in impaired kidney
function.
Rationale:
1. Developed by the American Geriatrics Society.
2. Identifies high-risk medications for adults ≥65 years.
3. Examples: benzodiazepines (falls, cognitive impairment), anticholinergics
(delirium).
4. Reduces adverse drug events and hospitalizations.
7. What is the cytochrome P450 (CYP450) system?
Correct Answer: Many medications are metabolized through the liver
enzyme system called cytochrome P450. Metabolism can be inhibited or
induced by drugs, leading to drug-drug interactions.
Rationale:
1. CYP450 enzymes (e.g., CYP3A4, CYP2D6, CYP2C9) metabolize most drugs.
2. Inhibitors decrease metabolism → increased drug levels → toxicity.
3. Inducers increase metabolism → decreased drug levels → therapeutic
failure.
4. Genetic polymorphisms cause variable metabolism (poor, intermediate,
extensive, ultra-rapid).
8. What is the mnemonic “VISA credit card debt Inhibits Spending on
CK and GQ” for CYP450 inhibitors?
Correct Answer: Valproate, Isoniazid, Sulfonamides, Amiodarone,
Chloramphenicol, Ketoconazole, Grapefruit juice, Quinidine.
Rationale:
1. These drugs inhibit CYP450 enzymes, particularly CYP3A4.
, 4|Page
2. Inhibition increases levels of co-administered drugs metabolized by
same enzyme.
3. Grapefruit juice inhibits intestinal CYP3A4, increasing bioavailability of
many drugs (statins, calcium channel blockers).
4. Monitor for toxicity when these are added to a regimen.
9. What do CYP450 inhibitors do?
Correct Answer: Decrease CYP450 enzyme activity, keeping medication in
the body longer, which can cause toxicity.
Rationale:
1. Inhibition reduces drug metabolism.
2. Half-life increases; drug accumulates.
3. Examples: ketoconazole + midazolam → prolonged sedation.
4. Dose reduction may be needed when inhibitor is added.
10. What do CYP450 inducers do?
Correct Answer: Increase CYP450 activity, causing drugs to leave the body
faster.
Rationale:
1. Induction speeds up metabolism.
2. Drug levels decrease, potentially falling below therapeutic range.
3. Examples: rifampin + oral contraceptive → breakthrough bleeding,
pregnancy.
4. Dose increase may be needed when inducer is added.
11. What is the mnemonic “Chronic Alcoholics Steal Phen Phen and
Never Refuse Greasy Carbs” for CYP450 inducers?
Correct Answer: Chronic alcoholics, St. John’s Wort, Phenytoin,
Phenobarbital, Nevirapine, Rifampin, Griseofulvin, Carbamazepine.
Rationale:
1. Chronic alcohol use induces CYP2E1.
2. St. John’s Wort induces CYP3A4 (interacts with many drugs).
3. Rifampin is a potent inducer of multiple CYP enzymes.
4. Carbamazepine induces its own metabolism (autoinduction).
NR565 / NR 565 Advanced Pharmacology
Care of the Fundamentals Midterm
Exam | Chamberlain University
(2026/2027) | Verified Questions &
Answers with Rationales
Exam Structure:
Subject: Advanced Pharmacology (NR565)
Source: NR565 / NR 565 Advanced Pharmacology Care of the Fundamentals – Midterm
Exam Review (Chamberlain)
Format: Multiple Choice & Open-Ended Q&A
1. Which schedule drugs can APRNs prescribe?
Correct Answer: Schedule II – V
Rationale:
1. APRN prescriptive authority varies by state, but most allow schedules II-
V.
2. Schedule I drugs (heroin, LSD, marijuana federally) have no accepted
medical use and cannot be prescribed.
3. Some states restrict schedule II prescribing (e.g., no refills, specific
documentation).
4. APRNs must register with the DEA to prescribe controlled substances.
2. Who determines and regulates prescriptive authority?
Correct Answer: Nurse practitioner scope of practice is determined by
state practice and licensure laws.
Rationale:
1. Each state’s Nurse Practice Act defines APRN scope.
2. State Boards of Nursing, Medicine, or Pharmacy may regulate prescriptive
authority.
, 2|Page
3. Federal government regulates drug scheduling but not prescriptive
authority.
4. Some states require collaborative agreements or physician supervision.
3. How does limited prescriptive authority impact patients within the
healthcare system?
Correct Answer: Limited authority creates problems for the patient. The
patient is not able to get the care they need.
Rationale:
1. Delays in care when APRN must wait for physician co-signature.
2. Increased healthcare costs due to unnecessary office visits.
3. Barriers to timely pain management or medication refills.
4. Reduced access in rural or underserved areas where APRNs are primary
providers.
4. What are the key responsibilities of prescribing?
Correct Answer:
1. Be prudent and deliberate in your decision-making process.
2. Have a documented provider-patient relationship.
3. Do not prescribe for family, friends, or yourself.
4. Document a thorough history and physical examination.
5. Include discussions of risk factors, side effects, and therapy options.
6. Have a documented plan for drug monitoring or titration.
Rationale:
1. Prudent prescribing minimizes errors and adverse events.
2. A documented relationship is legally required for prescribing.
3. Prescribing for self or family lacks objectivity and is ethically problematic.
4. Thorough documentation protects both patient and provider.
5. What are the pharmacokinetic and pharmacodynamic
considerations for older adults?
Correct Answer: Drug accumulation secondary to reduced renal function;
polypharmacy (≥5 medications daily); greater severity of illness; presence
of comorbidities; use of drugs with low therapeutic index (e.g., digoxin);
increased individual variation due to altered pharmacokinetics; inadequate
supervision of long-term therapy; poor patient adherence.
, 3|Page
Rationale:
1. Reduced renal function decreases drug excretion, increasing toxicity risk.
2. Polypharmacy increases drug-drug interactions.
3. Low therapeutic index drugs require close monitoring.
4. Comorbidities alter drug response and increase adverse event risk.
6. What are the Beers Criteria?
Correct Answer: Potentially Inappropriate Medication (PIM) use in older
adults; PIM use due to medication-disease or medication-syndrome
interactions; medications to be used cautiously; clinically significant drug
interactions to avoid; medications to avoid or adjust in impaired kidney
function.
Rationale:
1. Developed by the American Geriatrics Society.
2. Identifies high-risk medications for adults ≥65 years.
3. Examples: benzodiazepines (falls, cognitive impairment), anticholinergics
(delirium).
4. Reduces adverse drug events and hospitalizations.
7. What is the cytochrome P450 (CYP450) system?
Correct Answer: Many medications are metabolized through the liver
enzyme system called cytochrome P450. Metabolism can be inhibited or
induced by drugs, leading to drug-drug interactions.
Rationale:
1. CYP450 enzymes (e.g., CYP3A4, CYP2D6, CYP2C9) metabolize most drugs.
2. Inhibitors decrease metabolism → increased drug levels → toxicity.
3. Inducers increase metabolism → decreased drug levels → therapeutic
failure.
4. Genetic polymorphisms cause variable metabolism (poor, intermediate,
extensive, ultra-rapid).
8. What is the mnemonic “VISA credit card debt Inhibits Spending on
CK and GQ” for CYP450 inhibitors?
Correct Answer: Valproate, Isoniazid, Sulfonamides, Amiodarone,
Chloramphenicol, Ketoconazole, Grapefruit juice, Quinidine.
Rationale:
1. These drugs inhibit CYP450 enzymes, particularly CYP3A4.
, 4|Page
2. Inhibition increases levels of co-administered drugs metabolized by
same enzyme.
3. Grapefruit juice inhibits intestinal CYP3A4, increasing bioavailability of
many drugs (statins, calcium channel blockers).
4. Monitor for toxicity when these are added to a regimen.
9. What do CYP450 inhibitors do?
Correct Answer: Decrease CYP450 enzyme activity, keeping medication in
the body longer, which can cause toxicity.
Rationale:
1. Inhibition reduces drug metabolism.
2. Half-life increases; drug accumulates.
3. Examples: ketoconazole + midazolam → prolonged sedation.
4. Dose reduction may be needed when inhibitor is added.
10. What do CYP450 inducers do?
Correct Answer: Increase CYP450 activity, causing drugs to leave the body
faster.
Rationale:
1. Induction speeds up metabolism.
2. Drug levels decrease, potentially falling below therapeutic range.
3. Examples: rifampin + oral contraceptive → breakthrough bleeding,
pregnancy.
4. Dose increase may be needed when inducer is added.
11. What is the mnemonic “Chronic Alcoholics Steal Phen Phen and
Never Refuse Greasy Carbs” for CYP450 inducers?
Correct Answer: Chronic alcoholics, St. John’s Wort, Phenytoin,
Phenobarbital, Nevirapine, Rifampin, Griseofulvin, Carbamazepine.
Rationale:
1. Chronic alcohol use induces CYP2E1.
2. St. John’s Wort induces CYP3A4 (interacts with many drugs).
3. Rifampin is a potent inducer of multiple CYP enzymes.
4. Carbamazepine induces its own metabolism (autoinduction).
