NR-566: ADVANCED PHARMACOLOGY CARE OF THE
FAMILY FINAL EXAM GUIDE WITH PRACTICE TEST
MULTIPLE CHOICE QUESTIONS (COMPLETE) VERIFIED
ANSWERS A+ GRADE HIGH YIELD
Question 1: A 65-year-old African American male with hypertension is
started on lisinopril 10mg daily. Two weeks later, he reports a dry,
persistent cough. What is the most appropriate next step? A. Continue
lisinopril – the cough will resolve B. Switch to losartan C. Add a beta-
blocker to suppress the cough D. Switch to amlodipine
Rationale: Correct answer: B. ACE inhibitors cause dry cough in 5-20%
due to bradykinin accumulation. ARBs (losartan) have much lower
cough incidence and are the preferred switch.
Question 2: A 72-year-old with HFrEF (EF 35%) is on lisinopril,
carvedilol, and furosemide. Which medication would provide additional
mortality benefit if added? A. Spironolactone B. Digoxin C.
Hydralazine D. Nitroglycerin patch
Rationale: Correct answer: A. Spironolactone (MRA) reduces mortality
in HFrEF (RALES trial). Digoxin reduces hospitalizations only.
Hydralazine/nitrate only for African Americans.
Question 3: A patient with asthma is using albuterol 3-4 times daily and
has nighttime awakenings from wheezing twice per week. PEFR is 65%
predicted. According to GINA guidelines, what is the most appropriate
next step? A. Add low-dose ICS (fluticasone) B. Add LABA (salmeterol)
,
as monotherapy C. Increase albuterol to 2 puffs every 4 hours D. Add
oral prednisone daily
Rationale: Correct answer: A. Uncontrolled asthma (SABA use
>2x/week, night symptoms) requires adding low-dose ICS. LABA
monotherapy is dangerous (increased asthma death).
Question 4: A 28-year-old pregnant woman at 32 weeks gestation has
BP 155/95 mmHg. Which antihypertensive is
CONTRAINDICATED? A. Labetalol B. Nifedipine C. Methyldopa D.
Lisinopril
Rationale: Correct answer: D. ACE inhibitors and ARBs are teratogenic
and contraindicated in pregnancy. Labetalol, nifedipine, and methyldopa
are safe.
Question 5: A 58-year-old with type 2 diabetes and CKD stage 3b (GFR
40 mL/min) has HbA1c 7.5% on metformin 1000mg BID and glipizide
10mg BID. Which medication would provide cardiovascular and renal
benefit regardless of glucose control? A. Sitagliptin B. Empagliflozin C.
Pioglitazone D. Insulin glargine
Rationale: Correct answer: B. SGLT2 inhibitors reduce CV events and
slow CKD progression independent of glycemic effect.
Question 6: A patient is prescribed warfarin for atrial fibrillation. Which
medication would INCREASE the INR and bleeding risk when
added? A. Rifampin B. Phenytoin C. Carbamazepine D. Amiodarone
Rationale: Correct answer: D. Amiodarone inhibits CYP2C9 and
CYP3A4, increasing warfarin levels. Rifampin, phenytoin, and
carbamazepine are inducers that decrease warfarin effect.
,
Question 7: A 32-year-old with schizophrenia is started on clozapine
after failing two other antipsychotics. Which monitoring test is
REQUIRED by the REMS program? A. CBC with differential (ANC) B.
EKG C. TSH D. Fasting glucose
Rationale: Correct answer: A. Clozapine REMS requires ANC
monitoring: weekly x6 months, then q2w x6 months, then q4w due to
agranulocytosis risk.
Question 8: A 45-year-old with COPD (FEV1 50% predicted) has had 2
exacerbations requiring antibiotics/steroids in the past year. Blood
eosinophils are 120 cells/mcL. He is on tiotropium (LAMA) alone. What
is the most appropriate next step? A. Add LABA (salmeterol) B. Add
ICS (fluticasone) C. Add roflumilast D. No change
Rationale: Correct answer: A. GOLD Group E (high exacerbation risk)
initial treatment is LABA+LAMA. ICS added only if eos ≥300. Low eos
means ICS not indicated.
Question 9: A patient with bipolar disorder on lithium has a trough level
of 1.4 mEq/L and reports coarse tremor, nausea, and mild confusion.
What is the most appropriate next step? A. Continue same dose – this is
therapeutic range B. Reduce lithium dose C. Add propranolol for
tremor D. Start olanzapine for confusion
Rationale: Correct answer: B. Therapeutic lithium maintenance range is
0.6-0.8 mEq/L. Level >1.2 with symptoms indicates toxicity. Reduce
dose.
,
Question 10: A 68-year-old with CKD stage 4 (GFR 25 mL/min) is
prescribed gabapentin for neuropathic pain. What is the appropriate
starting dose? A. 300mg three times daily B. 300mg daily C. 100mg
three times daily D. 600mg at bedtime
Rationale: Correct answer: B. Gabapentin is renally excreted. At GFR
25 mL/min, recommended dose is 300mg daily. Standard doses would
cause toxicity.
Question 11: A 55-year-old with HFrEF (EF 30%) is hospitalized with
acute decompensation. He is on sacubitril/valsartan, carvedilol,
spironolactone, and furosemide. Which medication should be HELD
during acute decompensation? A. Sacubitril/valsartan B. Carvedilol C.
Spironolactone D. Furosemide
Rationale: Correct answer: B. Beta-blockers should be held in acute
decompensated HF (negative inotrope). Restart when stable.
Question 12: A patient is prescribed amoxicillin for otitis media. Which
statement about amoxicillin is TRUE? A. It requires renal dose
adjustment B. It is a beta-lactam antibiotic that inhibits cell wall
synthesis C. It has excellent activity against MRSA D. It is a first-line
treatment for Pseudomonas infection
Rationale: Correct answer: B. Amoxicillin inhibits cell wall synthesis.
No MRSA activity. No Pseudomonas activity. Renal adjustment only at
GFR <10.
Question 13: A 42-year-old with major depressive disorder and
insomnia is started on mirtazapine 15mg at bedtime. Which side effect is
FAMILY FINAL EXAM GUIDE WITH PRACTICE TEST
MULTIPLE CHOICE QUESTIONS (COMPLETE) VERIFIED
ANSWERS A+ GRADE HIGH YIELD
Question 1: A 65-year-old African American male with hypertension is
started on lisinopril 10mg daily. Two weeks later, he reports a dry,
persistent cough. What is the most appropriate next step? A. Continue
lisinopril – the cough will resolve B. Switch to losartan C. Add a beta-
blocker to suppress the cough D. Switch to amlodipine
Rationale: Correct answer: B. ACE inhibitors cause dry cough in 5-20%
due to bradykinin accumulation. ARBs (losartan) have much lower
cough incidence and are the preferred switch.
Question 2: A 72-year-old with HFrEF (EF 35%) is on lisinopril,
carvedilol, and furosemide. Which medication would provide additional
mortality benefit if added? A. Spironolactone B. Digoxin C.
Hydralazine D. Nitroglycerin patch
Rationale: Correct answer: A. Spironolactone (MRA) reduces mortality
in HFrEF (RALES trial). Digoxin reduces hospitalizations only.
Hydralazine/nitrate only for African Americans.
Question 3: A patient with asthma is using albuterol 3-4 times daily and
has nighttime awakenings from wheezing twice per week. PEFR is 65%
predicted. According to GINA guidelines, what is the most appropriate
next step? A. Add low-dose ICS (fluticasone) B. Add LABA (salmeterol)
,
as monotherapy C. Increase albuterol to 2 puffs every 4 hours D. Add
oral prednisone daily
Rationale: Correct answer: A. Uncontrolled asthma (SABA use
>2x/week, night symptoms) requires adding low-dose ICS. LABA
monotherapy is dangerous (increased asthma death).
Question 4: A 28-year-old pregnant woman at 32 weeks gestation has
BP 155/95 mmHg. Which antihypertensive is
CONTRAINDICATED? A. Labetalol B. Nifedipine C. Methyldopa D.
Lisinopril
Rationale: Correct answer: D. ACE inhibitors and ARBs are teratogenic
and contraindicated in pregnancy. Labetalol, nifedipine, and methyldopa
are safe.
Question 5: A 58-year-old with type 2 diabetes and CKD stage 3b (GFR
40 mL/min) has HbA1c 7.5% on metformin 1000mg BID and glipizide
10mg BID. Which medication would provide cardiovascular and renal
benefit regardless of glucose control? A. Sitagliptin B. Empagliflozin C.
Pioglitazone D. Insulin glargine
Rationale: Correct answer: B. SGLT2 inhibitors reduce CV events and
slow CKD progression independent of glycemic effect.
Question 6: A patient is prescribed warfarin for atrial fibrillation. Which
medication would INCREASE the INR and bleeding risk when
added? A. Rifampin B. Phenytoin C. Carbamazepine D. Amiodarone
Rationale: Correct answer: D. Amiodarone inhibits CYP2C9 and
CYP3A4, increasing warfarin levels. Rifampin, phenytoin, and
carbamazepine are inducers that decrease warfarin effect.
,
Question 7: A 32-year-old with schizophrenia is started on clozapine
after failing two other antipsychotics. Which monitoring test is
REQUIRED by the REMS program? A. CBC with differential (ANC) B.
EKG C. TSH D. Fasting glucose
Rationale: Correct answer: A. Clozapine REMS requires ANC
monitoring: weekly x6 months, then q2w x6 months, then q4w due to
agranulocytosis risk.
Question 8: A 45-year-old with COPD (FEV1 50% predicted) has had 2
exacerbations requiring antibiotics/steroids in the past year. Blood
eosinophils are 120 cells/mcL. He is on tiotropium (LAMA) alone. What
is the most appropriate next step? A. Add LABA (salmeterol) B. Add
ICS (fluticasone) C. Add roflumilast D. No change
Rationale: Correct answer: A. GOLD Group E (high exacerbation risk)
initial treatment is LABA+LAMA. ICS added only if eos ≥300. Low eos
means ICS not indicated.
Question 9: A patient with bipolar disorder on lithium has a trough level
of 1.4 mEq/L and reports coarse tremor, nausea, and mild confusion.
What is the most appropriate next step? A. Continue same dose – this is
therapeutic range B. Reduce lithium dose C. Add propranolol for
tremor D. Start olanzapine for confusion
Rationale: Correct answer: B. Therapeutic lithium maintenance range is
0.6-0.8 mEq/L. Level >1.2 with symptoms indicates toxicity. Reduce
dose.
,
Question 10: A 68-year-old with CKD stage 4 (GFR 25 mL/min) is
prescribed gabapentin for neuropathic pain. What is the appropriate
starting dose? A. 300mg three times daily B. 300mg daily C. 100mg
three times daily D. 600mg at bedtime
Rationale: Correct answer: B. Gabapentin is renally excreted. At GFR
25 mL/min, recommended dose is 300mg daily. Standard doses would
cause toxicity.
Question 11: A 55-year-old with HFrEF (EF 30%) is hospitalized with
acute decompensation. He is on sacubitril/valsartan, carvedilol,
spironolactone, and furosemide. Which medication should be HELD
during acute decompensation? A. Sacubitril/valsartan B. Carvedilol C.
Spironolactone D. Furosemide
Rationale: Correct answer: B. Beta-blockers should be held in acute
decompensated HF (negative inotrope). Restart when stable.
Question 12: A patient is prescribed amoxicillin for otitis media. Which
statement about amoxicillin is TRUE? A. It requires renal dose
adjustment B. It is a beta-lactam antibiotic that inhibits cell wall
synthesis C. It has excellent activity against MRSA D. It is a first-line
treatment for Pseudomonas infection
Rationale: Correct answer: B. Amoxicillin inhibits cell wall synthesis.
No MRSA activity. No Pseudomonas activity. Renal adjustment only at
GFR <10.
Question 13: A 42-year-old with major depressive disorder and
insomnia is started on mirtazapine 15mg at bedtime. Which side effect is
