NR667 FNP CAPSTONE WEEK 2 PRACTICE EXAM
2026/2027 | 150 Questions Full Length | Chamberlain
University | 100% Correct Answers | Pass Guaranteed - A+
Graded
Section 1: Advanced Pharmacology & Polypharmacy
Management (Q1-25)
Question 1 A 78-year-old patient with hypertension, osteoarthritis, and mild
cognitive impairment is taking lisinopril, hydrochlorothiazide, ibuprofen 600mg TID,
and diphenhydramine 25mg nightly for sleep. Which medication is potentially
inappropriate per the 2023 Beers Criteria?
A. Lisinopril
B. Hydrochlorothiazide
C. Ibuprofen
D. Diphenhydramine [CORRECT]
Rationale: Diphenhydramine is listed in the 2023 Beers Criteria as potentially
inappropriate in older adults due to anticholinergic properties causing confusion,
urinary retention, constipation, and increased fall risk. While chronic NSAID use
(ibuprofen) in older adults requires caution (renal, GI, cardiovascular risks),
diphenhydramine carries a stronger Beers recommendation for avoidance. Lisinopril
and HCTZ are appropriate for hypertension management.
Correct Answer: D
Question 2 A 68-year-old with CKD Stage 3b (eGFR 38 mL/min), heart failure with
reduced EF (35%), and type 2 diabetes presents for medication reconciliation after
hospital discharge. Current meds: metformin 1000mg BID, lisinopril 20mg daily,
furosemide 40mg BID, atorvastatin 80mg daily, and aspirin 81mg daily. Which
adjustment is most critical?
,A. Increase metformin to 1500mg BID for better glycemic control
B. Discontinue metformin due to eGFR <45 mL/min [CORRECT]
C. Switch lisinopril to losartan for better renal protection
D. Add spironolactone 25mg daily for mortality benefit
Rationale: FDA labeling contraindicates metformin when eGFR falls below 30
mL/min and recommends discontinuation when eGFR is 30-45 mL/min due to lactic
acidosis risk. Option A is dangerous. Option C is unnecessary—lisinopril provides
equivalent renal protection. Option D, while evidence-based in HFrEF, is secondary to
the immediate safety concern of metformin in declining renal function.
Correct Answer: B
Question 3 A 72-year-old nursing home resident is on 14 medications including
amiodarone, warfarin, omeprazole, and ciprofloxacin for recent UTI. The FNP is
deprescribing. Which medication should be prioritized for discontinuation first based
on Beers Criteria and risk-benefit?
A. Omeprazole
B. Warfarin
C. Amiodarone [CORRECT]
D. Ciprofloxacin
Rationale: Amiodarone is potentially inappropriate per Beers Criteria as first-line
antiarrhythmic in older adults due to toxicity profile (pulmonary fibrosis, thyroid
dysfunction, hepatotoxicity, corneal deposits). As a non-first-line agent for atrial
fibrillation rate control, safer alternatives (beta-blockers, digoxin) should be
considered. While long-term PPIs and fluoroquinolones have risks, amiodarone's
organ toxicity profile makes it the highest priority for deprescribing review.
Correct Answer: C
Question 4 A 45-year-old patient on fluoxetine 40mg daily for depression asks about
starting St. John's Wort for mood enhancement. What is the FNP's primary concern?
,A. Serotonin syndrome due to pharmacodynamic interaction [CORRECT]
B. Reduced fluoxetine absorption due to chelation
C. Increased risk of photosensitivity
D. Hypertensive crisis from tyramine interaction
Rationale: St. John's Wort (hypericum perforatum) is a potent CYP3A4 inducer and
also inhibits serotonin reuptake. Combined with fluoxetine (SSRI), there is significant
risk of serotonin syndrome—manifesting as mental status changes, autonomic
instability, and neuromuscular abnormalities. Option B is incorrect (no chelation).
Option C is a side effect of St. John's Wort alone but not the primary concern. Option
D describes MAOI interactions, not SSRI + herbal combinations.
Correct Answer: A
Question 5 During a transition of care from hospital to home, an 82-year-old's
discharge medication list includes metoprolol succinate 50mg daily (new),
atorvastatin 40mg daily (home), aspirin 81mg daily (home), and clopidogrel 75mg
daily (new). The hospital list also shows atorvastatin 80mg daily. What is the priority
reconciliation action?
A. Continue both aspirin and clopidogrel indefinitely for dual antiplatelet therapy
B. Clarify atorvastatin dose discrepancy and verify indication for dual antiplatelet
therapy [CORRECT]
C. Discontinue clopidogrel immediately to reduce bleeding risk
D. Increase metoprolol to 100mg daily for optimal cardioprotection
Rationale: Medication reconciliation requires resolving dose discrepancies
(atorvastatin 40 vs 80mg) and verifying duration/intication for DAPT. Dual antiplatelet
therapy duration depends on stent type (bare metal vs drug-eluting) and bleeding
risk assessment. Option A assumes indefinite DAPT without verification. Option C
discontinues without indication review. Option D inappropriately titrates beta-
blocker without assessment.
Correct Answer: B
, Question 6 A 65-year-old with polypharmacy (12 medications) presents with new-
onset confusion. Vitals stable. Which medication combination most likely represents
a prescribing cascade?
A. Amlodipine + hydrochlorothiazide
B. Donepezil + memantine
C. Furosemide → urinary incontinence → oxybutynin → anticholinergic confusion
[CORRECT]
D. Metformin + glipizide
Rationale: A prescribing cascade occurs when an adverse drug effect is
misdiagnosed as a new medical condition, prompting additional medication.
Furosemide causes urinary urgency/frequency, misdiagnosed as incontinence leading
to oxybutynin (anticholinergic), which then causes confusion in this older adult—
completing the cascade. The FNP should recognize this pattern, discontinue
oxybutynin, and address the diuretic timing/dose instead.
Correct Answer: C
Question 7 An 81-year-old with insomnia is prescribed zolpidem 5mg nightly. Per
2023 Beers Criteria, what is the primary safety concern?
A. Increased risk of falls and fractures [CORRECT]
B. Hepatotoxicity requiring LFT monitoring
C. QT prolongation and torsades de pointes
D. Worsening of glaucoma
Rationale: The 2023 Beers Criteria recommend avoiding benzodiazepine receptor
agonists (zolpidem, eszopiclone, zaleplon) in older adults due to increased risks of
falls, fractures, cognitive impairment, and motor vehicle accidents. Non-
pharmacologic sleep hygiene and cognitive behavioral therapy for insomnia (CBT-I)
are preferred first-line approaches.
Correct Answer: A
2026/2027 | 150 Questions Full Length | Chamberlain
University | 100% Correct Answers | Pass Guaranteed - A+
Graded
Section 1: Advanced Pharmacology & Polypharmacy
Management (Q1-25)
Question 1 A 78-year-old patient with hypertension, osteoarthritis, and mild
cognitive impairment is taking lisinopril, hydrochlorothiazide, ibuprofen 600mg TID,
and diphenhydramine 25mg nightly for sleep. Which medication is potentially
inappropriate per the 2023 Beers Criteria?
A. Lisinopril
B. Hydrochlorothiazide
C. Ibuprofen
D. Diphenhydramine [CORRECT]
Rationale: Diphenhydramine is listed in the 2023 Beers Criteria as potentially
inappropriate in older adults due to anticholinergic properties causing confusion,
urinary retention, constipation, and increased fall risk. While chronic NSAID use
(ibuprofen) in older adults requires caution (renal, GI, cardiovascular risks),
diphenhydramine carries a stronger Beers recommendation for avoidance. Lisinopril
and HCTZ are appropriate for hypertension management.
Correct Answer: D
Question 2 A 68-year-old with CKD Stage 3b (eGFR 38 mL/min), heart failure with
reduced EF (35%), and type 2 diabetes presents for medication reconciliation after
hospital discharge. Current meds: metformin 1000mg BID, lisinopril 20mg daily,
furosemide 40mg BID, atorvastatin 80mg daily, and aspirin 81mg daily. Which
adjustment is most critical?
,A. Increase metformin to 1500mg BID for better glycemic control
B. Discontinue metformin due to eGFR <45 mL/min [CORRECT]
C. Switch lisinopril to losartan for better renal protection
D. Add spironolactone 25mg daily for mortality benefit
Rationale: FDA labeling contraindicates metformin when eGFR falls below 30
mL/min and recommends discontinuation when eGFR is 30-45 mL/min due to lactic
acidosis risk. Option A is dangerous. Option C is unnecessary—lisinopril provides
equivalent renal protection. Option D, while evidence-based in HFrEF, is secondary to
the immediate safety concern of metformin in declining renal function.
Correct Answer: B
Question 3 A 72-year-old nursing home resident is on 14 medications including
amiodarone, warfarin, omeprazole, and ciprofloxacin for recent UTI. The FNP is
deprescribing. Which medication should be prioritized for discontinuation first based
on Beers Criteria and risk-benefit?
A. Omeprazole
B. Warfarin
C. Amiodarone [CORRECT]
D. Ciprofloxacin
Rationale: Amiodarone is potentially inappropriate per Beers Criteria as first-line
antiarrhythmic in older adults due to toxicity profile (pulmonary fibrosis, thyroid
dysfunction, hepatotoxicity, corneal deposits). As a non-first-line agent for atrial
fibrillation rate control, safer alternatives (beta-blockers, digoxin) should be
considered. While long-term PPIs and fluoroquinolones have risks, amiodarone's
organ toxicity profile makes it the highest priority for deprescribing review.
Correct Answer: C
Question 4 A 45-year-old patient on fluoxetine 40mg daily for depression asks about
starting St. John's Wort for mood enhancement. What is the FNP's primary concern?
,A. Serotonin syndrome due to pharmacodynamic interaction [CORRECT]
B. Reduced fluoxetine absorption due to chelation
C. Increased risk of photosensitivity
D. Hypertensive crisis from tyramine interaction
Rationale: St. John's Wort (hypericum perforatum) is a potent CYP3A4 inducer and
also inhibits serotonin reuptake. Combined with fluoxetine (SSRI), there is significant
risk of serotonin syndrome—manifesting as mental status changes, autonomic
instability, and neuromuscular abnormalities. Option B is incorrect (no chelation).
Option C is a side effect of St. John's Wort alone but not the primary concern. Option
D describes MAOI interactions, not SSRI + herbal combinations.
Correct Answer: A
Question 5 During a transition of care from hospital to home, an 82-year-old's
discharge medication list includes metoprolol succinate 50mg daily (new),
atorvastatin 40mg daily (home), aspirin 81mg daily (home), and clopidogrel 75mg
daily (new). The hospital list also shows atorvastatin 80mg daily. What is the priority
reconciliation action?
A. Continue both aspirin and clopidogrel indefinitely for dual antiplatelet therapy
B. Clarify atorvastatin dose discrepancy and verify indication for dual antiplatelet
therapy [CORRECT]
C. Discontinue clopidogrel immediately to reduce bleeding risk
D. Increase metoprolol to 100mg daily for optimal cardioprotection
Rationale: Medication reconciliation requires resolving dose discrepancies
(atorvastatin 40 vs 80mg) and verifying duration/intication for DAPT. Dual antiplatelet
therapy duration depends on stent type (bare metal vs drug-eluting) and bleeding
risk assessment. Option A assumes indefinite DAPT without verification. Option C
discontinues without indication review. Option D inappropriately titrates beta-
blocker without assessment.
Correct Answer: B
, Question 6 A 65-year-old with polypharmacy (12 medications) presents with new-
onset confusion. Vitals stable. Which medication combination most likely represents
a prescribing cascade?
A. Amlodipine + hydrochlorothiazide
B. Donepezil + memantine
C. Furosemide → urinary incontinence → oxybutynin → anticholinergic confusion
[CORRECT]
D. Metformin + glipizide
Rationale: A prescribing cascade occurs when an adverse drug effect is
misdiagnosed as a new medical condition, prompting additional medication.
Furosemide causes urinary urgency/frequency, misdiagnosed as incontinence leading
to oxybutynin (anticholinergic), which then causes confusion in this older adult—
completing the cascade. The FNP should recognize this pattern, discontinue
oxybutynin, and address the diuretic timing/dose instead.
Correct Answer: C
Question 7 An 81-year-old with insomnia is prescribed zolpidem 5mg nightly. Per
2023 Beers Criteria, what is the primary safety concern?
A. Increased risk of falls and fractures [CORRECT]
B. Hepatotoxicity requiring LFT monitoring
C. QT prolongation and torsades de pointes
D. Worsening of glaucoma
Rationale: The 2023 Beers Criteria recommend avoiding benzodiazepine receptor
agonists (zolpidem, eszopiclone, zaleplon) in older adults due to increased risks of
falls, fractures, cognitive impairment, and motor vehicle accidents. Non-
pharmacologic sleep hygiene and cognitive behavioral therapy for insomnia (CBT-I)
are preferred first-line approaches.
Correct Answer: A
