Pharmacotherapeutics COMPLETE TESTBANK| Advanced
Nursing Practice test |QUESTIONS AND WELL EXPLAINED
ANSWERS | 2026
1 A 68-year-old patient with chronic kidney disease (eGFR 25
mL/min/1.73 m2) requires initiation of an ACE inhibitor for heart
failure. Which adjustment is most appropriate when selecting and
dosing an ACE inhibitor?
A. Use full standard starting dose because ACE inhibitors are
renally cleared equally.
B. Start at lower-than-standard dose and titrate slowly while
monitoring potassium and creatinine.
C. Avoid ACE inhibitors entirely and substitute with high-dose
loop diuretic.
D. Start combined ACE inhibitor and ARB for faster effect.
Correct Answer: B
Explanation: In CKD with reduced eGFR, start ACE inhibitors at
a lower dose and upward titrate with close monitoring of renal
function and potassium; full standard doses risk hyperkalemia
and creatinine rise (A incorrect); diuretics are adjuncts not
substitutes for ACE inhibitors (C incorrect); combining ACE
inhibitor and ARB increases adverse events without
morbidity/mortality benefit (D incorrect).
2 Which pharmacokinetic change commonly occurs with aging
that affects drug dosing in older adults?
A. Increased hepatic blood flow leading to faster clearance of
high-extraction drugs.
B. Increased total body water causing higher plasma
concentrations of hydrophilic drugs.
C. Decreased renal clearance reducing elimination of renally
,excreted drugs.
D. Increased serum albumin raising free fraction of highly
protein-bound drugs.
Correct Answer: C
Explanation: Aging commonly reduces renal clearance,
necessitating dose adjustments for renally eliminated drugs (A is
opposite—hepatic blood flow typically decreases; B is incorrect—
total body water decreases, lowering volume for hydrophilic
drugs; D is incorrect—serum albumin often decreases,
increasing free fraction, not raising it).
3 A 24-hour ambulatory patient is prescribed warfarin after a
DVT. Which co-prescribed medication requires the greatest
immediate attention because it may increase warfarin effect via
CYP inhibition?
A. Rifampin
B. Carbamazepine
C. Erythromycin
D. St. John’s wort
Correct Answer: C
Explanation: Erythromycin inhibits CYPs and can increase
warfarin anticoagulant effect acutely (A and B induce CYPs and
would decrease warfarin effect; D induces CYPs and decreases
warfarin effect).
4 A patient on digoxin presents with nausea, visual halos, and
bradycardia; serum potassium is 3.1 mEq/L. What is the most
likely explanation for these findings?
A. Digoxin toxicity potentiated by hypokalemia.
,B. Hypokalemia alone causes visual halos.
C. Digoxin toxicity occurs only with hyperkalemia.
D. Bradycardia rules out digoxin toxicity.
Correct Answer: A
Explanation: Digoxin toxicity is potentiated by hypokalemia and
causes gastrointestinal and visual symptoms plus
bradyarrhythmias (B incorrect—visual halos are classic for
digoxin; C incorrect—hyperkalemia is seen in acute digoxin
overdose but hypokalemia increases susceptibility; D incorrect—
bradycardia is consistent with toxicity).
5 An advanced practitioner prescribes high-dose aspirin for
arthritis in a patient taking warfarin. Which adverse interaction is
most concerning?
A. Aspirin decreases warfarin INR by inducing metabolism.
B. Additive antiplatelet effect increasing bleeding risk.
C. Aspirin chelates warfarin, reducing absorption.
D. Aspirin permanently reverses warfarin’s anticoagulation.
Correct Answer: B
Explanation: Aspirin causes antiplatelet effects that add to
warfarin’s anticoagulation, increasing bleeding risk (A and C
are incorrect mechanisms; D is false).
6 A pregnant patient in her first trimester requires treatment for
hypothyroidism. Which is the best pharmacotherapeutic choice?
A. Methimazole started immediately.
B. Propylthiouracil (PTU) in first trimester, switch to
methimazole thereafter.
C. Radioactive iodine therapy.
D. Defer treatment until postpartum.
, Correct Answer: B
Explanation: For hyperthyroidism in pregnancy, PTU is
preferred during the first trimester due to teratogenic risk of
methimazole; radioactive iodine is contraindicated (C), and
delaying treatment risks fetal/maternal complications (D). Note:
question context is hypothyroidism—if truly hypothyroid,
levothyroxine is indicated; but among antithyroid agents for
pregnancy the PTU→methimazole switch is standard—ensure
correct diagnosis before prescribing.
7 A patient with poorly controlled type 2 diabetes is started on an
SGLT2 inhibitor. Which adverse effect should the clinician
counsel the patient about?
A. Increased risk of urinary tract and genital mycotic infections.
B. Significant hypoglycemia when used as monotherapy.
C. Marked weight gain.
D. Increased risk of pancreatitis.
Correct Answer: A
Explanation: SGLT2 inhibitors increase glucosuria and raise
risk of genital mycotic and some UTIs (B incorrect—low
hypoglycemia risk as monotherapy; C incorrect—they often
cause modest weight loss; D incorrect—pancreatitis is associated
more with GLP-1 agonists/DPP-4 inhibitors, not SGLT2s).
8 In a patient with acute severe asthma exacerbation, which
medication provides the most rapid bronchodilation when
administered by nebulizer?
A. Ipratropium bromide alone.
B. Short-acting beta2 agonist (albuterol) nebulized.
Nursing Practice test |QUESTIONS AND WELL EXPLAINED
ANSWERS | 2026
1 A 68-year-old patient with chronic kidney disease (eGFR 25
mL/min/1.73 m2) requires initiation of an ACE inhibitor for heart
failure. Which adjustment is most appropriate when selecting and
dosing an ACE inhibitor?
A. Use full standard starting dose because ACE inhibitors are
renally cleared equally.
B. Start at lower-than-standard dose and titrate slowly while
monitoring potassium and creatinine.
C. Avoid ACE inhibitors entirely and substitute with high-dose
loop diuretic.
D. Start combined ACE inhibitor and ARB for faster effect.
Correct Answer: B
Explanation: In CKD with reduced eGFR, start ACE inhibitors at
a lower dose and upward titrate with close monitoring of renal
function and potassium; full standard doses risk hyperkalemia
and creatinine rise (A incorrect); diuretics are adjuncts not
substitutes for ACE inhibitors (C incorrect); combining ACE
inhibitor and ARB increases adverse events without
morbidity/mortality benefit (D incorrect).
2 Which pharmacokinetic change commonly occurs with aging
that affects drug dosing in older adults?
A. Increased hepatic blood flow leading to faster clearance of
high-extraction drugs.
B. Increased total body water causing higher plasma
concentrations of hydrophilic drugs.
C. Decreased renal clearance reducing elimination of renally
,excreted drugs.
D. Increased serum albumin raising free fraction of highly
protein-bound drugs.
Correct Answer: C
Explanation: Aging commonly reduces renal clearance,
necessitating dose adjustments for renally eliminated drugs (A is
opposite—hepatic blood flow typically decreases; B is incorrect—
total body water decreases, lowering volume for hydrophilic
drugs; D is incorrect—serum albumin often decreases,
increasing free fraction, not raising it).
3 A 24-hour ambulatory patient is prescribed warfarin after a
DVT. Which co-prescribed medication requires the greatest
immediate attention because it may increase warfarin effect via
CYP inhibition?
A. Rifampin
B. Carbamazepine
C. Erythromycin
D. St. John’s wort
Correct Answer: C
Explanation: Erythromycin inhibits CYPs and can increase
warfarin anticoagulant effect acutely (A and B induce CYPs and
would decrease warfarin effect; D induces CYPs and decreases
warfarin effect).
4 A patient on digoxin presents with nausea, visual halos, and
bradycardia; serum potassium is 3.1 mEq/L. What is the most
likely explanation for these findings?
A. Digoxin toxicity potentiated by hypokalemia.
,B. Hypokalemia alone causes visual halos.
C. Digoxin toxicity occurs only with hyperkalemia.
D. Bradycardia rules out digoxin toxicity.
Correct Answer: A
Explanation: Digoxin toxicity is potentiated by hypokalemia and
causes gastrointestinal and visual symptoms plus
bradyarrhythmias (B incorrect—visual halos are classic for
digoxin; C incorrect—hyperkalemia is seen in acute digoxin
overdose but hypokalemia increases susceptibility; D incorrect—
bradycardia is consistent with toxicity).
5 An advanced practitioner prescribes high-dose aspirin for
arthritis in a patient taking warfarin. Which adverse interaction is
most concerning?
A. Aspirin decreases warfarin INR by inducing metabolism.
B. Additive antiplatelet effect increasing bleeding risk.
C. Aspirin chelates warfarin, reducing absorption.
D. Aspirin permanently reverses warfarin’s anticoagulation.
Correct Answer: B
Explanation: Aspirin causes antiplatelet effects that add to
warfarin’s anticoagulation, increasing bleeding risk (A and C
are incorrect mechanisms; D is false).
6 A pregnant patient in her first trimester requires treatment for
hypothyroidism. Which is the best pharmacotherapeutic choice?
A. Methimazole started immediately.
B. Propylthiouracil (PTU) in first trimester, switch to
methimazole thereafter.
C. Radioactive iodine therapy.
D. Defer treatment until postpartum.
, Correct Answer: B
Explanation: For hyperthyroidism in pregnancy, PTU is
preferred during the first trimester due to teratogenic risk of
methimazole; radioactive iodine is contraindicated (C), and
delaying treatment risks fetal/maternal complications (D). Note:
question context is hypothyroidism—if truly hypothyroid,
levothyroxine is indicated; but among antithyroid agents for
pregnancy the PTU→methimazole switch is standard—ensure
correct diagnosis before prescribing.
7 A patient with poorly controlled type 2 diabetes is started on an
SGLT2 inhibitor. Which adverse effect should the clinician
counsel the patient about?
A. Increased risk of urinary tract and genital mycotic infections.
B. Significant hypoglycemia when used as monotherapy.
C. Marked weight gain.
D. Increased risk of pancreatitis.
Correct Answer: A
Explanation: SGLT2 inhibitors increase glucosuria and raise
risk of genital mycotic and some UTIs (B incorrect—low
hypoglycemia risk as monotherapy; C incorrect—they often
cause modest weight loss; D incorrect—pancreatitis is associated
more with GLP-1 agonists/DPP-4 inhibitors, not SGLT2s).
8 In a patient with acute severe asthma exacerbation, which
medication provides the most rapid bronchodilation when
administered by nebulizer?
A. Ipratropium bromide alone.
B. Short-acting beta2 agonist (albuterol) nebulized.
