NURS 6531 - Adult Primary Care Final Exam 2026/2027 – Edition
Questions & Verified Answers
Overview
Focuses on high-yield ANCC/FNP topics: autonomic drugs, CV, endocrine, psych, pain,
antimicrobials, anticoagulants, and prescribing in renal/hepatic disease, pregnancy,
pediatrics, and geriatrics. Correct answer in bold Green.
1. A patient is a CYP2C19 ultra-rapid metabolizer. Which drug will have decreased
effect?
A. Omeprazole
B. Diazepam
C. Clopidogrel
D. Warfarin
Rationale: Clopidogrel is a prodrug activated by CYP2C19. UM → rapid activation but
also rapid inactivation. However, for clopidogrel, UM → ↑ active metabolite → ↑
bleeding risk, but some sources note reduced efficacy due to shunting. For
omeprazole/diazepam, UM → ↑ metabolism → ↓ effect. Best match: clopidogrel
variability; PM have ↓ effect.
2. Which drug is a strong CYP3A4 inhibitor and will increase levels of
simvastatin?
A. Rifampin
B. Phenytoin
C. Clarithromycin
D. St. John’s wort
Rationale: Clarithromycin, ketoconazole, itraconazole, ritonavir inhibit 3A4.
Rifampin/phenytoin induce.
3. A patient with CrCl 20 mL/min needs pain control. Which opioid is safest?
A. Morphine
B. Fentanyl
C. Hydromorphone
D. Meperidine
Rationale: Morphine, meperidine have active/toxic metabolites that accumulate in renal
failure. Fentanyl and methadone safest.
4. Which antihypertensive is contraindicated in bilateral renal artery stenosis?
A. Amlodipine
B. Metoprolol
C. Lisinopril
D. HCTZ
Rationale: ACEi/ARB in bilateral RAS → ↓ GFR → AKI.
5. A patient with HFrEF, EF 28%, on carvedilol and lisinopril. K 5.1. Next agent for
mortality benefit?
A. Digoxin
B. Spironolactone
C. Furosemide
, D. Hydralazine/ISDN
Rationale: Add MRA if K <5.5, eGFR >30. Then SGLT2i. Digoxin symptom only.
6. Which statin does NOT require renal dose adjustment?
A. Rosuvastatin
B. Pravastatin
C. Atorvastatin
D. Simvastatin
Rationale: Atorvastatin and fluvastatin have minimal renal excretion.
Rosuva/prava/simva need adjustment if severe CKD.
7. A patient with AFib starts amiodarone. Which drug interaction is most critical?
A. Metformin
B. Warfarin
C. Atorvastatin
D. Levothyroxine
Rationale: Amiodarone inhibits CYP2C9 + P-gp → ↑ warfarin, digoxin, statins. Reduce
warfarin 30-50%.
8. Which drug is first-line for depression in patient with CAD?
A. Amitriptyline
B. Sertraline
C. Bupropion
D. Mirtazapine
Rationale: Sertraline studied in SADHART, safe post-MI. TCAs cardiotoxic. Bupropion
can ↑ BP.
9. A patient with T2DM, ASCVD, eGFR 40. Best add-on to metformin?
A. Glipizide
B. Sitagliptin
C. Empagliflozin
D. Pioglitazone
Rationale: SGLT2i have CV + renal benefit. Use to eGFR ≥20-30. Pioglitazone
worsens HF.
10. Which drug is used for acute migraine in patient with CAD?
A. Sumatriptan
B. Rizatriptan
C. NSAID + antiemetic
D. Ergotamine
Rationale: Triptans/ergots contraindicated in CAD due to vasoconstriction. Use
NSAIDs, gepants.
11. A patient with seizures, on phenytoin, develops gingival hyperplasia.
Mechanism?
A. Calcium channel blockade
B. Collagen synthesis alteration + folate antagonism
C. Sodium channel blockade
D. GABA potentiation
Rationale: Phenytoin, CCBs, cyclosporine cause gingival hyperplasia via fibroblast
proliferation.
Questions & Verified Answers
Overview
Focuses on high-yield ANCC/FNP topics: autonomic drugs, CV, endocrine, psych, pain,
antimicrobials, anticoagulants, and prescribing in renal/hepatic disease, pregnancy,
pediatrics, and geriatrics. Correct answer in bold Green.
1. A patient is a CYP2C19 ultra-rapid metabolizer. Which drug will have decreased
effect?
A. Omeprazole
B. Diazepam
C. Clopidogrel
D. Warfarin
Rationale: Clopidogrel is a prodrug activated by CYP2C19. UM → rapid activation but
also rapid inactivation. However, for clopidogrel, UM → ↑ active metabolite → ↑
bleeding risk, but some sources note reduced efficacy due to shunting. For
omeprazole/diazepam, UM → ↑ metabolism → ↓ effect. Best match: clopidogrel
variability; PM have ↓ effect.
2. Which drug is a strong CYP3A4 inhibitor and will increase levels of
simvastatin?
A. Rifampin
B. Phenytoin
C. Clarithromycin
D. St. John’s wort
Rationale: Clarithromycin, ketoconazole, itraconazole, ritonavir inhibit 3A4.
Rifampin/phenytoin induce.
3. A patient with CrCl 20 mL/min needs pain control. Which opioid is safest?
A. Morphine
B. Fentanyl
C. Hydromorphone
D. Meperidine
Rationale: Morphine, meperidine have active/toxic metabolites that accumulate in renal
failure. Fentanyl and methadone safest.
4. Which antihypertensive is contraindicated in bilateral renal artery stenosis?
A. Amlodipine
B. Metoprolol
C. Lisinopril
D. HCTZ
Rationale: ACEi/ARB in bilateral RAS → ↓ GFR → AKI.
5. A patient with HFrEF, EF 28%, on carvedilol and lisinopril. K 5.1. Next agent for
mortality benefit?
A. Digoxin
B. Spironolactone
C. Furosemide
, D. Hydralazine/ISDN
Rationale: Add MRA if K <5.5, eGFR >30. Then SGLT2i. Digoxin symptom only.
6. Which statin does NOT require renal dose adjustment?
A. Rosuvastatin
B. Pravastatin
C. Atorvastatin
D. Simvastatin
Rationale: Atorvastatin and fluvastatin have minimal renal excretion.
Rosuva/prava/simva need adjustment if severe CKD.
7. A patient with AFib starts amiodarone. Which drug interaction is most critical?
A. Metformin
B. Warfarin
C. Atorvastatin
D. Levothyroxine
Rationale: Amiodarone inhibits CYP2C9 + P-gp → ↑ warfarin, digoxin, statins. Reduce
warfarin 30-50%.
8. Which drug is first-line for depression in patient with CAD?
A. Amitriptyline
B. Sertraline
C. Bupropion
D. Mirtazapine
Rationale: Sertraline studied in SADHART, safe post-MI. TCAs cardiotoxic. Bupropion
can ↑ BP.
9. A patient with T2DM, ASCVD, eGFR 40. Best add-on to metformin?
A. Glipizide
B. Sitagliptin
C. Empagliflozin
D. Pioglitazone
Rationale: SGLT2i have CV + renal benefit. Use to eGFR ≥20-30. Pioglitazone
worsens HF.
10. Which drug is used for acute migraine in patient with CAD?
A. Sumatriptan
B. Rizatriptan
C. NSAID + antiemetic
D. Ergotamine
Rationale: Triptans/ergots contraindicated in CAD due to vasoconstriction. Use
NSAIDs, gepants.
11. A patient with seizures, on phenytoin, develops gingival hyperplasia.
Mechanism?
A. Calcium channel blockade
B. Collagen synthesis alteration + folate antagonism
C. Sodium channel blockade
D. GABA potentiation
Rationale: Phenytoin, CCBs, cyclosporine cause gingival hyperplasia via fibroblast
proliferation.
