NUR 635 Final Exam Review Tyler/Sarhan
| Complete Practice Exam Questions with
100% Verified Correct Answers and Detailed
Rationales | Latest Update - 2026/2027 Edition
– (100% Correct Solutions) Already Graded A+
Question 1
A 45-year-old female patient with a history of seizure disorder is currently maintained on
carbamazepine therapy. Which of the following laboratory parameters is NOT indicated for
routine monitoring during carbamazepine treatment?
A. Complete blood count with differential
B. Serum glucose levels
C. Therapeutic drug levels
D. Arterial blood gas analysis
Answer: D
Rationale: Carbamazepine monitoring includes routine CBC (due to risk of blood dyscrasias
such as agranulocytosis and aplastic anemia), serum glucose monitoring (as carbamazepine
can affect glucose metabolism), and therapeutic drug levels to ensure efficacy and prevent
toxicity. Arterial blood gas analysis is not indicated for routine monitoring of carbamazepine
therapy. Option D is the correct answer as it represents the exception to standard monitoring
parameters.
Question 2
A nurse practitioner is reviewing antimicrobial susceptibility patterns for the local hospital to
guide empiric antibiotic selection. Which of the following tools provides the most accurate
representation of local resistance patterns?
A. Formulary reference guide
B. Antibiogram
C. Kirby-Bauer susceptibility chart
D. Clinical practice guideline
Answer: B
Rationale: An antibiogram is a summary of antimicrobial susceptibility patterns of local
bacterial isolates, which provides essential data for guiding empiric antibiotic selection based
on specific institutional resistance patterns. A formulary reference guide (Option A) lists
available medications but does not provide resistance data. The Kirby-Bauer technique
(Option C) is a laboratory method for testing susceptibility, not a summary tool. Clinical
1
,practice guidelines (Option D) provide general recommendations but may not reflect local
resistance patterns. Therefore, the antibiogram is the correct tool for this purpose.
Question 3
A 17-year-old adolescent presents with mild comedonal acne characterized by open and
closed comedones primarily on the forehead and cheeks. Which of the following represents
the most appropriate first-line pharmacological intervention?
A. Oral isotretinoin 20 mg twice daily
B. Topical clindamycin 1% gel once daily
C. Benzoyl peroxide 5% gel applied topically
D. Systemic prednisone 10 mg daily
Answer: C
Rationale: First-line treatment for mild comedonal acne includes topical agents such as
benzoyl peroxide, topical retinoids, or combination topical therapies. Benzoyl peroxide is
particularly effective for comedonal acne due to its keratolytic and antibacterial properties.
Oral isotretinoin (Option A) is reserved for severe, nodulocystic, or treatment-resistant acne.
Topical antibiotics alone (Option B) are not recommended as monotherapy for mild acne due
to concerns about antibiotic resistance. Systemic corticosteroids (Option D) are not indicated
for routine management of mild acne.
Question 4
A 32-year-old patient with a known diagnosis of persistent asthma presents for follow-up. The
patient reports using their rescue inhaler three to four times per week and experiencing
nighttime awakenings twice weekly. The patient currently uses albuterol as needed. Which of
the following represents the most appropriate next step in asthma management according to
step therapy guidelines?
A. Continue current regimen with reinforcement of inhaler technique
B. Add a low-dose inhaled corticosteroid to the current regimen
C. Initiate a long-acting beta-agonist as monotherapy
D. Add oral leukotriene receptor antagonist
Answer: B
Rationale: According to stepwise asthma management guidelines, a patient who is using their
short-acting beta-agonist (SABA) more than two times per week or experiencing nighttime
awakenings requires step-up therapy. The most appropriate next step is to add a low-dose
inhaled corticosteroid (ICS) to the SABA, which represents Step 2 therapy. Continuing the
current regimen (Option A) would not address the patient's inadequate symptom control.
Long-acting beta-agonists (Option C) should never be used as monotherapy in asthma due to
safety concerns and the risk of asthma-related death. Adding a leukotriene receptor antagonist
(Option D) could be considered but ICS is the preferred initial controller therapy.
2
,Question 5
An 18-month-old child is brought to the clinic with a 24-hour history of fever, irritability, and
pulling at the right ear. Otoscopic examination reveals a bulging, erythematous, opaque, and
immobile tympanic membrane. Which of the following represents the most appropriate initial
therapeutic intervention?
A. Observation with return precautions for 48-72 hours
B. Weight-based oral amoxicillin therapy
C. Intramuscular ceftriaxone 50 mg/kg
D. Topical antibiotic otic drops
Answer: B
Rationale: This clinical presentation is consistent with acute otitis media (AOM),
characterized by acute onset of symptoms with middle ear inflammation and effusion. The
presence of a bulging, erythematous, and immobile tympanic membrane in a symptomatic
child confirms the diagnosis. For a child of this age with a 24-hour history of fever and classic
findings, antibiotic therapy is indicated. Weight-based amoxicillin is the first-line treatment
for AOM, given at a dose of 80-90 mg/kg/day divided into two doses. Observation (Option A)
is not appropriate for a child with fever and classic AOM findings. Intramuscular ceftriaxone
(Option C) is reserved for treatment failure or patients who cannot tolerate oral therapy.
Topical otic drops (Option D) are not appropriate for AOM as the infection is behind the
tympanic membrane.
Question 6
A 68-year-old patient is diagnosed with herpes zoster (shingles) affecting the thoracic
dermatomes. The patient has a history of hypertension and chronic kidney disease stage 3.
Which of the following is the most important consideration when prescribing valacyclovir for
this patient?
A. Monitoring liver function tests and counseling regarding alcohol abstinence
B. Adjusting the dose based on renal function and encouraging adequate hydration
C. Monitoring platelet count and counseling regarding aspirin avoidance
D. Monitoring blood pressure and assessing for hypertensive crisis
Answer: B
Rationale: Valacyclovir is a prodrug of acyclovir that is primarily eliminated through renal
excretion. In patients with renal impairment, dose adjustment is essential to prevent drug
accumulation and potential neurotoxicity. Additionally, patients should be counseled to
maintain adequate hydration to prevent crystalluria. Liver function monitoring (Option A) is
not the primary concern with valacyclovir. Platelet monitoring (Option C) is not specifically
indicated. Blood pressure monitoring (Option D) is not directly related to valacyclovir therapy.
3
, Question 7
A 16-year-old female presents with moderate inflammatory acne characterized by multiple
papules and pustules on the face, chest, and back. The patient has not responded to over-the-
counter topical treatments. Which of the following represents the most appropriate initial
prescription for this patient?
A. Oral ascorbic acid supplementation
B. Short-course topical steroid therapy
C. Combination therapy with benzoyl peroxide and a topical retinoid
D. Oral antibiotic monotherapy
Answer: C
Rationale: For moderate acne, the most appropriate initial prescription is combination therapy
with a topical retinoid and benzoyl peroxide or a topical antibiotic. Combination therapy
addresses multiple pathogenic factors in acne, including follicular hyperkeratinization and
bacterial colonization. Ascorbic acid (Option A) has no role in acne treatment. Topical
steroids (Option B) are not indicated for acne and can worsen the condition. Oral antibiotic
monotherapy (Option D) is not recommended as first-line treatment for moderate acne and
should be used in combination with topical agents.
Question 8
A 55-year-old patient with a history of chronic pancreatitis is prescribed pancreatic enzyme
replacement therapy. The nurse practitioner should prescribe this medication using which of
the following units of measurement?
A. Carbohydrase activity units
B. Pepsin activity units
C. Lipase activity units
D. Pepsinogen activity units
Answer: C
Rationale: Pancreatic enzyme replacement therapy is standardized and prescribed in lipase
activity units. Lipase is the primary enzyme responsible for fat digestion, and dosing is based
on lipase content. Carbohydrase (Option A) refers to enzymes that digest carbohydrates but is
not the primary unit for dosing. Pepsin (Option B) and pepsinogen (Option D) are gastric
enzymes related to protein digestion and are not relevant to pancreatic enzyme replacement
therapy.
Question 9
A 28-year-old female with a history of generalized tonic-clonic seizures maintained on
phenytoin presents for a routine follow-up. She has been sexually active with her male partner
and inquires about starting an oral contraceptive. Which of the following represents the most
4
| Complete Practice Exam Questions with
100% Verified Correct Answers and Detailed
Rationales | Latest Update - 2026/2027 Edition
– (100% Correct Solutions) Already Graded A+
Question 1
A 45-year-old female patient with a history of seizure disorder is currently maintained on
carbamazepine therapy. Which of the following laboratory parameters is NOT indicated for
routine monitoring during carbamazepine treatment?
A. Complete blood count with differential
B. Serum glucose levels
C. Therapeutic drug levels
D. Arterial blood gas analysis
Answer: D
Rationale: Carbamazepine monitoring includes routine CBC (due to risk of blood dyscrasias
such as agranulocytosis and aplastic anemia), serum glucose monitoring (as carbamazepine
can affect glucose metabolism), and therapeutic drug levels to ensure efficacy and prevent
toxicity. Arterial blood gas analysis is not indicated for routine monitoring of carbamazepine
therapy. Option D is the correct answer as it represents the exception to standard monitoring
parameters.
Question 2
A nurse practitioner is reviewing antimicrobial susceptibility patterns for the local hospital to
guide empiric antibiotic selection. Which of the following tools provides the most accurate
representation of local resistance patterns?
A. Formulary reference guide
B. Antibiogram
C. Kirby-Bauer susceptibility chart
D. Clinical practice guideline
Answer: B
Rationale: An antibiogram is a summary of antimicrobial susceptibility patterns of local
bacterial isolates, which provides essential data for guiding empiric antibiotic selection based
on specific institutional resistance patterns. A formulary reference guide (Option A) lists
available medications but does not provide resistance data. The Kirby-Bauer technique
(Option C) is a laboratory method for testing susceptibility, not a summary tool. Clinical
1
,practice guidelines (Option D) provide general recommendations but may not reflect local
resistance patterns. Therefore, the antibiogram is the correct tool for this purpose.
Question 3
A 17-year-old adolescent presents with mild comedonal acne characterized by open and
closed comedones primarily on the forehead and cheeks. Which of the following represents
the most appropriate first-line pharmacological intervention?
A. Oral isotretinoin 20 mg twice daily
B. Topical clindamycin 1% gel once daily
C. Benzoyl peroxide 5% gel applied topically
D. Systemic prednisone 10 mg daily
Answer: C
Rationale: First-line treatment for mild comedonal acne includes topical agents such as
benzoyl peroxide, topical retinoids, or combination topical therapies. Benzoyl peroxide is
particularly effective for comedonal acne due to its keratolytic and antibacterial properties.
Oral isotretinoin (Option A) is reserved for severe, nodulocystic, or treatment-resistant acne.
Topical antibiotics alone (Option B) are not recommended as monotherapy for mild acne due
to concerns about antibiotic resistance. Systemic corticosteroids (Option D) are not indicated
for routine management of mild acne.
Question 4
A 32-year-old patient with a known diagnosis of persistent asthma presents for follow-up. The
patient reports using their rescue inhaler three to four times per week and experiencing
nighttime awakenings twice weekly. The patient currently uses albuterol as needed. Which of
the following represents the most appropriate next step in asthma management according to
step therapy guidelines?
A. Continue current regimen with reinforcement of inhaler technique
B. Add a low-dose inhaled corticosteroid to the current regimen
C. Initiate a long-acting beta-agonist as monotherapy
D. Add oral leukotriene receptor antagonist
Answer: B
Rationale: According to stepwise asthma management guidelines, a patient who is using their
short-acting beta-agonist (SABA) more than two times per week or experiencing nighttime
awakenings requires step-up therapy. The most appropriate next step is to add a low-dose
inhaled corticosteroid (ICS) to the SABA, which represents Step 2 therapy. Continuing the
current regimen (Option A) would not address the patient's inadequate symptom control.
Long-acting beta-agonists (Option C) should never be used as monotherapy in asthma due to
safety concerns and the risk of asthma-related death. Adding a leukotriene receptor antagonist
(Option D) could be considered but ICS is the preferred initial controller therapy.
2
,Question 5
An 18-month-old child is brought to the clinic with a 24-hour history of fever, irritability, and
pulling at the right ear. Otoscopic examination reveals a bulging, erythematous, opaque, and
immobile tympanic membrane. Which of the following represents the most appropriate initial
therapeutic intervention?
A. Observation with return precautions for 48-72 hours
B. Weight-based oral amoxicillin therapy
C. Intramuscular ceftriaxone 50 mg/kg
D. Topical antibiotic otic drops
Answer: B
Rationale: This clinical presentation is consistent with acute otitis media (AOM),
characterized by acute onset of symptoms with middle ear inflammation and effusion. The
presence of a bulging, erythematous, and immobile tympanic membrane in a symptomatic
child confirms the diagnosis. For a child of this age with a 24-hour history of fever and classic
findings, antibiotic therapy is indicated. Weight-based amoxicillin is the first-line treatment
for AOM, given at a dose of 80-90 mg/kg/day divided into two doses. Observation (Option A)
is not appropriate for a child with fever and classic AOM findings. Intramuscular ceftriaxone
(Option C) is reserved for treatment failure or patients who cannot tolerate oral therapy.
Topical otic drops (Option D) are not appropriate for AOM as the infection is behind the
tympanic membrane.
Question 6
A 68-year-old patient is diagnosed with herpes zoster (shingles) affecting the thoracic
dermatomes. The patient has a history of hypertension and chronic kidney disease stage 3.
Which of the following is the most important consideration when prescribing valacyclovir for
this patient?
A. Monitoring liver function tests and counseling regarding alcohol abstinence
B. Adjusting the dose based on renal function and encouraging adequate hydration
C. Monitoring platelet count and counseling regarding aspirin avoidance
D. Monitoring blood pressure and assessing for hypertensive crisis
Answer: B
Rationale: Valacyclovir is a prodrug of acyclovir that is primarily eliminated through renal
excretion. In patients with renal impairment, dose adjustment is essential to prevent drug
accumulation and potential neurotoxicity. Additionally, patients should be counseled to
maintain adequate hydration to prevent crystalluria. Liver function monitoring (Option A) is
not the primary concern with valacyclovir. Platelet monitoring (Option C) is not specifically
indicated. Blood pressure monitoring (Option D) is not directly related to valacyclovir therapy.
3
, Question 7
A 16-year-old female presents with moderate inflammatory acne characterized by multiple
papules and pustules on the face, chest, and back. The patient has not responded to over-the-
counter topical treatments. Which of the following represents the most appropriate initial
prescription for this patient?
A. Oral ascorbic acid supplementation
B. Short-course topical steroid therapy
C. Combination therapy with benzoyl peroxide and a topical retinoid
D. Oral antibiotic monotherapy
Answer: C
Rationale: For moderate acne, the most appropriate initial prescription is combination therapy
with a topical retinoid and benzoyl peroxide or a topical antibiotic. Combination therapy
addresses multiple pathogenic factors in acne, including follicular hyperkeratinization and
bacterial colonization. Ascorbic acid (Option A) has no role in acne treatment. Topical
steroids (Option B) are not indicated for acne and can worsen the condition. Oral antibiotic
monotherapy (Option D) is not recommended as first-line treatment for moderate acne and
should be used in combination with topical agents.
Question 8
A 55-year-old patient with a history of chronic pancreatitis is prescribed pancreatic enzyme
replacement therapy. The nurse practitioner should prescribe this medication using which of
the following units of measurement?
A. Carbohydrase activity units
B. Pepsin activity units
C. Lipase activity units
D. Pepsinogen activity units
Answer: C
Rationale: Pancreatic enzyme replacement therapy is standardized and prescribed in lipase
activity units. Lipase is the primary enzyme responsible for fat digestion, and dosing is based
on lipase content. Carbohydrase (Option A) refers to enzymes that digest carbohydrates but is
not the primary unit for dosing. Pepsin (Option B) and pepsinogen (Option D) are gastric
enzymes related to protein digestion and are not relevant to pancreatic enzyme replacement
therapy.
Question 9
A 28-year-old female with a history of generalized tonic-clonic seizures maintained on
phenytoin presents for a routine follow-up. She has been sexually active with her male partner
and inquires about starting an oral contraceptive. Which of the following represents the most
4
